20011685 Ver 1_COMPLETE FILE_20011116

ow A r?9pc
r
O -C
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
Christopher and Stephanie Massoth
1722 Virginia Avenue
Kill Devil His, NC 27948
APPROVAL of 401 Water (duality Certification
Dear Mr. and Mrs. Massoth:
December 5, 2001
DWQ # 01-1685
Dare County
You have our approval, in accordance with the attached conditions, to fill 0.04 acre of wetlands for the purpose of
constructing a single family residence on Lot 22, Block 227-A, Southern Shores subdivision in Dare County, as described in
your applcabon materials received by the Division of Water Quality on November 16, 2001. After reviewing your
application, we have decided that this fill is coveted by General Water Quality Certification Number 3106, which can be
downloaded from our web site at hfD://h2o.enrstate.nc.ush*ocwetiands. This Certification allows the use Nationwide Permit
Number 18 at)en the US Army Corps of Engineers (USAGE) issues it. In addition, you should get any other federal, state or
local permits before you go ahead with your project including (but not limited to) Sediment and Erosion Control, Coastal
Stormwater. Mori-Discharge, State Stormwater and Water Supply Watershed regulations. Also this approval will expire
when the accompanying 404 permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your
project, you must notify us in writing, and you may be required to send us a new application for a new certification. If the
property is sold, the new owner must be given a copy of the Certification and approval letter and is thereby responsible for
complying *M a] conditions. If total wetland fibs for this prDjEd (now or in the future) exceed one acre, compensatory
mitigation may be required as described in 15A NCAC 2H -0506 (h). For this approval to be valid, you must follow the
c',or6itions fisled in the attached certification aril those listed below.
1 _ Deed noSications or similar mechanisms shag be paced on all remaining jurisdictional wetlands and waters to
na ify the state in order to assure compliance for future warliand and/or water impact. These mechanisms shall be put in
place within 30 Clays of the date of this letter or S)e irs nca_ of the 404 Permit (whichever is later).
It you do not accept any of the conditions rat this ce.:r i.rjori, you r,:-w--y ask for an adjud'icatory hearing. You must act
wid-in 60 days of tie date that you receive this lifer. To ask for a hearing, send a written petition which conforms to
Glw4 ter 150B sat tie North Carolina General Sdakdes to 1f;ie Office of Atkirimistraiive Hearings, 6714 Mail Service Center,
Raleigh, NC 27B99-6714. This certification and its condiftons are final and binding unless you ask for a hearing.
This fettercunpletes the review of the won of Water Qualiity under Section 401 of the Clean Water Act. If you have
any questions, pieese telephone Tom Steffens in the D'1MOVl n Regional Office at 252-946-6481 or Bob Zarzecki at
919-733-17M _
J. , Ph.D.
Director
Att?l?Xiier?
cc: USACE'llloa3t* glom Regulatory Field Ofiioe
9Nn DWO Regional Office
File copy
Central Flle2s 01-1685
Douglas Dt?rlittlan: Quible & Associates, P.C.; PO Drcae-s 870, Kay Hawk, NC 27949 _
NCDEM
N. C. Vwaion of W mw. puWky 1650 Mail Service Cdr Fl8 NC 27
WoL 9'G8b4 P'/9173;i-7015 Customer Service
1 800 623-7748
Quible
Quibie & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING
SINCE 1959
November 13, 2001`
Mr. John R. Dorney
Water Quality Certification Program
NC Division of Water Quality
4401 Reedy Creek Road
Raleigh, NC 27607 011685
Re: Lot22, Southern Shores - #18 Permit Application
Dear Mr. Dorney:
P.O. Drawer 870
Iatty Hawk, NC 27949
Phone:[phone]
Fax: [phone]
PRINCIPALS
Sean C. Boyle, P.E.
Joseph S. Lassiter, C.E.P.
Eduardo J. Valdivleso, P.E.
ASSOCIATES
Joseph J. Anlauf, P.E.
David S. Neff
The purpose of this correspondence is for Quible & Associates, P.C. to provide the North
Carolina Division of Water Quality, with a Nationwide #18 Permit application submitted by our
firm on behalf of Christopher & Stephanie Massoth. The subject property is located at 95 Duck
Woods Drive in Southern Shores, Dare County, North Carolina.
The Massoth's are proposing to fill area approximately 1,742 sf (04 acres) in size, this will
provide the necessary setback requirements for the proposed conventional wastewater system and
single family residence. Enclosed is a check for $200.00, a plat that indicates the proposed
layout of the residential development and the area to be filled.
Thank you for your attention to this infonnation. If you have questions please contact me at 252-
261-3300.
Sincerely,
Quible & Associates, P.C.
'.
Douglas A. Donnan
cc: Tom Walker
A
01 1685
DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 18
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: Christopher B. & Stephanie Massoth
2. MAILING ADDRESS: 1722 Virginia Avenue
CITY: Kill Devil Hills STATE:
SUBDIVISION NAME:
NC ZIP CODE: 27948
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): Lot -22, Block 227-A, Southern Shores
95 Duck Woods Dr.
3. TELEPHONE NUMBER (HOME)
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: Quible & Associates, P. C., PO Drawer 870, Kitty Hawk, NC
27949, 252-261-3300
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Dare NEAREST TOWN OR CITY: Southern Shores
1
hit',

SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.): 95 Duckwoods Dr. - 'h mile east of Wright Memorial
Bridge.
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: Pasauotank
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW) WATER
SUPPLY (WS-I OR WS-II)? YES [ ] NO [X] IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [X]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
Developed
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO [X] IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [X] IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 0.04 Ac. (1,723 sf)
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0.04 Acres
2

10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0.04 Ac
FLOODING:
DRAINAGE:
EXCAVATION:
OTHER:
TOTAL ACRES TO BE IMPACTED: 0.04 Ac
].Ob. (1) STREAM CHANNEL TO BE-IMPACTED BY-THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION): N/A
LENGTH BEFORE:
AFTER-
WIDTH BEFORE (BASED ON NORMAL HIGH WATER CONTOURS):
WIDTH AFTER:
AVERAGE DEPTH BEFORE:
AFTER:
NA (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? N/A
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/i" X 11" DRAWINGS
ONLY): Lot will be cleared for residential development and wetland areas will
be filled using a backhoe and grading equipment
13. PURPOSE OF PROPOSED WORK: Wetlands to be impacted are for the residential
development of the lot. The purpose of the fill is to meet the setback
requirements of the Dare County Health Department
3
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
The site plan and drainfield location for proposed single family dwelling
Make it necessary for the subject wetlands to be impacted. The suitable
area for wastewater has made it necessary to fill the existing wetlands and
meet the required setbacks.
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET)
REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING
ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT
MAY BE AFFECTED Y THE PROPOSED PROJECT. DATE CONTACTED: 11/12/01
(ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED:11/12/01
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [ ] NO (X) (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [X]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ ] NO [X)
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE
WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED
TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003,
TELEPHONE [phone].
4
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLANDS DELINEATION MAP SHOWING ALL WETLANDS, STREAMS,
LAKES AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 4, 18, 21, 26,
29 AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE
SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS
100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL
DATA SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Developed
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
On-site wastewater - Conventional
9. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATED THE PROPOSED ACTIVITY IS
CONS TENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.
c
WNER S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (189))
5
CURRITUCK
SOUND
AR M71C
OCEAN
SI TE
fOU1fIERN
SNORES
= MARTIN S
4"T
V* ?
t KITTY
MAN
VICINITY MAP NTS
N18'33'49"W
100.01
I @I
iE
I LIGHND
?- YJ
71") TO BE FILLED
' /
'
jL - ((wE
nAms
ll - EX. PIPE
0 - EX. REBAR
REBAR SET
- EX. CONC. MON.
CONC. MON. SET
- EX. P/K NAIL
O - P/K NAIL SET
- SEINER SERVICE
- NEATER METER
- PHONE PEDESTAL
- C.A.T.V.
Ld
NOTES:
1. THIS SURVEY IS SUBJECT TO ANY FACTS THAT MAY BE
DISCLOSED BY A FULL AND ACCURATE TITLE GM.
2. AREA BY COORDINATE COMPUTATION - 29, ., F.
3. F.I.R.M. ZONE: AE (EL B') t (2' FREE
4. PIN NO.: 20 90!715 54 0094
5. RECORDED REFERENCE: PC C. SL 115-F
6. BUILDING LINES SHOWN HEREON MUST BE VERIFIED.
THE SURVEYOR MAM NO CERTIFICATION AS TO
ZONING ANO/Oft RESIIgCTTVE COVENANT' UIBACKS.
7. ELEVATIONS 1929: AS SHOWN
N/F
DUCK WOODS
COUNTRY CLUB, INC.
(M8 5. PC 34)
D _
18'33'49" W 100.01' _
l,AilE/? 790 S.F.)
3
94
8
LOT 22
WETLANDS
(AREA: 925 S.F.)
ti'p'
AB
r
.r

DEM ID: CORPS ACTION ID:
011685
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 18
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: Christopher B. & Stephanie Massoth
2. MAILING ADDRESS: 1722 Virginia Avenue
SUBDIVISION NAME:
CITY: Kill Devil Hills STATE: NC ZIP CODE: 27948
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): Lot ::22, Block 227-A, Southern Shores
95 Duck Woods Dr.
3. TELEPHONE NUMBER (HOME)
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: Quible & Associates, P. C., PO Drawer 870, Kitty Hawk, NC
27949, 252-261-3300
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Dare NEAREST TOWN OR CITY: Southern Shores
1

SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.): 95 Duckwoods Dr. - 1A mile east of Wright Memorial
Bridge.
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: Pasquotank
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW) WATER
SUPPLY (WS-I OR WS-II)? YES [ ] NO [X] IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [X]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
Developed
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO [X] IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [X] IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 0.04 Ac. (1,723 sf)
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0.04 Acres
2
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0.04 Ac EXCAVATION:
FLOODING:
DRAINAGE:
OTHER:
TOTAL ACRES TO BE IMPACTED: 0.04 Ac
- ].Ob. (1) STREAM CHANNEL TO BE IMPACTED BY-THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION): N/A
LENGTH BEFORE: AFTER:
WIDTH BEFORE (BASED ON NORMAL HIGH WATER CONTOURS):
WIDTH AFTER:
AVERAGE DEPTH BEFORE:
AFTER:
NA (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? N/A
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/h" X 11" DRAWINGS
ONLY): Lot will be cleared for residential development and wetland areas will
be filled using a backhoe and grading equipment
13. PURPOSE OF PROPOSED WORK: Wetlands to be impacted are for the residential
development of the lot. The purpose of the fill is to meet the setback
requirements of the Dare County Health Department
3
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
The site plan and drainfield location for proposed single family dwelling
Make it necessary for the subject wetlands to be impacted. The suitable
area for wastewater has made it necessary to fill the existing wetlands and
meet the required setbacks.
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET)
REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING
ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT
MAY BE AFFECTED Y THE PROPOSED PROJECT. DATE CONTACTED: 11/12/01
(ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED:11/12/01
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [ ] NO [X) (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [X]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ ] NO [X]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE
WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED
TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003,
TELEPHONE [phone].
4
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLANDS DELINEATION MAP SHOWING ALL WETLANDS, STREAMS,
LAKES AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 4, 18, 21, 26,
29 AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE
SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS
100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL
DATA SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Developed
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
On-site wastewater - Conventional
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATED THE PROPOSED ACTIVITY IS
CONS TENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.
fa&4 I?Xdy)V
WNER S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g))
5
DURINTUCX
9"D
ATLANTIC
omm
fO1 llm
imam
= MARTIN'6
POINT
t v Ium
HAWK
VICINITY MAP (NTS)
NISii3 49'W
100.01'
e1 _ _
? IlCdND X114.
?!E TO BE FILLED /
11I1t - WETLANDS
- EX. PIPE
- EX. REBAR
REBAR SET
- EX. CONC. MON.
CONC. MON. SET
- EX. P/K NAIL
0 - P/K NAIL SET
?(- SEWER SERVICE
- WATER METER
- PHONE PEDESTAL
- C.A.T.V.
UTILITY POLE
r- OUY WIRE
L5
NOTES:
1. THIS SURVEY IS SUBJECT TO ANY FACTS THAT Y BE
DISCLOSED BY A FULL AND ACCURATE TITLE MOCH.
2. AREA BY COORDINATE COMPUTATION - 29,7 4#.
3. F.I.R.M. ZONE: AE EL B') + (2' FREER
4. PIN NO.: 20 906718 84 0594
5. RECORDED REFERENCE: PC C. SL 116-F
8. BUR.DMIO LINES SHOWN HEREON MUST BE VERIFIED.
THE SURVEYOR MAM NO OERTIFICAT ON AS TO
ZONING AND/OR RESFRICI V[ COVENAN? SETBMMCKS.
7. ELEVATIONS (NOVD 1920 AS SHOWN
DUCKNWOODS
COUNTRY CLUB, INC.
(M8 5. PQ 34)
IED _
N 18'33'49' W 100.01' _
kARLA: 796 S.F.)
2 'M. L_
83
I
t? J
94
LOT 22
WETLANDS
(AREA 926 S.F.) I Q AS
ryti
A4 L41- JL AL
. I ICI ?I ?I
I
Latitude 36°06'40"
Longitude 75°43'30"
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Data Point A5 - UP
Project/Site: 1 ^T 77 RI nrK 777-A i Cni itha-rn Shnrpr Date: 111111711
Applicant/Owner: rr... iStnnh .r. r B St?nhnnie Massoth County: Dare
Investigator: nijihla R Assndsles, P C:- -Dnug Dnrman State: NC
Do Normal Circumstances exist on the site? es No Community ID: A5
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID: A
Is the area a potential Problem Area? Yes Z5) Plot ID: NA
(If needed, explain on reverse.)
VFrFTOTInN
Dominant Plant Series Stratum Indicator Dominant Plant Series Stratum Indicator
1. Pinus taeda O FAC 6. Smilax bona-nox GR FAC
2. Quercus nigra O FACW 10.
3. Nyssa biflora O FACW+ 11.
4. Fagus grandifolia O FACU 12.
5. Carya giabra O FACU 13.
5. Quercus virginiana UN FACU+ 14.
4. Myrica cerifers UN FAC+ 15.
5. Vitas spp. UN FACW 16.
Percent of Dominant Species that ae OBL, FACW or FAC 100%
(Excluding FAC-).
Remarks: Hydrophytic Vegetation Present
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- Recorded Data(Describe in Remarks) :
-Stream, Lake, or Tide Gauge
-Aerial Photographs
-Other
No Recorded Data Available
- Wetland Hydrology Indicators:
Primary Indicators:
- Inundated
-Saturated in Upper 12 inches
-Water Marks
- Drift Lines
- Sediment Deposits
Field Observations: -Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: N/A (In.) -Oxidized Root Channels in Upper 12 inches
-Water-Stained Leaves
Depth to Free Water in Pit: >12" (In.) - Local Soil Survey Data
- FAC-Neutral Test
Depth to Saturated soil: >12" (In.) -Other (Explain in Remarks)
Remarks:
Wetland Hydrology not Present
SOILS
Map Unit Name
(Series and Phase): Ousley Fine Sand

Taxonomy (Subgroup):
Drainage Class: Morlerateig Well Dralnari
Field Observations
Confirm Mapped Type? Yes No
Profile Description
Depth
(inches)
Horizon Matrix Color
(Munsell Moist) Mottle Colors
(Munsell Moist) Mottle
Abundance/Contrast Texture, Concretions,
Structure,d etc.
0-3" A 10 YR 5/2
3" - 17" C1 10 YR 5/4

Hydric Soil Indicators:
-Histosol -Loncretions
_HIstic Epipedon -High Organic Content in Surface Layer in Sandy Soils
_Sulfidic Odor -Organic Streaking in Sandy Soils
__4quic Moisture Regime Listed on Local Hydric Soils List
-Reducing Conditions -Listed on national Hydric Soils List
-Gleyed or Low-Chroma Colors Other (Explain in Remarks)
Remarks: Hydric Soils Not Present
WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes No (Circle)
(Circle)
Wetland Hydrology Present? Yes No
Hydric Soils Present? Yes No Is this Sampling Point Within a Wetland? Yes No
Remarks: (Does or Does not meet criteria set forth in the 1987 Army Corps of Engineerrs Wetland Delineation Manual
Does not meet all criteria set forth in 1987 Army Corps of Engineers Wetland Delination Manual.
Data Point not located in a wetland.
Latitude 36°06'40"
Longitude 75°43'30"
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Data Point A5 - Wet
Project/Site: I at 29- Rlnrk 227 -A / Southern Shnres Date: 11-1-01
Applicant/Owner: f'hri pher B. R Stephanie Mnssnth County: Dare
Investigator: 01 chip R Acanriatne, P-(,' - nrntg nnrman State: Nr
Do Normal Circumstances exist on the site? yii No Community ID: A5
Is the site significantly disturbed (Atypical Situation)? Yes (ITDo Transect ID: A
Is the area a potential Problem Area? Yes o Plot ID: "'A
(If needed, explain on reverse.)
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Dominant Plant Series Stratum Indicator Dominant Plant Series Stratum Indicator
1. Nyssa biflora O FACW+ 9.
2. Nyssa sylvatica O FAC 10.
3. Acer rubrum O FAC 11.
4. Persea borbonia UN FACW 12.
5. Myrica cerifera UN FAC 13.
6. Smilax bona-nox GR FAC 14.
7. 15.
g. 16.
Percent of Dominant Species that ae OBL, FACW or FAC
(Excluding FAC-). 100%
Remarks: Hydrophyfic Vegetation Present
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_ Recorded Data(Describe in Remarks) :
Stream, Lake, or Tide Gauge
--Aerial Photographs
-Other
No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
Inundated
Saturated in Upper 12 Inches
Water Marks
_ Drift Lines

Field Observations: _ Sediment Deposits
Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: <- ?? (In.) - Oxidized Root Channels in Upper 12 inches
-Water-Stained Leaves
Depth to Free Water in Pit: c19" In.) Local Soil Survey Data
-FAC-Neutral Test
Depth to Saturated soil: 111 In.) -Other (Explain in Remarks)
Remarks:
Wetland Hydrology Present
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Map Unit Name
(Series and Phase): rnnn

Taxonomy Subgroup):

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Drainage Class: poorly ri?atnarl
Field Observations
confirm Mapped Type? Yes No
Profile Description
Depth
(Inches)
Horizon Matrix Color
(Munsell Moist) Mottle Colors
(Munsell Moist) Mottle
Abundance/Contrast Texture, Concretions,
Structure,d etc.
0-3" Oat 10YR 2/1
3-14" Oa2 10YR 3/1
14-18" A 10YR 5/2

Hydric Soil Indicators:
_Histosol -Concretions
_Histic Epipedon .01gh Organic Content in Surface Layer in Sandy Soils
.2LSulfidic Odor -Organic Streaking in Sandy Soils
_Aquic Moisture Regime Misted on Local Hydric Soils List
-Reducing Conditions -Listed on national Hydric Soils List
-Gleyed or Low-Chroma Colors Other (Explain In Remarks)
Remarks: Hydric Soils Present
WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes No (Circle)
(Circle)
Wetland Hydrology Present? Yes No
Hydric Soils Present? Yes No Is this Sampling Point Within a Wetland? es No
Remarks: (Does or Does not meet criteria set forth in the 1987 Army Corps of Engineerrs Wetland Delineation Manual
Does meet all criteria set forth in 1987 Army Corps of Engineers Wetland Delination Manual.
Data Point located in a wetland.
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