20021121 Ver 1_COMPLETE FILE_20020712

NOV.04'2002 15:23 252975_399 USACE WASH
#4771 P.002/304
U.S.A, Y CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action 1D. 200211.011
GENERAL PERMIT (REGIONi
County Dare
AND NATIONWIDE) VERIFICATION
Property Owner: Rex TiUett
Address: F.O. Box 1119
Mantep, NC 27954
Telephone No.: _
Size and location of project (water body,
name/number, town, etc.) 0.47 acre tot located
Description of activity
Applicable Law: X Section 404 (Clean
_ Section 10 (Rivers
Author. ization: Regional General Perm
Nationwide Permit Nur
ter Act, 33 USC 1344)
Harbors Act, 33 USC 403)
118
Your work is authorized by the above n
accordance with the attached conditions an
Section 404 of the Clean Water Act (as ind
a Section 401 water quality certification fr(
(919) 733-17$6). For any activity within tl
the Coasstal. Area Management Act (CAMV
Division of Coastal Management (telephor
Please read and comply with the attache
subj cot the perrnittee to a stop work order,
This Department of the Army veri.ticatii
to obtain any other required Federal, State
If there are any questions regarding this
The Corps of Engineers regulatory prograr
24.
Corps Regulatory Official I r
Expiration Date of Verification 09_/09/
erenced permit provided it is accomplished in strict
your submitted plans. If your activity is subject to
;ated above), before beginning work you must receive
n the N.C. Division of Water Quality (telephone
twenty coastal counties subject to regulation under
prior to beginning work you must contact the N.C.
[phone].
conditions. Any violation of these conditions may
restoration order and/or appropriate legal action.
I does not relieve the permittee of the responsibility
local approvaWpermits.
verification, any of the conditions of the Permit, or
please contact Tom Walker at f252) 975-1.61.6 ext,
Date 09/09/2002
SURVEY PLATS, FIELD SKETCH, TLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHE TO THE FILE COPY OF THIS FORM, IF
REQUIRED OR AVAILABLI?.
® North Carolina Wildlife Resources Commission
Charles R. Fullwood, Executive Director
1721 Mail Service Center
Raleigh, North Carolina 27699-1721
919-733-3633
MEMORANDUM
TO: Tom Walker
US Army Corps of Engineers, Washington Regional Field Office
And
John Dorney
NC Division of Water Quality, 401/Wetlands Unit
FROM: David McHenry, Coastal Coordinator
NCWRC - Habitat Conservation Section
DATE: August 9, 2002
SUBJECT: Pre-Construction Notification (PCN) 404 Permit Applications in Dare County for:
Cindy L. Jones DWQ No. 021118
William E. Jones DWQ No. 021119
George W. Spicer DWQ No. 021120
Rex D. Tillet DWQ No. 021121
Biologists with the North Carolina Wildlife Resources Commission (NCWRC) reviewed
the permit applications with regard to the associated impacts on fish and wildlife resources. A
site visit of the area was conducted on August 5, 2002. Our comments are provided in
accordance with provisions of the Fish and Wildlife Coordination Act (48 Stat. 401, as amended;
16 U.S.C. 661 et. seq.), the Clean Water Act of 1977 (as amended), and the Coastal Area
Management Act (G.S. 113A-100 through 113A-128), as amended.
Each applicant proposes to individually fill 0.1 acre of wetland on his or her respective lot
off of Scuppernong Road in Manteo. According to the applicants, the fills are required to meet
the septic separation requirements of Dare County prior to residential construction. All of the
lots were subdivided from a single contiguous parcel that is currently marked by iron pipes. The
survey plats for the subdivided lots are all dated June 24, 2002. The lots contain a mix of young
loblolly pine (Pinus taeda), red maple (Acer rubrum), and shrub-scrub vegetation with the
wetland portions comprised of additional hyrdophytic vegetation and areas of standing water.
Based on examination of topographic features, the project area appears to be in the Doughs Creek
watershed. Doughs Creek is a designated nursery area that connects to the south to Shallowbag
Bay, which is classified as SC by the Environmental Management Commission.
Wetlands Tracking
FProJ ,.C'fi 4
Facility Name ltex ll. Tillett County DARE.
Project Number Ili. 1121 County2
Q Inactive Region Washingt??n
Project Type. ppq)ose of residcntial till DCM Office Elizabeth Cily
Location Ro?tool c SOUrlll l?Lanteo COE Office Washin(rtoi
4
' i
401s Last Total Total Total
Total Mit
Recvd Sent to Recvd Action 401 401
Mit
Recvd From Date Region Region Date Last Action Acres Feet Acres Feet
401

401

- otal for Project:. 0.1tt f .
l T

inspections/ Viol
ions

Inspection Date Inspector Compliant Letter Type Date Sent Reply Date Current St

I

OF W A T ?R4
O G
? -1
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
July 31, 2002
Dare County
DWQ Project No. 02-1121
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Rex D. Tillett
P.O. Box 1119
Manteo, NC, 27954
Dear Mr. Tillett:
On July 12, 2002, the NC Division of Water Quality received your application for a 401 Water Quality Certification to
construct a residence on your property on Scuppernong Road, Roanoke Island in Dare County. In accordance with 15A
NCAC 2H .0506, a site evaluation has been conducted by Mr. Tom Steffens of the DWQ Washington Regional Office.
Based on this review, we have determined that significant uses would be removed or degraded by this project. Specifically,
please address the following issues so that we may further review your application:
Mr. Steffens has discussed this project, along with three others adjacent to your property, with Molly Fullwood of the
Dare County Health Department. They noted that there are no records of these applications, septic evaluations of these
properties, house placements, or development plans. Furthermore, North Carolina State setback rules are based on
time of plat recorded, which could make the required setbacks 50 or 100 feet. The rules also state that a septic system
cannot be placed in any wetland fill. Septic systems must be placed 50 or 100 feet from the original 404 delineation line
after the fill, depending upon the time the plat was recorded. Please provide evidence that the wetland fill, house and
septic system locations are acceptable to Dare County;
2. Please provide a site map showing the location and configuration of the proposed house and any associated decks,
driveways or other structures, required County setback limits and provide justification for the specific wetland fill areas
needed.
Until the information requested in this letter is provided, I will request (by copy of this letter) that the Corps of Engineers
place this project on hold. Also, this project will be placed on hold for our processing due to incomplete information (15A
NCAC 2H.0507(h)).
Thank you for your attention. If you have any questions, please contact Tom Steffens in our Washington Regional
Office at [phone] or Cyndi Karoly in Raleigh at [phone].
Sincerely,
John Dorney
JRD/cbk
cc: Corps of Engineers Washington Regulatory Field Office
Washington DWQ Regional Office
File Copy
Central Files
Wesley M. Meekins, Jr., P.O. Box 1998, Manteo, NC, 27954
Molly Fulwood, Environmental Specialist, Dare County Health Department, P.O. Box 1000, Manteo, NC, 27954
021121
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
Customer Service
1 800 623-7748
4 projects on their way to you
Subject: Re: 4 projects on their way to you
Date: Mon, 29 Jul 2002 15:37:00 -0400
From: Tom Steffens <[e-mail]>
To: Cyndi Karoly <cyndi.karoly @ ncmail. net>
Cyndi,
I have the 4 projects now-
I suggest that these projects be put on HOLD after just now speaking with
Dare Co (Manteo) environmental health, who say they have no knowledge of
these applications or septic evaluations of these properties on record. Nor
do they have any record of house placements or development plans.
Further, their setback rules are based on time of plat recorded, and could
make the setbacks 50 or 100 feet. Their rules say that they cannot place a
septic system in any wetland fill, and has to be placed 50 or 100ft. from
the original 404 line after the fill. Its conceivable that the fill is
necessary to place the house, so the septic can be on the highland.
f agree that its rather convienent that all of them are .1 acres regardless
of the geometry, and I wonder if the 4 names are being used to cover for 1
entity thats trying to avoid mitigative issues on the whole area.
Put it on HOLD and ask for more info concerning house and septic placement,
along with statements of the setback rules and how they apply on these
properties.
By the way, the folks in the Manteo office were very very interested in
seeing how this comes out, even to the point of wanting to meet us onsite.
Apparently they have been having problems/questions like this lately..
questions or comments, call or write
toms
Cyndi Karoly wrote:
> Deborah and Tom
> Danny and I are triaging four projects to you today. They are:
> 021118, Cindy L. Jones
> 021119, William E. Jones
> 021120, George W. Spicer
> 021121, Rex D. Tillett
> All four are adjacent lots in the same unnamed subdivision in Dare
> County. All were sent in by the same consultant, W.M. Meekins. All
> have identical fill requirements of 4356 square feet despite the fact
> that each site has a completely different geometric configuration. How
> convenient.
> In each case, they're claiming they can't avoid wetland fill due to the
> county's "setback requirements" but neglect to explain how that
> logically leads to wetland fill.
> They haven't included the house plats on the maps, but we wanted you to
> check out some issues if possible before we correspond with the
> applicants and consultant.
> First of all, do you know of prior impacts in this subdivision? These
> four lots alone add 0.4 more acres total to any prior fill. We could be
> approaching mitigation requirements.
> Second, do you know of any setback requirements which would lead to a
> fill requirement? That sounds like an unjustified avoidance detail.
> Third, please note configuration of lots for houses and access to see if
> the fill is warranted.
F2 7/10/02 9r33 AM
4 projects on their way to you
Subject: 4 projects on their way to you
Date: Mon, 15 Jul 2002 14:31:48 -0400
From: Cyndi Karoly <[e-mail]>
To: [e-mail], [e-mail], [e-mail]
Deborah and Tom
Danny and I are triaging four projects to you today. They are:
021118, Cindy L. Jones
021119, William E. Jones
021120, George W. Spicer
021121, Rex D. Tillett
All four are adjacent lots in the same unnamed subdivision in Dare
County. All were sent in by the same consultant, W.M. Meekins. All
have identical fill requirements of 4356 square feet despite the fact
that each site has a completely different geometric configuration. How
convenient.
In each case, they're claiming they can't avoid wetland fill due to the
county's "setback requirements" but neglect to explain how that
logically leads to wetland fill.
They haven't included the house plats on the maps, but we wanted you to
check out some issues if possible before we correspond with the
applicants and consultant.
First of all, do you know of prior impacts in this subdivision? These
four lots alone add 0.4 more acres total to any prior.fill. We could be
approaching mitigation requirements.
Second, do you know of any setback requirements which would lead to a
fill requirement? That sounds like an unjustified avoidance detail.
Third, please note configuration of lots for houses and access to see if
the fill is warranted.
Fourth, are these 0.1 acre figures legitimate?
Anything else you're aware of?
Thanks. These will be in the mail to you on 7/16.
I of 1 7/15/02 2:32 PA
FILE Copr°
-
021121
`YJ
l
:Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
enteral Water Qtiali?Certifcations, and Riparian Buffer and «7atershed Buffer Rules
This for;nh is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nation,vide, Regional or General Permits as required by Section 404 of the Clean \Vater Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's_
(D%1'Q) associated General 401 Water Quality Certifications. Thus form is also to be used for anv
roject requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of V ater
Qual=J- . Tliis form should not be used if you are requesting an Individual 404 Permit or Individual 40i
\Vater Quality Certification. The USACE Individual Permit application form is available online at
;%t??ytu.saw.usace.anmv.miUwedands,Penm app ht1n.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits; and to determine wlvch permit applies to your project, please go to the
USACE website at http:/; «1? ?? .saw.usace.anmv rniU?? et] mds%re tour htni or contact one of the field
onrces listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolita. and provides additional information regarding the identification and
: e a'ation of wetlands aihd waters of the U.S.
The Cr WQ issues a correspondilg Certification (General or Individual), and carrot tell the applicant
,vnuch 401 Certification will apply until die 404 Permit type has been determined by the USACE.
.?puhcants are encouraged to visit DWQ's 401/Wetlands Unit website at
rm: n2o.eru.state:ne.us/ncwetlands to read about current requirements for the 401 Water Quality__Cer Lincation Program and to determine whether or not Riparian Buffer Rules are applicable. The
ap,,hlicarit is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In. some cases, written approval for some General Certifications is not required,
rro: ided that the applicant adheres to all conditions of the GC. Applicants lacking access.. to the
interiie_t_ -
should contact DWQ's Cenh-il Office in Raleigh at [phone].
Trout Waters Coorduzation - Special coordination with the North Carolina Wildlife Resources.
Coria-mission (NCWRC) is also required for projects occurring in any of North Carolina's t-wenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCNVRC _
eriona] coordinator (listed by county on the last page of this application).
Page i of 12

C,A 1A Coordination -If the project occurs un any of North Carolina's nventy coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management- (DCM) at [phone]. DCM will deters ine whether or not the project involves a M
designated Area--of Environmental Concern, un whiclh case DCM will act as the lead pennitting agency.
In such cases, DCM will require a Coastal Area Management Act (C.AMA) Pernit and vill coordinate
the 404/401 Permits.
USACE Permits - Subunit one copy of this form, along with supportinq narn-adves, maps, data fD?rrl,s,
;)i,otos, etc.-_LO the -applicable USACE Regulatory Field Office (addresses are listed at the end of this
!icatiorh). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address a7formation needs for all USACE Nationwide, Regional or General permits, _ as well as
i_.forratior - required for State authorizations, certifications, and coordination. Fully providing the
:on-nation requested on this form will result ai a complete application for any of the USACL-
Narion vide, Regional or General pernzits. To review the n iriianum annount of Infornnatron that must be
provided for a complete PCN for each USACE Nationwide pemit, see Condition 13, 65 Fed.Reg. 12593
("March 9, 2000), available at httn://w\Am,,.saw. usace.arnn.v_tali
l;? -e.tlan.ds n?rofi.n?rll edge<_J t?f.`
j ocessing tunes vary by pemnit and begun once the application has been detern nuhed to be complete.
..ase contact the appropriate regulatory field office for specific answers to permit processing periods.
401 «ater Quality Certification or Buffer Rules - All information is required urn]ess oche,vise stated
,>s optional. Lncomplete applications will be retuned. Submit seven collated copies of all USACE
Pe unit materials to the Division of Water Quality, 401/Wedands Unit, 1650 Mail Service Center;
Raleigh, N-C; 27699-1-650: --If written approval is required or specifically requested for a 401
C2-, f,cation, then a non-refundable application fee is required. In brief, if project impacts include less
:],.an one acre- of ' Culnulative wetland/water unpacts and less than 150 feet currrulative impacts to
_..ea:ns, then a fee of 5200 is required. If either of these thresholds is exceeded, then a fee of 5475 is
requied. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the fi-ont of the application package. For more
hfo-nhat.rnn, see the DWQ website at http:;/h2o.ehnr.state.nc u?'ncwetlande%fee; html. The fee rhnust be
ai,a ci,ed % ith the application unless the applicant is a federal agency in which case the check may be
issued orm a separate office. In such cases, the project must be identifiable on tie U.S. Treasury check
?o that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state •
(ah a cover letter) that only
Bu e, Rule approval is sought in writing. Wetlands or waters of the U.S. may not be innpacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification; die Division of Water Quality has 60 days to prepare a «-ritten response to tine
aoplicant. This may include a 401 Certification, an on-hold letter pendin<r receipt of additional
requested information, or denial.
Page 2 of 12
Office Use Only: Form Version Apid 2001
USACE Action ID No. n??N?n i\Tri021121
I
If anv particular item is not applicable to this project, please enter "Not Applicable" or "MA" rather than
1eaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
Section 404 Permit
0 Section 10 Permit
? 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: 18
3. If-tlus notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ? N/A
4.. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for'
mitigation of impacts (see section VIII - Mitigation), check here: ? N/A
It. Applicant Information
1. Owner/Applicant Information
Name:. Rex D. Tillett
Mailing Address:.. P.O. Box 1119
Manteo, NC 27954
-Telephone Number- 252-473-4700 Fax Number: N/A
E-mail Address: N/A
2-. Agent Information (A signed and dated copy of dze Agent Authorization letter must be M
attached if the Agent has signatory authority for the owner/applicant.)
blame: Wesley M. Meekins, Jr. -
Company Affiliation: W. M. Meekins, Jr. & Assoc., Inc.
Mailing Address: P.O. Box 1998
n eo, NC 279b4
Telephone Number: 252-473-2626 Fax Number: 252-473-2626
E-mail Address: N/A
Page 3 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also .provide a detailed site plan showing Property..
.
boundaries and development plans in relation to sun-ounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropiate.USGS Topographic Quad Map and MRCS Soil Survey with the p-opemy
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as -the property is clearly defined. Fore"adnnirnistrative and distribution ptu-poses, the
USACE requires information to be subnnitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size Construction
drawings rather dean a sequential sheet version of the full-size plans. If full-size plans are . _
reduced to a small scale such that the final version is illegible, the applicant will -be Informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Private lot
2. T.I.P. Project Number (NCDOT'Only): N/A
Props ty.1dentification Number (Tax PIN): 11988011561441
?. Location
County: Dare Nearest Town Manteo
Subdivision division name (?rclude phasellot number): N/A
-
Directions to site (include road numbers, landmarks, etc.US64- 64 1 mile Wort o
Manteo to Swaim Road east of US64=264 thence im o angina venue
cross Wingina Avenue to Scuppernong Road- Down Scuppernong oa
172 mile on rig
a.. Site coordinates, if available (UTM or Lat/Long): N/A -
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use oncondition of the site at the time of this application:
Wooded undeveloped
7. Property size (acres): 0.47
8. Nearest body of water (streann/river/sound/ocearn/lake): Roanoke Sound
9. River Basin: N/A
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httxn:i,lh2o.enr.state.nc.usiadmian/maus!.)
Page 4 of 12
10. -Describesthe purpose of the proposed work- Fill for separation 12urposes for small
dwellina
-1 1.-List the type of equipment to be used to construct the project:_ Loader & dump truck
12. Describe the land use i.n the vicinity of this project: Residential
ll . Prior Project History
If junsciictional determinations and/or permits have been requested and/or obtained for dins
project (il-rcluding all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and _
certnations -were' issued or withdrawn. Provide photocopies of previously issued per nits,
certifications or other useful information. Describe previously approved wetland, streann and
buuei :nnuacfs, along with associated mitigation (",here applicable). If this is a NCDOT project,
list and describe permits issued for prior segnments of the same T.I.P. project, aloncy \v th
coast,action schedules.
N A y.
Future Project Plans
.ore any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work From the curent
application: N/A
%T Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to detenmmine, delineate and map all impacts to
wetlands open water, and stream channels associated with the project. The applicant must also
provide justification for these itmpacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and peretmnial) must be shown on a
deli=neation map, whether or not impacts are proposed to these systems. Wetland and stream __
evaluation and delumeation fonris' should be included as appropriate. Photograph's may Be
included at the applicant's discretion. If this proposed impact is strictly for wetland or streamm
nmitigation, list and describe the u-rrpact in Section VIII below. If additional space is neecied ..For
listing or description, please attach a separate sheet.
-? Page 5 of 12
I . Wet] and Impacts
w-lattd Impact
Site Nuriber
(indicate on ma)
Type of Impact:" Area of
Impact
(acres) Located within
100-year Floodplain"
( es/po)... Distance to
Nearest Stream
(linear feet)
Type of Wctlancl
--
1 fill 0.1 yes 875' to di h 404

I I

,, -:POI, .1pa' „-y <mu ,U?„u,y temporary impacts. impacts ntcrude, but are not limited to: mechanized clearing, grading. fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t impacts due to both structure and flooding.
" 100-Year floodp.lains•are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Map:'
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA M ap Service Center at 1-801358-9616,or
o,:iine at httn:Uwww.fcma.eov.
List a wetland type that best describes wetland to be impacted (e.g., freshwatcrisaltwater marsl;, forested wetland, bca\,cr pond,
Carolina Bay, bog, etc.)
List the total acreage (estunated) of existing wetlands on the property: 0.10 _
Tofal area 'of wetland impact proposed: 0.10 acre
Stream Impacts, including all intermittent and perennial streams
S:reatm impact
Site Number
(;ndicate on may)
Type of Impact` Length of
Impact
(linear feet) Avcrage Width
Stream Name*' of Su-eam
Before Im act Perennial or
Inrcrmincnt?

(ole
asc spccifv)
i
I
N A
I
I

?
I

.-,,. -- I I-P-1 -P-- Y -U ,ucuuty tcutpUtaty unpactS. impacts inciucle, butare not llmtted to: culverts and associated rip:mp,
cams (scparateiy list inTpracts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
sabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at - -
w.ttses.tov. Several intemet sites also allow direct download and printing of USGS maps (c.g., www.tonor.onc com,
?k \%-% ?nanaiiest Corn, etc.).
Cumulative impacts (Iinear distance in feet) to all streams on site: 875' to ditch
Page 6 of 12
3-. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
;nd:cate on map)
Type of Impact* Area of
Impact
(acres) Name of Waterbody

(ifapplicable) Type of waterbody
(lake, pond, estuary, souitid,
bay, ocean, etc.)
N/A

i I -

-:ss ?acn impact separaiciy ano ioennry temporary impacts. impacts muuae, OUT are not I11110tet7 to: fail, cacavatior., ;;redei;
^oodin- eraina e, bulkheads, etc. `
µ. Pond Creation
if construction of a pond is proposed, associated wetland and stream impacts should b?
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands Di stream ? wetlands
Describe the method of construction (e.g., dam/embanlanent, excavation, installation. of
draw-down valve or spillway, etc.): N/A
Proposed.. use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout' pond,-
local stomtwater requirement, etc.): N/A
Size of watershed draining to pondN/A Expected pond surface area:__.??_
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed in-rpacts. It may be usefill to provide
information related to site constraints such as topography, builds lg ordinances, accessibility, and
5nanci-al viability of the project. The applicant may attach drawings of alten.ladve, lower-llnpact-
site layouts, and explain why these desib 7 options were not feasible. Also discuss ho-\v mz pacts -
"Vere minimized once the desired site plan was developed. If applicable, discuss consUuction
techniques to be followed during construction to reduce impacts.
0.1 acre of fill is necessary because of separation _re"irements of Dare County
Health Department from ,a-conventional septic system. Si-.t fence will-? bie - ..
placed around fill area to retain any silt runoff then area will be seeded.
Page 7 of 12 M .. .
VIII. Mitiotion .
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Div:ision of Water_ Quality for projects involving greater than or equal to one acre of impacts -to, ..
freshwater wetIiiids -o`r greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Perruts, published in the Federal. Register on March 9, 2000, nitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are ninimal. Factors
iicluding size and type of proposed impact and fiunction and relative value of the irinpacted
aquatic resource will be considered in deterniniig acceptability of appropriate and practicable
nutigation as proposed. Examples of mitigation that may be appropriate and practicable include;
but are not limited to: reducing the size of the project; establishing and mauntarnung wetland
and/or upland vegetated buffer's 'to protect open waters such as streams; and i-eplacin'- losses o
aquatic resource fttnctions and values by creating, restoring, enhancing, or preseiving similar
fiunctions and values, preferable in the same watershed.
If nutioation is required for this project, a copy of the ntigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required ..mitigation plan or NCWRP concurrence shall be placed on mold as-
incomplete. An applicant may also choose to review the current guidelines for srreani restoration
L- -DWQ's--Draft Technical Guide for Streanr Work in North Carolina, availabl. at
littID://h2o.en.r.state.].C.as/ncwetlmid isttmt?ide.htrnl.
1. Provide a brief description of the proposed mitigation plan. The description should pro'\"ide
as much information as possible, including, but not lmited to: site location, (attach directioias
and/or map, if offsite), affected strean and river basin, type and amouit (acreage/linear et)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan vie"V,
preservation mechaism (e.g., deed restrictions, conservation easement, etc.), and a
._..
description of, the current site conditions and proposed method of construction. . Please attach
a separate sheet if more space is'needed.
N/A
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the vox undicaung that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is.... available as atm. option. For additional infornation regarding the application
process for the NCWRP, check the NCWRP website at hrtr :'?,2o err t8 t'. nC uS' ?'ru`index htrn 1f
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the.followu* lg information:
Amotuzt of stream nnitigation requested (linear feet): N/A
Amount of buffer nmitigation requested (square feet): N/A
-- -
Amount of Riparian wetland nnitigation requested (acres): N/A
Anmount of Non-riparian wetland mitigation requested (acres): N/A
-
Amount of Coastal wetland mitigation requested (acres): N/A
D:. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local
land?
Yes ? No o
if yes, does the project require preparation of an environ> mental document pursuant _ to_ -the
requirements of the National or North Carolina Envi-onrnental Policy Act (_NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at (919)-733-5083 to review current thresholds for environmental documentation.
Yes ? No
if.yes, has the doounjent review been finalized by the State Clearinghouse? if so, please attic" a
copy of the NEPA or-SEPA final approval letter.
Yes. ? No ? N/A
1. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It -is time applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant Must also provit
justification for these impacts in Section VII above. All proposed impacts must be listed her°tn,
and must be clearly identifiable on the acconmpanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the D\k/Q
Regional Office may be included as appropriate. Photographs may also be inluded at=_-.lTe. -
applicant's discretion.
Will the project impact protected riparian buffers identified w)thln 15A NCAC 2B 0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify N/A - )
Yes ?....._ ._-No ? If you answered "yes", provide-the following i.nfonnation:
Pa.-c 9 of 12
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
nutigalloil is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zea}e? Impact
(square feet) Multiplier Required
Mitigation
_ 3 N/A
2 l .5 N/A
Total N/A
Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.
If buffer rr ltlgatlon is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Eruhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate info) rnation as
identified within 15A NCAC 2B•:0242 or.0260. ._....
N/A
\I. Sto'rr°nwater (DWQ Only)
Desch-be inver-vious acreage (both existing and .proposed) versus total acreage on the -site.
Discuss stonmwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
N/A
XII. Se-wage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
Conventional septic tank
VIII. Violations (DWQ On.l*)
Is this site in-violation' of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No Fj?
Is tlus an after-the-fact permit application?
Yes .? No
Page 10 of 12
lI? Other Circumstances (Optional):
It is-the applican_ts..responsibility to subnut the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list- constraints associated with constnictio.,n or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for takes, dates associated with Endangered and
Tlnt•eatened Species, accessibility problems, or other issues outside of the applicant's control).
ature
A:aplicaint/Agenf's Sign Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee (redell Mitchell
lk
P Union
Watauga
_1S Army Corps of Engineers Avery
Buncombe Clay
Cleveland
Jackson
Lincoln
o
Rowan
Yancey
1 _•i Paton Avenue Burke Gaston Macon Rutherford
oo-rn 208
NC 28801-5006
Asheville Cabarrus Graham Madison Stanley
,
Tel°phone: [phone] Caldwell Haywood
derson
H McDowell
Mcckicnburg Swain
Transylvania
Fa\ (KS) 271-4858 Catawba en
h Regulatory Field Office
lei
R Alamance Durham Johnston Rockingham Wilson
dki
Y
g
a
US .army Corps Of EngineerS• Alieghany Edgecombe Lee
h
N Stokes ..
Surr n
a
6508 Falls of the Neuse Road Ashe
Caswell Franklin
Forsyth as
Northampton y
Vance
Suite 120
NC 270715.
Ieioh
? Chatham Granville, Orange Wake
W
.
,
a
Telephone: [phone]
Davidson
Guilford
Halifax
Person
Randolph
arren
Wilkes
Fax: [phone] Davie
i
Regulatory Field Office
zon
\Vashin
Beaufort
Currituck
Jones
Pitt
ll
T
,
g
US Army Corps Of Engineers" Bet-tie Dare
tes
G Lenoir
Martin yrre
Washington
t Office Box 1000
Pos Camden
Carteret` a
Green
Pamlico
Wayne _-
WishinRton,YQC 27881-1000 Chowan Hertford Pasquotank
Telephone: [phone] Craven Hyde Perquimans `Croatan National Forest Only
=av [phone]
ton Regulatory Field Office
V6imin Anson Duplin Onslow
g
US Army 'Corps Of Engineers Bladen Harnett
ke
H Pender
Richmond
Post Office Box 1890 Brunswick
Carteret o
Montgomery Robeson
Wilmington, NC 28402-1890
Telephone: [phone] Columbus Moore Sampson
tland
Sc
Fax [phone] Cumberland New Hanover o
Page I1 of 1.2.
US Fish and Wildlife Service / National Marine Fisheries Service
.. r sla and Wildlife Service US Fish and;;rildlife Service National Marine Fisheries Seri-/ice-
R-n'.eioh Field Office Asheville Field Office Habitat Conservation Division
Pos: Office Box 33726 160 Zillicoa Street Pivers Island
Raieieh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: (252) 72.8-j4)90 ..--
_,._.._ North Carolina State Agencies - _ ---•
D •• ision of Water Quality Division of Water Quality State Historic Preservation Office
401 We lands Unit Wetlands Restoration Program Department:OfCultUral R.esourccs
?.: d i} Se,titiEe C?nte 1619 Mail Service Center 4617 Mail "Service Ceab[et'-_`.--:
Ra?c:_h. NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 27699-4617
-ele hone: [phone] Telephone: [phone] Telephone: [phone]
;.'.!'_I}•9,? 7 ?'r9959 Fax: [phone] . -.: Fax: [phone]
CAM.A and NC Coastal Counties
?: rsio^o-t Eoas'al Manage;nent Beaufort Chowan Hertford Pasquotank- _
o Mail 5f^vice C-,, ter Bel-tic Craven Hydc Pender -'
NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Te"7hone: (919;) 733.2293 Camden Dare Onslow Tyrrell
=a>: 9) 1495 Carteret Gates Pain!ico ;;-ashington
NIC«'RC and NC Trout Counties _-
es:ern Piedmont Region Coordinator Alleghany Caldwell Watauga ~
3355 idlewild Road Ashe Mitchell %ill;es
Ke-nc-sville, NC 27284-9180 Avery Stokes _
eioaaite:: (13.6)^769:9453 Burke Sung
'ountain Region Coordinator Buncombe Henderson Polk
,^"'C, Grc_tcSnoky Mtn.,Ex.pre..ss\vIy Cherokee Jackson Rutherford
nesv,ne,'?C 2878b? Clay Macon Swain
Tcicohonc: [phone] Graham Madison Transylvania
Z ,-23)506-;754 Haywood NlcDoA,cll Yancey
_.. ?... _ Page 12 of 12
NOTES:
1. F.I.R.M. ZONE: " A6"/ 9.0'
SUBJECT TO CHANGE BY F.E.M.A.
2. MAP REFERENCE MADE TO
OB. -1433, PG. -199
DARE COUNTY REGISTRY.
3. PIN # 11988011561441
4. THIS SURVEY IS SUBJECT TO ANY
FACTS THAT MAY BE DISCLOSED
BY A FULL AND ACCURATE TITLE
SEARCH.

VICINITY MAP nts I
242.26'
153.43'
NORTH CAROLINA
c/o DEPARTMENT 0
DB. - 1254, PG.
N <V
O 1111
.o
N 44° 111 " 0" E
324

oa
>s
Z -;
0
3
N
1
z
GEORGE W. SPICER
DB. - 1433, PG. - 200
LEA
• EXISTING IRON PIPE
O IRON PIPE SET
-, 09
153.43'
STATE /
F JUSTICE
- 749
S 44°17'24" W -+-
88.83'
?o
- 120.68' ' t
3
<?\ "'00?
SITE 1 a y? ?. N o
4,356 sq ft ERNESTI
FILL AREA N pg,
i
20,670 sq ft TOTAL
16,314 sq ft UPLAND
UPLANDS
153.43'
S 44°17'10" W -
SCUPPERNONG ROAD 60' R/W
fJIf
$EAL -
L-t
7 Ca
I, WESLEY M. MEEKINS JR., CERTIFY THAT
UNDER MY DIRECTION AND SUPERVISION
THIS PLAT WAS DRAWN FROM AN ACTUAL
FIELD LAND SURVEY: THAT THE RATIO OF
PRECISION AS CALCUALTED IS 1/10,000 +
THAT THIS PLAT WAS PREPARED IN
ACCORDANCE WITH N.C.A.C. TITLE 21,
CHAPTER 56, SECTION 1600. WITNESS MY
ORIGINAL SIGNATURE, REGISTRATION NO.
AND SEAL THIS th DAY RF JUG, A.D. 2002
WESLEY M. IyI?EKINS, JR. PLS - 1465
W.M. MEEki1NS JR. & ASSOC., INC.
Land Surveyors and Planners
P.O. Box 1998
Manteo, N.C. 27954
Job No. RIN-2052-02
N ?
L!l
26.98' ?t 120.00'

Q?
4?0
00
N/F
NE A. SCARBOROUGH
- 708, PG. - 588
ks?
/
V /
p
3
S 44°17'10" W -

/O
V
O
30? i
CJ? /
O

A PLAT OF
LAND FOR
REX D. TILLETT
ROANOKE ISLAND NAGS HEAD TWSP.
DARE COUNTY
NORTH CAROLINA
SURVEYED ON: 6/24/02
SURVEYED BY: W.M. MEEKINS JR. & ASSOC., INC.
1"=50'
50 25 0 50 100
WESLEY M. MEEKINS, JR.
President
R.L.S. 1465
TELEPHONE
[phone]
(9'19) 473-3362
N.C. 1-800-225-7163
W. M. MEEKINS, JR. & ASSOCIATES, Inc.
Land Surveyors and Planners
Surveying the Outer Banks
Box 1998
MANTEO, N. C. 27954
July 11, 2002
021121
Enclosed please find seven collated copies of application for fill permit.
Please direct any correspondence to Wesley M. Meekins, Jr., P.O. Box 1998,
Manteo, NC 27954.
Thank You. CMrA - J
PAYMENT
RECEIVED
? r f? x
z
12
.