20031125 Ver 1_COMPLETE FILE_20030909

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Office Use Only: Form Version October 2001
• DWQ No. 0 .8USACE Action ID No.
C(OPY
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
1. Check all of the approval(s) requested for this project: NE-TIMPS 10 GROUP
Section 404 Permit
Section 10 Permit S F P - 9 2003
401 Water Quality Certification nl?TER Q?J?4l?IT1? SECTION
Riparian or Watershed Buffer Rules J2. Nationwide, Regional or General Permit Number(s) Requested: *,A •ri k.4; A 1 .
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. M payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section V1II - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Informatio
Name: J o S ?, /1 An 57A TCN
Mailing Address: '10O `? C4.4 i f7VC
--le **k-i--
Telephone Number: a 61 - l 5 Fax Number: 27";1 - ;t C t o
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 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 surrounding 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 appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted 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 than 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.
Name of project:
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): '?7410031a 677
4. Location
County: VA/ic_ Nearest Town: A44/V
Subdivision name (include phase/lot number): IV
-_ 1A
Directions to site (include road numbers, landmarks, etc.):
5:2, t"3 0 01AAle-1 7Z"d
5. Site coordinates, if available (UTM or Lat/Long): A#41r,4 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 or condition of the site at the time of this application:
VA CA n } l cr(
b
7. Property size (acres): a A4
8. Nearest body of water (stream/river/sound/ocean/lake): / A16er'hzle 50/,-,a/
9. River Basin: PA Asq ti4 7/A1k
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 6 of 12
10. Describe the purpose of the proposed work: CM rt ?ie
T of ?, d r 5...VA04 g //1 '4 ?.. 00 k a ,00
A e it' {c i t / dti k ti
IV.
11. List the type of equipment to be used to construct the project: ?Jp2e--- *""?? -Tk
12. Describe the land use in the vicinity of this project: ?rr; An4 )
Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including 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
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
A
V.
Future Project Plans

Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and,? ro vide justification for the exclusion of this work from the current application:
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts 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 perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet. 5pc
Page 7 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
F4t- f. Fll 41 AO& 4 °q We.{ A"Af I lay ? o 14/4
°y i W ?t4l

.wf (:ill 1 2

a?!?? y 300&r'

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams /vI
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization 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
www,usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapcluest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. MA
Area of Type of Waterbody
Open Water Impact Name of Waterbody (lake, pond, watery, sound,
Site Number Type of Impact* impact (if applicable) (l ba ocean, etc.
(indicate on map) _ (acres
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: 611, excavation, dredging.
flooding, drainage, bulkheads, etc.
l?h
4. Pond Creation
if construction of a pond is proposed, associated wetland and stream imp?tsoshould
should
included above in the wetland and stream impact sections. Also, the propo pd
be described here and illustrated on any maps included with this application. wetlands
Pond to be created in (check all that apply): ? uplands ? stream
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. ,? S2_ 11 3
MA 1 a
;a
Of./
0
G
4,A l I O+A
NO.e,lN A
4, 00 (519
VIII. Mitigation
.?.#4 Ae-4f LoAkt
rA1lo
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams. ??
Page 9 of 12
USACE _ In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative rovpalue of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation 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 maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation 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 hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
htLtp-//h2o enr state nc us/newetlands/strmaide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a slarate sheet if more space is needed.-
2.
vU
Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating 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 an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at htta-/1h2o O! state nc us/w Jndex.IWL If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):_
Amount of Non-riparian wetland mitigation requested (acres
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
JX. Environmental Documentation (DWQ omy)
I)oes the project involve an expenditure o public I' `s or (lie, use of public (federal' tatc/local)
lano?
Yves i'4©
If yes, does the project require preparation of an environmental document pursuant to the
regwrernents of the National Or i OTth Catolirta Erivironmeiit.al Policy Act (NEPAISEPA)?
Notc: ff you are not sure whether a l`1FPA,'`'tt f'A document is required, call the SFPA.
coordinator at [phone] to review c.rarrerat [hresholds for environmental documentation,.
Yes, [j No
ff ales, bas the doC:arment review been finalized lad` lrc; State: Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.,
-Y-es F_1 NC? El
X. Proposed Impacts on riparian and Watershed Buffers (D Q OnlY)
It is the applicant's (ear agent's) responsibility to determine:, delineate and neap all Impacts to
required state; and local, buffers associated N,,?,ith the project. The applicant must also provide
justification for these impacts in Section VIl ahcvc, All proposed impacts must be listed herein,
and must be clearty iderttibable on the acc,omparfving site flan:. All buffers inust be shown on a
.map, whether or not impacts are proposed tea the buffers, Correspondence from the DWQ
Regional Office may be included a:, appropriatc_ Photographs may also be included at the
applicant's, discretion.
Wili tine praject impact protected ripariarf buffers identified within 15A NCAC 2ll .0233
(heirs`), 15A NCA. 2B ,0259 (Tar-Pnilico), ; :;A NCAC 2B .0250 (Raandletnaii Rules and
Water Supply 3uPier Requirements), € r other (picaw, identify P
Yes F-1 No rt if`vou ansNivered' "Eyes", provide the following information:
?denti y the square feet an(] acreage of impact to each zone of the riparian buffers. If buffer
;mitigation is required calculate the rettuired amount, of mitigation by applying the buffer
multipliers.
iatipac.i f Required "
Zone-
totalne i extends out 30% feet pcmendicnine f -M'-1- of'c:hannet; Zane extends m
adiblionai 20 teet fin-.n thu edge of'Zonc 1.

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.1 ?A .
G,L^V-ek p'L?4eL---J
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastew ter generat(V from the proposed project, or available capacity of the subject facility.
XM. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No 0
Is this an after-the-fact permit application?
Yes ? No Q0
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit 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 construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
??0-3
'Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

qv
i
MAP
LEGEND OF SYMBOLS:
®PROPOSED FILL AREAS(4,320 SF)
PROPOSED CONSERVATION EASEMENT ( 8,550 SF)
C3 EXISTING CONCRETE MONUMENT
El CONCRETE MONUMENT SET
O EXISTING IRON PIPE
O IRON PIPE SET
O EXISTING REBAR
O CALCULATED POINT
+ PK NAIL PROPOSE
A RIGHT OF WAY MONUMENT BULKHEAD
GEODETIC MONUMENT
b POWER POLE ?
0 TELEPHONE HEAD
Q CABLE T.V. HEAD
? TRANSFORMER
JQ HYDRANT MTL
gg ft_ /
44
M -'-9
,P442,8 sa ft
AU*14AFM..E
s . 80UND
ME-LINE ONL
Wm nAd ra un
° LINE OP
POST
53,011 eOT(1.22 aa.) i14 ?, _"_..
UPLANDS 22 259 SF
WIN WETLANDS 35,752 S pp.AA S 'TOTAL
RR LLpF ?q?p?
24d0cRE
MARY LIZZETT MIDOM UPLAND . 3 ACRES LOT 2
Da. - I, F16. - $95 54,150 of (1.24 ac.)
UPLANDS 22,492 SF
1
AL
=r
LARRY S. SNORER Sr. 1
LAIPW S. SHORCS Jr.
06.-IIN,PO.-410
AL END OF LINE OF
PEEN IGEE POST
PA OF GUR C4RNER
END OF PAVEMENT
NATIONWIDE #18 PERMIT SITE PLAN
JOSEPH A. STATEN
CROATAN TOWNSHIP - MASHOES - DARE COUNTY - NORTH CAROUNA
so' q' ,qo' 2qo' 390' Quibte and Associates, P.C.
GRAPHIC SCALE 1"-100' BNGINNERS, PUNNBRSt BNYIRONMENTAL SCINNUS
FILE: p03040 SURVEYED: 5/7/03 PLATTED: 0/10/03 P.O. DRAIIR'R 870. A7TTY HAWK, N.C. 27848
G: \2003\p03040\p03040SHETCH2.dwg Fri Jul 18 14:21:11 2003 Quible & Associates, PX.
NOTES:
1. F.I.R.M. ZONE: LISTED ON MAP
SUBJECT TO CHANGE BY F.E.M.A.
2. MAP REFERENCE MADE TO
OB. - 56, PG. - 296 &
DB. - 473, PG. - 31
DARE COUNTY REGISTRY.
3. PIN # 1 398 41 00382 67 7
4. THIS SURVEY IS SUBJECT TO ANY
FACTS THAT MAY BE DISCLOSED
BY A FULL AND ACCURATE TITLE
SEARCH.
A2-A3 N 86"12'45W 55,49
A3-A4 N 80"50'38"W 24.65'
B1-B2 S 55°'19'53"E 21.77'
B2-B3 S 06"51'52"W 15.24'
B3-B4 S 23"42'44W 15.01'
B4-B5 N 72"59'09"W 30.20'
C1-C2 N 66"03'29"E 45.99'
C2-C3 N 87"03'33"E 37.59
C3-134 N 84°28'33"E 39.37'
LEGEND OF SYMBOLS
¦ EXISTING CONCRETE MONUMENT
C] CONCRETE MONUMENT SET
• EXISTING IRON PIPE
O IRON PIPE SET
® EXISTING REBAR
O CALCULATED POINT
-}- PK NAIL
? RIGHT OF WAY MONUMENT
0 GEODETIC MONUMENT
b POWER POLE
0 TELEPHONE HEAD
& CABLE T.V. HEAD
? TRANSFORMER
0 WATER METER
JO, HYDRANT _
.ar

'
?a
•An
a
ALB6Y
&V
NL6

SOUND
.. A
W
tai

or rr v a ar e
" '
"Nx" x "m r n"rnx;r •:! !f /I
ee rs d! m d$
VICI N ITY M A P(NTS)
I1-1I5 CERTIFIES THAT THIS COPY OF THIS PLAT
ACCURATELY DEPICTS THE BOUNDARY OF THE
JURISDICTION OF SECTION 404 OF THE CLEAN WATER ACT
UNDER THE PRESENT LAW AND REGULATIONS AS
DETERMINED BY THE UNDERSIGNED ON THIS DATE
UNLESS THERE IS A CHANGE IN THE LAW OR OUR
PUBLISHED REGULATIONS, THIS DETERMINATION OF
SECTION 404 JURISDICTION MAY BE RELIED UPON FOR A
PERIOD NOT TO EXCEED FIVE (5) YEARS FROM THIS DATE
THIS DETERMINATION WAS MADE UTILIZING THE 1967
CO XII E ERS WET DS EUN TION MANUAL
ft ?Rl_?'PRESERTATIOE
49
MLE
DATE- 4 7'
N/F
MARY LIZZETT MIDGETT
DB. - 1, PG. - 325
\ yr WETLAND
19,136 sq ft\
rl/3 0 ?k
85
? F\Oro Sss ? X75,. .Eb?f
'k TIE-LINE ONLY
\
.k

?r

• ? ti
rf y
e
WETLAND /
41,331 sq ft
,je
TIE-LINE ONLY
N 81`4439"W
M~ 118,01' \ \ &0,
A4 J
^' ? ti .ZONF`Nf
A3 A2 Al \
LINE OF \
FENCE POST
_ WETLAND
891 sq ft
12
END OF LINE OF
3 FENCE POST
ONLINE
PARCEL OF LAND
2,46 ACRES TOTAL m
?y
UPLAND /
1,03 ACRES l?
3.8'
X
C4
I')
,je
\ ?ySy ?` 9p
H
. PFSRo.? 6p.?
f
END OF LINE OF
FENCE POST
ONLINE
p9
S64 F
3
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 CAL CUALTED IS 1/10,000 + : THAT THIS
PLAT WAS PREPARED IN ACOORDANCE WITH N.C.A.C.
TITLE 21, CHAPTER 56, SECTION 1600. WITNESS MY
ORIGINAL SIGNAITURE, REGISTRAkTION NO, AND SEAL
THIS 1,Gth JDAYy//OF APRIL. A.0.* 2003-,-,
W.M. MEEKINS JR. &ASSOC., INC.
Land Surveyors and Planners
P.O. Box 1998
Manteo, N.C. 27954
Job No. MH-452-03 REVISED 05/07/03: 404 PLAT
N/F
LARRY S. SHORES Sr. &
LARRY S, SHORES Jr.
DB. - 1183, PG. - 470
I, W.M. MEEKINS JR., P.L.S., CERTIFY THAT THIS
SURVEY IS OF AN EXISTING PARCEL OR PARCELS
OF LAND AND DES,,,NOT CREATE A NkW STREET
ORC}•IANCpE TING S REE ' .
WESLEY M
®yryyyeaS614A 0
X01+ 4 nsosxw[+ ?A
ie,
tip LA45
CONTROL CORNER r'+y?r ,??!1?` ?€? :?`~
P.C. OF CURVE END OF PAVEMENT 11, to `a
A PLAT OF LAND
FOR
JOSEPH` A. STATEN
MASHOES CROATAN TWSP.
DARE COUNTY NORTH CAROLINA
SURVEYED ON: 04/14/03
SURVEYED BY: W.M. MEEKINS JR. & ASSOC., INC.
1"=100'
100 50 0 100 100
COPY
Office Use Only:
USACE Action ID No.
Form Version October 2001
No. <<, d
If any particular item is not applicable to this project, please enter "Not Applicable" or' N/A" rather than
leaving the space blank.
NETLANRS 1401 GPM
I. Processing
SEA' c1 Mu:.
1. Check all of the approval(s) requested for this project:
® Section 404 Permit 441ATERQUALPSECTION,
Section 10 Permit
401 Water Quality Certification
Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: / hA :ri w?
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Informatio
Name: Tot L, A ^ '57A M
Mailing Address: -100 9
Ir • / w w ? A? c..
Telephone Number: a ' 61 -1 `i Fax Number: ay'"? - 2 ?? ` t 0
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant-)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 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 surrounding 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 appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted 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 than 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:
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): C?V 1 f b 0 3 gc? G 7 7
4. Location //.At-_a County: VAAet Neare t Town: AAnAf Ho??i? fNn+21
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.):
S 2. t"3 0 k11A4-,e_f end
5. Site coordinates, if available (UTM or Lat/Long): 4#464a
(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 or condition of the site at the time of this application:
VACAA?
7. Property size (acres): Q A4
8. Nearest body of water (stream/river/sound/ocean/lake): ? A16601AMIQ 5 V AeJ
9. River Basin: PAW L1oT?"k
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 6 of 12
1 o. Describe the purpose of the proposed work: 'Clt-• tt ??e ??^'?f F 1/) P g I S?
or. .0al k. A
1A, off
IV.
11. List the type of equipment tto,' be used to construct the project:
12. Describe the land use in the vicinity of this project:*'
Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including 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
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
n schedules. ?`? tA1''el M l Pa ^e^?`q-' ()§
j4j At./ V.

Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
L
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts 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 perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
'P.A-r.10114I As-eA 40 Wei A"Af J &a2 6F' o t4/4 oy W?f ,?r+,?/f

-ro JA- 113 00(ri?

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Irnpacts, including all intermittent and perennial streams /VI
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization 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
www.us s.eov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. 0?h
Area of Type of Wateaterbody
open Water Impact Name of Waterbody (lake, pond, Wry, sound,
Site Number Type of Impact* Impact (if applicable) (l bay, ocean, etc.
(indicate on map) (acres
List each impact separately and identify temporary impacts. Impacts include, but are not limited to. fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
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. wetlands
Pond to be created in (check all that apply): ? uplands ? stream
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
V111.
Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed durin construction to reduce impacts.
os0, ^.4 "'r'A f^ c?,r??Sr? l?er:Ae! ro r??•; 'F'•?• 52 111
14 L f3et?f-4061L^ C1 4-C-2- CS-er- 1%
n^00J rivM " 0 11 0+
l k L-AA*f l l AA Ac
4, 00 (5 Orr) " Z. $4 Aced w\ N fir. .Z"Vy?.w .
VM. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams. y?
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation 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 maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in rider
for USACE or DWQ to consider the application complete for processing. Any applicaon
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream ealto etiat
in DWQ's Draft Technical Guide for Stream Work in North Carolina,
hqp://h2o.enr.state.nc.us/ncwe?tlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
Of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a seplarate sheet if more space is needed.
2.
!?U
Mitigation may also be made by payment into the North Carolina Wetlands Restoration
program (NCWRP) with the NCWRP's written agreement. Check the box indicating 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 an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at httn-//h22o ern state nc usl nEmdex.htnL If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation ti 'Q
Ices the project involy° aaa oxp€rdiwre of pubhc rands or die. use. ofpublic- (federallstatenocal)
Lund?
x'es 1? No
if yes, dc.>es the proiect fequirc. arcparat-id n ref -,i eliviron end document pursuant to the
requirements of the N a.tionil or OT-th Carolina Ilnviio ental Policy Act. (NETA/SAI'A)?
Notc: xx you are not sure kvhether z T?-.E ' A 'StT decrement is requir-d; call the SEP
coordinator at (9 i 9) 733-3083 to ueview currant thresholds for er.-v rorunental d ac urnen tlon.
Yes [-J No L$
tff-yes, has s-lie document review been finalizes by dte State Clearinghouse' If so, please attach a
copy of the NEPA or S1v_t'A n41 approval l °trc?.
ye"', _! No r
Proposed Impacts on. Mparl. and latershed tauffe (D Only.)
It is the applicant's (or agenVs) responsib lity to deterrr!ine, delineate and ar;ap all impacts to
required state and local bu#f?r associated with tbn prgject. The applican. must also provide
Justification for these inivacts it.a Section. V11 above. All proposed impacts must be listed herein,
and must be, clearly identifiable on the accompartying site Irian. AUI buffers must, shown. on a
map, whether or not impacts arc proposed to #.f e buf %Ms. Correspondence from the 13WQ
f,ZeVonal Office may be iarcluded aas alyprop iatc. Photographs may also be inckn-ded at the
applicant°s discretion,
WiI4 the project impact protected 6parzar, bu-c rs dcntified -%itbin I5A I*Ft;:AC 2B .0233
ease), I5! NCAt sB .02_` 9 (tar-P amlicol, i 5A NC AC 2B .0250 Martdleman Rules and
Water Supply Buffer Recfuirenients), or other (plcztie identify.
Lal if oaa araswr:;rcd ;tyes", provide the fdllowin information:
Yes 17 No
Iden iffy the square feet and iacrcagc of impact to each zone of the riparian buffers. if buffer
initigaton is required calculate the rdaqufftd z+.rzaount of aiifigation by applying the buffer
Inultipliers.
Zone*

i
S 1
I t'4lYdt
Zonw 9 e„tet?tts P..: J0 .,?c: --._ di r 10,1, iForla nc 2. ?t:tnk cs# channel; /,me 2 extends w.
ad i ienpl '10 feet tit?m the edge of Zone L

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property. J??^ ?
GM-TO p?i?c.? ??
XU. Sewage 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.
Se,,• ? !c. -' Y Pk---L --
Xffi. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Suffer Rules?
Yes ? No 0
Is this an after-the-fact permit application?
Yes ? No 0
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicznt may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
A , / y/?/
Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

Vi
.LEGEND OF SYMBOLS:
M PROPOSED FILL AREAS(4,320 SF)
'PROPOSED CONSERVATION EASEMENT ( 8,650 SF)
D EXISTING CONCRETE MONUMENT
M CONCRETE MONUMENT SET
O EXISTING IRON PIPE
O IRON PIPE SET
O EXISTING REBAR
O CALCULATED POINT
? PK NAIL PROPOSE
A RIGHT OF WAY MONUMENT BULKHEAD
A GEODETIC MONUMENT
b POWER POLE
0 TELEPHONE HEAD
lSl CABLE T.V. HEAD
D TRANSFORMER ?pT
A HYDRANT N?TLA
Aql oq ft- ,

8oum
S eta
IE-UNE ONL
71
h%
/p4S2,5 eq ft
JNE Jy!
02
A2 A'?.
ornon?rn
R LINE OF
POST
LOT 1
93.011 of 1.22 cc.) A
UPLANDS 2 259 SF
WETLANDS 35,752 S LL?
ppqq?? ?q?p
MCI% TOT
MARY LIZZUTT MI06M UPLAND) 03 ACRE
Co. - I, Io. - 92
LOT 2
54,150 of (1.24 cc.)
11151 ?une nn Ann nr
NOTES: LEGEND OF SYMBOLS

1. F.I.R.M. ZONE: LISTED ON MAP
SUBJECT TO CH
¦ EXISTING CONCRETE MONUMENT Qtld?
S°04o 300M(?D
ANGE BY F.E.M.A.
2. MAP REFERENCE MADE TO
El CONCRETE MONUMENT SET
DB. - 56, PG. - 298 &
OB. - 473, PG. - 31
• EXISTING IRON PIPE F!0
?Or
sSSol 'N Ebb
51S?RY.
K Q IRON PIPE SET \ ? !/ ?6
• ?OF ?
3. PIN
39841000382
4. THIS SURVEY IS SUBJECT TO ANY
®IXISTING REBAR ?? 7F
Tr
FACTS THAT MAY BE DISCLOSED 0 CALCULATED POINT \ TIE-LINE ONLY
By A SEARCH.L AND ACCURATE TITLE -}- PK NAIL \
404 LINE9_ ? RIGHT OF WAY MONUMENT
Points Bearin Distance
1
_
'
"
' A GEODETIC MONUMENT
TT-A2
A2-A3 N 88
47
30
W
N 86"12'45V 43.21
55.49 b POWER POLE \
A3-A4 N 80150'38"W 24.85' 0 TELEPHONE HEAD
B1-B2
B2-83 S 55"19'53"E
S OB°51'52"W 21.77'
1524' CABLE T.V. HEAD ?Ir
o
BS-B4 S 23"42'44"W 15.01' ? TRANSFORMER r
B4-B5
C1-C2 N 72"59'09"W
N 86"03'29"E 30.20'
45
99' 0 WATER METER POND .r
C2-133 N 87°03'33"E .
37,59 J0,HYDRANT „
C3-C4 N 84°28'33"E 39.37' o h
.
a M
^a 'V
?
I Jl
'A« N
AuKV /Y
KLN
SVIINO

I ?

r 4rll
-.W

DI"fI1KT ° '? N
as ?r r?r is to
VICINI TY M AP (NTS)
0
• ? ti
1 ?y
WETLAND 1
41,331 sq ff
;e
TIE-LINE ONLY
x'
N 81144'39"W? -
,•? >k 118,07' F&epo J..
A4 ?NF\NF
A3 A2 Al
LINE OF ?
THIS CERTIFIES THAT THIS COPY OF THIS PLAT oy FENCE POST
ACCURATELY DEPICTS THE BOUNDARY OF THE
JURISDICTION OF SECTION 404 OF THE CLEAN WATER ACT
UNDER THE PRESENT LAW AND REGULATIONS AS
DETERMINED BY THE UNDERSIGNED ON THIS DATE B1 WETLAND
UNLESS THERE IS A CHANGE IN THE LAW OR OUR 891 sq ft
PUBLISHED REGULATIONS, THIS DETERMINATION OF
SECTION 404 JURISDICTION MAY BE RELIED UPON FOR A 82 END OF LINE OF
PERIOD NOT TO EXCEED FIVE (5) YEARS FROM THIS DATE 85 B3 FENCE POST
THIS D MINATION WAS MADE UTILIZING THE 1987 ONLINE
C0 0 INFERS W);TDS EUN TION MANUAL
?.? B4
? ?
_ PARCEL OF LAND
2.46 ACRES TOTAL ??'
49
TITLE- UPLAND
1,03 ACRES N/F
DATE-l? LARRY S. SHORES Sr. & o
3.8' LARRY S, SHORES Jr.
a OB. - 1183, PG. - 470
N/F
MARY LIZZETT MIOGETT
D8. - 1, PG. - 325 C2 C3 C4 I, W.M. MEEKINS JR., P.L.S., CERTIFY THAT THIS VEY IS
OF AN
STING PARC C1 ,k OFRLAND AND DES, INOT CREATEEA OR PARRECANE STING S RE WW ST
c~ ,? 'Ir C5 OR '
hy?' 'k WETLAND T-- ? WESLEY M
19,136 sq ft
'I` o END OF LINE OF 4dana?aA
` ?'4 Sys ?{69p. ONN NEPOST +e0?es® ?I CA/ q? ??ff
\ yASy? 9yBYBn? 'i` yr ?"'° x.83/o°-g
Rpp ? ;.o
6p, beAL
Ss?s 6p9 rCot
Z_ CONTROL CORNER
P.C. OF CURVE END OF PAVEMENT
I, WESLEY M. MEEKINS JR., CERTIFY THAT UNDER MY A PLAT OF LAND
DIRECTION AND SUPERVISION THIS PLAT WAS DRAWN FOR
FROM AN ACTUAL FIELD LAND SURVEY: THAT THE RATIO
OF PRECISION AS RED IN LIED IS 1 INICIE + : THAT THIS
PLAT WAS PREPARED N AC?RDANOE WITH N.C.A.C.A.C. A*
JOSEPH ? STATEN
TITLE 21, CHAlyl"ER 56, SECTION 1600. WITNESS MY MASHOES CROATAN TWSP.
ORIGINAL SIG TURE, REGISTRATION NO. AND SEAL
THIS 1 th A F APRIL, A. 2003...
DARE COUNTY NORTH CAROLINA
.mss'
WESLEY - SURVEYED ON: 04/14/03
VAEEKINS, JR. PILS 1465
W.M. MEEKINS JR. & ASSOC., INC. SURVEYED BY: W.M. MEEKINS JR. & ASSOC., INC.
Land Surveyors and Planners
P.O. Box 1998 V =100'
Manteo, N.C. 27954
Job No. MH4.52-03 REVISED 05/01/03: 404 PLAT l00 50 0 100 200