20091239 Ver 2_401 Application_20100810

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Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification C Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the

Corps:
? Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: NA or General Permit (GP) number: NA
1 c. Has the NWP or GP number been verified by the Corps? ? Yes ? No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
? 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ® Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required?
NO For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ® Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Canady Landing Lot #3
2b. County: Beaufort p
2c. Nearest municipality / town: Aurora 3_
2d. Subdivision name: Canady Landing SEP
2e. NCDOT only, T.I.P. or state
project no:
MR," b
3. Owner Information 5 11 k8' RANCH
3a. Name(s) on Recorded Deed: Judson T. Whitehurst
3b. Deed Book and Page No. 1639/350
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 802 Recycling Lane
3e. City, state, zip: Greenville,NC 27834
3f. Telephone no.: 252-916-4770
3g. Fax no.: 252-752-9016
3h. Email address: [e-mail]
Page 1 of 1
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: James A. Burgess II
5b. Business name
(if applicable): Burgess Land Surveying P.A.
5c. Street address: 2609 MacGregor Downs Rd.Unit 5
5d. City, state, zip: Greenville,NC 27834
5e. Telephone no.: 252-227-9992
5f. Fax no.: 252-758-4900
5g. Email address: [e-mail]
Page 2 of 2
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 14006853
1 b. Site coordinates (in decimal degrees): Latitude: 35.33310 Longitude: - 76.62733
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 2.04 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Hatter Creek 29-33-12
proposed project:
2b. Water Quality Classification of nearest receiving water: Sa HQW, NSW
2c. River basin: Tar-Pamlico (030307)
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Residential mowed yard and concrete gokart/skateboard track onsite and residential use adjoining property.
3b. List the total estimated acreage of all existing wetlands on the property:
1.24 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
278.54LF
3d. Explain the purpose of the proposed project:
Build a playground.
3e. Describe the overall project in detail, including the type of equipment to be used:
A concrete track is to be installed for the use of gokarts and skateboards.This is to take place in areas of maintained lawn
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes ? No ? Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
®Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: DCM
Name (if known): Emily Journigan Other: Mike Thomas/Kelly Spivey
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for ® Yes ? No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Major variance in the past and application was returned 1/05/2010
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 3 of 3
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ? Streams - tributaries ® Buffers
? Open waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes
? No ? Corps
? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ? P ? T ? PER ? Corps
? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts
3i. Comments:
Page 4 of 4
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
Open water
impact number
- Permanent (P)
or Temporary
T 4b.
Name of waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody type 4e.

Area of impact (acres)
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4E Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpose of 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 5 of 5
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason for Buffer Zone 1 impact Zone 2 impact
Permanent (P) impact Stream name mitigation (square feet) (square feet)
or Temporary required?
T
131 ®P ? T playground Hatter Creek ®Neos 4779.68 1681.80
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 4779.68 1681.80
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Foot print was decreased so as not to impact wetland areas using fill.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
No fill was placed in wetland areas and no equipment will be allowed into wetland areas.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ? Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps
? Mitigation bank
2c. If yes, which mitigation option will be used for this project? ? Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete If Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
Page 6 of 6
PCN Form - Version 1.3 December 10, 2008 Version
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ? No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 7
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ® Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes No
Comments: Vegetation is currently diffusing water flow with no erosion.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 9.86%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Less than 10,000sgft of impervious
surface.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties

4a.
Which of the following state-implemented stormwater management programs apply ? HQW
? ORW
(check all that apply):
? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ? No
6. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 8 of 8
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ® No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ® Yes ? No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ® Yes ? No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. 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.
There is an existing septic tank and drain field on subject property. Intermittent use with motorhome.
Page 9 of 9
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ® Yes ? No
impacts?
®
Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Dale Suiter USFWS
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ®Yes ? No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Division of Marine Fisheries- Anne Deaton
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC Cultural Resources
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: Not applicable
8c. What source(s) did you use to make the floodplain determination? DFIRM 3720750800E20040702

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Applicant/Agent's Printed Name pplicant/Agent's Signature Date
(Agent's sign is valid only if an authorization letter from the applicant
is provided.
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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is 4 ?pY
North Carolina Department of Cultural Resources
State Historic Preservation Office
Peter B. Sandbeck, Administrator
Beverly Eaves Perdue, Governor
Linda A Carlisle, Secretary
Jeffrey J. Crow, Deputy secretary
July 29, 2010
James Burgess, II
Re: Construct Playgound, Beaufort County, ER 10-1415
Dear Mr. Burgess:
Thank you for your letter of July 26, 2010, concerning the above project
Ofbce of Archives and History
Division of I-fistoricaf Resources
David Brook, Director
We have conducted a review of the project and are aware of no historic resources which would be affected by
the project Therefore, we have no comment on the project as proposed.
The above comments are made pursuant to Section 106 of the National Historic Preservation Act and the
Advisory Council on Historic Preservation's Regulations for Compliance with Section 106 codified at 36 CFR
Part 800.
Thank you for your cooperation and consideration. If you have questions concerning the above comment,
please contact Renee Gledhill-Earley, environmental review coordinator, at 919-807-6579. In all future
communication concerning this project, please cite the above-referenced tracking number.
Sincerely,
Pctcr Sandbeck
Location: 109 Bast Jonas Strcct, Raleigh NC 27601 Marling Address: 4617 Mad Service Center, Raleigh NC 27699-4617 Telephone/Fax: [phone]-6599
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BY THE PLAT PREPARER:
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~ ~ MUNICIPALITY THAI' HAS AN ORDINANCE
o ~ THAT REGULATES PARCELS OF LAND: _-B. THIS SURVEY IS LOCATED IN A PORTION OF
SITE A COUNTY OR MUNICIPALITY THAT IS UNREGULATED AS TO AN ORDINANCE THAT
CANADY LANDIING RD P REGULATES PARCELS OF LAND;
r _,_._.C. ANY ONE OF THE FOLLOWING: 1. THIS SURVEY IS OF AN EXISTING
z. ~ ~ AREA PARCEL OR PARCELS OF LAND AND
9 2.39 AGRES DOES NOT CREATE A NEW ROAD OR CHANGE AN EXISTING ROAD:
fl (104, 212.69 SQFT) << ~ 2. THIS SURVEY IS OF AN EXISTING BUILDING OR OTHER STRUCTURE, OR
~ - UUD50N WHITEHURST rn ' SPRING CR K RD ~ Mq ~ W NATURAL FEATURE:, SUCH AS A WATER
Rgy a COURSE; ___3. THIS SURVEY IS A CONTROL SURVEY:
~ D, THIS SURVEY IS OF ANOTHER CATEGORY, T SUCH AS THE RECOMBINATION OF EXISTING
C~ NO r s~ PARCELS, A COURT--ORDERED SURVEY, OR
. ~ ~ 9F r~q ; m Pd NP5 -~0 ORgO NO ~ d OTHER EXCEPTION TO THE DEFINITION OF
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WETLAND DETAILS LAMA LINES L99 N56°54~59'~w 29.es' L12 N49°39'09"Vd 28.56' ~
L93 N10'36'10"Vd 24,38' ! CERTIFICATION
• L94 N09°3A'59"E 11.40'
~~C)T ~ L15 N22°0?'24"E 25.22'
BEING ALL OF OEED BOOKS AND PAGES AS SHOWN L16 N10°49'54"E 22.92' AND BOAT SLIPS AS DESIGNATED, L9' N93°25`44"E 13.57' I, JAMES A. BURGESS II CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION
RiCHLAND TOWNSHIP, BEAUFORT COUNTY, NORTH CAROLINA L18 NOB°59'98"E 22.49' FROM AN ACTUAL SURVEY MADE BY ME JABII DEED DESCRIPTIONS
L99 N09°26':32"W 15.94' PEC(JRDED TN BOOK t,fl' Z6 MAP BOOK.,_NA _,PAGE-.1J~`._;THAT THE RATIO OF
OWNER; -JUDSON WHITEHURST ANO ED WHITEHURST JR. L20 N24°19'37"W 18.36' PRECISION AS CALCULATED BY LATITUDES
ADDRESS R VISION ®®``~~~~g~~~~~'®®®® AND DEPARTURES IS 1: 10,000 + ; THAT
E 5 CARp ~o~®®®® AS BOUNDARIES NOT SURVEYED SHOWN BROKEN LINES PLOTTED FROM INFOR- MATION FOUND IN BOOKS REFERENCED
PHONE REVISION OF MAP DATED 02/OB/OB ~o SS9~®®® ,9 ENTITLED "BOl1NDARY SURVEI'- m®°ti e®® HEREON
~ ~ CANADY LANDING-LOTS 1, 2, Wi, AND 4" ~ °9` ® a
0 B ~ map 0 0 02/18/08- BEARINGS, LOT 6, LDT 6A, TITLE ~ S4>
PROFESSIONAL LAND S~JR1lEYORS 06/15/09- WETLAND flETAILS ~ a: 00 WITNESS MY ORIGINAL SIGNATURE, REGIS- C2
OB 05.10- CAMA LINE REVISED ~ ~ ~0 2609 MAOGREGOR DOWNS RD UNIT 5 / J ~ "o~~+®cb TRATION NUMBER, AND SEAL THIS 5TH
GREENVILLE N.C, 2763 G , U~. ,gyp ® DAY OF _ AUGUST 20 10
252-758-4 ~ SCALE 1 =50 ® ~ 900 LICENSE 0-207.. p SIGNED
SURVEYED T8 APPROVED IT y..- PROFESS AL LAND SURVEY 6R
W JABII 08 05 2010 5O 1O0 DRA N DATE' ~ / / - REGISTRATION NUMBER __L-:3960
CHECKED JA8 TI SCALE: 9."=50'
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