20100495 Ver 1_401 Application_20100610

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) 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: 29 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ?X 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 ?X Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ
401 Certification:
? Yes ?X 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 ?X 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 Q No
2. Project Information
2a. Name of project: Access Road Improvement
2b. County: Beaufort County
2c. Nearest municipality / town: Bath, NC
2d. Subdivision name: Mixon Creek
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed: Dwight Lane Woolard
3b. Deed Book and Page No. 1648; 931
3c. Responsible Party (for LLC if
applicable): Dwight Lane Woolard
3d. Street address: 1130 Parkridge Lane, Apt 103
3e. City, state, zip: Raleigh, NC, 27605
3f. Telephone no.: 919-457-6069
3g. Fax no.: 919-549-4310
3h. Email address: [e-mail]
Page 1 of 10
PCN Form - Version 1.4 January 2009
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:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 86911 / 08A07-017858
1b. Site coordinates (in decimal degrees): Latitude: 35.43 Longitude: 76.77
1 c. Property size: 4 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Mixon Creek
2b. Water Quality Classification of nearest receiving water: SC;NSW
2c. River basin: Tar Pamlico
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 property
3b. List the total estimated acreage of all existing wetlands on the property: 0.5
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 0
3d. Explain the purpose of the proposed project:
The proposed project is to upgrade the existing road by grading it into less steep slopes and through the additional of a gravel surface.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project will employ a dump truck and a road grading equipment (most probably a grading tractor).
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /

project (including all prior phases) in the past? ?X Yes ? No ? Unknown

Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
? Preliminary ?X Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Mike Thomas Agency/Consultant Company: CAMA
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
On 11/20/2009, issued a determination of location of coastal wetlands on the property - see first attachment.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ?X Yes ? No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
This property has existing permits for septic system installation - see second attachment.
6. Future Project Plans
6a. Is this a phased project? ? Yes ?X No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.4 January 2009
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.
Wetland impact
number
Permanent (P) or
Temporary T 2b.
Type of impact 2c.
Type of wetland 2d.
Forested 2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other) 2f.
Area of
impact
(acres)
W1 Choose one Choose one Yes/No -
W2 Choose one Choose one Yes/No
W3 - Choose one Choose one Yes/No
W4 - Choose one Choose one Yes/No
W5 - Choose one Choose one Yes/No -
W6 Choose one Choose one Yes/No
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.
Stream impact
number
Permanent (P) or
Temporary (T) 3b.
Type of impact 3c.
Stream name 3d.
Perennial (PER) or
intermittent (INT)? 3e.
Type of
jurisdiction 3f.
Average
stream
width
(feet) 3g.
Impact
length
(linear
feet)
S1 - Choose one
S2 - Choose one
S3 - Choose one
S4 - Choose one
S5 - Choose one -
S6 - Choose one
3h. Total stream and tributary impacts
3i. Comments:
Page 4 of 10
PCN Form - Version 1.4 January 2009
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 individual) 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 - Choose one Choose
02 - Choose one Choose
03 - Choose one Choose
04 - Choose one Choose
4f. 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 number 5b.
Proposed use or
purpose of pond 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one
P2 Choose one
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:
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 ou MUST fill out Section D of this form.
6a. Project is in which protected basin? ? Neuse ?X Tar-Pamlico ? Catawba ? Randleman ? Other:
6b.
Buffer Impact
number -
Permanent (P) or
Temporary T 6c.
Reason for impact 6d.
Stream name 6e.
Buffer
mitigation
required? 6f.
Zone 1
impact
(square
feet 6g.
Zone 2
impact
(square
feet
131 P Driveway Mixon Creek - Wetland No 2,800 3,400
B2 P Driveway Mill Creek No 1,500 1,800
B3 Yes/No
B4 Yes/No
B5 Yes/No
B6 - Yes/No
6h. Total Buffer Impacts: 4,300 5,200
6i. Comments:
A diagram has been included that illustrates the driveway (roadbed) impact calculation - see third attachment.
Page 5 of 10
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
In the proposed project, the main issue will be preventing runoff into the wetlands area, and we will employ traditional erosion control barriers such as
silt fences to mitigate this problem.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The location of the driveway was selected to minimize the collective impact to the Mixon Creek Wetland and Mill Creek which boarder each side of the
only access pathway.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ?X No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank

? 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: Choose one
Type: Choose one
Type: Choose one Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Makin 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: Choose one
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.
Page 6 of 10
PCN Form - Version 1.4 January 2009
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 Yes X No
buffer mitigation?
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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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 10
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ?X 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.
Attachment show required diffuse flow map - see third attachment. Q Yes ? No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 5.4%
2b. Does this project require a Stormwater Management Plan? ? Yes 0 No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
The impact of the proposed project is very small and steps will be taken to prevent any erosion.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
? Phase II
? NSW
3b. Which of the following locally-implemented stormwater management programs ? 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
? HQW
4a. Which of the following state-implemented stormwater management programs apply ?ORW
(check all that apply): ?Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
5. 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 10
PCN Form - Version 1.4 January 2009
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 Q 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
l
tt
? Yes
? No
e
er.)
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 ?X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ?Yes ?X 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 ?X 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.
There are plans to build a three-bedroom residence on the property in the future.
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.
This project will not generate any wastewater.
Page 9 of 10
PCN Form - Version 1.4 January 2009
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 ?X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes Q No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. -
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
North Carolina Threatened and Endangered Species website
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes Q No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
National Marine Fisheries Service
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 ?X 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 State Historic Preservation Office website
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes Q No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?

Dwight Woolard / 6?? 06-18-2010
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)
Page 10 of 10
Owner Address(2) Raleigh. NC 276 ? Lang Term Acceptance Rate;GP©/SQI-
Owner Phone #:[phone] .
C% Trench Width :3 FT '""'
P,(-)Perty Address Mixon Creek Trench Spacing {QC) 9 FT t \ ,.,??
roperty Addressi2.I Lot :jt)
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O?PIN 6662-30-52t!3 37 ?t+c Tank Volume 1000 "yam
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Prepared with QuiKP1atPro32 by
8eautort County Health L)epartment 'COP Fee Numott 3 5 9 6 8
F Environmental Health Section Count) ID Number 6662305216
(rwt? 11 ? c.' 220 North Market St. NEW
Evakiated For
Washington NC 27889

Phone: [phone] Fax: [phone]
PERMJTiiLIDUtITIL
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'NOTE TO MSPECTIOliS DIVISION Bu Permits canna be Issued will, on ly an improvement permit Q Open Fill Sheet
Appucant Dwight Woolard Properir Owner Dwight Woolard
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Address 1130 Parkrbge Lane ..caress 1130 Parkndge Lane
Cliff Ralf Cit. Ratefgh
3tate,ztp NC 27605 Staler2rp NC 27605
Phone IF [phone]
Phone •
Address Mixon Creek Drive Pt QA4Lt1t_Location_St,Utrtt9M4 os
Road a Bath NC 27808 Su.at.tv.n Mixon Creek Phase Lot 30
Township 119"J#oas
Structure SINGLE FAMILY Drive East from Bath to Mixon Creek Drive. Lift chain loop over top of
ix)-t fn antnr {xnpErty
a Or Sedraa7r 3
a of People 4
'Water Supply PUBLIC.
1811119 SYStem System SOtatis fond
'Site Classification PS 1.1 int^nu!m T ranch Depth
Design FraA 3 6 0 is atimurn Trench Depth
Sod Applicalion Rate - 3 Fill Depth
'System Class ificalion?Description Septic Tarw
TYPE tl A CONY SYSTEM (SINGLE-fAMILY OR 480 GPO OR
LESSI Pump Required
'Proposed System CONVENTIONAL
Pumv Tan,
1 Inches
1 tj Inches
Inches
1 0 0 0 G aeon s
(eves 1`;.140 #U at Be Required
1 0 0 0 Gasons
Repair S, stern Required Y*s (:)NO ( No. out has A adabra Space
R&RAIr System
'Site Classification s
Sod Application Rate 3
'System Class ifecationi 3;cription
TYPE tl A CONY SYSTEM (SINGLE-IAMB Y OR 480 GPD OR
LESSI
'Proposed System- CONVENTIONAL
U*runurn Trench Depth
03 ,utmum Trench Depth
Fill Depth
Pump Required
Pump Tank
1 inches
Inches
inch*$
Yes (-)NO * Mal Do Required
1 0 0 0 Gasons
No grading or construction aclrvdt is adowed un artas destgnsted for system and repax wdhous approva of Health Department
-Sir Mgdetl oss Set 1000gai tank and install 4 Imes (3' x 100) conventional rock trenches for initial and repair. maintain setbacks
ine issuance or mis petmq at fie Health Department in no oat guarantees the issuance of other permits 1
is responsible for checking aids appioprtals go,.vning oodlts in mooing fhtu r*qurtlments
'Permit C gndtgons An Authorization to Construct will be issued upon approvat of final site plan by SCHD
In• ue?WVFIV [aria LOC 1 neasrn ueparmt an% may impose condttions on the issuance, and may rewke the permits for failure of the system to
*Misty the condrtions, the rules, or this artlcla This permit is subject to rewcation it the site plan, pat or Inliencled use changes (NCGS 13OA-M
(% The person owning or controlling the system shall be responsible for assuring compliance with the taws, rules, and permit conditions
regarding system Ioeauon, installation, operation, main m ng, req'ng. and repair (A93A(lo) .
'Authorized State Agent 2018 • Hager htallt?v,t Date of Issue 1 1 / 0 0
:-)Hand Draatng t "Si a Plan/Drawing attached." Iolal Time (HH Rll.!
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