20120793 Ver 1_401 Application_20120812

Quible
20120793
Quible & Associates, P.C.
P.O. Drawer 870
Kitty Hawk, NC 27949
ENGINEERING - ENVIRONMENTAL SCIENCES - PLANNING - SURVEYING
Phone 252 - 261 -3300
SINCE 1959
Fax* 252- 261 -1260
Web quible.com
Roberto Scheller
NC Division of Water Quality
943 Washington Square Mall
Washington, NC 27889
August 16, 2012
RE: Lot 6, Block 6, Jackson Dunes
Ocracoke, Hyde County, North Carolina
Nationwide 18 and 401 Certification
Mr. Scheller,
Enclosed is a Nationwide 18 and 401 Water Quality Certification submission for 0.10 acres of
Section 404 wetland impacts associated with a single family residential homesite. The section
404 wetlands line was delineated by Emily Jurnigan of USACE in May 2012.
Enclosed are five copies of the following:
• Agent Authorization Statement
• Site Plan
• PCN Application
• USGS Vicinity Map
• $240 Processing Fee Check to NCDENR
• NCEEP Acceptance Letter
• Copy of the Hyde County on -site wastewater system Improvement Permit
Please review and process this permit request. If you have any questions or require additional
information, please contact me at (252) 261 -3300.
Sincerely,
Quible & Associates, P.C.
qwh �Z�
Brian Rubino
CC: William Wescott, USACE
Christopher M. May, Jr.
AUG 222012

May 31, 2012
RE: Stern Heirs Parcel
Ocracoke Village, Hyde County, NC
Pin # 9500 -69 -0499
I authorize Quible & Associates, P.C. to act as agent for the purpose of environmental
permitting, including USACE and DWQ permits for future residential construction on this lot.
o 4?- X44rf T-
f--"A"tY Date
Name: ebo(J-V4 ,e
Title: - azsj�,I'
!

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20120793
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
Pre - Construction Notification (PCN) Form
A. Applicant Information ( t
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit ❑Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes ® No
1d. 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?
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:
Lot 6, BL C, Jackson Dunes
2b. County:
Hyde
2c. Nearest municipality / town:
2d. Subdivision name:
none
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name on Recorded Deed:
Herbert Stern Heirs (Attn: Christopher M. May, Jr.)
3b. Deed Book and Page No.
DB 137/ PG 67
3c. Responsible Party (for LLC if
applicable):
N/A
3d. Street address:
P.O. Box 233 un
3e. City, state, zip:
Crownsville, MD 21033�a_
3f. Telephone no.:
410.849.2100
ROtJALan
3g. Fax no.:
W�9was�
3h. Email address:
Page 1 of 11
PCN Form — Version 1.0 November 2008 Version

Section A. Applicant Information, continued
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:
Brian Rubino
5b. Business name
(if applicable):
Quible & Associates, P.C.
5c. Street address:
P.O. Drawer 870
5d. City, state, zip:
Kitty Hawk, NC 27949
5e. Telephone no.:
(252) 261 -3300
5f. Fax no.:
(252) 261 -1260
5g. Email address:
brubino @quible.com
Page 2 of 11
PCN Form — November 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
9500 -69 -0499
1 b. Site coordinates (in decimal degrees):
35.111510`N - 75.968937`W
1 c. Property size:
0.54 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Pamlico Sound
2b. Water Quality Classification of nearest receiving water:
SA
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:
Single Family Residential. Nearby properties include single family residential homesites and undeveloped wetlands and
uplands.
3b. List the total estimated acreage of all existing wetlands on the property:
0.19 ac.
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 purpose of this wetland impact permit request is for minor wetland fill impacts associated with the fill of 0.10 acres of
wooded Section 404 wetlands for a residential homesite. The on -site septic treatment system will be located in the
location as permitted by Hyde county Health Dept. (see emclosed Improvement Permit).
3e. Describe the overall project in detail, including the type of equipment to be used:
Proposed building construction and associated grading will require minor wetland impacts. Equipment will include
backhoe, dump trucks and compactors.
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?
® Yes ❑ No ❑ Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ® Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Emily Jurnigan
Agency /Consultant Company: US Army Corps of
Engineers
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Delineated by USACE in May 2012 and Surveyed by Seaboard Surveying immediately after
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
TO Yes ® No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 3 of 11
PCN Form — Version 1.0 November 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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
Type of wetland
Forested
(Corps - 404, 10
Area of impact (acres)
Permanent (P) or
impact
(if known)
DWQ — non -404, other)
Temporary T
W1 ® P ❑ T
fill
shrub - forested
404/
❑ Yes ® No
® Corps
0.10
® DWQ
non - riparian
W2 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W3 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes ❑ No
El Corps
❑ DWQ
2g. Total wetland impacts
0.10
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.
Stream impact
Type of
Stream name
Perennial (PER) or
Average stream width (feet)
Impact
number -
impact
intermittent (INT)?
length
Permanent (P) or
(linear feet)
Temporary (T)
S1 ❑ P ❑ T
❑ PER ❑ INT
S2 ❑ P ❑ T
❑ PER ❑ INT
S3 ❑ P ❑ T
❑ PER ❑ INT
S4 ❑P ❑T
❑PER [_1 INT
S5 ❑P ❑T
El PER F1 INT
S6 ❑ P ❑ T
❑ PER ❑ INT
3g. Total stream and tributary impacts
3h. Comments:
Page 4 of 11
PCN Form — Version 1.0 November 2008 Version

C. Proposed Impacts Inventory, continued
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 o en water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of
impact number
waterbody
Type of impact
Waterbody type
Area of impact (acres)
— Permanent
(if
(P) or
applicable)
Temporary T
01 ❑P ❑T
02 ❑P [IT
03 ❑P ❑T
04 ❑P ❑T
4f. Total open water impacts
4g. Comments:
Page 5 of 11
PCN Form — November 2008 Version

C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If pond or lake construction pro osed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upkand
Pond ID
Proposed use or
(acres)
number
purpose of 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:
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 any impacts require mitigation, then y ou 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
Buffer
Zone 1 impact (square
Zone 2 impact
Permanent (P)
for impact
Stream name
mitigation
feet)
(square feet)
or Temporary
required?
T
61 ❑P ❑T
[]Yes ®No
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form — November 2008 Version

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.
Fill will be sloped and stabilized; septic system is located in natural uplands.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Silt fencing to be maintained until disturbed area is stabilized with grass.
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 ❑ 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
Quantity
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:
0.1
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 7 of 11
PCN Form — Version 1.0 November 2008 Version

D. Impact Justification and Mitigation, continued
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
Reason for impact
Total impact
(square feet)
Multiplier
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
Total buffer mitigation required:
6c. 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).
6d. Comments:
Page 8 of 11
PCN Form — November 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
El Yes No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included?
❑ Yes ❑ No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non -404 Jurisdictional General Permit?
❑ Yes ® No
2b. Is the project subject to General Certification 3704 or 3705?
❑ Yes ® No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state - implemented stormwater
® Coastal counties
management programs (check all that apply)?
❑ HQW
If so, attach one copy of the approval letter from the DWQ and one copy of the
❑ ORW
❑ Session Law 2006 -246
approved stormwater management plan.
❑ Other:
3b. In which local government's jurisdiction is this project?
Hyde County
3c. Is this local government certified to implement a state stormwater program?
❑ Yes ® No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site Ian?
< 25 % at max. build out
4b. Does this project contain any areas that meet the criteria for "high density" per
El Yes No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and /or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
4d. Has a completed BMP Supplement Form with all required items been submitted
for each stormwater BMP?
❑Yes No
Page 9 of 11
PCN Form — Version 1.0 November 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
❑ Yes ❑ No
letter.)
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.
An on -site septic treatment system will be installed to serve the homesite (see Hyde County Improvement Permit).
Page 10 of 11
PCN Form — Version 1.0 November 2008 Version

F. Supplementary Information, continued
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
El Yes No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
El Yes No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
[I Raleigh
❑ 'Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program
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?
Mapping data and field investigation; proposed impact area is not within an area of surface waters.
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
E:] 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?
National Register of Historic Places
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: This type of fill is allowable with permit in AE zones.
8c. What source(s) did you use to make the floodplain determination? NFIP Flood Zone Maps (www.nefloodmaps.com)
D. VK-N�Jn a
/ Jet
D
Applicant/Agent's Signature
Applicant/Agent's Printed Name
(Agent's signature is valid only if an authorization letter from the applicant
Date
is rovided.
Page 11 of 11
PCN Form — November 2008 Version

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NOTES.
1 OWNER THE ESTATE OF HERBERT J STERN
LEGEND
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Phone: [phone]
!
PROPOSED WETLANDS
3
SURVEY INFORMATION AS PER SEABOARD SURVEYING &
�' ' '• '_`
IMPACTS (4,,3535 6 SQ.FT.)
PLANNING, SIGNED BY MANSON RAY MEEKINS, ON
4/30/12
33'"
EXISTING SPOT ELEVATION
4
TOTAL LOT AREA. 23,411 SOFT (0 54 AC)
0
EXISTING CONCRETE MONUMENT
WETLAND AREA. 8,308 SQ.FT (0 19 AC )
UPLAND AREA. 15,103 SQ.FT. (0 35 AC.)
0
EXISTING IRON ROD
5
THE SECTION 404 WETLAND LINES SHOWN ON THIS PLAN
0
IRON ROD SET (BY SURVEYOR)
HAVE BEEN CONFIRMED BY US ARMY CORPS OF
ENGINEERS
A
EXISTING PK NAIL
6
THE PURPOSE OF THIS PERMIT REQUEST IS TO FILL 010
AC OF SECTION 404 WETLANDS
®
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PROJECT
COPYRIGHT © 2012
QUIBLE & ASSOCIATES, P.C.
NATIONWIDE IS FILL PLAN
P12047
THIS DOCUMENT IS THE PROPERTY OF QUIBLE
& ASSOCIATES. P C. ALL RIGHTS ARE
RESERVED ANY REPRODUCTION OF THIS OR
Quible SINCE 1959
LOT 6 BLK � PT I
.
DRAWN BY
ssociates P.
ENGINEERING * CONSULTING * PLANNING
TA$
POSSESSION WITHOUT PRIOR PERMISSION OF
QUIBLE & ASSOCIATES, P C WILL CONSTITUTE
VIOLATION OF COPYRIGHT LAWS VIOLATION
WILL BE SUBJECT TO LEGAL ACTION
JACKSON DUNES SUBDIVISION
CHECKED BY
OCRACOKE
HYDE COUNTY
ENVIRONMENTAL SCIENCES * SURVEYING
BDR
IF THIS PLAN OR PLAT IS NOT SIGNED AND
SEALED BY A LICENSED PROFESSIONAL THEN
THIS PLAN OR PLAT SHALL BE CONSIDERED
NORTH CAROLINA
NC License C -0208
PO Drawer 870, Kitty Hawk, NC 27949
0 40 80
DATE
PRELIMINARY AND NOT A CERTIFIED DOCUMENT
Phone: [phone]
7/6/12
AND SHALL NOT BE USED FOR CONSTRUCTION,
RECORDATION, SALES OR LAND CONVEYANCES
GRAPHIC SCALE IN FEET 1"=40
Fax: [phone]
E —Mail: administrator ®quible.com

Y
o rstem t
PROGRAM
July 10, 2012
Herbert Stein Heirs
attn: Christopher May, Jr.
PO Box 233
Crownsville, MO 21032 Expiration of Acceptance: January 10, 2013
Project: Lot 6, BLC Jackson Dunes County: Hyde
The purpose of this letter is to notify you that the North Carolina Ecosystem Enhancement Program (NCEEP) is willing to accept
payment for compensatory mitigation for impacts associated with the above referenced project as indicated in the table below. Please
note that this decision does not assure that participation in the NCEEP will be approved by the permit issuing agencies as mitigation
for project impacts. It is the responsibility of the applicant to contact these agencies to determine if payment to the NCEEP will be
approved. You must also comply with all other state, federal or local government permits regulations or authorizations associated
with the proposed activity including SL 2009 -337• An Act to Promote the Use of Compensatory Mitigation Banks as amended by
S.L. 2011 -343.
This acceptance is valid for six months from the date of this letter and is not transferable. If we have not received a copy of the
issued 404 Permit/401 Certi6cation/CAMA permit within this time frame, this acceptance will expire. It is the applicant's
responsibility to send copies of the permits to NCEEP. Once NCEEP receives a copy of the permit(s) an invoice will be issued based
on the required mitigation in that permit and payment must be made prior to conducting the authorized work. The amount of the In
Lieu Fee to be paid to NCEEP by an applicant is calculated based upon the Fee Schedule and policies listed at www.nceep.net.
Based on the information ;upplied by you in your request to use the NCEEP, the impacts that may require compensatory mitigation are
summarized in the following table. The amount of mitigation required for this impact is determined by permitting agencies.
Impact
River
Basin
CU
Location
Stream (feet)
Wetlands (acres)
Buffer I
(Sq. Ft.)
Buffer II
(Sq. Ft.)
Cold
Cool
Warm
Riparian Non-Riparian
Coastal Marsh
Tar - Pamlico
03020105
0
0
0
0 0.10
0
0
0
Upon receipt of payment, EEP will take responsibility for providing the compensatory mitigation. The mitigation will be performed in
accordance with the N.C. Department of Environment and Natural Resources' Ecosystem Enhancement Program In -Lieu Fee
Instrument dated July 28, 2010.
Thank you for your interest in the NCEEP. If you have any questions or need additional information, please contact Kelly Williams at
(919) 716 -1921.
Sincerely,`
zanne ek
Acting Director
cc: Karen Higgins, NCDWQ Wetlands /401 Unit
William Wescott, USACE- Washington
Roberto Scheller, NCDWQ- Washington
Doug Huggett, NCDCM - Morehead City
Brian Rubino, agent
File
RPiS"t0Y'LK�5... E ... Prot", Oar Shag
North Carolina Ecosystem Enhancement Program, 1652 Mail Service Center, Raleigh, NC 27699 -1652 / 919 - 715 -0476 / www.nceep.net

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HYDE COUNTY HEALTH DEPARTMENT
P.O. Box 100 Swan Quarter, NC 27885
Phone # [phone]
IMPROVEMENT PERMIT
INITIAL INSTALLATION: XXX EXPANSION: REPAIR:
Permit No: 52112 -3 Date: May 21, 2012
Permittee: The Estate of Herbert 3. Stern
Address: C/O Christopher May, P.O. Box 233, Crownsville. Md. 21032
Phone No.: (410) 849 -2100
Property Location: Lot #6 Blk C Part 1, 3ackson Dunes S /D, Ocracoke
Facilities to be served: 4 bedroom house
Water Supply: community
Wastewater Flow GPD: 480
Wastewater System Type: iI -c, shallow placement
Wastewater System Repair: same
Long Term Acceptance Rate: 1.2 gpd /sq.ft.
Absorption Area: 600 sq.ft.
Septic Tank'Capacity: 1000 gallons with Miter
Pump Tank Capacity: NA
Total W-"7/Trench Length: 30' Width: 20'
/Trench Spacing: 3 on center
Maximum &d /Trench Bottom Depth: 12" below the naturally occurring soil surface

IMPROVEMENT PERMIT
STERN ESTATE
PAGE 2
CONDITIONS:
1. Installation of the wastewater system shall be in strict accordance with the
approved site plan, and all specifications which are a part of this permit.
2. If rock is used, place geotextile fabric over the bed prior to backfilling.
3. Place a 6" cap of soil (the last i" to be topsoil) over the drainfield to extend 5' past
the bed sidewalls prior to tapering. Shape to shed surface water and establish a
grass cover. Maintain grass height not to exceed 3 " -4 ".
4. Use water conserving fixtures i.e. 1.6 gallon flush toilets; 2 gpm shower heads,1
gpm all lavatories. Try to spread out laundry throughout the week. Do not pour
grease or harsh cleaning chemicals into the house drains.
This Improvement Permit shall be valid:
Without expiration
upon a showing satisfactory to the Hyde County Health Department that the site and soil
conditions are unaltered, that the facility, design wastewater flow, and wastewater
characteristics are not increased, and that a wastewater system can be installed that
meets the permitting requirements in effect on the date this permit was issued. This
permit is subject to revocation if site plans or the intended use changes.
Authorized
Registered Environmental Health Specialist
Hyde County Health Department

Ran So
'THIS CERTIFIES THAT THIS COPY OF THIS PLAT ACCURATELY DEPICTS
Q THE 80UNOARY OF THE JURISDICTION OF THE SECTION 404 OF THE CLEAN
1�AFjf 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 DETERMINAT10H OF
SECTION 404 JURISDICTION MAY BE RELIED UPON FOR A PERIOD NOT
TO EXCEED 5 YEARS FROM THIS DATE.' (THIS DETERMINATION WAS
MADE UTILIZING THE 1987 CORPS OF ENGINEEERS WETLAND
DELINEATION MANUAL)
Utuu/py,, /'Y.`
CAR 4
SEAI
L 259 LOT 8 ,.
5 BLOCK C R
�L/ ?fin ": ' �� JACKSON'S DUNES t.5 Nr
L/ o` (PC A. SL. 197A)
nmgtd.`
VX s•/ 66•
zn
LINE TABLE
1. THIS SURVEY IS SUBJECT TO ANY FACTS THAT MAY BE
LENGTH
N
DISCLOSED BY A FULL AND ACCURATE TITLE SEARCH. u
L1
2. AREA BY COORDINATE COMPUTATION - 23,411 S.F.
e� SITE
3. F.I.R.M. ZONE. AE; B.F.E.: 6.0' (PER F.I.R.M.) - V FREEBOARD -
28.72
4. PIN NO.: 9500 -69 -0499
L3
5. RECORDED REFERENCE PC A. SL 197A; DO 133, PC. 67 Qt
0OL1M
6. MINIMUM BUILDING LINES (MBL) SHOWN HEREON ARE PER THE
23.77
CURRENT LOCAL ZONING REGULATIONS. OTHER SETBACKS
L5
AND /OR RESTRICTIONS MAY APPLY AND MUST BE VERIFIED
T
t/Y REBAR
PRIOR TO CONSTRUCTION. FLUSH
16.61
7. ELEVATIONS (NAVO 19aa): AS SHOWN V
Utuu/py,, /'Y.`
CAR 4
SEAI
L 259 LOT 8 ,.
5 BLOCK C R
�L/ ?fin ": ' �� JACKSON'S DUNES t.5 Nr
L/ o` (PC A. SL. 197A)
nmgtd.`
VX s•/ 66•
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LINE TABLE
LINE
LENGTH
BEARING
L1
28.00
go
L2
28.72
y E - EX. CONC. MON.
L3
24.67
IY1 Q
L4
23.77
P/K NAIL SET
L5
17.81
T
L6
16.61
0. N, ® - PHONE PEDESTAI
L7
12.22
538.4525'E
L8
27.33
520'17'39'W
L9
16.73
®- ELECT. TRANS.
34.33
t.2f aC
BG - BELOW GRADE
40.80
C1i�i
18.02
14.67
N84'12'4 8"E
FLI
28.38
1. 7' '
22.12
N 0'16'
28.20
70. 73
13.48
L19
13.28
S57 *03'57"E
L20
17.86
5 i' 1"
L21
28.84
N78-14'30'E
L22
38.91
67'02'49'
L23
106.60
L24
18.78
L25
39.69
L26
21.01
N 6'1 '
L27
21.72
N '43' 4'
L28
32.62
N7 'p "
L29
19.40
8.14"
L30
62.06
L31
2.95
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,/qCKSO/v �1
I, MANSON RAY MEEKINS, P.L.S., CERTIFY THAT THIS PLAT WAS DRAWN
UNDER MY SUPERVISION FROM AN ACTUAL SURVEY UNDER MY SUPERVISION;
THAT THE RATIO OF PRECISION AS CALCULATED IS 1:10,000 +; THAT THIS
PLAT IS PREPARED IN ACCORDANCE WITH SECTION .1600 OF THE STATE
BOARD OF REGISTRATION RULES *STANDARDS OF PRACTICE" AND THIS
IS A SURVEY OF AN EXISTING PARCEL OF LAND.
,
W ti,!_9111. NMI
011-11111125'
t t •
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LEGEND
RADIUS
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go
Q - REBAR SET
135.17
y E - EX. CONC. MON.
10.20
i Z.. ❑ - CONC. MON. SET
IY1 Q
m ♦ - EX P/K NAIL
IH
P/K NAIL SET
87.79
M SEWER SERVICE
`
Z tj ®- WATER METER
0
tz Q
0. N, ® - PHONE PEDESTAI
J
-/ X.d. C.A.T.V.
538.4525'E
L6 Q UTILITY POLE
° GUY WIRE
FIRE HYDRANT
®- ELECT. TRANS.
0.25' x 0.35' AG - ABOVE GRADE
CONa MON.
t.2f aC
BG - BELOW GRADE
C1i�i
FLAGWETLANDS
LOT 2
� N
EO
N N BLOCK C
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1.5• AG
0.56'
LOT B -1
SUBD. OF LOT 1, OLK. C
JACKSON'S DUNES
(DB 145, PG. 165)
0.69' GAP ROUND
ta+a Ac;
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CURVE TABLE
CURVE
RADIUS
DELTA
LENGTH
CHORD
CHD.BRG.
CI
135.17
4'I
10.20
10.20
'4 '
C2
135.17
87.79
62.81
82.81
7 '41"
C3
135.17
7.59'11'
16.84
538.4525'E
S - OCRACOKE
T F1 CAROLINA
40 20 A V & PLANNING, INC. C -1536
1 in - , `� BOX 58, NAGS HEAD, NC 27959
_ OFFICE: (252) 480 -9998 FAX: [phone]
LE•1205767 SURVEYED: 3/08/12 JRM PLATTED: 3/09/12 MRM
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HYDE COUNTY HEALTH DEPARTMENT SITE PLAN
ESTATE OF:
HERBERT J. STERN
PERMIT #52112 -3
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'THIS CERTIFIES THAT THIS COPY OF THIS PLAT ACCURATELY DEPICTS
THE BOUNDARY OF THE JURISDICTION OF THE 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 5 YEARS FROM THIS DATE." (THIS DETERMINATION WAS
MADE UTIUZING THE 1987 CORPS OF ENGINEEERS WETLAND
DELINEATION MANUAL.)
NOTES:
1. THIS SURVEY IS SUBJECT TO ANY FACTS THAT MAY BE
DISCLOSED BY A FULL AND ACCURATE TITLE SEARCH.
2. AREA BY COORDINATE COMPUTATION - 23,411 S.F.
3. F.I.R.M. ZONE: AE; B.F.E.: 6.0' (PER F.I.R.M.) = 1' FREEBOARD
4. PIN NO.: 9500 -69 -0499
5. RECORDED REFERENCE: PC A. SL 197A; DS 133, PG. 67
6. MINIMUM BUILDING LINES (MBL) SHOWN HEREON ARE PER THE
CURRENT LOCAL ZONING REGULATIONS. OTHER SETBACKS
AND /OR RESTRICTIONS MAY APPLY AND MUST BE VERIFIED
NAME
TITLE
DATE
/ I PRIOR TO CONSTRUCTION. 1/2' REBAR
7. ELEVATIONS (NAVD 1988): AS SHOWN FLUSH
T LOT 5 DIA\
N S ROUND
BLOCK C CONC. MON.
JACKSON'S DUNES ''o. G
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0.69' GAP 6' DIA.
ROUND
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/ 1.2' AG
1��

HYDE COUNTY HEALTH DEPARTMENT
P.O. Box 100 Swan Quarter, NC 27885
Telephone No. (252) 9264380
DIVISION OF ENVIRONMENTAL HEALTH
AUTHORIZATION FOR WASTEWATER
SYSTEM CONSTRUCTION
Installation: XXX Expansion: Repair:
Permit #: 52112 -3 Date: May 21, 2012
Owner: The Estate of Herbert J. Stem
Address: C/O Christopher May, P.O. Box 233, Crownsville, Md. 21032
Phone No.: (410) 849 -2100
Properly Location: Lot #6 Bik C Part I, Jackson Dunes S /D, Ocracoke
No. of Bedrooms: 4 bedroom house
Business (No. of people, seats, etc.): 8 max.
System Classification: II -c, shallow placement
Wastewater Flow: 480 gpd
Water Source: community

AUTHORIZATION FOR WASTEWATER
SYSTEM CONSTRUCTION
STERN ESTATE
PAGE 2
CONDITIONS:
1. Installation of the wastewater system shall be in strict ',accordance with the
Improvement Permit #52112 -3 and all ,specifications thereof.
******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
This Authorization For Wastewater System Construction shall be valid for 5
years from the date of issuance.
d Environe I Reg Health Specialist Date