20120976 Ver 1_401 Application_20121012

oc'�F 4V A TFAQG
201 20976
Office Use Only:
Corps action ID no.
DWQ project no.
Form Verslon 1.3 Dec 10 2008
Pre - Construction Notification PC Form
A. Applicant Information
_
1. Processing
1a. Coypess) of approval sought from the
N Section 404 Permit ❑ Section 10 Oermit
P
1b. Specify Nationwide Permit (NWP) number: 42 or General Permit (GP) number: '
1c. Has the NWP or GP number been verified by the Corps?
® Yes
(!rNo
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
le. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
® Yes ❑ No ❑ Yes
® No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
❑ yes
© NO
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
® Yes
❑ No
below.
Ill. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
304 Moray Court - horse pasture
2b. County:
2c Nearest municipality / town:
Onslow
Hubert
2d. Subdivision name:
Highlands at Queens Creek
UU2e.
NCDOT only, T.I.P. or state`
project no:
OCT
n ,
3. Owner Information
3a. Name(s) on Recorded Deed,
Eva C. Jakobsson and Erik Muniz and.
A7E`fi gUA11
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
304 Moray Court
3e. City, state, zip:
Hubert, NC 28539
3f. Telephone no.:
910 - 320 - 07001703 -966 -8253
3g. Fax no.:
3h. Email address:
charranlOOO@gmai.i.-coin--/[e-mail]
Page 1 of 11
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:
w
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

S. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID):
13078 -18
1 b. Site coordinates (in decimal degrees):
Latitude: 34.687871 Longitude: - 77.19946
(OD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
4.05 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Queens Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
SA HOW
2c. River basin: White Oak; 03020302
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 neighborhood amongst forested /cleared pocosin and pine savannah
3b. List the total estimated acreage of all existing wetlands on the property:
375
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:
Grade and smooth out fire plow lines and ruts and place fence for horse pasture.
3e. Describe the overall project in detail, including the type of equipment to be used:
We will utilize tractors and a small excavator at the edge of the wetlands to remove the existing root system and pile it up
on the property inside the wetlands for decomposition. All frees will remain in place. The earth will then be leveled to
create a level horse pasture where grass seed will be added to create a viable pasture for horses to graze. Equipment
used will be small wheeled farm tractor with bush hog. small excavator and drag and /or wheel harrow. Fence posts will
be sunk using a post hole digger to dig a 24 -36 inch hole for insertion of a fence post. All soil rernoved for the hole will be
used to pack the hole for the post. No additional soil will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes El No El 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. Pittman Soil Consulting
Name (if known): Haywood Pittman
Other,
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation,
SAW- 2007 - 01429, 8/24/2007
S. Project History
5a. Have permits or certifications been requested or obtained for ®Yes ❑ No El Unknown
this project (including all prior phases) in the past?
5b If yes, explain in detail according to "help file" instructions,
The subject Lot is part of file Highlands subdivision, permitted under NW 29 on 2/28/2008.
Page 3 of 11
PC Form -- Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑Yes No
6b. If yes, explain.
Page 4 of 11
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 ❑ Suffers
❑ 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)
Temporar (T)_
Plowing /raking
Pocosin
® Yes
❑ No
® Corps
10 DWQ
96
W1 ®P ❑ T
W2 ®P ❑ T
_
Fence posts
- --
Pocosin
® Yes
-[:]-No
® Corps
-❑ DWQ
003
W3 ❑ PC] T
El Yes ^
❑Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
- —
- ----
❑ No
❑ DWQ
W5 ❑ P [] -r
© Yes _
El Corps
❑ No
n DWQ
-
W6 ❑ PEI T
❑Yes
El Corps
_ - - --
❑ No
❑ DWQ
2g. Totat wetland impacts
—.963 - --
2h. Comments: N/A
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 impart
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
33 ❑ P ❑ T
_
❑ PER
❑ Corps
- - - - -- — -
-
- - -- -- - - - --
- -
F-1 INT —_
❑ PER
❑ DWQ
S4 ❑ P [IT
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ WT
❑ DWQ
— —
3h. 'rota) stream and tributary impacts
3i. Comments: _
Page 5 of 11
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.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. - - -~ 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded f xcavaterl Flooded
_Filled
- - �- -- - - _ -
r P1
5f. Total
-
5g. Comments;
oil. {S a Uaill iiiyil haiald Peiliut it:uulle.l?
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 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
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
im act
required?
❑ Yes - - --
B1 [] P [IT
No
B2 ❑P ❑T
_
_❑
❑Yes
-- -a3• -El
. __. - - - --
--------------- ��_- �_._._
❑ No �
P O.7___
El Yes
-
❑ No
- -- -------- - - - - -`
fih. Total buffer impacts
_ --
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 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.
All trees will be left in place, no soil will be added to the area worked on, fire breaks that were cut in the land will be repaired.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Silt fence will be installed if required and new vegetation (grass seed) will be immediately planted after soil is repaired.
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
❑ 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 Pui chased (attach iecEipt and letter) i ype (quantity
3c. Comments:
4. Complete If Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
4b. Stream mitigation requested:
-❑ Yes
linear feet
❑ warm [l cool - ❑cold
4c. If using stream mitigation, stream temperature: i
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested,
^ acres `Y �-
4f. Non - riparian wetland mitigation requested:
4g. Coastal (tidal) wettand mitigation requested:
acres
acres
4h. Comments:
6. 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 7of11
PCN Form - Version 1.3 December 10, 2008 Version

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
Zone 2
3 (2 for Catawba)
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,
permiltee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
61). Corm-nents.
Page 8 of 11
PCN Form —Version 1.3 December 10, 2008 Verlsion

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
[� Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? if no, explain why.
❑ Yes No
❑
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
2.8%
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. if this project DOES NOT require a Stormwater Management Plan, explain why: Leveling this ground will not affect the
natural drainage of stormwater.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
C;rtified Local Governrnent�—
2e Who will be responsible for the review of file 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
❑ 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
attached?
❑ Yes Na
6. DWQ 401 Unit Stormwater Review
5a. Does the Storrwater Management Plan meet the appropriate requirements?
0 Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 11
PCN Form -- Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes
® No
use of public (federal /state) land?
i
1b. 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)?
10. If you answered "yes" to the above, has the document review been finalized by the
l
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 211 .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.
NIA: The land being restored will be used as horse pasture.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. 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.
[] Raleigh
j] 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 database, 6/19/2012
6. Essential Fish Habitat (Corps Requirement)
^in'or
6a_ Will this project occur near an area designated as essential fish habitat�[j Yes ® Nou�—
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA EFH Mapper
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 0 Yes 0 No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)9
t-
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NCHPOWES GIS resource
8. Flood Zone Designation (Corps Requirement)
—[8a. Will this project Occur in a FEMA- designated 100 -year floodpiain? ❑Yes No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Er
.. 4
oGfo,x
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signatur
(Agent's signature is valid only if an authorization ter frorn the applicant
isprovided.)
Page 1 1 of 11
PCN Form – Version 1.3 December 10, 2008 Version

r