20202002 Ver 1_PCN Revised Per RFAI 4-7-21_20210407

Division of W tee Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 26, 2020 Ver 3.3
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right -click on the document and you can print
a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN%20HeIp%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Brunswick
Is this a NCDMS Project*
Yes No
Is this project a public transportation project?*
Yes No
la. Type(s) of approval sought from the Corps: *
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No

lb. What type(s) of permit(s) do you wish to seek authorization?*
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
This form may be used to initiate the standard/individual permit process with the Corps. Please contact your Corps
representative concerning submittals for standard permits. All required items that are not provided in the E-PCN can be
added to the miscellaneous upload area located at the bottom of this form.
lc. Has the NWP or GP number been verified by the Corps?*
Yes No
Nationwide Permit (NWP) Number: 29 - Residential Developments
NWP Numbers (for multiple NWPS):
Id. Type(s) of approval sought from the DWR: *
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual Permit
Pre -Filing Meeting Information
401 Water Quality Certification - Express
Riparian Buffer Authorization
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able to
accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance with 40
C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall request a pre -
filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5) all certification
requests shall include documentation that a pre -filing meeting request was submitted to the certifying authority at least 30
days prior to submitting the certification request. Click here to read more information on when this form is needed prior to
application submission or here to view the form.
ID#
20202002
Pre -fling Meeting or Request Date*
12/18/2020
Version
1
Attach documentation of Pre -Filing Meeting Request here: *
DWR Pre -Filing Meeting Request Form 12-18-2020.pdf 55.21KB

le. Is this notification solely for the record because written approval is not required?
*
For the record only for DWR 401 Certification:
Yes No
For the record only for Corps Permit: Yes No
If. Is this an after -the -fact permit application?*
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
Acceptance Letter Attachment
lh. Is the project located in any of NC's twenty coastal counties?*
Yes No
li. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
Yes
No Unknown
1 j. Is the project located in a designated trout watershed?*
Yes No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-
Coordination/Trout.aspx
B. Applicant Information
la. Who is the Primary Contact?*
Dana A. Lutheran
lc. Primary Contact Phone:*
1 b. Primary Contact Email:*
[e-mail] [phone]
Id. Who is applying for the permit?*
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
Yes No

2. Owner Information
2a. Name(s) on recorded deed:*
7H LLC
2b. Deed book and page no.:
4296/1135
2c. Responsible party:
Spencer Hackney
2d. Address*
128 Inlet Point Drive
Wilmington NC
28409 US
2e. Telephone Number: *
[phone]
2f. Fax Number:
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:*
Mr. Nathan Sanders
3b. Business Name:
Dominion Land Corp.

3c. Address*
PO Box 3167
Wilmington NC
28403 US
3d. Telephone Number:*
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name: *
Dana A. Lutheran
4b. Business Name:
Southern Environmental Group, Inc. (SEGi)
3e. Fax Number:
4c. Address*
5315 South College Road
Suite E
Wilmington NC
28412 US
4d. Telephone Number:*
[phone] 4e. Fax Number:
4f. Email Address: *
[e-mail]

Agent Authorization Letter*
Agent Authorization Form Signed.pdf 34.82KB
C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
Isabella Park
1 b. Subdivision name:
NA
1 c. Nearest municipality / town: *
Maco
2. Project Identification
2a. Property Identification Number:
0150004301,0150004302,
0150004303 and
0150004304
2c. Project Address
3429 & 3498 Andrew Jackson Highway
Northwest
2d. Site coordinates in decimal degrees
2b. Property size:
40
NC
US
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS
device) after the decimal place as appropriate, based on how the location was determined. (For example, most mobile
phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*

34.28581 8.12942
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Hood Creek
3b. Water Resources Classification of nearest receiving water: *
C;sw
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.*
030300050406
River Basin Lookup
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application: *
The project site is devoid of any man made structures, but there are several existing soil roads that meander
through the property (see Aerial Photo, as part of Soil Survey). A review of historical aerials (1993-2019) revealed
the vegetation, within the upland portion of the property, has been managed and, as recently as 2015, saplings
were planted on a portion of the site. The project is bordered by US Hwy. 74/76 (Andrew Jackson Hwy.), to the
south, and undeveloped land to the north, east and west. A Industrial/commercial site, located approximately 0.4
mile to the west, is the only development within close proximity to the site. The surrounding tracts are zoned
Commercial - Intensive and Commercial - Low Density. The project site is zoned Commercial Low Density (CLD)
(see Zoning Map). Several High Pocosin, with Pocosin fringe, wetland complexes are scattered about the project
site (see site plan). The site is located in an area that is experiencing rapid growth and where dwellings are in high
demand and there is low inventory.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
*
Yes No Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the project site. (for DWR)
Isabella Park Topo Map 092515.pdf
Isabella Park LiDAR Map 092515.pdf
584.36KB
484.41 KB

4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site. (for DWR)
Isabella Park Soils Map 092515.pdf 881.52KB
4f. List the total estimated acreage of all existing wetlands on the property:
10 +/-
4g. List the total estimated linear feet of all existing streams on the property:
0
4h. Explain the purpose of the proposed project: *
The purpose of this project is to install road, utilities and stormwater management systems, that will support the
proposed 170 lot, high density, subdivision, as well as prepare lots, for a 65' x 30' building footprint dwellings.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The work will include widening on existing road crossing, which will entail placing a single 18" RCP, overlain with
clean earthen soil, within approximately 0.003 acre of wetlands. The road will be topped with asphalt. Additionally,
two cul-de-sacs (i.e., Wild Plum Lane and Juniper Leaf Court) will be installed and will entail placing clean earthen
soil within -acre of wetlands, as well as installing two outfall structures for Ponds 1 and 3, which will entail
placing an energy dissipator within 0.009-acre of wetlands. Lastly, placing clean earthen fill within acre of
wetlands for the purpose of providing a adequate building envelopes for the following lots: 8, 9, 11, 1-1, 18, 29, 31 &
32, 66 & 67, 125-127, 153-155, 157-159 and 160-162 (see attached site plans for details). Heavy machinery, such
as bulldozers, excavators and dump trucks, will be used to complete the work. Indirect impacts are not anticipated
with this project. One last impact (Impact Area 13) will take place next to lot 124, where the pump station is to
be located. The impact is 0.025-acre. Total permanent impacts to wetlands is 0.433-acre.
4j. Please upload project drawings for the proposed project.
ISABELLA PARK WETLAND IMPACT MAP - 02-22-21.pdf 285.95KB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2007-3592

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant
Company:
Other:
David Scibetta
SEGi
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the
Corps or DWR.
issued 9/27/16 expires 9/27/21
5d1. Jurisdictional determination upload
Isabella Park JD 092716.pdf 2.23MB
6. Future Project Plans
6a. Is this a phased project?*
Yes No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize
any part of the proposed project or related activity? This includes other separate and distant crossing for linear
projects that require Department of the Army authorization but don't require pre -construction notification.
This project is not part of PUD. Previous permits and certifications have not been issued for this project, and no
further permits or certifications are needed, to make the project viable.
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries
Open Waters Pond Construction
Buffers
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area
impacted.
"W." will be used in the table below to represent the word "wetland".

2a. Site
#* (?)
2a1 Reason*
(?)
2b. Impact
type* (?)
2c. Type of W.*
2d. W. name *
2e.
Forested*
2f. Type of
Jurisdicition *
(?)
2g.
Impact
area *
1
Pond 1 outfall
P
Pocosin
A
Yes
Corps
0.004
2
Lot fill - Lot 8
P
Pocosin
F
Yes
Corps
0.003
3
Lot fill - Lot 9
P
Pocosin
F
Yes
Corps
0.002
4
Lot fill - Lot 11
P
Pocosin
B
Yes
Corps
0.000
5
Lot fill - Lot
P
Pocosin
B
Yes
Corps
0.010
6
Lot fill - Lots
15-17
P
Pocosin
B
Yes
Corps
0.047
7
Lot fill - Lot 18
& Road
Crossing
P
Pocosin
B
Yes
Corps
0.020
8
Pond 3 outfall
P
Pocosin
B
Yes
Corps
0.005
9
Lot fill - Lot 29
P
Pocosin
B
Yes
Corps
0.006
10
Lot fill - Lots
31 & 32
P
Pocosin
B
Yes
Corps
0.007
11
Juniper Leaf
Ct.
P
Pocosin
B
Yes
Corps
0.045
12
Lot fill - Lots
66 & 67
P
Pocosin
B
Yes
Corps
0.030
13
Lot fill - Lot 8
P
Pocosin
J
Yes
Corps
10.025
arracl
14
Lot fill - Lot
126
P
Pocosin
J
Yes
Corps
0.002
15
Lot fill - Lots
127 & 128
P
Pocosin
K
Yes
Corps
0.030
16
Wild Plum
Lane
P
Pocosin
E
Yes
Corps
0.028

17
Lot fill - Lots
153 -159
P
Pocosin
E
Yes
Corps
0.045
18
Lot fill - Lots
157 & Road
Crossing-159
P
Pocosin
E
Yes
Corps
0.060
19
Lot fill - Lots
160-162
P
Pocosin
E
Yes
Corps
0.064
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.443
2g. Total Wetland Impact
0.443
2h. Comments:
Please see attached Wetland Impact Map
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project: *
The Applicant avoided wetland impacts, by utilizing the existing soil road, as one of it's
proposed roads, for the subdivision. Also, the Applicant stopped Juniper Leaf Court short,
instead of extending it out further, which would have created the need to impact significantly
more wetlands, at this location, than what is currently proposed. By doing this, the Applicant
lost one lot. Lastly, the Applicant chose to remove two lots (i.e. between Lots 124 and 125),
thereby avoiding impacting wetlands for those two structures.
lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques: *
The Applicant will install sediment and erosion control measures, prior to undertaking land
disturbing activities. The measures will be monitored regularly, to ensure they are operating
as intended, and repaired as necessary. Additionally, orange construction fencing will be
installed along all approved wetland impact limits, to identify, on the ground, the authorized
limits of disturbance. This should ensure that unauthorized impacts to wetlands does not take
place during the construction process.
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
2c. If yes, mitigation is required by (check all that apply):
DWR Corps
2d. If yes, which mitigation option(s) will be used for this project?
Mitigation bank Payment to in -lieu fee
Permittee Responsible
program Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Lower Cape Fear Umbrella Bank (Sneeden & White Springs
Tracts)
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Non -riparian wetland 1.0
Attach Receipt and/or letter
3c. Comments
Has been requested and will be sent upon receipt.
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website.
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by
DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you
must fill out this entire form - please contact DWR for more information.
Yes No
F. Stormwater Management and Diffuse Flow Plan (required by
DWR)
Recent changes to the stormwater rules have required updates to this section .***

1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian
Buffer Protection Rules?
Yes No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
This project is not located within one of NC Riparian Buffer River Basins.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
Yes No
To look up low density requirement click here 15A NCAC 02H .1003(2).
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater
program or state -approved local government stormwater program? *
Yes No
Q N/A - project disturbs < 1 acre
Hin,. Iu, a �« u y ,,,:emptions, or grandfathering from state or Ic a iy implemented stormwater programs or projects that satisfy star
locally -implemented stormwater programs through use of community in -lieu programs should answer no to this question.
3. Stormwater Requirements
3a. Select whether a completed stormwater management plan (SMP) is included for review and approval or if
calculations are provided to document the project will not cause degradation of downstream surface waters. *
Stormwater Management Antidegradation Calculations
Plan
3b. Stormwater Management Plan: If submitting a SMP for review and approval, it shall comply with the high -density
development requirements set forth in 15A NCAC 02H .1003. Include all appropriate stormwater control measure
supplemental forms and associated items.
3c. Antidegradation Calculations: If submitting calculations to document the project will not cause degradation of
downstream surface waters, the documentation shall include a detailed analysis of the hydrological impacts from
stormwater runoff when considering the volume and velocity of stormwater runoff from the project built upon area
and the size and existing condition of the receiving waterbody(ies).

Comments:
The engineer, Norris and Tunstall, will be applying for a High Density Stormwater Permit, from the county and the
state.
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state)
land?*
Yes No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules
(15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?*
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development,
which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
Previous impacts have not take place and future impacts are not anticipated. The project will
entail using strict S&EC measures to ensure sediment does not discharge into downstream
receiving waters.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity available
at that plant.
Municipal water and sewer are available.
5. Endangered Species and Designated Critical Habitat (Corps
Requirement)

5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
Yes
No Unknown
5e. Is this a DOT project located within Division's 1-8?*
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?*
Yes No
5g. Does this project involve bridge maintenance or removal?*
Yes No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?**
Yes No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines,
such as jackhammers, mechanized pile drivers, etc.?*
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat?*
US FWS IPaC
Consultation Documentation Upload
Species List_ Raleigh Ecological Services Field Office.pdf 167.44KB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
This site does not contain a waterbody that would support EFH.

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data:
http_//gis.ncdcr.gov/hpoweb/
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 status (e.g., National Historic Trust designation or properties significant in North
Carolina history and archaeology)?*
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological
resources? *
NC SHPO HPOWEB 2.0 (see attached)
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8c. What source(s) did you use to make the floodplain determination?*
Brunswick Co. GIS Flood Map (see attached)
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Isabella Park SHPO HPOWEB 2.0 Map.pdf 1.78MB
Isabella Park Flood Map.pdf 1.72MB
Signature

By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a
written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:*
Dana A. Lutheran
Signature*
Date
3/1/2021 (Revised 4/7/21)