20210979 Ver 1_ePCN Application_20210530

DWR
Division of Water Resources
Initial Review
Pre -Construction Notification (PCN) Form
April 4, 2021 Ver 4
Has this project met the requirements for acceptance in to the review process?*
6 Yes
✓ No
Is this project a public transportation project?*
CYes 0' No
Change cnly 1 needed.
BIMS # Assigned* Version#*
20210979 1
Is a payment required for this project?*
0. No payment required
✓ Fee received
✓ Fee needed - send electronic notification
Select Project Reviewer*
Robert Tankard:eads\rbtankard
Information for Initial Review
la. Name of project:
COURTESY COPY Pond
la. Who is the Primary Contact?*
Jeff Haas
lb. Primary Contact Email:*
[e-mail]
Date Submitted
5/30/2021
Nearest Body of Water
Tull Bay
Basin
Pasquotank
Water Classification
N/A
Site Coordinates
Latitude:
36°28'09.0"N
A. Processing Information
Reviewing Office *
Washington Regional Office - [phone]
lc. Primary Contact Phone:*
[phone]
Longitude:
76°06'41.3"W
County (or Counties) where the project is located:
Currituck
Is this a NCDMS Project
✓ Yes 0. No
Is this project a public transportation project?*
✓ Yes 0- No
Pre -Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes f• No

ID# Version
Pre -fling Meeting or Request Date
6/26/2021
Attach documentation of Pre -Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
DWR Pre -Filing Meeting Request Form.pdf
Fie type mast be FCF
la. Type(s) of approval sought from the Corps:
f7 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
I— Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
✓ Yes
✓ No
1b. What type(s) of permit(s) do you wish to seek authorization?
r Nationwide Permit (NWP)
I— Regional General Permit (RGP)
17 Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
✓ Yes rNo
Are you a federal applicant?*
✓ Yes rNo
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act.*
There is no concern and I will comply with the coastal zone management act.
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
ld. Type(s) of approval sought from the DWR:
17 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
17 Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
If. Is this an after -the -fact permit application?*
✓ Yes rNo
54.3KB
I— 401 Water Quality Certification - Express
r Riparian Buffer Authorization
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
✓ Yes ( No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
✓ Yes rNo
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes
r No r Unknown
1j. Is the project located in a designated trout watershed?
✓ Yes r No
B. Applicant Information
Id. Who is applying for the permit?
I7 Owner I— Applicant (other than owner)
✓ Yes r No
C.' Yes r No
le. Is there an Agent/Consultant for this project?*
✓ Yes r No

2. Owner Information
2a. Name(s) on recorded deed:
Jeffery Haas Abigail Haas
2b. Deed book and page no.:
2c. Contact Person:
2d.Address
Street Address
LOT 1 Ballace Estates
Address Line 2
Ballance Farms Road
Oty
Moyock
Fbstal / Zip Code
27958
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
State / Province / Region
NC
Country
USA
2f. Fax Number:
[phone]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
lc. Nearest municipality/town:
Moyock
2. Project Identification
2a. Property Identification Number:
2b. Property size:
10
2c. Project Address
Street Address
LOT 1 Ballace Estates
Address Line 2
Ballance Farms Road
City State / Bovine / Region
Moyock NC
Postal / Zip Code Country
27958 USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Tull Bay
3b. Water Resources Classification of nearest receiving water:*
N/A
3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
030102051106
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:*
Farm land and Wooded lot.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No Unknown
4b(2). Is Any Portion of the Work Already Complete? *

✓ Yes r No
If yes, describe the completed work.
4c. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application. not related to the 404 or 401.
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)
Ballance Estates.pdf 2.6MB
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)
4f. List the total estimated acreage of all existing wetlands on the property:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
Requesting information on digging and stocking a 1/2 - 1 acre pond approximately 8-10 feet deep with minnows, blue gill, and catfish.
In the approximate location of the word "LOT 1" I would like to build a pond. Please advise on a way forward.
We do not own the property however we are due to close at the end
of July this year.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Pond water run off will drain to Tull Bay.
4j. Please upload project drawings for the proposed project.
4k. Will this activity involve dredging in wetlands or waters?*
✓ Yes f: No
If yes, Describe the type of dredging, the composition of the dredged material and the location of disposal area.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
✓ Yes
Comments:
f No r Unknown
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
✓ Preliminary r Approved r Not Verified 6 Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
✓ Yes r 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?
7. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list)
7. Adjoining Addresses File Upload
Oick the upload button or drag and drop files here to attach docunent
pdf only
8. Scheduling of Activity:

D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands
r Open Waters
✓ Streams -tributaries r Buffers
fJ Pond Construction
2h.Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
5. Pond or Lake Construction
5a. Pond ID number 5b. Proposed use or purpose of 5c. Wetland
P1
P2
5g. Comments:
pond
Other
5h. Is a dam high hazard permit required?
r Yes
If yes, permit ID no:
5i. Expected pond surface area (acres):
5k. Method of construction:
r• No
impacts
(acres)
5d. Stream
impacts (feet)
Flooded Filled Excavated Flooded Filled Excavated
5f. Total:0
0
5j. Size of pond watershed (acres):
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:
Pond will be used for fishing only.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Pond will be used for fishing only.
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 r No
2c. If yes, mitigation is required by (check all that apply):
r DWR r Corps
2d. If yes, which mitigation option(s) will be used for this project?
[ Mitigation bank r Payment to in -lieu fee r Permittee Responsible
program Mitigation
5e. Upland
(acres)
U
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
G Yes rNo
What type of SCM are you providing?

r Level Spreader
r Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
r Other SCM that removes minimum 30% nitrogen
r Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
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
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 r No
c WA - project disturbs < 1 acre
Comments:
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 RNo
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 r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
✓ Yes a No
3b. If you answered "no," provide a short narrative description.
Personal pond use only.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
✓ Yes rNor N/A
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 a No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
✓ Yes ( No
5d. Is another Federal agency involved?*
✓ Yes
5e. Is this a DOT project located within Division's 1-8?
✓ Yes f No
F No r Unknown
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
✓ Yes F No
5g. Does this project involve bridge maintenance or removal?
✓ Yes f No
5h. Does this project involve the construction/installation of a wind turbine(s)?"
✓ Yes F 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 r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
unknown
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
✓ Yes a No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
unknown
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 status?*
✓ Yes ( No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
unknown
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
✓ Yes a No
8c. What source(s) did you use to make the floodplain determination?*
unknown
Miscellaneous
Comments
n/a
Miscellaneous attachments not previously requested.
Signature
*
17 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:
Jeffery Haas
Signature
�zy
Date
5/30/2021

DWR Pre -Filing Meeting Request Form
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Is this a transportation project?*
Type(s) of approval sought from the DWR:
l 401 Water Quality Certification -
Regular
lW Individual Permit
I— Shoreline Stabilization
Jeff Haas
[e-mail]
Jeff Haas
Pond
Currituck
Street Address
LOT 1 of Ballance Estates
Address Line 2
Ballance Farms Rd
City
Moyock
Fbstal / Zip Code
27958
C Yes t^ No
I— 401 Water Quality Certification -
Express
I— Modification
Does this project have an existing project ID#?*
(' Yes c: No
State / Rovince / Region
NC
Country
USA
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.*
Requesting information on digging and stocking a 1/2 - 1 acre pond
approximately 8-10 feet deep with minnows, blue gill, and catfish.
In the approximate location of the word "LOT 1" I would like to build a
pond. Please advise on a way forward.
We do not own the property however we are due to close at the end
of July this year.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing

meeting request.
• !also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature *
Submittal Date 5/30/2021

Bissell Professional Group
Firm License # C-956
3512 North Croatan Highway
P.O. Box 1068
Kitty Hawk, North Carolina 27949
I(252) 261-3266
FAX [phone]
BISSELL
CONCEPTUAL LAYOUT &
AERIAL PLAN
THIS DOCUMENT IS THE SOLE PROPERTY OF BPG, INC. OF KITTY
HAWK, NORTH CAROLINA. THE REPRODUCTION, IN WHOLE OR
PART, OR THE MODIFICATION OF ANY DETAIL OR DESIGN IS NOT TO
BE MADE WITHOUT THE EXPRESS WRITTEN CONSENT OF MARK S.
BISSELL, PRINCIPAL OF BPG, INC., COPYRIGHT 2005.
PRELIMINARY SITE PLAN
LLA1
REVISIONS
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DESCRIPTION
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DATE:
06/30/20
SCALE:
1" = 200'
DESIGNED:
BPG
CHECKED:
MSB
DRAWN:
KFW
APPROVED:
BPG
SHEET: 1 OF 1 1
CAD FILE:
472500MINE 1
PROJECT NO:
4725
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