20211032 Ver 1_ePCN Application_20210622

DWR
Dlrlslon of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
Change only if needed.
BIMS # Assigned
20211032
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Robert Tankard:eads\rbtankard
'Information for Initial Review
la. Name of project:
COURTESY COPY Kelly
1a. Who is the Primary Contact?*
John & Gigi Kelly
1b. Primary Contact Email:*
[e-mail]
Date Submitted
6/22/2021
Nearest Body of Water
Currituck Sound
Basin
Pasquotank
Water Classification
SC
Site Coordinates
Latitude: Longitude:
36.284221-75.803768
A. Processing Information
County (or Counties) where the project is located:
Currituck
Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
Pre -Filing Meeting Information
Version#*
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Is this a courtesy copy notification?*
r Yes r No

ID#
Version
Pre -fling Meeting or Request Date
6/25/2021
Attach documentation of Pre -Filing Meeting Request here:
nick the upload button or drag and drop files here to attach document
Pre -Filing Meeting Request Form.pdf
File type mast be FCF
1a. Type(s) of approval sought from the Corps:
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number: 18 - Minor Discharges
NWP Numbers (for multiple NWPS):
N/A
1d. Type(s) of approval sought from the DWR:
fJ 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
772.61 KB
r 401 Water Quality Certification - E>q)ress
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
John & Gigi Kelly
2b. Deed book and page no.:
DB 1508 Page 392
r Yes r No
r Yes r No

2c.Contact Person:
N/A
2d.Address
Street Address
536 Barn Court
Address Line 2
City
Corolla
Postal / Zip Code
27927
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
George H. Wood, PWS
4b. Business Name:
Environmental Professionals, Inc.
4c.Address
Street Address
224 Colington Ridge
Address Line 2
City
Kill Devil Hills
Postal / Zip Code
27948
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(ff appropnate)
The Currituck Club
1c. Nearest municipality/ town:
Corolla
2 Project Identification
State / Rwince / legion
NC
Country
USA
2f. Fax Number:
State / Rwince / Region
NC
Country
USA
4e. Fax Number:
2a. Property Identification Number:
2b. Property size:
117A00004150000
.62
2c. Project Address
Street Address
536 Barn Court
Address Line 2
City
State / Rwince / Ibgion
Corolla
NC
Postal / Zip Code
Country
27927
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Currituck Sound
3b. Water Resources Classification of nearest receiving water:*
SC

3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
03010205220010
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 has been cleared. The general land use in the area is residential.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
.25
4g. List the total estimated linear feet of all existing streams on the property:
0
4h. Explain the purpose of the proposed project:*
To provide a deck for the residence.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Construction of deck over wetlands.
Hand Tools
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): George H. Wood, PWS
Agency/Consultant Company: Environmental Professionals, Inc.
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
6. Future Project Plans
6a. Is this a phased project?*
r 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?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
W Wetlands r Streams -tributaries r Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
a. Site #* (?) 2a1 Reason (?) 2b. Impact type * (?) �2c. Type of W. 2d. W. name * 2e. Forested * 2f. Type of 2g. Impact
Jurisdicition*M area*
porch const t
Estuarine Woody Wetland non -riparian t
Both 0.022
(acres)

2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.022
2g. Total Wetland Impact
0.022
2i. Comments:
i E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The deck will be elevated and only the area needed for the deck pool shed will be disturbed.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
A landscape will be constructed to minimize encroachment.
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?
r Yes r No
2c. If yes, mitigation is required by (check all that apply):
r DWR W Corps
2d. If yes, which mitigation option(s) will be used for this project?
W Mitigation bank r Payment to in -lieu fee r Permittee Responsible
program Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
The Great Dismal Swamp Restoration Bank
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Non -riparian wetland .044
3c. Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
No protected riparian buffers in the area.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r' Yes r No
U
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)? *
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Only direct impacts are anticipated.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r No r NIA
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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?'
r Yes r No
r Unknown
Si. 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFW Web Page
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
No in -water impacts
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?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
SHPO Web Page - Existing Subdivision
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
Project elevated on pilings
8c. What source(s) did you use to make the floodplain determination?*
Surveyor

Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one
file when possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
dick the upload button or drag and drop files here to attach document
Kelly-PCN Misc. Documents.pdf 8.99MB
File crust be FOF a KM7
Comments
Signature u
W 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:
George H. Wood, PWS
Signature
PA?c #. wa
Date
6/22/2021

EMY101 MENTAL
�RaE6�3 OG---
PLANNING FOR
A BETTER
ENVIRONMENT
June 14, 2021
The Great Dismal Swamp Restoration Bank, LLC
Attn: Ms. Beverly White
P.O. Box 6186
Chesapeake, VA 23323
Dear Ms. White,
This letter is to request confirmation of acceptance for mitigation credits for the John and Gigi Kelly's
application for proposed impacts to wetlands.
Corps' Project Number:
Waterway:
Permittee's Name:
Location of Impact:
Permit Action:
Impacts (Acres/Linear Feet):
Impact NWI Classification:
Impact Hydrologic Unit Code:
Anticipated Mitigation:
In Process
Non -Riparian
John & Gigi Kelly
Lot 415 — Currituck Club PUD-Currituck County, NC
U.S. Army Corps of Engineers' Permit
0.022 Acres
None
Pasquotank 03010205220010
0.044 Acres
Thank you for providing a letter of acceptance for these proposed impacts.
Sincerely,
Environmental Professionals, Inc.
George H. Wood, CEP, PWS
P.O. BOX 3368 • HILL DEVIL HILLS, NORTH CAROLINA 27948
MOBILE: [phone] . OFFICE: 252441-0239
EMAIL: [e-mail]

?'he treat E1 ismaCSwamy R.estorationBank, %LC
P. Q. Box 6186
Chesapeake, VA 23323
June 21, 2021
Mr. George Woad
Environmental Professionals, Inc.
P.O. Box 3368
Kill Devil Hills, NC 27948
Permittee: John & Gigi Kelly
Project: Lot 415 Currituck Club PUD
Currituck County, NC
Dear Mr. Wood:
Phone [phone]
Fax [phone]
The following price quote is given in reply to your request for the purchase of 0.044 Non -Riparian wetland
mitigation credits (HUC Code 03010205) from The Great Dismal Swamp Restoration Bank - Timberlake Farm. These
credits are currently available from our Timberlake mitigation bank.
The cost will be One Thousand, Seven Hundred, Sixty Dollars ($ 1,760.00). This quote will expire on September 30,
2021. You will need to submit to the USCOE the necessary application for said mitigation, and receive USCOE
permission to furnish said required credits from our Timberlake bank.
To complete this transaction, we will require payment in full. Once payment is received, the credit sale will be
reported to the US Army Corps of Engineers. Please provide and/or confirm the following information:
Corps Project #: In Process
Waterway: Non -Riparian
Permittee Name: John & Gigi Kelly
Locality of Impact: Lot 415 — Currituck Club PUD
Currituck County, NC
Permit action (i.e., IP, NWP-39, enforcement, etc.) N/A
Impacts (acres/linear feet): 0.022 / Anticipated Requirement: 0.044
Impacts Hydrologic Unit Code: 03010205
Mitigation Bank, Permittee, and Consultant agree not to discuss with any other party the details and/or pricing of
this agreement, unless necessary for regulatory matters. Information contained herein shall be held in the strictest
confidence.
Thank you for allowing us to quote this project. We took forward to working with you.
Sincerely,
Bever y ite
Manage — counting / Sales
GDSRB
CC: File

DWR Pre -Filing Meei
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:
Is this a transportation project?*
ing Request Form
George H. Wood, PWS
[e-mail]
John & Gigi Kelly
Lot 415 - The Currituck Club
Currituck
Street Address
536 Barn Court
Address Line 2
city
Corolla
Postal / Zip Code
27927
Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Individual Permit
Shoreline Stabilization
Yes No
Does this project have an existing project ID#?*
Yes No
NORT44 GAROUNA
Eft*0AmeA1W 4W11Y
State / Province / Region
NC
Country
USA
401 Water Quality Certification - Express
Modification
Do you know the name of the staff member you would like to request a meeting with?
Chris Pullinger
Please give a brief project description below and include location information.
The applicant proposes to construct a deck, utility room, and walkway over 0.022 acres of Section 404 wetlands. The
applicant proposes to provide 0.044 acres of wetlands from The Great Dismal Swamp Restoration Bank.
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.
I 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 *
Awol
Submittal Date 1 6/16/2021

AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Landowner of record authorizes Environmental Professionals, Inc. to:
1, enter the property to gather environmental and site information, including delineation of
environmental regulatory jurisdictions;
2. enter the site with the regulatory agencies (i.e. U.S. Army Corps of £ngincers,
North Carolina Division of Coastal Management, North Carolina Division of Water
Quality, etc.) as needed to review regulatory alignmcm(s) and/or to identify additional
regulatory jurisdictions;
3. submit plats and other information to acquire regulatory agency confirmations, approvals,
and/or determinations (U.S. Army Corps of Engineers, North Carolina Division of
Coastal Management, North Carolina Division of Water Quality, etc.); and
4. act as agent for the purposes of obtaining environmental permits, authorizations, and/or
determinations,
l,andowncr J '
�6lnl� ! ;
✓sue J
Date
Date

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: 536 Barn Court
City, State: Corolla, North Carolina
County: Currituck
Parcel Index Number(s) (PIN): 117A00004150000
B. REQUESTOR INFORMATION
Name: Environmental Professionals, Inc. -
Mailing Address: Attn: George Wood
PO Box 3368-Kill Devil Hills, NC 27948
Telephone Number: 252-423-1234/252-441-0239
Electronic Mail Address: [e-mail]
Select one:
11 I am the current property owner.
I am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION2
Name: John & Gigi Kell
Mailing Address: 536 Barn Court
Corolla, NC 27927
Telephone Number:
Electronic Mail Address:
Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION"
By signing below, l authorize representatives ofthe Wilmington District, U.S.Army Cotes of
Engineers tCtirps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 189.9. 1, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Ca"pattcity: M Owner ❑Authorized Agent'
E. REASON FOR JD REQUEST; (Check as many as applicable)
❑ 1 intend to construct/develop a project or perform activitie on this parcel which would be
desh,med to avoid all aquatic resources.
❑ l intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
1 intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step ill a future permitting
process.
❑ l intend to construct/develop a project or perform activities on this parcel which may
require authorization firom the Cogs; this request is accompanied by my permit application
and the JD is to be used in the Permitting process.
❑ 1 intend to construct/devetop a projector perform activities in a navigable water of the:
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
A Cortrs 1 D is required in order obtain lily local/state authorization.
I attend to contest Jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not caisi ovur the aquatic resource on the parcel.
HI believe that the site may be comprised entirely of dry land.
Other:__
For NC'tx1T requests following the current NC;t)OTtUSACi protoc olc, st ip to Part F:,
{ tf there are rtmltiple parcels ontted by different partics, Pleas, provide it, Ulm ing for deli additional parcel on a
continuation sheet.
Mnst provide agent authorization fvrnt/letter signed by otvucr(s),
Wrsian: hiay 2017 Page 3

urisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
1-1 I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
✓❑ I am requesting that the Corps provide an approve JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
✓❑ Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
91 Size of Property or Review Area 0.62 acres.
❑✓ The property boundary (or review area boundary) is clearly physically marked on the site
Version: May 2017 Page 4

Jurisdictional Determination Request
H• REQUESTS FROM CONSULTANTS
W1 Project Coordinates (Decimal Degrees): Latitude: 36.284221
Longitude:-75.803768
❑✓ A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I lx17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).'
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
• Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
e Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. htip://www.saw.usace army mil/Missions/Reizulatory Permit
Proerarndurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
aCompleted appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDS. please complete an Approved Jurisdictional Determination Form'
Vicinity Map
Aerial Photograph
USGS Topographic Map
® Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
1-1 Landscape Photos (if taken)
NCWAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
Other Assessment Forms
n rv-auw.u�aw.aim .rmuronatsioyiaocsire ato !re docglJD/RGL 08-02 AM A Prelim JD Form fillable. df
' Please see b tn://www.saw usace army mil/Missions/Regulatory Permit Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department o0ustice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AM), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission ofrequested information is voluntary; however, ifinformation is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

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1SURVEY IS SUBJECT TO ANY FACTS THAT MAY BE
LEGEND
DISCLOSED BY A FULL AND ACCURATE TITLE SEARCH,
- EX. PIPE
2. AREA BY COORDINATE COMPUTATION = 27,109 S.F.
- EX. 3/4" REBAR
3. F.I.R.M. ZONE: AS SHOWN
4. PIN NO.: 117A00004150000
0 - CALCULATED POINT
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S. RECORDED REFERENCE: P.C. J, SL 123-124; D.B. 1508. PG, 392
0 - EX. 4" X 4" GONG. MON.
0 - Cl: TYP,
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5. MINIMUM BUILDING UtES (MBL) SHOWN HEREON ARE PER THE CURRENT
CAMA WETLAND FLAG
F3e1
LOCAL ZONING REGULATIONS & RECORDED PLAT. OTHER SETBACKS
- EX, PA NAIL
g
AND/OR RESTRICTIONS MAY APPLY AND MUST BE VERIFIED
A - MAG NAIL & WASHER SET
d9,�S
AVASEs
PRIOR TO CONSTRUCTION,
j$( - SEWER SERVICE
7. ELEVATIONS NAVD 1988:
® - WATER METER
HIGH GROUND O BUILDING = 5.5'
aLOW GROUND BUILDING = 4.8'
-PHONE PEDESTAL
FIRST FLOOR = 6.09'
- C.A.TV.
1-
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GARAGE = 6.00'
UTILITY POLE
.
8EXISTING LOT COVERAGE: (ZONING) 7,212 S.F. (26.6%)
- GUY WARE
4-
SITE
(ROOF OVERHANGS INCLUDED)
FIRE HYDRANT
(OPEN DECKS AND STAIRS OVER IMPERVIOUS NOT INCLUDED)
® - ELECT. TRANS.
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(CURRITUCK CLUB P.U.D.): 7,044 S.F. (26.0%)
AG - ABOVE GRADE
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9. PROPOSED LOT COVERAGE. (ZONING) 7,302 S.F. (28 9%)
BG - BELOW GRADE
VICINITY MAP NTS STRUCTURE:: TUCK (IINRICL DES HOUSED ROOFS, PORCHES)SF 2,945 SF (10.9%)
UNCOVERED DECKS OR PATIOS & STAIRS 1,164 SF (4.3%) •u+,�,
DRIVING & PARKING AREAS 2,780 SF (10.3�
'1' PRESERVATION STRIP TO BE RETAINED BY POOL/POOL DECK 1.324 SF (4.8%)
CURRITUCK SHOOTING CLUB ALONG MEAN 10. PROPOSED LAND DISTURBANCE AREA (AS SHOWN) 1,176 S.F. (.02 ACRES)
HIGH WATER LINE OVER ENURE LENGTH OF
THE DEVELOPMENT UNLESS OTHERWISE NOTED." N/F
(PER PC J. SL 124)
N/F CURR. ASSOC.-
N59'09'03nW N3 RES. PARTNERSHIP
CURRITUCK CLUB 3 L 61.79 \�¢ (PARCEL NO.:012700000050000)
PROPERTY OWNERS b 2d8 pRgINAGEUESMT. C6 C7 ° �s, OPEN SPACE
ASSN. INC. \ e'
(PC J, SL. 123) ^ III �o' vEG. stf Y� D / SHORELINE AND i'
WETLANDS +� \ / PRESERVATION STRIP
(D.B. 1314, PG. 246) Co! (10,914 S.F.) C7 / C11 PER RECORD PLAT
C3
(DIFFERENT RESULTS
COASTAL 0.1 BGti �I' C4 (� /75' CAMA AEC % 0.1' AG MAY BE OBTAINED BY
WETLANDS �i �� / (PC J. SL 124)/ /,} �/'7 AN UPDATED
NORMAL WATER LEVEL,
\ LINE (C1-C11)-'� Cl C2 ; ' x� 3g�! ?Y�f �• DETERMINATION)
PROP. CONC • ! o�
e � LOT 414
\ PROP. FENCE P / °j
m ,� N.F.I.P. ZONE
N.F.I.P. ZONE 7 =:'� - f�. o ,,: "AE• B.F,E. 4.0'
"AE" B.F.E. 4.0' I +20' FREEBOARD
`+2.0' FREEBOARD �.6' /I PROP. LANDSCAPE WALL (TYP)
e� 2/L7 PROP. POOL SHED
LOT 12 � _- '
``? 6 i' o� 04 WETLAND LINE
C. CLUB, PH, 1 �N.F.I.P. ZONE r /
PC F, SL 5 "'" (0.2%) h� / wra.o 353 0.5`' AT;'-----'
( ) / �^ '��� N.F.I.P. ZONE
e...r'r €X- V-. FENCE X" (0.2X)
EX. POOL MECH.
"or EXIST 8' X 15' PAKING SPACE (TYP)
PER AS -BUILT SURVEY
P
_ N.F.I.P. ZONE 15' CH -. y DATED 8/27/12.
s• "� 'X• / EXISTING ._, _ '
N 2 STORY FRAME G\�
vO1i DWELL ON PILINGS .>C v: UPLANDS N.F.I.P. ZONE �'�I
j WITH ENCL ON SLAB `(16,195 S.F.), �_ „X" i
SLOT 415 ,? 4--N.F.I.P. ZONE
SS-J,,,Jr R "X" (0.2%)
osW" LOT 416
FAx.;c O,tttgttttUAA44,. �<p �\ - J: Z 25' UTILITY &
zc" P, ��� �O y\ CAR0 •.� \ ,.�,7, DRAINAGE EASEMENT
�W�� 0SSI•,.0 •,• FLUSH :✓ ; ;Y 0.6' AG
°FE /py,�y L CZ
SEAL _ FLUSH
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L-2592 ot 1p-tA
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,•`'FLUSH
till IN It I . . 1
CURVE TABLE
CURVE
I RADIUS
DELTA
LENGTH
CHORD
CHO.BRG.
C1
67.50
4 '13"
36.27
35.83
S6 ' "E
I
C2
67.50
30'21'
35.77
35.36
S35'49'02"E
C3
67.50
47'4 '
49.13
48.05
�
404 WETLANDS LINE TABLE
UNE
LENGTH
BEARING
L1
18.39
S46'OV13"W
L2
29.09
S78.37'48"W
L3
18.86
N86' '48"W
L4
28.80
N2 •30'19"W
L5
28.43
NO2'22'36"W
LB
14.50
N10Y3'25"W
L7
21.56
Ni-1 .4"W 11
2' CONC. - BARN '
APRON COURT'
APRON
-HISTORIC LOOP ' LOT 413
/L.0 /LAND DISTURB CE Slw1WI - 40' PRIVATE R 7�,)
lEV. 04/09/21: COASTAL WETLAND T COVERAGE ( (P.C. J. SL. 124)-
PHYSICAL SURVEY/WETLANDS PLAT FOR
JOHN JO SEPH KELL Y & GI GI GA YLE KELL Y
LOT 415 - HISTORIC SHOOTING CLUB LOTS - THE CURRITUCK CLUB
POPLAR BRANCH TOWNSHIP - CURRITUCK COUNTY - NORTH CAROLINA
I u ° SEABOARD SURVEYING & PLANNING, INC. C-1536
1 inch = 50 ft. 103F W. WOOD HILL DR., P.O. BOX 58, NAGS HEAD, NC 27959
LE: 2009546 SURVEYED:11 i20i2D dD PI Ar n, nt /3n OFFICE: [phone] FAX: [phone]