20130740 Ver 1_Triage Check List_20130722

ENVIRONMENTAL PROFESSIONALS, INC.
Planning for a Better Environment
P.O. Box 3368
Kill Devil Hills, NC 27948
Telephone: [phone]
Fax: [phone]
Email: [e-mail]
TO: North Carolina Division of Water Quality
401 Wetlands Unit
Attn: Ms. Karen Higgins
1650 Mail Service Center
Raleigh, NC 27699 -1650
Oil ATTACHED
LETTER OF TRANSMITTAL
20130740
DATE: July 11, 2013
JOB NO.: 09 -075
RE: Greg & Jennifer Stewart
COPIES
DATE
DESCRIPTION OF DOCUMENTS
5
7 -11 -13
Pre - Construction Notification PC Form
5
5 -26-13
Signed Authorization to Act As Representative Form
5
7 -6 -13
Wetlands Fill Permit Plat
5
11 -16 -09
Wetland Survey
THESE ARE SUBMITTED AS CHECKED BELOW:
vi For your approval /Review & Comment
❑ For your use ❑ Other:
❑ As requested
REMARKS:
COPY TO: Project File
Greg & Jennifer Stewart
SIGNED: 41 Z/A /46j
GAtorge H. Wood, CEP, PWS

mot WAT�9pG
o <
20130740
Office Use Only:
Corps action ID no.
DWQ project no
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps:
Q Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes Q No
1d. Type(s) of approval sought from the DWQ (check all that apply):
Q 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
because written approval is not required?
For the record only for DWQ
401 Certification:
❑X Yes ❑ No
For the record only for Corps Permit:
Q 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 ❑X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
Yes ❑ No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ® No
2. Project Information
2a. Name of project:
Greg & Jennifer Stewart
2b. County:
Dare
2c. Nearest municipality / town:
Southern Shores
2d. Subdivision name:
Southern Shores
2e. NCDOT only, T.I.P. or state project no:
N/A
3. Owner Information
3a. Name(s) on Recorded Deed:
Greg & Jennifer Stewart
3b. Deed Book and Page No.
D.B. 1794 Pg. 0270
3c. Responsible Party (for LLC if
applicable):
N/A D
3d. Street address:
946 Highland Avenue JUL
3e. City, state, zip:
Dunedin, FL 34698
3f. Telephone no.:
252 - 202 -7872 jZds- t'!!Ft ukury
3g. Fax no.:
252 - 261 -8280 "ch
3h. Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

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:
George H. Wood
5b. Business name
(if applicable):
Environmental Professionals, Inc.
5c. Street address:
1404 South Virginia Dare Trail
5d. City, state, zip:
Kill Devil Hills, NC 27948
5e. Telephone no.:
252 - 441 -0239
5f. Fax no.:
252-441 -0721
5g. Email address:
obxwood @yahoo.com
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
Parcel: 030181000 PIN: 986710459308
1b. Site coordinates (in decimal degrees):
I Latitude: 52.6697 Longitude: - 56.1621
1c. Property size:
-0.61 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Gin Guite Creek
2b. Water Quality Classification of nearest receiving water:
SC
2c. River basin:
Pasquotank
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:
Unimproved wooded lot - land use in vicinity is single -family residential
3b. List the total estimated acreage of all existing wetlands on the property: 0.03
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3d. Explain the purpose of the proposed project:
Prepare the site for single -family residential construction
3e. Describe the overall project in detail, including the type of equipment to be used:
Lot will be cleared with dozer - low areas filled with material on site.
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?
❑X Yes ❑ No ❑ Unknown
Comments:
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): George H. Wood, PWS
Agency /Consultant Company:
Other: Environmental Professionals, Inc.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
In process
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
[]Yes ❑X No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
N/A
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
N/A
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑X 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.
Wetland impact
number
Permanent (P) or
Temporary
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 P
Fill
Bottomland Hardwood Forest
Yes
Corps/DW$k
0.03
W2 -
Choose one
Choose one
Yes/No
-
W3 -
Choose one
Choose one
Yes/No
W4 -
Choose one
Choose one
Yes/No
-
W5 -
Choose one
Choose one
Yes/No
-
W6 -
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
0.03
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.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 -
Choose one
-
S2 -
Choose one
-
S3 -
Choose one
-
-
S4 -
Choose one
-
-
S5 -
Choose one
-
S6 -
Choose one
3h. Total stream and tributary impacts
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

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.
Open water
impact number
Permanent (P) or
Temporary
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
O1 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
S. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
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 you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet )
6g.
Zone 2
impact
(square
feet
131 -
Yes /No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
86 -
Yes/No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Project designed to fill wetlands necessary for setbacks for sewage disposal.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
None Available.
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 Q 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: N/A
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
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:
Choose one
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non - riparian wetland mitigation requested:
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 6 of 10
PCN Form — Version 1.4 January 2009

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
3 (2 for Catawba)
Zone 2
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,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 10

i
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 Q No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
17%
2b. Does this project require a Stormwater Management Plan?
❑ Yes © No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Less than 25% coverage.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
N/A
2e. Who will be responsible for the review of the Stormwater Management Plan?
N/A
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
Southern Shores
❑ 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 Pro ram Review
gCoastal 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
❑ Yes Q No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑X Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑X Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

i
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes © No
use of public (federal /state) land?
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 ❑x No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. 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
E[O]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.
On -site wastewater
Page 9 of 10
PCN Form — Version 1.4 January 2009

.
S. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ❑X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑X Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Web Page
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?
Does not impact water.
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
❑ 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?
web data base
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
❑ Yes Q No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
survey
George H. Wood, PWS
July 11, 2013
Applicant/Agent's Printed Name
WpIiciiitMgenls Signature
Date
(Age 's signature is valid Pnty if an authorization
letter from the applidant is provided.)
Page 10 of 10

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86.66
GRAPIW SCAM 17 - 3W
WETLAND FILL PERMIT
FOR GREG & JENNIFER STEWART
LOT 30, BLOCK 227A, SOUTHERN SHORES, N.C.
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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 Engineers,
North Carolina Division of Coastal Management, North Carolina Division of Water
Quality, etc.) as needed to review regulatory alignment(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.
dowse Date
0C3
li t Date
aaefflj�
JUL 1 8 2013

NOTES
I. AREA BY COORDINATE COMPUTATION= ,46,87nq.Ft.
2 F.LR M. ZONE SUBJECT TO CHANGE BY••F.'E:M:A.
3. IT IS THE SOLE RESPONSIBILITY OF'THE
PERMIT17N4 MUNICIPALITY TO VERIFY SITE
COMPLIANCE WITH A4C ORDINANCES, ZONING, &
SETBACKS REQUIREMENT$' PRIOR TO THE ISSUANCE
OF PERMITS. SURVEYOR } MAKES NO CERTIFICATION
AS TO COMPLIANCES EITHER SHOWN OR IMPLIED.
4. THIS SURVEIL IS" SUBJECT TO ANY FACTS THAT
MAY BE DISCLOSED BY A FULL AND ACCURATE
TITLE SEARCH
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MOW 6RAOE \
THIS CERTIRES THAT THIS COPY OF THIS PLAT WENTIRES \
AS WETLANDS ALL AREAS OF WETLANDS RE4ULATEO
PURSUANT TO SECTION 404 OF THE CLEAN WATER ACT Ih
AS DETERMINED BY THE UNDERSI4NED ON THIS DATE. C)
OTHER AREAS OF UPLANDS MAY EXIST ON THIS SITE BUT
HAVE NOT BEEN FORMALLY DELINEATED OR IDEAITIRED
BY THIS PLAT. UNLESS THERE IS A CHAN4E W THE LAW N
OR OUR PUSUSHED RE4ULATIONS, T141S DETERMINATION
MAY BE RELIED UPON FOR A PERIOD NOT TO EXCEED
FIVES) YEARS FROM THIS DATE. THIS DETERMINATION
WAS MADE UnLIZW4 THE 1987 CORPS OF EN41MEERS
WETLANDS DEUNA nON MANUAL
VICINITY MAP
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DUCK WOODS DRIVE
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CURVE TABLE
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"86.66
RC. C SL 116E 9867"fS83,40 22/16/09 MILANO SURVEY FOR:
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D.B. 2794 P .,270 03osssaa� q -s76w JENNIFER BRADLEY STEWART
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1, "llE F- AJftQ CERTIFY THAT UNDER MY LOT 7J0, BLOCK 7A
DIRECTION AND SUPERVISION THIS PLAT WAS ./EF SOUTHERN SHORES
DRAWN FROM AN SURVEY AS�
PER RECORDED T THE RATIO
OF PRECISION • 10400+; ATLAAMC TOWNSHIP DARE COUNTY NORTH CAROLINA
THAT THIS P d.
AccR �b o .cac. ° a'
EASTERN
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�Y GEOMATICS.$ PLLC
• �� "PROFESSIONAL SURVEYINQ SERVICES"
IIIII L-46vz P.O. BOX 1026
r TNS SM IS AMM. IM PLAT Is To BE oollso� KILL DEVIL KILLS, N.C. 27948
ao ' a 10s, APPFIW'�A,°0"DA10N� PHONE / FAX: [phone]
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