20211506 Ver 1_ePCN Application_20211017

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Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS # Assigned*
Version#*
20211506
1
Is a payment required for this project?
No payment required
What amout is owed?*
Fee received
$240.00
Fee needed - send electronic notification
$570.00
Reviewing Office*
Select Project Reviewer*
Washington Regional Office - [phone]
Robert Tankard:eads\rbtankard
Information for Initial Review
1a. Name of project:
Davis - Roberts Residence
la. Who is the Primary Contact?*
Doug Dorman
1 b. Primary Contact Email: * 1c. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
10/17/2021
Nearest Body of Water
Currituck Sound
Basin
Pasquotank
Water Classification
SC
Site Coordinates
Latitude:
Longitude:
36.339299
-75.821629
A. Processing Information u
County (or Counties) where the project is located:
Currituck
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Pre -Filing Meeting Information
Is this a courtesy copy notification?*
Yes No

ID#
Version
Pre -fling Meeting or Request Date
10/26/2021
Attach documentation of Pre -Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
Davis - Roberts Pre -Filing Request.pdf
File type must be PDF
1a. 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
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 18 - Minor Discharges
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
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:
53.17KB
401 Water Quality Certification - Express
Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?"
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1 i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. 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:
Cynthia Davis & Doris Roberts
2b. Deed book and page no.:
1622/230
Yes No
Yes No

2c. Contact Person:
2d.Address
Street Address
11934 New Bond Drive
Address Line 2
City
Huntersville
Postal / Zip Code
28078
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Doug Dorman
3b. Business Name:
Atlantic Environmental Consultants, LLC
3c.Address
Street Address
PO Box 3266
Address Line 2
City
Kitty Hawk
Postal / Zip Code
27949
3d. Telephone Number:
[phone]
3f. Email Address:
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Doug Dorman
4b. Business Name:
Atlantic Environmental Consultants, LLC
4c.Address
Street Address
PO Box 3266
Address Line 2
City
Kitty Hawk
Postal / Zip Code
27949
4d. Telephone Number:
[phone]
M. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1 b. Subdivision name:
(if appropriate)
Monteray Shores
1c. Nearest municipality / town:
Corolla
State / Province / Region
NC
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
3e. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:

2. Project Identification
2a. Property Identification Number:
2b. Property size:
115C00000490000
0.25
2c. Project Address
Street Address
888 Searidge Drive
Address Line 2
City
State / Province / Region
Corolla
NC
Postal / Zip Code
Country
27949
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.
0301020513
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: *
This is an existing vacant residential lot in the Monterey Shores Subdivision in Corolla, Currituck County. The general land use in the vicinity is residential.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0.10
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 is to construct a single family residence on a sound front lot in the Monterey Shores Subdivision. The proposed residential construction will impact 0.35 acres of wetlands.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The property will be cleared were proposed house is to be constructed. Silt fence will be installed at the wetland fill limits to prevent further impacts from surface runoff. Proposed fill
material to be placed on lot prior to house construction for access reasons. Indirect impacts from new impervious surfaces would include additional surface runoff. Surface runoff will be
minimal with Currituck County Stormwater requirements for new construction. Equipment to be used includes dump trucks, backhoe, and small tractor.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
• Yes No Unknown
Comments:
Wetland line was verified by the USACOE, Anthony Scarbraugh
5b. If the Corps made a jurisdictional determination, what type of determination was made?
• Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
No AID Yet. Wetlands verified on 08/18/21 by Anthony Scarbraugh
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Doug Dorman
Agency/Consultant Company: Atlantic Environmental Consultants, LLC
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
Wetlands verified on 08/18/21 by Anthony Scarbraugh
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?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
2. Wetland Impacts
2a1 Reason (?)
2b. Impact type"(?)
2c. Type of W.*
2d. W. name*
2e. Forested*
r,.)Type of Jurisdicition*
2g. Impact
area"
Residence
P
Estuarine Woody Wetland
Davis -Roberts
Yes
Both
ffE�]
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.020
21. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.020
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed residence has access to the Monteray Shores Central wastewater system therefore, the house is not limited to a specific number of
bedrooms based on a onsite wastewater system. The house has been designed at Four bedrooms which has minimized the wetland impacts to 918
square feet.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The proposed house, driveway and parking will be constructed as close to the front property boundary as possible while still providing safe ingress
and egress to Sea Ridge Drive.
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 program Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Hidden Lakes
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Non -riparian wetland 0.04 acres
3c. Comments
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)
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?
Yes No
If no, explain why:
Riparian Buffer Rules do not apply.
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
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 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 result in additional development, which could impact nearby downstream water quality?
Yes No
3b. If you answered "no," provide a short narrative description.
No additional impacts associated with this project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No 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 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
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
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
Unknown

51. 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 Fish and Wildlife Website.
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?
No Essential Fish Habitat within project area. The wetland area does not support Essential Fish Habitat.
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?*
Environmental Review from North Carolina State Historical Preservation Office.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8b. If yes, explain how project meets FEMA requirements:
Home will be constructed within local, state and federal flood area requirements.
8c. What source(s) did you use to make the floodplain determination?*
Currituck County Flood Plain Maps.
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.
Click the upload button or drag and drop files here to attach document
Davis - Roberts Rev Site Plan.pdf 2.01 MB
File must be PDF or KMZ
Comments
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:
Doug Dorman
Signature
Date
10/17/2021