20211539 Ver 1_ePCN Application_20211022

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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*
20211539
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Robert Tankard:eads\rbtankard
Information for Initial Review
1a. Name of project:
COURTESY COPY 224 Tower Lane
la. Who is the Primary Contact?*
Brian Rubino
1 b. Primary Contact Email:
[e-mail]
Date Submitted
10/22/2021
Nearest Body of Water
Roanoke Sound
Basin
Pasquotank
Water Classification
SA
Site Coordinates
Latitude:
36.003686
A. Processing Information
County (or Counties) where the project is located:
Dare
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Pre -Filing Meeting Information
Longitude:
-75.711039
Version# *
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
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Is this a courtesy copy notification?*
Yes No

ID# Version
Pre -fling Meeting or Request Date
Attach documentation of Pre -Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
File type most 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 401 Water Quality Certification - Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
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:
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
11. 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:
Bradley E. Cale
2b. Deed book and page no.:
DB 2463, PG 671
Yes No
Yes No

2c. Contact Person:
2d.Address
Street Address
319 Bromley Dr
Address Line 2
City
Mullica Hill
Postal / Zip Code
08062
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Brian Rubino
4b. Business Name:
Quible & Associates P.C.
4c.Address
Street Address
PO Box 870
Address Line 2
City
Kitty Hawk
Postal / Zip Code
27949
4d. Telephone Number:
[phone]
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Carlyle on the Sound
1c. Nearest municipality / town:
Kill Devil Hills
2. Project Identification
2a. Property Identification Number:
987310266357
2c. Project Address
Street Address
224 Tower Lane
Address Line 2
City
Kill Devil Hills
Postal / Zip Code
27948
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Roanoke Sound
3b. Water Resources Classification of nearest receiving water:*
SA
State / Province / Region
NJ
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2b. Property size:
0.64
State / Province / Region
NC
Country
USA

3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
030102051404
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 subject property is comprised of undeveloped uplands and wetlands. Adjacent properties include single family residences and undeveloped uplands and wetlands.
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:
0.20
4g. List the total estimated linear feet of all existing streams on the property:
n/a
4h. Explain the purpose of the proposed project:
Fill to accommodate a single family residence, with associated driveway and septic system. The upland area on the property will be utilized to the fullest extent possible. The terrain is
steep and the fill will accommodate the footprint of the proposed development and the fill slopes needed to maintain an adequate building area plateau.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
Bull dozer and excavator, compaction equipment, pile driving equipment. Trees in the footprint of the construction area will be cut and root masses excavated prior to fill and grading. Silt
fencing and low retaining walls will contain the fill and will prevent off -site siltation.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
Field approved by USACE.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Brian Rubino
Agency/Consultant Company: Quible & Associates
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
Field confirmation on August 17, 2021.
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?
No
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
J
2a1 Reason (?)
2b. Impact type* (?)
2c. Type of W.*
2d. W. name*
2e. Forested*
2f. Type of Jurisdicition*
2g• Impact
area
Residential
�
L
Estuarine Woody Wetland
Wetland
Yes
Corps
]
0.099
(acres)

2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.099
2i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.099
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Existing uplands onsite are utilized to the fullest extent possible. As mentioned above, the upland terrain is steep and shallow fill slopes will be created to
accommodate the homesite. In order to minimize fill area needed, low retaining walls will be constructed on the eastern fill slope terminus.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
retaining walls, no construction or fill within the CAMA AEC, slopes will be vegetated.
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:
GDSRB
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Riparian wetland .1 acres
3c. Comments
See attached letter of credit availability.
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?
Yes No
If no, explain why:
No DWR buffer in Pasquotank RB; CAMA 30' Buffer does exist from edge of NWL shoreline.
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
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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.
This request is specific to the subject lot and will not enable any additional development.
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
5d. Is another Federal agency involved?*
Yes No
5e. Is this a DOT project located within Division's 1-8?
Yes No
Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NCNHP
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 surface waters are involved.
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?*
National Register of Historic Places and past experience with projects in the same subdivision.
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:
The lot is partially within the AE4 Zone per FEMA. The first floor elevation of the home will be built at an elevation no lower than 8' (Dare County
Development rules), which is would be at least 4' above the flood zone elevation.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map (nc0oodmaps.com and Dare County GIS)
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
P21084-NAT 18 PLAN-101821.pdf 462.28KB
Dare County Parcel Data.pdf 3.83MB
NRCS_Soil_Map.pdf 735.38KB
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:
Brian Rubino
Signature
Date
10/22/2021