20131104 Ver 1_401 Application_20131013

TRANSMITTAL
Date: October 3, 2013
20131104
(� Quible SINCE 1939
& Associates, P.C.
ENGINEERING a CONSULTING ; PLANNING
ENVIRONMENTAL SCIENCES a SURVEYING
Phone: [phone]
Fax: [phone]
Web: www.quible.com
Re: John F. Conner Jr. Pre - construction Notification (PCN) Form
Ms. Laurie Dennison
NC DENR — DWQ
WBS Compliance & Permits
1650 Mail Service Center
Raleigh, NC 27699 -1650
Dear Ms. Dennison
,r R_ Lr§ae�
OCT 1 5 2013
Enclosed are five copies of an a USACE/DWQ Pre - Construction Notification Form (PCN) for a
USACE NW #18 /DWQ 401 Certification application proposing fill of 0.09 of an acre of jurisdictional
section 404 wetlands. Included with the application are five copies of the plat depicting the proposed
project, and the pre - construction notification form, and a letter of mitigation credits from the Great
Dismal Swamp Restoration Bank, LLC.
Thank you for your attention to these submittals. Please review and let if you have questions or
need additional information.
S' cerely,
Jo S. Lassiter, Senior Environmental Scientist
Quible & Associates, P.C.
Cc: Brian Rubino, Quible, John Conner, Jr., Josh Pelletier, USACE

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NOT INTENDED FOR CONVEYANCE
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PROJECT
COPYRIGHT © 2013
QUIBLE & ASSOCIATES, P.C.
P 12081
THIS DOCUMENT IS THE PROPERTY OF QUIBLE
& ASSOCIATES, PC ALL RIGHTS ARE
DRAWN BY
RESERVED. ANY. REPRODUCTION OF THIS OR
POSSESSION WITHOUT PRIOR PERMISSION OF
JMH
QUIBLE & ASSOCIATES, PC WILL CONSTITLTE
ENVIRONMENTAL SCIENCES • SURVEYING
VIOLATION OF COPYRIGHT LAWS VIOLATICt4
CHECKED BY
WILL BE SUBJECT TO LEGAL ACTION
BDR
IF THIS PLAN OR PLAT IS NOT SIGNED AL,D
Phone: [phone]
I
SEALED BY A LICENSED PROFESSIONAL TH_N
Fox: (252) 261 -1260
THIS PLAN OR PLAT SHALL BE CONSIDERED
DATE
PRELIMINARY AND NOT A CERTIFIED DOCUMENT
AND SHALL NOT BE USED FOR CONSTRUCTION.
09/04/13
RECORDATION, SALES OR LAND CONVEYANC_S.
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OCT 1 5 ?013
PROPOSED GRAVEL
DRIVE 1,170 SF
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- PIN#. 0536 - 0769 -3215
PARCEL #• 017009/2/
- PARCEL AREA- 22,09544 5F r 0.51 AC
- ARE45 BY COORDINA7E t-E i D
- R6TREMGE DO 393, P5 624
- B'.YWARY 5MOM BA5ED ON 5bRVEY BY TR/AN&LE
ENGINEERING AND 5WvL -y/h6, /NC DATED 10103/79
AND DARE Ca#VTY TAX 1NFGteM77CN
- F/6_0 SURVEY DATE- 0016643
- PROPERTY 15 LOCATED IN Fl R_ M. ZONE AE' (EL 6)
PANEL# 373005 -:W bJ DATED 09/20106.
(5 5-ECT TO CHAASE BY FEMA)
/0.67'
USACE NATIONWIDE 18 FOR
E
Quible SINCE' 1959
JOHN F. CONNER, JR.
& Associates, P.C.
PARCEL IN BUXTON
ENGINEERING • CONSULTING * PLANNING
HATTERAS TOWNSHIP DARE COUNTY
ENVIRONMENTAL SCIENCES • SURVEYING
NORTH CAROLINA
NC License #: C -0208
0 40 80
PO Drawer 870, Kitty Hawk, NC 27949
Phone: [phone]
I
Fox: (252) 261 -1260
GRAPHIC SCALE IN FEET 1"=40
E —Mail: administrator®quible.com

,V
of WA
Office Use Only:
2 0 1 3 1 1 0 4 Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit ❑Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ 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
❑ No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
® Yes
❑ No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
John F. Conner Jr.
2b. County:
Dare
2c. Nearest municipality / town:
Buxton
2d. Subdivision name:
NA
2e. NCDOT only, T.I.P. or state
project no:
NA
3. Owner Information OCT 1 5
3a. Name on Recorded Deed:
John F. Conners, Jr.
DB 393/ PG 0624 jt
WA
Omani
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
P.O. Box 71
3e. City, state, zip:
Buxton, NC 27920
3f. Telephone no.:
252.216.5624
3g. Fax no.:
NA
3h. Email address:
NA
Page 1 of 11
PCN Form — Version 1.0 November 2008 Version

a
Section A. Applicant Information, continued
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:
Brian Rubino
5b. Business name
(if applicable):
Quible & Associates, P.C.
5c. Street address:
P.O. Drawer 870
5d. City, state, zip:
Kitty Hawk, NC 27949
5e. Telephone no.:
(252) 261 -3300
5f. Fax no.:
(252) 261 -1260
5g. Email address:
brubino ®quible.com
Page 2 of 11
PCN Form — November 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID):
PRN 13233
1 b. Site coordinates (in decimal degrees):
35.1069'N - 75.9700'W
1c. Property size:
0.69 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Pamlico Sound
proposed project:
2b. Water Quality Classification of nearest receiving water:
SA
2c. River basin:
Tar- Pamlico
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:
undeveloped commercial property with a combination of vegetated and mowed uplands and Section 404 wetlands.
3b. List the total estimated acreage of all existing wetlands on the property:
0.29 ac.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
The purpose of this wetland impact permit request is for minor wetland fill impacts associated with the fill of 0.0 acres of
non - riparian Section 404 wetlands for a residential homesite. The on -site septic treatment system will be located on Lot
29 as permitted by Hyde county Health Dept. (see emclosed Improvement Permit).
3e. Describe the overall project in detail, including the type of equipment to be used:
Proposed building construction and associated grading will require minor wetland impacts. Equipment will include
backhoe, dump trucks and compactors.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
® Yes ❑ No ❑ Unknown
project (including all prior phases) in the past?
4b. If the Corps made the jurisdictional determination, what type
® Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency /Consultant Company: Josh Pelletier, US Army
Name (if known): Quibie &Associates, P.C.
Corps of Engineers
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
See attached information
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 3 of 11
PCN Form — Version 1.0 November 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
® 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.
2b.
20.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of
Type of wetland
Forested
(Corps - 404, 10
Area of impact (acres)
Permanent (P) or
impact
(if known)
DWQ — non -404, other)
Temporary
shrub- forested
® Corps
W1 ®P ❑ T
fill
El Yes ® No
® DWQ
0.094
non-riparian
W2 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W3 ❑ P [IT
❑ Yes ❑ No
Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
2g. Total wetland impacts
1 0.10
2h. Comments: a
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.
3b.
3c.
3d.
3e.
3f.
Stream impact
Type of
Stream name
Perennial (PER) or
Average stream width (feet)
Impact
number -
impact
intermittent (INT)?
length
Permanent (P) or
(linear feet)
Temporary (T)
S1 ❑ P ❑ T
❑ PER ❑ INT
S2 ❑ P ❑ T
❑ PER ❑ INT
S3 ❑ P ❑ T
❑ PER ❑ INT
S4 ❑P ❑T
[I PER El INT
S5 ❑P ❑T
El PER [I INT
S6 ❑ P ❑ T
❑ PER ❑ INT
3g. Total stream and tributary impacts
3h. Comments: na
Page 4 of 11
PCN Form — Version 1.0 November 2008 Version

C. Proposed Impacts Inventory, continued
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 o en water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of
impact number
waterbody
Type of impact
Waterbody type
Area of impact (acres)
— Permanent
(if
(P) or
applicable)
Temporary
01 ❑ PEI T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
M. Total open water impacts
4g. Comments: na
Page 5 of 11
PCN Form — November 2008 Version

C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If pond or lake construction pro osed then 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
Flooded
P1
P2
5f. Total
5g. Comments: na
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 y ou MUST fill out Section D of this form.
6a.
Project is in which protected basin?
❑ Neuse El Tar-Pamlico ❑Other:
❑ Catawba ❑ Randleman
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)
Bi ❑P ❑T
❑Yes ®No
B2 ❑ PEI T
El Yes ❑No
B3 ❑P ❑T
El Yes El No
6h. Total buffer impacts
6i. Comments: na
Page 6 of 11
PCN Form — November 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Fill has been limited to the area required to provide adequate room for the ingress, egress and storage of boats/trailers.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Silt fencing to be maintained until disturbed area is stabilized with grass..
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
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: Dismal Swamp Mitigation Bank
3b. Credits Purchased (attach receipt and letter)
Type
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 mltlgatlon, stream temperature:
warm, cool, cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non - riparian wetland mitigation requested:
0.094
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h.. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
Ea. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
na
Page 7 of 11
PCN Form — Version 1.0 November 2008 Version

D. Impact Justification and Mitigation, continued
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
Reason for impact
Total impact
(square feet)
Multiplier
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
Total buffer mitigation required:
6c. 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).
na
6d. Comments:
Page 8 of 11
PCN Form — November 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included?
❑ Yes ❑ No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non -404 Jurisdictional General Permit?
❑ Yes ® No
2b. Is the project subject to General Certification 3704 or 3705?
❑ Yes ® No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state - implemented stormwater
® Coastal counties
management programs (check all that apply)?
❑ HQW
If so, attach one copy of the approval letter from the DWQ and one copy of the
❑ ORW
❑ Session Law 2006 -246
approved stormwater management plan.
❑ Other:
3b. In which local government's jurisdiction is this project?
Dare County
3c. Is this local government certified to implement a state stormwater program?
❑ Yes ® No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site plan?
23.8 % at max. build out
4b. Does this project contain any areas that meet the criteria for "high density' per
❑ Yes ® No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
4d. Has a completed BMP Supplement Form with all required items been submitted
El No
for each stormwater BMP?
Page 9 of 11
PCN Form — Version 1.0 November 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ® No
use of public (federal/state) land?
1 b. 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 ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. 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
letter.)
❑ Yes ❑ No
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.
Not required for this use
Page 10 of 11
PCN Form — Version 1.0 November 2008 Version

F. Supplementary Information, continued
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program
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?
Mapping data and field investigation; proposed impact area is not within an area of surface waters.
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?
National Register of Historic Places
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
E Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: This type of fill is allowable with permit in AE zones.
8c. What source(s) did you use to make the floodplain determination? NFIP Flood Zone Maps (www.ncfloodmaps.com)
Joseph S. Lassiter agent for John
Conner
4svalid
Septembei26,
t/Agent's Signature
2013
Applicant/Agent's Printed Name
(AgenCsignat y if an authorization letter from the applicant
is provided.)
Date
Page 11 of 11
PCN Form — November 2008 Version

The Great Dismal Swamp RestorationBank, LLC
P. 0. Box 6186
Chesapeake, VA 23323
September 19, 2013
Joseph Lassiter
Quible & Associates, P.C.
8 Juniper Trail
P.O. Drawer 870
Kitty Hawk, NC 27949
RE: John F Connor, Jr.
0.51 acre Parcel, Hatteras Township
P.O. Box 71
Buxton, NC 27920
Dear Mr. Lassiter:
Phone [phone]
Fax [phone]
The following price quote is given in reply to your request for the purchase of 0.193 wetland mitigation credits (HUC
Code 03010205) from The Great Dismal Swamp RestorationBank Timberlake Farm. These credits are currently available
from our Timberlake mitigation bank.
The cost will be Three Thousand, Eight Hundred, Sixty Dollars ($ 3,860.00). This quote will expire on December 31, 2013.
You will need to submit to the USCOt 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 #:
Waterway:
Permittee Name:
Locality of Impact:
Permit action (i.e., IP, NWP -39, enforcement, etc.)
Impacts (acres /linear feet): .193
Impacts NWI classification:
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 on this project. We look forward to working with you.
Sincerely,
Beverly M kite
GDSRB Accounting