20211633 Ver 1_ePCN Application_20211108

DW R
mrlsloa of ware. Resources
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*
20211633
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 5201 N Croatan Hwy
la. Who is the Primary Contact?*
Brian Rubino
1 b. Primary Contact Email:
[e-mail]
Date Submitted
11/8/2021
Nearest Body of Water
Atlantic Ocean
Basin
Pasquotank
Water Classification
SB
Site Coordinates
Latitude:
36.097717
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:
-75.712207
Version# *
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
u
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
Please provide the date of the previous submission."
9/16/2015
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
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:
S & S Properties
Yes No
Yes No

2b. Deed book and page no.:
DB 2520, PG 780
2c. Contact Person:
Yaron Sibony
2d.Address
Street Address
353 Village Rd
Address Line 2
City
Virginia Beach
Postal / Zip Code
23454
2e. Telephone Number:
[phone]
2g. Email Address:"
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Brain 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
1 b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Kitty Hawk
2. Project Identification
2a. Property Identification Number:
987717101641
2c. Project Address
Street Address
5201 N Croatan Hwy
Address Line 2
City
Kitty Hawk
Postal / Zip Code
27949
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Atlantic Ocean
Stale / Province / Region
VA
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2b. Property size:
0.96
State / Province / Region
NC
Country
USA
3b. Water Resources Classification of nearest receiving water:*
SB

3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
030102051403
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 site currently consists of undeveloped wooded/shrub uplands and wetlands. Adjacent properties include single family residences and commercial properties.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
• Yes No Unknown
If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW-2015-01511
4f. List the total estimated acreage of all existing wetlands on the property:
0.083
4g. List the total estimated linear feet of all existing streams on the property:
n/a
4h. Explain the purpose of the proposed project: *
The purpose of this project is construct a new commercial retail store on and undeveloped parcel. The proposed impacts to wetlands are primarily to create a stormwater infiltration and
collection basin that is being permitted through DEMLR. Some of this wetland area includes proposed site parking as well.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
Construction of a new retail facility with associated parking, on -site septic system, and stormwater basin and swales. The property will be cleared and graded according to the engineered
plans to accommodate the proposed site development. Skid steers, excavators, and dump trucks will be utilized for the site work.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
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, P.C.
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
Field verified by Kyle Barnes (USACE ) in 2015 prior to issuance of a Nationwide 18 for the prior owner. The Nationwide 18 was never utilized and has since expired. This request is
impact the same area that was permitted to be filled in 2015.
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
2a. Site #* (?) ��2al Reason M 2b. Impact type*(?) 2c. Type of W.* 2d. W. name* 2e. Forested* 2f. Type of Jurisdicition" 2g. Impact
M area*

Commercial P Small -Basin Wetland Wetland No Corps 0.083
development (acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.083
2i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.083
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The site plan primarily uses the 404 wetland pocket for stormwater collection and treatment.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All fill will be sloped and seeded. Silt fencing will be used to contain fill.
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:
Great Dismal Swamp Restoration Bank
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Non -riparian wetland 0.166
3c. Comments
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:
There are no riparian buffers in this river basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?"
Yes No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federallstatellocal) 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.
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?
NC Natural Heritage Program Database
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 present within the proposed work area.
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
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 Site is partially within the A flood zone. This type of development is allowed within this flood zone as long as local, state and federal requirements
regarding minimum first floor elevations are met.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Maps and nconemap.com
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
NRCS_Soil_Map.pdf
574.7KB
USGS_KITTY HAWK.pdf
1.85MB
SAW-2015-01511 Wilkinson_NWP.pdf
240.96KB
P98040.1-Agent Authorization.pdf
12.98KB
P98040.1-SHEET 2-110821.pdf
927.72KB
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
11/8/2021
U