20211635 Ver 1_ePCN Application_20211108

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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*
20211635
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Wilmington Regional Office - [phone]
Information for Initial Review
1a. Name of project:
4201 Barnes Bluff Road SE
la. Who is the Primary Contact?*
Dana Lutheran
1 b. Primary Contact Email:
[e-mail]
Date Submitted
11/8/2021
Nearest Body of Water
AICWW
Basin
Cape Fear
Water Classification
SA;HQW
Site Coordinates
Latitude:
33.922939
A. Processing Information
County (or Counties) where the project is located:
Brunswick
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Pre -Filing Meeting Information
Longitude:
-77.065890
Version# *
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Holley Snider:eads\hasnider
1c. Primary Contact Phone:*
[phone]
u
Is this a courtesy copy notification?*
Yes No

ID# Version
None received
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:
Wesley Summer
2b. Deed book and page no.:
1266/1293
Yes No
Yes No

2c. Contact Person:
Wes Summer
2d.Address
Street Address
409 Chatterson Drive
Address Line 2
City
Raleigh
Postal / Zip Code
27615
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Dana Lutheran
4b. Business Name:
Southern Environmental Group, Inc. (SEGi)
4c.Address
Street Address
5315 South College Road
Address Line 2
Suite E
City
Wilmington
Postal / Zip Code
28412
4d. Telephone Number:
[phone]
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Proiect Information
1 b. Subdivision name:
(if appropriate)
Barnes Bluff
1c. Nearest municipality / town:
Shallotte
2. Project Identification
State / Province / Region
NC
Country
us
2f. Fax Number:
State / Province / Region
NC
Country
us
4e. Fax Number:
2a. Property Identification Number: 2b. Property size:
236EB0291.22 1.22
2c. Project Address
Street Address
4201 Barnes Bluff Road SE
Address Line 2
City State / Province / Region
Southport NC
Postal / Zip Code Country
us
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
AICWW
3b. Water Resources Classification of nearest receiving water:*
SA;HQW

3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300050802
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 project site is an approximately 1.22-acre, undeveloped, mostly wooded, residential lot, within the Barnes Bluff subdivision. The lot is adjacent to the AICWW and contains both
coastal and section 404 wetlands, within its limits (see attached site plan). General land use in the vicinity of the project 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:
0.50
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 of this project is construct a single family dwelling, with adequate maintenance corridor around the structure.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The work will involve installing a retaining wall and back filling with clean earthen soil, which will permanently impact approximately 0.03-acre of bottomland hardwood forest wetlands.
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
A PJD is being sought as part of this permit application
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): David Scibetta
Agency/Consultant Company: SEGi
Other:
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?
To SEGi's and the Applicant's knowledge, no previous permits were used to construct the subdivision. No additional impacts are necessary to make the project viable.
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
u
2a1 Reason (?)
2b. Impact type*(?)
2c. Type of W.*
2d. W. name*
2e. Forested*
r.)1Typeof Jurisdiciti29.
Impact
area
Lot fill
L
Bottomland Hardwood Forest
A
Yes
Both
0.030
(acres)
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.000 0.030

2g. Total Wetland Impact
0.030
21. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The Applicant minimized impacts to wetlands by limiting the maintenance corridor to less than 10' off the building footprint and positioning the proposed
structure as close to the road as possible.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Prior to undertaking land disturbing activities, the limit of wetland impact will be clearly marked with construction fencing and silt fence. The measure will
be inspected weekly and/or after a rain event that produces more than 1" of rainfall within a 24 hour period.
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 this project DOES NOT require Compensatory Mitigation, explain why:
Due to the de minimis amount of proposed wetland impact and the use of a retaining wall to minimize impacts, the Applicant is not proposing mitigation.
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:
The project site is not located within one of NC's Riparian Buffer River Basins.
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:
The project is less than 10,000 SF of built upon area.
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.
The use of sediment fence, during construction, and the retaining wall should ensure sediment does not discharge into adjacent wetlands and
downstream receiving waters.
4. Sewage Disposal (DWR Requirement)

4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated at a
treatment plant, list the capacity available at that plant.
Municipal sewer is available.
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 Unknown
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
5i. 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?
The NLEB is the only listed species that warrants additional assessment. According to the USFWS, the NLEB is typically associated with dense, interior
forests. This site does not provide the preferred habitat, as it is located adjacent to a large water body, as well within a residential subdivision, and
therefore the proposed project is not likely to adversely effect the NLEB.
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 part of this project will take place below the normal high water line.
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?*
This site does not contain existing structures and is not within an area that has been designated as a National Historic Place.
8. Flood Zone Designation (Corps Requirement)
Be. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8b. If yes, explain how project meets FEMA requirements:
The existing grade will not be increased by more than 24", where located within the LMWA. Heated floor space will be elevated at least 2' above base
flood elevation and enclosed floor space will contain flood vents.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Insurance Map 3720208600 K
Miscellaneous
U
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
4201 Barnes Bluff Road SE PCN Attachments.pdf 1.24MB
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:
Dana A. Lutheran
Signature
Date
11/8/2021

4201 Barnes Bluff Road SE F_C li
4201 Barnes Bluff Road SE PCN Attachments
Table of Content
Attachment
Title
1
Agent Authorization
2
4201 Barnes Bluff Road SE Parcel Information
3
Preliminary Jurisdictional Determination Request Packet
4
4201 Barnes Bluff Road SE Wetland Impact Ma
5
Brunswick Co. Flood Ma

4201 Barnes Bluff Road SE E-6i
Attachment 1
Agent Authorization

5EG1
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: L-29 BARNES BLUFF PLAT 20/77-78
LOT NO. PLAN NO. PARCEL I.D. 236EB029
STREET ADDRESS: 4021 Barns Bluff Road
Property Owner (please print): Town of Oak Island
The undersigned, registered property owner of the above noted property, does hereby authorize
Southern Environmental Group, Inc. (SEGi) to act on their behalf in matters regarding areas of
environmental concern.
Property Owner's Address (if different than property above):
A4 (-Q („ 0 N C z.--7 (, / S
Telephone:
Email Address:
('411 s (te SA t. F 5 .
We hereby certify the above information submitted in this application is true and accurate to the best of
our kn wledge.
Property OwnG,eAuthorized Signature SEGi Authorized Signature
We S (C-4 C--- g-� dL ( ty- Dana A. Lutheran
Print Name Print Name
/C - T ` z-/ 9/15/2021
Date Date

4201 Barnes Bluff Road SE F_(-}i
Attachment 2
4201 Barnes Bluff Road SE Parcel Information

9/15/21, 8:46 AM
BRUNSWICK COUNTY
Appraisal Card
9/15/2021 8:41:33 AM
SUMMER WESLEY E ET SUMMER SHEILA J Return/Appeal Parcel: 236EB029
Notes:
PLAT: UNIQ ID
/ 106529
39390530 ID NO:208614343268
BRUNSWICK COUNTY (100), DOSHER HOSP TAX (100), OAK ISLAND (100), OAK ISLAND CARD NO. 1
FIRE (15) of 1
Reval Year: 2019 Tax Year: L-29 BARNES BLUFF PLAT 20/77-78 1.0000 LT SRC=
2021
Appraised by 53 on 08/20/2018 30OF HARBOR VILLAGE/ CAMBRIDGE TW-03 CI- FR- EX- AT- LAST ACTION
14 08 20180820
CONSTRUCTION DETAIL
MARKET VALUE
DEPRECIATION
CORRELATION OF VALUE
TOTAL POINT VALUE
Eff.
BASE
BUILDING ADJUSTMENTSUSEMOD
Area QUAL
RATE
RCNEYB
YB
REDENCETO
OTAL ADJUSTMENT
981
00
1 1
1
1
% GOOD
BUILDING VALUE - CARD 0
JDEPR.
TYPE: VACANT LAND
EPR. OB/XF VALUE - CARD 21,000
FACTOR
OTAL QUALITY INDEX
ARKET LAND VALUE - CARD 140,000
STYLE:
OTAL MARKET VALUE - CARD 161,000
OTAL APPRAISED VALUE - CARD 161,000
OTAL APPRAISED VALUE - PARCEL 161,000
OTAL PRESENT USE VALUE - PARCEL 0
OTAL VALUE DEFERRED - PARCEL 0
OTAL TAXABLE VALUE - PARCEL $ 161,000
PERMIT
CODE I DATE I NOTE I NUMBER AMOUNT
ROUT: WTRSHD:
SALES DATA
OFF.
RECORD
DATE
DEED
INDICATE SALES
BOOK
PAGE
MOjYR
TYPE
/U
VII
PRICE
01266
1293
1211998
WD
U
V
175000
01125
1252
1
1997
WD
U
V
0
HEATED AREA
NOTES
SUBAREA
UNIT
ORIG %
ANN DEP
%
OB/XF DEPR.
GS RPL CODE DESCRIPTIONCOUNTLTH
WTHUNITS
PRICE
COND
BLDG#
AYB EYB
RATE
OV
COND
VALUE
SLIP
1
1 301
01
301
700.001
0.00
_
12004120141
Sol
1
1001
21000
TYPE AREA % CS 11 IBOAT
FIREPLACE TOTAL OB/XF VALUE 21,000
SUBAREA
TOTALS
BUILDING DIMENSIONS
LAND INFORMATION
OTHER
ADJUSTMENTS AND
LAND
TOTAL
HIGHEST AND
USE
LOCAL
FRON
DEPTH
LND COND
NOTES
ROAD
UNIT
LAND
UNT
TOTAL
ADJUSTED
LAND
OVERRIDE
LAND
BEST USE CODE
ZONING
TAGE
DEPTH
/ SIZE
MOD FACT
RF AC LC TO OT
TYPE
PRICE
UNITS
TYP
ADJST
UNIT PRICE
VALUE
VALUE
NOTES
SFR WATERW
0104
CLD
0
1 0
1 1.0000
0 1.0000
PS
140,000.00
1.000
LT
1.000
140,000.00
140000
TOTAL MARKET LAND DATA
140,000
TOTAL PRESENT USE DATA
https://tax.brunsco.net/itsnet/AppraisalCard.aspx?parcel=236EB029&TaxYear=2021 1 /1

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4201 Barnes Bluff Road SE Vicinity Map

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Attachment 4
4201 Barnes Bluff Road SE Wetland Impact Map

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Attachment 5
Brunswick Co. Flood Map