20211764 Ver 1_ePCN Application_20211206

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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#*
20211764
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:
OBX Dreams, LLC
1a. Who is the Primary Contact?*
Doug Dorman
1 b. Primary Contact Email: * 1c. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
12/6/2021
Nearest Body of Water
Atlantic Ocean
Basin
Pasquotank
Water Classification
SC
Site Coordinates
Latitude:
Longitude:
35.214050
-75.680670
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
Is this a courtesy copy notification?*
Yes No

ID#
Version
Pre -fling Meeting or Request Date
11 /1 /2021
Attach documentation of Pre -Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
Kaufman Pre-Filling.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:
118.25KB
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 L 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:
David Kaufman - OBX Dreams, LLC
2b. Deed book and page no.:
1920/0199
Yes No
Yes No

2c. Contact Person:
2d.Address
Street Address
4123 Echo Glenn Drive
Address Line 2
City
Dallas
Postal / Zip Code
75244
2e. Telephone Number:
[phone]
2g. 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]
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Summerplace
1c. Nearest municipality / town:
Hatteras
2. Project Identification
2a. Property Identification Number:
959405192440
2c. Project Address
Street Address
57219 Summerplace Drive
Address Line 2
City
Hatteras
Postal / Zip Code
27943
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Atlantic Ocean
3b. Water Resources Classification of nearest receiving water:*
Sc
State / Province / Region
TX
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2b. Property size:
0.35
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.
03010205
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 property is a vacant lot in the Summerplace subdivision located in Hatteras, Dare County, NC. The general land use in the project area 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:
0.02
4g. List the total estimated linear feet of all existing streams on the property:
0
4h. Explain the purpose of the proposed project: *
The proposed project is to construct a single family residence on a vacant lot in the Surnmerplace subdivision.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The property will be cleared and filled for preparation of the proposed house.The proposed house construction will impact 0.02 acres (937 sf) of wetlands. Indirect impacts will include
additional surface runoff to road side swales. Equipment to be used includes dump trucks, backhoe, and small tractor.
5. Jurisdictional Determinations
Sa. 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:
Not issued at this time
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
Verified by Billy Standridge in September 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?
D. Proposed Impacts Inventory
1. Impacts Summary
1 a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
2. Wetland Impacts
2al Reason M
2b. Impact type*(?)
pe of W.*
2d. W. name*
2f. Type of Jurisdicition *��2g.
M
Impact
area*
House Construction
Isolated Wetlands
man
L__]
Both
]
0.020
(acres)

2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.020
2g. Total Wetland Impact
0.020
2i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Due to the size, location and available space on the existing property the impacts to the wetlands are unavoidable.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction of an engineered wastewater system was reviewed to reduce the size of the drainfield and allow the proposed house to be located closer to
the back property line. This option did not significantly reduce the wetland impacts and increased the design and construction costs by $30,000+ for the
engineered wastewater system.
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 size of the wetland impacts we are not proposing compensatory mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1 a. 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:
Project area not within NC Riparian Buffer Protection area.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPOES 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 (1 5A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (1 5A 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 development proposed.
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 constructionfl nstal lation of a wind turbine(s)?*
Yes No
Unknown
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?
US Fish and Wildlife welbsite.
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?
Area would 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 FEIVIA-clesignated 100-year floodplain?*
Yes No
8b. If yes, explain how project meets FEIVIA 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?*
Dare County Flood 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.
Chck the upload button or drag and drop files here to attach document
Kaufman COE Site Plan.pdf 81.96KB
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 oftime.
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");
understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
intend to electronically sign and submit the PCN form.
Full Name:
Doug Dorman
Signature
'O"yow".
Date
12/6/2021