20140314 Ver 1_401 Application_20140414

20140314 ARM IL
Geothermal, Environmental,
& Well Drilling
April 3, 2014 P
NC Division of Water Quality
Attn: Karen Higgins
DWR- 401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
RE: Lot 4 -A Family Division for Laura Murphy
Pender County, North Carolina
Ms. Higgins,
In response to your request dated April 2, 2014, please find enclosed four (4) additional
copies of the Pre - Construction Notice package previously submitted. Please let me know if
you have any further questions or needs.
Sincerely,
Gene YoyAg, I
Environmental
APR 8 2014
wXrrre
Applied Reciource Management, FC
P 0. Box 882, 257 Transfer Station Road, Hampstead, NC 28445, 910.270.2919, Fax [phone]

March 18, 2014
NC Division of Water Quality
Attn: Jennifer Burdette
1650 Mail Service Center
Raleigh, NC 27699 -1650
RE: Project Narrative
Lot 4A Family Division for Laura Murphy
Pender County, NC
Dear Ms. Burdette:
2 0 1 4 0 3 1 4
ARM
Gcothcrmal, Environmental,
& Well Drilling
On behalf of Davetta Gurganious, Applied Resources Management, P.C. is providing you with a
project narrative for the above referenced site.
The project is located at lot 4A Family Division for Laura Murphy on Malpass Corner Road in Pender
County. The property is approximately 1 acre. In order to construct a driveway for a home, fill
material will be needed in a small portion of the noted wetlands; therefore a Nationwide Permit 18 is
being sought.
The proposed project consists of construction of a driveway across two wetland points to acess an
area of uplands where a home is to be located. The wetland areas extend the entire width of the
access easement to the property in two portions and thus make this minimal impact necessary to
access the upland area.
The impact is expected to be approximately 0.05 acres. This wetland impact has been minimized by
reducing the footprint of the driveway to a minimal extent and accessing the upland areas at the
shortest span of wetland areas. Furthermore, fill is only being proposed driveway purposes only.
If you have any questions or require any additional information, please feel free to contact me at
(910) 270 -2919.
Sincerely,
j
Gene Y,,, n g, REH�
EnvironmerataL�cientist
L NR APP 8 2014
- wATLF
Y
4 rwb r 3ren:h
Applied Resource Management, f C
f' 0. Box 882, 257 Transfer Station Foad, Hampstead, NC 28443, 910.270.2919, Fax [phone]

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineer s
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State North Carolina County/pansh/borough Pender City Cume
Center coordinates of site (]at/long in degree decimal format) Lat 34 4840287 ° N, Long -78 08683° �V
Universal Transverse Mercator
Name of nearest waterbody Lee Ditch /Lewis Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows Moore's Creek
Name of watershed or Hydrologic Unit Code (HUC) 03030006
F1 Check if map /diagram of review area and /or potential Jurisdictional areas is /are available upon request
-1 Check if other sites (e g , offsite mitigation sites, disposal sites, etc ) are associated with this action and are recorded on a
different JD form
D. REVIEW PERFORMED POR SITE EVALUATION (CHECK ALL THAT APPLY):
Office (Desk) Determination Date
0 Field Determination Date(s)
,SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable raters of the US" within Rivers and Harbors Act (RHA) Jurisdiction (as defined by 33 CFR part 329) in the
review area [Required]
0 Waters subject to the ebb and flow of the tide
F1 Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce
Explam
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There A e "waters of the U S " within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): i
® TNWs, including territorial seas
Wetlands adjacent to TNWs
Relatively permanent waters' (RPWs) that flow dnectly or indirectly into TNWs
0 Non -RPWs that flow directly or indirectly into TNWs
® Wetlands directly abutting RPWs that flow dnectly of mdnectly into TNWs
R Wetlands adjacent to but not dnectly abutting RPWs that flow dnectly or indirectly into TNWs
0 Wetlands adjacent to non -RPWs that flow dnectly or indirectly into TNWs
M Impoundments of jurisdictional waters
F1 Isolated (interstate or mhastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non - wetland waters linear feet width (ft) and/or acres
Wetlands 0 72 acres
c. Limits (boundaries) of jurisdiction based on 1987 Delineation Manual
Elevation of established OHWM (if known)
2. Non - regulated watershvetlands (check if applicable):3
Q Potentially jurisdictional waters and /or wetlands were assessed within the,review area and determined to be not jurisdictional
Explain
1 Boxes checked below shall be supported by completing the appiopnate sections in Section III below
'- For purposes of this form an RPW is defined as a,tnbutary that is not a TNW and that typically flows year -round or has continuous flow at least- `seasonally"
(e g, typically 3 months)

SECTION III: CWA ANALYSIS
A. TNR's AND WETLANDS ADJACENT TO TN'sN's
The agencies n ill assert jurisdiction o -*er TNWs and n etlands adjacent to TNWs. If the aquatic i esource is a TNW, complete
Section III.A.1 and Section III.D.i. only; if the,aquatic resource is a ii etland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.I.; others%ise, see Section III.B below
1. TNW
Identify TNW
Summarize rationale supporting determination
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent"
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non - navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year -round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has yeas -round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available, information that documents}the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a,signiflcant nexus with a TNW. If the tributary has adjacent wetlands, the significantinexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. Th is, significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that ti ibutary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size
I'M cres
Drainage ai ea acres
Average annual rainfall inches
Avei age annual snowfall inches
(ii) Physical Characteristics:
(a) Relationship witli TNW
❑ Tributary flows dmectly into TNW
❑ Tributary flows through Pick List tributaries before entei mg TNW
Pioject waters aie Pick List river miles fiom TNW
Project waters are Pick List river mules fiom RPW
_.
Project waters aie Pick List aerial (stiaight) miles from TNW
Pioject waters aie Pict. List aerial (straight) mules fiom RPW
Pioject waters cross or serve as state boundaiies Explain
Identify flow route to TNW`
Tributary steam order, if known
"Note that the Instructional Guidebook contains additional information iegaidmg swales ditches washes, and erosional features generally and in the and
West
5 Flow route can be described by identifying, e g , tnbutary,a which flows tluough the review area, to flow into tnbutaiv b which then flows into TNW

(b) General Tributary Characteristics (check all that apply)
Tributary is ❑ Natural
❑ Artificial (man- made). Explain
❑ Manipulated (man - altered). Explain tributary appears to be altered around Oak Island airport
Tributary properties with respect to top of bank (estimate)
Average width feet
Average depth feet
Average side slopes Pi k Lisi.
Primary tributary substrate composition (check all that apply)
❑ Silts ❑ Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ❑ Vegetation Type/% cover
❑ Other Explain
Tributary condition/stability [e g , highly eroding, sloughing banks] Explain
Presence of run/rAe/pool complexes Explain
Tributary geometry Pick L s� t
Tributary b advent (approximate aver age slope) %
(c) Flow
Tributary provides for Pick List
Estimate average number of flow events in review area/year Pick List
Describe flow regime
Other information on duration and volume
Surface flow is Pick List. Characteristics
Subsurface flow Pick List Explain findings
El Dye (or other) test performed-
Tributary has (check all that apply)
❑ Bed and banks
❑ OHWM6 (check all indicators that apply)
❑ clear, natural line impressed on the bank
❑
❑ changes in the character of soil
❑
❑' shelving
❑
❑ vegetation matted down,,bent, or absent
❑
❑ leaf litter disturbed or washed away
❑
❑ sediment deposition
❑
❑ water staining
❑
❑ other (list)
❑ Discontinuous OHWM 7 Explain
If factors other than the OHWM were used to deterin
❑ High Tide Line indicated by ❑
❑ oil or scum line along shore objects
❑ fine shell or debns deposits (foreshore)
❑ physical markings / characteristics
❑ tidal gauges
❑ other (list)
the presence of litter and debris
destruction of terrestrial vegetation
the presence,of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
me lateral extent of CWAjunsdiction (check all that apply)
Mean High Water Mark indicated by
❑ survey to available datum,
❑ physical markings,
❑ vegetation lmes /changes in vegetation types
(iii) Chemical Char acteristics:
Characterize tributary (e g , water color is clear, discolored, oily film, water quality, general watershed characteristics, etc )
Explain could not determine due to lack of i am
Identify specific pollutants, if known
'6A natural of man -made discontinuity in the OHWM does not necessarily sever jurisdiction (e g , where the stream temporarily flows underground, or Nheie
the OHWM has been removed by development of-agricultural practices) Where there is a break in the OHWM that is unielated4o the wateibody s flow
regime (e g, flow over a Lock outcrop or tluough a culvert), the agencies will look for indicators of flow above and below the break
'Ibid

(iv) Biological Characteristics. Channel supports (check all that apply):
❑ Rrpanan comdor Charactenstics (type, average «vtdth)
❑ Wetland fringe Characteristics
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish /spawn areas Explain findings
❑ Other environmental ly- sensrtrve species Explain findings
❑ Aquatic/wildlife diversity Explain findings
2. Characteristics of iN etlands adjacent to non -TNW that flow directly or indir ectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics
Properties
Wetland size acres
Wetland type Explain
Wetland quality Explain
Project wetlands cross or serve as state boundaries Explain
(b) General Flow Relationship with Non -TNW
Flow is Pick List Explain
Surface flow is: Pick List
Characteristics
Subsurface flow PkK Lisi Explain findings
❑ Dye (or other) test performed
(c) Wetland Adjacency Determination with Non -TNW
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection Explain
❑ Ecological connection Explain
❑ Separated by berm/barrier Explain
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW
Project waters are Pick List aerial (straight) miles from TNW
Flow is from Pick L' ist.
Estimate approximate location of wetland as within the Pict. List floodplam
(ii) Chemical Characteristics:
Characterize wetland system (e g , water color is clear, brown, oil film on surface, water quality, general watershed
characteristics, etc ) Explain
Identify specific pollutants, if known
(iii) Biological Charactei istics. Wetland supports (check all that apply):
❑ Riparian buffer Characteristics (type, average width)
❑ Vegetation type /percent cover Explain
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn ar eas Explain findings
❑ Other envnonmentally- sensitive spedres Explain findings
❑ Aquatic /wildlife diversity Explain findings
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis Pick List
Approximately ( ) acres in total ate being considered in the cumulative analysis

For each wetland, specify the following
Directly abuts9 (YIN) Size (in acres) Directly abuts? (YIN) Size (in acres)
Summarize ovei all biological, chemical and physical functions being performed
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands, adjacent to the tributary to determine if they significantly affect the,chemical, physical, and biological integrity
of a TMV. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but ai a not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNNV). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood water s to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW9
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW9
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs9
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non -RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III D
2. Significant nexus findings for non -RPW and its adjacent wetlands, where the non -RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III D
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III D
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERSAVETLANDS ARE (CHECK ALL
THAT APPLIJ:
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area
® TNWs 800 linear feet 30 width (ft), Or, acres
Q Wetlands adjacent to TNWs acres
2. RPWs that flow directly or indirectly into TNWs.
® Tributaries of TNWs where tributaries typically flow year -round are jurisdictional Provide data and rationale indicating that
tributary is perennial unnamed branch shows constant flow
El Tributaries of TNiW where tributaries have continuous flow `seasonally" (e g . typically three months each year) aie
jurisdictional Data supporting-this conclusion is provided at Section III B Provide rationale indicating that tributary flows
seasonally

Provide estimates for Jurisdictional waters in the review area (check all that apply)
El Tributary waters linear feet width (ft)
El Other non - wetland waters acres
Identify type(s) of waters
3. Non -RPWs8 that flow directly or indirectly into TNWs.
El Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is Jurisdictional Data supporting this conclusion is provided at Section III C
Provide estimates for Jurisdictional waters within the review area (check all that apply)
El Tributary waters linear feet width (ft)
0 Other non - wetland waters acis
Identify type(s) of waters
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
® Wetlands directly abut RPW and thus are Jurisdictional as adjacent wetlands
El Wetlands directly abutting an RPW where tributaries typically flow year -round Provide data and rationale
indicating that tributary is perennial in Section III D 2, above Piovide iationale indicating that wetland is
directly abutting an RPW
® Wetlands directly abutting an RPW where tributaries typically flow "seasonally " Provide data indicatin g that tributary is
seasonal in Section III B and rationale in Section III D 2, above Provide rationale indicating that wetland is directly
abutting an RPW wetland exhibits channelization and drainage patterns indicating normal flow through them These
wetlands flow along drainage features that ultimately empty into Lee ditch and into lewis branch
Provide acreage estimates for Jurisdictional wetlands in the review area 0.72acres
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
El Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are Junsidictional Data supporting this
conclusion is provided at Section III C
Provide acreage estimates for Jurisdictional wetlands in the review area acres
6. Wetlands adjacent to non -RPWs that flow dii ectly or indirectly into TNWs.
El Wetlands adjacent to such waters, and have when considered m combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands in the review area acres
7. Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional
Demonstrate that impoundment was created fiom "waters of the US,- or
Demonstrate that water meets the criteria for one of the categories presented above (1 -6), of
0 Demonstrate that water is isolated with a nexus to coimmerce (see E below)
E. ISOLATED [INTERSTATE OR INTRA - STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
which are or could be used by interstate or foreign tiaveleis for recreational or other purposes
fiom which fish of shellfish are of could be taken and sold in interstate or foreign commerce
which are or could be used for industrial purposes by industries in interstate commerce
Q hlteistate isolated waters Explain
Other factors Explain
8See Footnote # 3
9 To complete the analysis refer to the key in Section III D 6 of the Instructional Guidebook
10 Pi ror to asserting or dechnmg CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
reNzew consistent with the process described in the Corps/EPA Memorandum Regai ding CRA Act Jurrsdictron Folloirnig Rapanos.

Identify «ater body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply)
Q Tributary waters linear feet width (ft)
Other non - wetland waters acres
Identify type(s) of waters
Wetlands acres
F. NON- JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
El If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and /or appropriate Regional Supplements
El Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in "SW.4NCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR)
El Waters do not meet the `Significant Nexus" standard, where such a finding is requu ed for junsdiction Explain
0 Other (explain, if not covered above)
Provide acreage estimates for non - Jurisdictional waters in the review area, where the sole potential bans ofjunsdiction is the MBR
factors (i e , presence of migratory bads, presence of endangered species, use of water for irrigated agriculture), using best professional
Judgment (check all that apply)
0 Non - wetland waters (i e, rivers, streams) linear feet width (ft)
E] Lakes /ponds acres
0 Other non - wetland waters acres List type of aquatic resource
El Wetlands acres
Provide acreage estimates for non- junsdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for Jurisdiction (check all that apply)
0 Non - wetland waters (i e , rivers, streams) linear feet, width (ft)
0 Lakes /ponds acres
F1 Other non - wetland waters acres List type of aquatic resource
El Wetlands acres
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply -checked items shall be included in case file and, where checked
and requested, appropriately reference souices below)
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant
® Data sheets prepaied/submitted by or on behalf of the applicant/consultant
❑ Office concurs with data sheets /delineation report
❑ Office does not concur with data sheets /delineation report
El Data sheets prepared by the Corps
Q Corps navigable waters' study
U S Geological Survey Hydrologic Atlas
❑ USGS NHD data
❑ USGS 8 and 12 digit HUC maps
® U S Geological Survey map(s) Cite scale & quad name Currie, NC Quadrangle
® USDA Natural Resources Conservation Service Soil Survey Citation
® National wetlands inventory map(s) Cite name
State /Local wetland inventory map(s)
❑ FEMA/FIRM maps
100 -year Floodplam Elevation is (National Geodectic Vertical Datum of 1929)
® Photographs ® Aerial (Name & Date) Pender County G1S
or ❑ Other (Name & Date)
❑ Previous detennmation(s) File no and date of response lettei
❑ Applicable /supporting case law
❑ Applicable /supporting scientific literature
El Other information (please specify)
B. ADDITIONAL COMMENTS TO SUPPORT JD: This is an extension of a previous JD that has since expued This JD extends drams
that were previously identified further upland in the drain

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site- Malpass Corner RD - Gurgarnous City/County Pander Sampling Date Feb 18, 2014
ApplicanYOwner Davetta Gurganious State NC Sampling Point Upland point
Investigator(s) Gene Young, REHS -A R M Section, Township, Range Currie NC
Landform (hdlslope, terrace, etc) Ridge Local relief (concave, convex, none) Linear Slope ( %) >1%
Subregion (LRR or MLRA) LRR T Lat 34 4840287 N Long -78 08683 W Datum
Sod Map Unit Name Leon NCWAM classification Pine flats
Are climatic / hydrologic conditions on the site typical for this time of year? Yes x No (If no,explain in Remarks )
Are Vegetation X , Sod or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes_ No x
Are Vegetation , Soil or Hydrology naturally problematic? (if needed, explain any answers in Remarks )
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No
Hydnc Soil Present? Yes No X Is the Sampled Area
Wetland Hydrology Present? Yes No X within a Wetland? Yes No X
Remarks Vegetation has been mowed on this property and easement areas Vegetation In adjacent areas appear
to be typical
HYDROLOGY
Wetland Hydrology Indicators
Secondary Indicators (minimum of two
required)
Pnmary Indicators (minimum of one is required, check all that apply)
_ Surface Sod Cracks (66)
Surface Water (Al)
_ Water - Stained Leaves (139)
_ Sparsely Vegetated Concave Surface
(B8)
_ High Water Table (A2)
_ Aquatic Fauna (1313)
_ Drainage Patterns (1310)
Saturation (A3)
_ Marl Deposits (B15)(LRR U)
_ Moss Trim Lines (1316)
Water Marks (131)
_ Hydrogen Sulfide Odor (C1)
_ Dry- Season Water Table (C2)
_ Sediment Deposits (B2)
_ Oxidized Rhizospheres on Living Roots
_ Crayfish Burrows (C8)
(C3)
Drift Deposits (133)
_ Presence of Reduced Iron (C4)
— Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (B4)
_ Recent Iron Reduction in Tilled Sods (C6)
_ Geomorphic Position (D2)
Iron Deposits (B5)
_ Thin Muck Surface (C7)
_ Shallow Aquitard (D3)
_ Inundation Visible on Aerial Imagery
_ Other (Explain in Remarks)
_ FAC- Neutral Test (D5)
(137)
Field Observations:
urface Water Present? Yes _ No x Depth (inches)
later Table Present? Yes No x Depth (inches) "
aturation Present? Yes No x Depth (inches) Wetland Hydrology Present? Yes _ No X
ncludes capillary fringe)
escribe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available
arks

Tree Stratum (Plot size 30' )
1
Absolute
% Cover
Dominant
Species?
Indicator
Status
Dominance Test worksheet.
Number of Dominant Species
That Are OBL, FACW, or FAC (A)
Total Number of Dominant
Species Across All Strata (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC 100 (A/B)
2
3
4
5
5
7
65
Cover
Sapling Stratum (Plot size 30' )
1
= Total
Prevalence Index worksheet*
Total % Cover of Multiply by
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals (A)
(B)
Prevalence Index = B/A =
2
3
4
5
6
7
Cover
Shrub Stratum (Plot size 30' )
1
= Total
2
3
Hydrophytic Vegetation Indicators,
Dominance Test is >50%
Prevalence Index is s3 0'
Problematic Hydrophytic Vegetation'
(Explain)
'Indicators of hydnc sod and wetland hydrology
must
4
5
6
7
Herb Stratum (Plot size 30' )
1
= Total
Cover
Definitions of Vegetation Strata,
Tree — Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height,and 3
in (7 6 cm) or larger in diameter at breast height
(DBH)
Sapling — Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and less
than 3 in (7 6 cm) DBH
Shrub — Woody plants, excluding woody vines,
approximately 3 to 20 ft (1 to 6 m) in height
Herb — All herbaceous (non- woody) plants,
including
herbaceous vines, regardless of size Includes
woody
plants, except woody vines, less than approximately
3 ft (1 m) in height
Woody vine — All woody vines, regardless of
height
2
3
4
5
6
7
g
9
10
11
12
Woody Vine Stratum (Plot size 30' )
1
= Total
Cover
2
3
4
5
= Total
Cover
Hydrophytic
Vegetation
Present) Yes No
Remarks (If observed, list morphological adaptations below) No vegetation on site due to mowing Grasses only growing

oampun roin[ u lava
Profile Description (Describe to the depth needed to document the Indicator or confirm the absence of Indicators )
Depth Matix Redox Features
Inches Color (moist) % Color (moist) % Type Loc Texture Remarks
0-4 10YR 311 Sandy loam
4-12 10YR 5/6 Loamy sand
12 -200 10YR 5/6 Sandy loam
Type C= Concentration, D= Depletion, RM= Reduced Matrix, CS= Covered or Coated Sand Grains
Hydric Soil Indicator:
_ Histosol (Al)
_ Polyvalue Below Surface (S8)(LRR S,
Histic Epipedon (A2)
_ Thin Dark Surface (S9) (LRR S, T, U)
Black Histic (A3)
_ Loamy Mucky Surface (F1) (LRR O)
Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
Stratified Layers (A5)
_ Depleted Matrix (F3)
Organic Bodies (A6)(LRR P, T, U)
_ Redox Dark Surface (176)
5 cm Mucky Mineral (A7)(LRR P, T,
_ Depleted Dark Surface (F7)
Muck Presence (A8)(LRR P, T)
— Redox Depressions (F8)
1 cm Mucky Mineral (A7)(LRR P, T,
_ Marl (F10) (LRR U)
Depleted Below Dark Surface (A11)
_ Depleted Ochric (F11) (MRLA 151)
_ Thick Dark Surface (Al2)
_ Iron - Manganese Masses (F12)(LRR
_ Coast Prairie Redox (A16)(MLRA
_ Unbnc Surface (F13( (LRR P, T, U)
_ Sandy Mucky Mineral (S1)(LRR O,S)
_ Delta Ochric (F17) (MRLA 151)
Sandy Gleyed Matrix (S4)
_ Reduce Vertic (F18) (MRLA 150A, 1506)
Location PL= Pore Lining, M= Matrix
1 cm Muck (A9) (LRR O)
2 cm Muck (A10) (LRR S)
Reduced Vertic (F18)(outside MLRA 150A,B)
Piedmont Floodplain Sods (F19)
Anomalous Bright Loamy Soils (F20)
(MRLA 1538)
Red Parent Material (TF2)
Very Shallow Dark Surface (TF12) (LRR T, U)
Other (Explain in Remarks)
s Indicators of hydrophytic vegetation
and
wetland hydrology must be present,
unless disturbed or problematic
Sandy Redox (S6) _ Piedmont Floodplain Soils (MRLA 149A)
Stripped Matrix (S6) _ Anomalous Bright Loamy Soils (F20) (MRLA 149A, 153C, 153D)
Restrictive Layer (if observed)
Type
Depth (inches)
Remarks:
soils do not appear to be hydric
Hydnc Soils Presents Yes _ No X

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site Maipass Corner RD - Gurganious City /County Pender Sampling Date Feb 18, 2014
Applicant/Owner Davetta Gurganious State NC Sampling Point Wetland point
Investigator(s) Gene Young, REHS -A R M Section, Township, Range Currie NC
Landform (hdlslope, terrace, etc ) Toe slope Local relief (concave, convex, none) Linear Slope ( %) >1%
Subregion (LRR or MLRA) LRR T Lat 34 4840287 N Long -78 08683 W Datum
Soil Map Unit Name Gnfton -loamy sand NCWAM classification Pine flats
Are climatic/ hydrologic conditions on the site typical for this time of year? Yes x No (If no,explain in Remarks )
Are Vegetation X , Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes_ No x
Are Vegetation , Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks )
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No
Hydnc,Soil Present? Yes X No Is the Sampled Area
Wetland Hydrology Present? Yes x No within a Wetland? Yes X No
2emarks Vegetation has been mowed on this property and easement areas Vegetation in adjacent areas appear
o be typical
HYDROLOGY
Wetland'Hydrology Indicators
Secondary Indicators (minimum of two
required)
Primary Indicators (minimum of one is required, check all that apply)
_ Surface Sod Cracks (136)
_ Surface Water (Al)
x Water - Stained Leaves (139)
_ Sparsely Vegetated Concave Surface
(B8)
High Water Table (A2)
_ Aquatic Fauna (1313)
_ Drainage Patterns (610)
x Saturation (A3)
_ Marl Deposits (B15)(LRR U)
_ Moss Trim Lines (B16)
Water Marks (B1)
_ Hydrogen Sulfide Odor (Cl)
_ Dry- Season Water Table (C2)
Sediment Deposits (132)
_ Oxidized Rhizospheres on Living Roots
_ Crayfish Burrows (C8)
(C3)
_ Drift Deposits (133)
_ Presence of Reduced Iron (C4)
— Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (B4)
_ Recent Iron Reduction in Tilled Soils (C6)
_ Geomorphic Position (D2)
Iron Deposits (135)
_ Thin Muck Surface (C7)
_ Shallow Aqutard (D3)
_ Inundation Visible on Aerial Imagery
_ Other (Explain in Remarks)
_ FAC- Neutral Test (D5)
(67)
Field Observations:
Surface Water Present? Yes _ No x Depth (inches)
Water Table Present? Yes x No_ Depth (inches) 2"
Saturation Present? Yes X No_ Depth (inches) 2" Wetland Hydrology Present? Yes x No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available.
arks:

Tree Stratum (Plot size 30' )
1 Loblolly Pine (Pmus taeda)
Absolute
% Cover
Dominant
Species?
Indicator
Status
FAC
Dominance Test worksheet-
Number of Dominant Species
That Are OBL, FACW, or FAC 4 (A)
Total Number of Dominant
Species Across All Strata 4 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC 100 (A/B)
25
Y
2 Svreetgum (Liguidambar styraciflua)
25
Y
FAC
3 Redbay (Persea borbonia )
15
Y
FACW
4
5
6
7
Sapling Stratum (Plot size 30' )
1
65
= Total
Cover
Prevalence Index worksheet
Total % Cover of Multiply by
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals (A)
(B)
Prevalence Index = B/A =
2
3
4
5
6
7
Cover
Shrub Stratum (Plot size 30' )
1
= Total
2
3
Hydrophytic Vegetation Indicators
X Dominance Test is >50%
Prevalence Index is s3 0'
Problematic Hydrophytic Vegetation'
(Explain)
'Indicators of hydric soil and wetland hydrology
must
4
5
6
7
Herb Stratum (Plot size 30' )
1
= Total
Cover
Definitions of Vegetation Strata
Tree — Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and 3
in (7 6 cm) or larger in diameter at breast height
(DBH)
Sapling — Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and less
than 3 in (7 6 cm) DBH
Shrub — Woody plants, excluding woody vines,
approximately 3 to 20 ft (1 to 6 m) in height
Herb — All herbaceous (non- woody) plants,
including
herbaceous vines, regardless of size Includes
woody
plants, except woody vines, less than approximately
3 ft (1 m) in height
Woody vine — All woody vines, regardless of
height
2
3
4
5
6
7
g
9
10
11
12
Woody Vine Stratum (Plot size 30' )
1
= Total
Cover
2
3
4
5
= Total
Cover
Hydrophytic
Vegetation
Present? Yes X No
Remarks (If observed, list morphological adaptations below) vegetation limited due to mowing Trees are noted from adjacent property

veil_ oampung roint wetiana
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of Indicators )
Depth Matix Redox Features
Inches Color (moist) % Color (moist) % Type Loc Texture Remarks
0 -8 10YR 2/1 Sandy loam Mucky
8-15 10YR 5/1 Loamy sand
15 -20 10YR 2/1 Loamy sand
Type C= Concentration, D= Depletion, RM= Reduced Matrix, CS= Covered or Coated Sand Grains
Hydnc Sod Indicator•
Histosol (Al)
_ Histic Epipedon (A2)
,Black Histic (A3)
_ Hydrogen Sulfide (A4)
Stratified Layers (A5)
Organic Bodies (A6)(LRR P, T, U)
_ 5 cm Mucky Mineral (A7)(LRR P, T,
X Muck Presence (A8)(LRR P, T)
_ 1 cm Mucky Mineral (A7)(LRR P, T,
_ Depleted Below Dark Surface (A11)
_ Thick Dark Surface (Al2)
_ Coast Prairie Redox (A16)(MLRA
Sandy Mucky Mineral (S1)(LRR O,S)
Sandy Gleyed Matrix (S4)
Polyvalue Below Surface (S8)(LRR S,
Thin Dark Surface (S9) (LRR S, T, U)
Loamy Mucky Surface (F1) (LRR O)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Marl (1710) (LRR U)
Depleted Ochric (1711) (MRLA 151)
Iron - Manganese Masses (F12)(LRR
Unbric Surface (F13( (LRR P, T, U)
Delta Ochric (F17) (MRLA 151)
Reduce Vertic (F18) (MRLA 150A, 150B
Location PL= Pore Lining, M= Matrix
1 cm Muck (A9) (LRR O)
2 cm Muck (A10) (LRR S)
Reduced Vertic (F18)(outside MLRA 150A,B)
Piedmont Floodplain Solis (1719)
Anomalous Bright Loamy Soils (F20)
(MRLA 153B)
Red Parent Material (TF2)
Very Shallow Dark Surface (TF12) (LRR. T, U)
Other (Explain in Remarks)
3 Indicators of hydrophytic vegetation
and
wetland hydrology must be present,
unless disturbed or problematic
Sandy Redox (S6) _ Piedmont Floodplain Solis (MRLA 149A)
_ Stripped Matrix (S6) _ Anomalous Bright Loamy Solis (F20) (MRLA 149A, 153C, 153D)
X Dark Surface (S7 )(LRR P S. T, U
Restrictive Layer (if observed)
Type
Depth (inches) Hydric Soils Present? Yes x No
Remarks:
soils appear to be hydric

C4 WA. F9
�G
1 1 T_
20 1 40 3 1 4
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form - Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:
2ection 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: /1 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes [}fro
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
le.
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 ❑moo
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
O-fes ❑ No
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes D-11-r-
2.
Project Information
2a.
Name of project:
Cf ,i _ 61 I` i> ; v 5. vrok
2b.
County:
lea ,,
2c.
Nearest municipality / town:
-4
C �tm
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
`a'y
L � /- ✓C '' =J' C
3b.
Deed Book and Page No.
4 o o /1+(,
3c.
Responsible Party (for LLC if
applicable):
11D 1
F
3d. Street address:
`-
�� tic. ;. l s�, Allp
3e. City, state, zip:
, J ; q.3'; `
3f.
Telephone no.:
NR • WTi-ff. :; :r
3g.
Fax no.:
" .... , .. ... .
3h.
Email address:
Page 1 of 10
PCN Form - Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a
Applicant is
DAgent ❑ Other, specify-
4b
Name.
! Q,-) ,
4c
Business name
(if applicable)
q J
% �d %•r :� r� ? -z� �reF t
4d
Street address
4e
City, state, zip.
�� 3
4f
Telephone no
Iv (7 -
4g
Fax no
4h
Email address
P1 e7-
5.
AgentlConsultant Information (if applicable)
5a
Name
5b
Business name
(if applicable)
5c
Street address
5d
City, state, zip,
5e
Telephone no
5f
Fax no -
5g
Email address
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a
Property identification no (tax PIN or parcel ID)
1 b
Site coordinates (m decimal degrees)
Latitude �'y� per? °' �� Longitude — 7 j
1c
Property size
i acres ` -1
2.
Surface Waters
2a
Name of nearest body of water to proposed project
7 , ✓^ a h IS clL
2b
Water Quality Classification of nearest receiving water
2c
River basin
611 z_k- i7-,vr- r 5c>-,
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. `t c _,rre., i <<,,,�i�{�c�.S Ctl� a„ �,z,ie"c l r,('�zr�`� +Fr ; C+
e6\ mss
3b.
List the total estimated acreage of all existing wetlands on the property p, 7 F( cue S ry T cow e.n�r2 f
3c
List the total estimated linear feet of all existing streams (intermittent,and perennial) on the property.
3d
Explain the purpose of the proposed project.--/ , fny� �, jl -its p,�� �f /S 7� �_7<Lc
3e
Describe the overall project in detail, including the type of equipment to be used
C wG L ( t J 1 F n -77,-,!-
' s� v_ , C L�rN.S � 7 ?u�tic7L fj i L R+ � ,
,:4--1 ve l
4.
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Yes ❑ No ❑ Unknown
Comments
4b
If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c
If yes, who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
Other ff,p %icy ( Auc:, �
4d.
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach docu` entation
5.
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past
❑Yes No nknown
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 10
PCN Form — Version 1 4 January 2009
IN

C. Proposed Impacts Inventory
1. Impacts Summary
la Which sections were completed below for your project (check all that apply).
Ietlands ❑ 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
2c
2d
2e.
2f.
Wetland impact
Type of impact
Type of wetland
Forested
Type of jurisdiction
Area of
number
Corps (404,10) or
impact
Permanent (P) or
DWQ (401, other)
(acres)
Temporary T
W1 f
Choose one j j
Choose one Pne-, r-
Yes /No ,N' �i
- qD
- 71 '8-
W2 f
Choose one
Choose one {? �^ �
Yes /No tiZ
- `4C)
W3
Choose one
Choose one
Yes /No
-
W4 -
Choose one
Choose one
Yes /No
-
W5
Choose one
Choose one
Yes /No
-
W6 -
Choose one
Choose one
Yes /No
-
2g Total Wetland Impacts:
2h Comments ;
Llf1�y�j�Y �Yi�F1;77:z�� C,�'YV� -GY
/
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
3g
Stream impact
Type of impact
Stream name
Perennial (PER) or
Type of
Average
Impact
number
intermittent (INT)?
jurisdiction
stream
length
Permanent (P) or
width
(linear
Temporary (T)
(feet)
feet)
S1
Choose one
S2
Choose one
/
-
S3
Choose one
S4 -
Choose one
-
-
S5
Choose one
-
S6
Choose one
3h Total stream and tributary impacts
31 Comments
Page 4 of 10
PCN Form — Version 1 4 January 2009

4. Open Water1mpacts
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 open water impacts below.
4a
Open water
impact number
Permanent (P) or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
01
Choose one
Choose
02 -
Choose one
Choose
03 -
T
Choose one
Choose
04 -
Choose one
Choose
4f Total open water impacts
4g Comments-
5. Pond or Lake Construction
If pond or lake construction proposed, the 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
P1
Choose one
P2
Choose one
5f Total:
5g Comments
5h Is a dam high hazard permit required
❑ Yes No If yes, permit ID no-
51 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 you MUST fill out Section D of this form
6a Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b
Buffer Impact
number —
Permanent (P) or
Temporary T
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required?
6f
Zone 1
impact
(square
feet )
6g
Zone 2
impact
(square
feet
B1
Yes /No
B2 -
Yes /No
B3 -
Yes /No
B4 -
Yes /No
B5 -
Yes /No
B6 -
Yes /No
6h Total Buffer Impacts:
61 Comments
Page 5 of 10

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
lb
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
5" ?-2 12�'l le Lv < %c "-J' /j L,
tt)-c4 "Ld al e4zS J
2.
Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a
Does the protect require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes Q_Nio
2b
If yes, mitigation is required by (check all that apply)
❑L.[_,, D Q El Corps
2c
If yes, which mitigation option will be used for this
projects
�UJ ti tion bank
[Ell a ment to in -lieu fee program
❑ Permittee Responsible Mitigation
3.
Complete if Using a Mitigation Bank
3a
Name of Mitigation Bank IA—
3b
Credits Purchased (attach receipt and letter)
Type Choose one
Type Choose one
Type Choose one
Quantity
Quantity
Quantity
3c Comments
4.
Complete if Making a Payment to In -lieu Fee Program JA
4a Approval letter from in -lieu fee program is attached
❑ Yes
4b
Stream mitigation requested
linear feet
4c
If using stream mitigation, stream temperature
Choose one
4d
Buffer mitigation requested (DWQ only)
square feet
4e
Riparian wetland mitigation requested
acres
4f
Non - riparian wetland mitigation requested
acres
4g
Coastal (tidal) wetland mitigation requested
acres
4h
Comments
5.
Complete if Using a Permittee Responsible Mitigation Plan
5a
If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 4 January 2009

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
Yes No
buffer mitigation?
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
6c
6d.
6e
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required:
6g 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)
6h Comments
Page 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a
Does the protect include or is it adjacent to protected riparian buffers identified
❑ Yes B-14-0
within one of the NC Riparian Buffer Protection Rules?
1 b
If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes ❑ No
2.
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
L
2b
Does this project require a Stormwater Management Plan?
❑ Yes LS No
2c
If this project DOES NOT require a Stormwater Management Plan, explain w/ by ,,�
,_V/ c-g f5 cL -� k'Wl
2d
If this protect DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
2e
Who will be responsible for the review of the Stormwater Management Plan?
3.
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this p ro ect?
❑ Phase II
3b
Which of the following locally - implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
El Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
Coastal counties
❑HQW
4a
Which of the following state - implemented stormwater management programs apply
❑ORW
(check all that apply)
❑Session Law 2006 -246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ©No
attached?
5.
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1 4 January 2009

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes EKO-
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
El 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,
El Yes 040
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after - the -fact permit application?
es ❑ No
2c
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s)
/PIZ tG�e'it-�zt c./ i �1 Gt � re- V1ll?cj q
3.
Cumulative Impacts (DWQ Requirement)
3a
Will this project (based on past and reasonably anticipated future impacts) result in
E] 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
/ `0,nr
3
1
Page 9 of 10
PCN Form — Version 1 4 January 2009

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 o
5b Have you checked with the USFWS concerning Endangered Species Act
Egl('es ❑ No
impacts?
5c If yes, indicate the USFWS Field Office you have contacted
--Z PA
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat? �J�bsrr� �RL� A1,1— �c ,4) / ,71
6. Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes EKO
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
A ✓T AleeL
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 1214- o
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?
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA - designated 100 -year floodplain?
❑ Yes ❑-Pd�
8b If yes, explain how project meets FEMA requirements
8c. What sources) did you use to make the floodplain determination?
Applicant/Agent's Printed Name
A licant/A nt's i nature
Date
(Agent's si Cature is vali -rf�an authorization
letter ft the hcant is provided )
M ...,... 4 !1 ..f 4 r%

Date: , ff
To Whom It May Concern:
RE: Agent Authorization Letter
I authorize Gene Young or any employee of Applied Resource Management, PC to act
as an agent on my behalf in all matters dealing with wetland Jurisdictional
Determinations or permitting.
Sincerely,
Property Address:

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Hampstead, NC28943
Map adapted from NCDOT Color Infrared Map
TITLE: FIGURE:
Lot 4A, Family Division for Laura Murphy
Site Vicinity
JOB: SCALE: DATE: DRAWN BY: 2
14020 1"= 100' 3/17/14 GY