20220415 Ver 1_ePCN Application_20220314

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Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6, 2021 Ver 4.2
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#*
20220415
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:
Conner Lot 1C
la. Who is the Primary Contact?*
Doug Dorman
1 b. Primary Contact Email: * 1c. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
3/14/2022
Nearest Body of Water
Pamlico Sound
Basin
Tar -Pamlico
Water Classification
SA
Site Coordinates
Latitude:
Longitude:
35.107439
-75.986329
A. Processing Information
County (or Counties) where the project is located:
Hyde
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
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? °t
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: Yes No
For the record only for Corps Permit: Yes No
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 It. 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:
John & Dauan Conner
2b. Deed book and page no.:
261 /477
2c. Contact Person:
2d.Address
Street Address
PO Box 71
Address Line 2
City
State / Province / Region
Buxton
NC
Postal / Zip Code
Country
27949
USA
2e. Telephone Number:
2f. Fax Number:
[phone]

2g. Email Address: *
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Doug Dorman
3b. Business Name:
3c.Address
Street Address
PO Box 3266
Address Line 2
City
Kitty Hawk
Postal / Zip Code
27949
3d. Telephone Number:
[phone]
3f. 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. Proiect Information and Prior Proiect History
1. Project Information
1b. Subdivision name:
(if appropriate)
Noner
1c. Nearest municipality / town:
Ocracoke
2. Project Identification
2a. Property Identification Number:
1697
2c. Project Address
Street Address
Lighthouse Road
Address Line 2
City
Ocracoke
Postal / Zip Code
27960
State / Province / Region
NC
Country
USA
3e. Fax Number
State / Province / Region
NC
Country
USA
4e. Fax Number
2b. Property size:
0.18
State / Province / Region
NC
Country
USA
u

3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
Pamlico Sound
3b. Water Resources Classification of nearest receiving water:"
SA
3c. What river basin(s) is your project located in?*
Tar -Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201050207
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:
This is a vacant lot across from the Ocracoke Lighthouse. General land use in the vicinity is mostly residential with some general business.
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:
0.13 acres
4g. List the total estimated linear feet of all existing streams on the property:
None
4h. Explain the purpose of the proposed project: *
The purpose of the project is to construct a 3 bedroom single family residence with on site wastewater system and parking.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
Site will be cleared and wetland area filled based on proposed site plan. Silt fence will be installed at toe of fill slope to prevent additional wetland impacts until new material can be
stabilized with vegetation. Indirect impacts may include additional surface runoff during the construction process. Equipment to include backhoe, dump trucks and small tractor.
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:
No AID issued yet
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Doug Dorman
Agency/Consultant Company: Atlantic Environmental Consultant, 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 on April 13, 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
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
U
2. Wetland Impacts

2a1 Reason (?)
2b. Impact type"(?)
2c. Type of W."
2d. W. name*
2e. Forested*
2f. Type of Jurisdicition*
29• Impact
area
House Const. IL
Estuarine Woody Wetland
Lot 1C
Yes
Both
0.100
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.100
21. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.100
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Several design options have been evaluated but the limited size of the lot will require wetland impacts to build the single family residence. Several
engineered septic system designs have been evaluated that could potential shift the house and parking in the upland area. None of the engineered
septic system designs significantly change the wetland impacts, therefore we decided on the most cost effective option of a Peat Bio filtration system.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Choosing to construct a the Peat Bio Filtration system for the septic system will eliminate the three additional per -treatment tanks for the septic system
and allow two of the three parking spaces to be located closer to the septic system and help avoid and minimize wetland impacts.
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
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
Yes No
4b. Stream mitigation requested:
(linear feet)
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non -riparian wetland mitigation requested:
(acres)
0.10
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more information.
Yes No
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
Is. 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 outside of NC Riparian Buffer setbacks.
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:
G. Supplementary Information
1. Environmental Documentation
1a. 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.
No future impacts are proposed for this lot.
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 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
51. 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 website.
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?
404 wetlands on site do 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 FEMA-designated 100-year floodplain?•
Yes No
8b. If yes, explain how project meets FEMA requirements:
House will be constructed above minimum base flood elevation.
8c. What source(s) did you use to make the floodplain determination?"`
Hyde County FEMA flood maps.
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
Conner Lot 1C Site Plan.pdf 435.85KB
Conner Signed Agent Authorization.pdf 603.67KB
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:
Doug Dorman
Signature
Date
3/14/2022

Gmail - (no subject)
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LEGEND
PROPOSED CONCRETE DRIVEWAY
PROPOSED WETLAND FILL ( 4,350 SF)
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JOHN CONNER SITE PLAN
NATIONWIDE PERIVIT
OCRACOKE - HYDE COUNTY - NORTH CAROLINA
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FILE: CONNER 2022 DATE:03/07/22 REVISED: