20211823 Ver 1_PCN Revision_20220224

NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2009-00366 (see attached) Date received:
[Click to enter.]
DWR project no. [Click enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 34.4277
Longitude (DD.DDDDDD): -77.6332
Form Version 4, April 4, 2021
Pre -Construction Notification (PCN) Form
(Ver. 4, April 4, 2021))
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk * are required. The form is not considered complete until all
mandatory questions are answered.
The online help file may be found at this link:
https://edocs.deq.nc.qov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
The help document may be found at this link:
http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-
Permits/Pre-construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as
DWR will not be able to accept your application without this important first step. The Pre -Filing Meeting
Request Form is used to satisfy 40 C.F.R. Section 121.4(a) which states "At least 30 days prior to
submitting a certification request, the project proponent shall request a pre -filing meeting with the certifying
agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all certification requests must
include documentation that a pre -filing meeting request was submitted to the certifying authority at least 30
days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) *: 7/22/2021
DWR ID # NA Version 1 (If applicable)
Page 1 of 22 PCN Form - Version 1.5, September 2020

A. Processing Information
County (counties) where project is located: *
Pender Additional (if needed).
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
applicant)
❑ Yes 0 No
Is this a public transportation project? *
(Publicly funded municipal, state, or federal road, rail,
or airport project)
❑ Yes 0 No
Is this a NCDOT project? *
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number: *
Click to enter.
1 a. Type(s) of approval sought from the Corps: *
0 Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
0 Yes ❑ No
Please provide the date of the previous submission. *
12/13/2021
1 b. What type(s) of permit(s) do you wish to seek
authorization? *
0 Nationwide Permit (NWP)
E Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as attachments and
submitted with this form.
lc. Has the NWP or GP number been verified by the Corps? *
a Yes E No
NWP number(s) (list all numbers ):
39
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
E Yes 0 No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act *
Click to enter text.
1d. Type(s) of approval sought from DWR (check all that apply): *
0 401 Water Quality Certification — Regular E 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
E Individual 401 Water Quality Certification
Page 2 of 22 PCN Form - Version 1.5, September 2020

Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in
accordance with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project
proponent shall request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section
121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre -filing meeting request was
submitted to the certifying authority at least 30 days prior to submitting the certification request.
To read more information on when this form is needed prior to application submission:
https://www.epa.gov/sites/production/files/2020-07/documents/clean water act section 401 certification rule.pdf
To view the form: https://edocs.deq.nc.gov/Forms/DWR-Pre-Filing-Meeting-Request
Is this a courtesy copy notification
❑ Yes Z No
le.
Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: *
❑ Yes III No
For the record only for Corps Permit: *
❑ Yes III No
1f.
Is this an after -the -fact permit/certification application? *
A Yes III No
1g.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
_ Yes ❑ No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h.
Is the project located in any of NC's twenty coastal counties? *
0 Yes ❑ No
1 i.
Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑Yes El No El Unknown
1j.
Is the project located in a designated trout watershed? *
❑ Yes ❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 22 PCN Form - Version 1.5, September 2020

B. Applicant Information
la.
Who is the primary contact? *
Dana A. Lutheran
1b.
Primary Contact Email: *
[e-mail]
lc.
Primary Contact Phone: * (###)###-####
[phone]
ld.
Who is applying for the permit/certification? * (check
all that apply)
Owner El Applicant (other than owner)
le.
Is there an agent/consultant for this project?*
® Yes ❑ No
2. Landowner Information
2a. Name(s) on Recorded Deed: *
Coastal Marine Properties, LLC
2b. Deed Book and Page No.:
4628/2380
2c. Contact Person (for corporations):
Tom Bowman
2d. Address *
Street Address:
104 Wyndham Way
Address line 2:
Click to enter.
City:
Wilmington
State/ Province/ Region:
NC
Postal/ Zip Code:
28411
Country:
US
2e. Telephone Number: * (###)###-####
[phone]
2f. Fax Number: (###)###-####
Click to enter.
2g. Email Address: *
[e-mail] &
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name: *
Same as owner
3b.
Business Name (if applicable):
Click to enter.
3c.
Address: *
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: * (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
Page 4 of 22
PCN Form - Version 1.5, September 2020

3f. Email Address: *
Click to enter.
4. Agent/ Consultant (if applicable)
4a. Name: *
Dana Lutheran
4b. Business Name:
Southern Environmental Group, Inc. (SEGi)
4c. Address: *
Street Address:
5315 South Collge Road
Address line 2:
Suite E
City:
Wilmington
State/ Province/ Region:
NC
Postal/ Zip Code:
28412
Country:
US
4d. Telephone Number: * (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to enter.
4f. Email Address: *
[e-mail]
Agent Authorization Letter:*
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 22 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1.
Project Information
la.
Name of project: *
Coastal Marine Storage Center
1 b.
Subdivision name (if appropriate):
NA
1c.
Nearest municipality/town: *
Hampstead/Surf City
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
Easement: 4215-10-5199-0000 Main Parcel: 4214-29-
2426-0000
2b.
Property size (in acres):
20 +/-
2c.
Project Address:
Street Address:
20822 US Highway 17 North
Address line 2:
Click to enter.
City:
Hampstead
State/ Province/ Region:
NC
Postal/ Zip Code:
Click to enter.
Country:
US
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 34.4277
Longitude (-DD.DDDDDD): *--77.6332
3.
Surface Waters
3a.
Name of nearest body of water to proposed project: *
UT to Virginia Creek
3b.
Water Resources Classification of nearest receiving
water: *
C
The Surface Water Classification map may be found at this link:
https://ncdenr. maps.arcgis.com/apes/webaroviewer/index. html?id=6e125ad7628f494694e259c80dd64265
3c.
In what river basin(s) is your project located? *
White Oak
Choose additional (if needed)
3d.
Please provide the 12-digit HUC in which the project is
located: *
030203020402
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apes/PublicInformation/index.html?appid=ad3a85a0c6d644a0b97cd069db238ac3
Page 6 of 22 PCN Form - Version 1.5, September 2020

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 easement area has been cleared of trees, except within the required buffer, and a gravel road has been
installed. This work was performed in 2018 and impacted 0.03-acre of a remnant wetland. The main parcel has
consists of five upland areas that are surrounded by Pocosin type wetlands. Upland Area 1 contains the
office/service building, a covered boat/ry storage building, gravel parking lot, for uncovered boat/ry storage, and
stormwater detention basin. All of this was done in 2018-2019. Since then and with the excessive growth the
area is experiencing, the need for boat/ry stoage has increased exponentially. Without thinking about it, the
Applicant extended the gravel road, through two areas of wetlands, to gain access to Upland Areas 2 and 3. The
road is approximately 22' wide and contains pipes, that ensure hydrologic connection. He also created additional
boat/ry storage, parking area around the perimeter of Upland Area 2 and 3. At this time, he is preparing Upland
Area 4, to serve as additional boat/ry storage area, and has installed a 22' wide soil road, with connection pipe,
to access the area. According to their estimates and preliminary survey work, approximately 0.37-acre of wetland
has taken place without authorization (please see attached site plan for details of unauthorized wetland fill).
Wetlands have been cleared of large trees and shrubs, outside the fill area, but it is not believed the wetlands
have been impacted as a result and will revegetate naturally. Residential and some commercial are the general
land uses in the vicinity of the project.
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past? *
o Yes ❑ No ❑Unknown
If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
SAW-2009-00366 (see attached)
[Click to enter.]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
►_ Yes E No
If yes, describe the completed work.
At this time, approximately 0.36-acre of wetland fill has taken place, without authorization. The work consist of
creating a gravel road, that provides access to Upland Areas 2, 3 and 4, as well as lot fill, within Upland Areas 2
& 3, which provides for additional boat/ry storage (please see attached site plan for details)
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
A state stormwater permit was secured for the upland development that took place on Upland Area 1.
4d. Attach an 8'/z x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'/z x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
property:
10 +/- acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property:
0 linear feet
4g1. List the total estimated acreage of all existing open waters on the
property:
0 acres
4h. Explain the purpose of the proposed project: *
The purpose of the project is to gain access to buildable uplands, and create additional boat/ry storage area, to
meet market demand.
Page 7 of 22 PCN Form - Version 1.5, September 2020

4i. Describe the overall project in detail, including the type of equipment to be used: *
The project consists of installing four road crossings and expanding the existing upland, to allow for additional
storage area. Impact Area 2 (0.36 AC ATF) is a 22' x 136' gravel road, with 18" and 15" pipes, and fill for
increased storage capacity. Impact Area 3 (0.01 AC AFT) includes installing a 22' x 23' gravel road crossing, with
15" pipe, to gain access to Upland Area 4. Impact Area 4 (0.07-acre proposed) is the last road crossing, which
provides access to Upland Area 5, and measures 22' x 132'. Three (3) 15" pipes will be installed along the run of
the roadway. In total, 0.47 AC or Pocosin type wetlands will be permanenty impacted. A bush hog, backhoe,
tractor and trucks will be used to complete the work.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters? *
❑ Yes ❑x No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter text.
Page 8 of 22 PCN Form - Version 1.5, September 2020

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or in
proposed impact areas?
o Yes ❑ No ❑Unknown
Comments:
Click to enter text.
5b. If the Corps made a jurisdictional determination,
what type of determination was made? *
❑x Preliminary ❑ Approved ❑ Emailed concurrence
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2009-00366 (see attached)
5c. If 5a is yes, who delineated the jurisdictional
areas?
Name (if known): David Scibetta
Agency/Consultant Company: SEGi
Other: Click to enter.
5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
July 20, 2018. The PJD does not expire. A site visit to evaluate the wetland line is being sought with this application.
5d1. Attach jurisdictional determinations.
6.
Future Project Plans
6a.
Is this a phased project?
0 Yes ❑ No
6b.
If yes, explain.
This is a two phase project. The first phase consisted of gaining access to Upland Area 1. Phase 2 consists of
gaining access to remaining upland areas (i.e., 2, 3, 4 and 5).
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to
authorize any part of the proposed project or related activity? This includes other separate and distant crossings
for linear projects that require Department of the Army authorization but don't require pre -construction
notification.
A NWP 18, for 0.03-acre of fill, was issued to facilitate the installation of the access road (see attached).
7.
Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
See attached
8.
Scheduling of activity:
The fill associated with Impact Areas 2 and 3 have already taken place. The Applicant intends to perform the
work as soon as the permits are secured.
Page 9 of 22 PCN Form - Version 1.5, September 2020

D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project
(check all that apply):
❑x Wetlands
❑ Buffers
❑ Pond Construction
❑ Streams - tributaries
❑ Open Waters
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #*
2a 1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Road/
Driveway
Crossing
Permanent
Pocosin
B
No
Corps
0.03 (2018)
W2
Road/
Driveway
Crossing
Permanent
Pocosin
B
No
Corps
0.36 (2021
ATF)
W3
Fill (Incl.
Riprap)
Permanent
Pocosin
B
No
Corps
0.01 (2021
ATF
W4
Road/
Driveway
Crossing
Permanent
Pocosin
B
Yes
Corps
0.07
(proposed)
W5
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1. Total temporary wetland impacts
0 ac
2g2. Total permanent wetland impacts
0.47 ac
2g3. Total wetland impacts
0.47 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Approximately 150 cy of clean earthen fill will be placed within wetlands.
Page 10 of 22
PCN Form - Version 1.5, September 2020

2i. Comments:
Click to enter text.
Page 11 of 22 PCN Form - Version 1.5, September 2020

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #*
3a
Impact
Reason*
3b.
Impact
Duration*
3c.
Impact Type*
3d.
Stream Name*
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft) *
S1
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
0 linear ft
3i2. Total permanent stream
impacts:
0 linear ft
3i3. Total temporary stream
impacts:
0 linear ft
3i4. Total stream and ditch
impacts:
0 linear ft
3j. Comments:
Click to enter.
Page 12 of 22 PCN Form - Version 1.5, September 2020

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
Site #*
4a1.
Impact Reason
4b.
Impact
Duration*
4c.
Waterbody Name*
4b.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g. Total temporary open water impacts
0 ac
4g. Total permanent open water impacts
0 ac
4g. Total open water impacts
0 ac
4h. Comments:
Click to enter.
5. Pond or Lake Construction
If pond or lake construction is proposed, complete the table below. (*This does NOT include offline stormwater
management ponds.)
5a.
Pond ID
#
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (ac)
5d.
Stream Impacts (ft)
5e.
Upland
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
P2
Choose one
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
P3
Choose one
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
5f. Total
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
5g. Comments:
Click to enter.
5h. Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i. Expected pond surface area (acres):
0
5j. Size of pond watershed (acres):
0
5k. Method of construction:
Click to enter.
Page 13 of 22 PCN Form - Version 1.5, September 2020

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
* (Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
B1
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B11
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: 0 sq ft
Zone 2: 0 sq ft
6h. Total permanent impacts:
Zone 1: 0 sq ft
Zone 2: 0 sq ft
6h. Total combined buffer impacts:
Zone 1: 0 sq ft
Zone 2: 0 sq ft
6i. Comments:
Click to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 14 of 22 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1.
Avoidance and Minimization
1a.
Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The Applicant first had the wetlands delineated by a professional Wetland Biologist. Then he positioned the
roads to cross perpendicular to the wetlands and at the narrowest points. Lastly, impacts for boat/ry storage
capacity was limited to that needed to make the project feasible.
1 b.
Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques: *
The Applicant installed silt fence along the limits of fill, to ensure that sediment does not discharge into the
adjacent wetlands.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? *
(check all that apply)
Z DWR Corps
2b. If yes, which mitigation option(s) will be used for this
project? * (check all that apply)
® Mitigation Bank
❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3.
Complete if using a Mitigation Bank (Must satisfy NC General Statute143-214.11 (d1).)
3a.
Name of mitigation bank:
NE Cape Fear Umbrella Mitigation Bank (Holly Shelter)
3b.
Credits purchased/requested:
Type: Non -riparian
Wetland
Quantity 1.0
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c.
Comments:
Once the mitigation bank is approved, SEGi will request the credit reservation letter.
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested:
Click to enter. linear feet
4c. If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO:RP:P27 BUTTON KEY:0
4d. Buffer mitigation requested (DWR only):
Click to enter. square feet
4e. Riparian wetland mitigation requested:
Click to enter. acres
4f. Non -riparian wetland mitigation requested:
Click to enter. acres
4g. Coastal (tidal) wetland mitigation requested:
Click to enter. acres
Page 15 of 22
PCN Form - Version 1.5, September 2020

4h. Comments:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
Click to enter.
5b. Attach mitigation plan/documentation.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a. Will the project result in an impact within a protected riparian buffer
that requires buffer mitigation?
❑ Yes ❑ No
If yes, please complete this entire section — please contact DWR for more information.
6b. If yes, identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required in the table below.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g. If buffer mitigation is required, is payment to a mitigation bank or
NC Division of Mitigation Services proposed?
❑ Yes ❑ No
6h. If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i. Comments:
Click to enter.
Page 16 of 22 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
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 El No
1 b.
All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
What Type of SCM are you
providing?
(Check all that apply)
❑ Level Spreader
ElVegetated Conveyance (lower seasonal high water table- SHWT)
❑ Wetland Swale (higher SHWT)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here.
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
❑Yes 0 No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
❑x Yes E No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20quality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state -
approved local government stormwater program? *
❑x Yes ❑x No
E n/a — project disturbs < 1 acre
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2d.
Which of the following stormwater management program(s) apply?
(Check all that apply.)*
❑ Local Government
❑x State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs *
El Phase II El USMP
❑ NSW ❑ Water Supply
Page 17 of 22
PCN Form - Version 1.5, September 2020

Please identify which local government stormwater program you are using. *
Click to enter.
State Stormwater Programs *
❑ Phase II
❑x Coastal Counties
❑ HQW or ORW
❑ Other
Comments:
The applicant secured a high density permit for Phase 1 and is working on securing a low density stormwater permit for
Phase 2.
Page 18 of 22 PCN Form - Version 1.5, September 2020

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
Z No
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 (North Carolina) Environmental
Policy Act (NEPA/SEPA)? *
❑ Yes
❑ No
lc.
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:
Click to enter.
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),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
8
Yes ❑ No
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
The Applicant fill approximately 0.32-acre of non -riparian wetlands, with the completion of two road crossings
and expansion of Upland Area 2 (see attached plan for details).
3.
Cumulative Impacts (DWR Requirement)
3a.
Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
downstream water quality? *
►z Yes E No
3b.
If you answered "no", provide a short narrative description:
Phase 1 required 0.03-acre of wetland fill for the access road. Phase 2 will require 0.47-acre of non -riparian
wetland fill for the purpose of access the remaining uplands, within the property, and expanding uplands to
increase boat/ry storage capacity.
3c.
If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdf)
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
Yes ❑ No ❑ N/A
Page 19 of 22
PCN Form - Version 1.5, September 2020

4b. If yes, 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.
Sewage is handled by on -site septic
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? (IPAC weblink: https://www.fws.gov/ipac/ [fws.govl) *
❑ Yes ❑x No
5b. Have you checked with the USFWS concerning Endangered Species
Act impacts?
❑ Yes ❑x No
5c. If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d. Is another federal agency involved? *
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8? *
❑ Yes Z No
5f. Will you cut any trees in order to conduct the work in waters of the*
U.S.?
L Yes ❑ No
5g. Does this project involve bridge maintenance or removal? *
❑ Yes Z No
5g1. If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
❑ Yes ❑ No
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http://saw-req.usace.army.mil/NLEB/1-30-17-signed NLEB-SLOPES&apps.pdf
If you answered yes to 5g1, did you discover any signs of bat use? *
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h. Does this project involve the construction/ installation of a wind
turbine(s)? *
❑Yes ❑x No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i. Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.? *
❑ Yes ❑x No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
Previous USFWS and NHP occurrences reports.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
Page 20 of 22
PCN Form - Version 1.5, September 2020

6a.
Will this project occur in or near an area designated as
an Essential Fish Habitat? *
❑ Yes
0 No
Is there submerged aquatic vegetation (SAV) around
the project vicinity? *
❑ Yes
0 No
❑ Unknown
Will this project affect submerged aquatic vegetation? *
❑ Yes
0 No
❑ Unknown
Explain: Click to enter.
6b.
What data source(s) did you use to determine whether your site would impact Essential Fish Habitat? *
This project does not include work within a waterbody that would support EFH or SAV.
7.
Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis.ncdcr.gov/hpoweb/
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 (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)? *
❑ Yes Z No
7b.
What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
Previous SHPO report
7c.
Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes
0 No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
Pender County GIS Flood Map
H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested
Page 21 of 22 PCN Form - Version 1.5, September 2020

I. Signature*
❑x By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• 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;
• The project proponent hereby agrees 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");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * Dana A. Lutheran
Signature: * Dana A. Lutheran
Date: * 2/24/2022
Page 22 of 22 PCN Form - Version 1.5, September 2020