20221003 Ver 1_401 Application_20220725

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW -
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Lot 253 Belvedere
2. Work Type: ✓❑Private ❑ Institutional ❑Government ❑ Commercial
Begin Date (Date Received):
Assign Action ID Number in ORM ❑
3. Project Description / Purpose [PCN Form B3d and B3e]:
To install a small wetland crossing for a driveway.
4. Property Owner / Applicant [PCN Form A3 or A4]: Paul Nowell
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Gene Young, REHS
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location — Coordinates, Street Address, and/or Location Description [PCN Form Bib]:
34.389316; -77.642293. Lakeview Drive, Hampstead, NC
8. Project Location — Tax Parcel ID [PCN Form Bla]: 4203-95-6595-0000
9. Project Location — County [PCN Form A2b]: Pender
10. Project Location —Nearest Municipality or Town [PCN Form A2c]: Hampstead, NC
11. Project Information — Nearest Waterbody [PCN Form B2a]: Nixon Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]: 03030001
Authorization: Section 10 ❑ Section 404 ✓❑ Section 10 and 404 ❑
Regulatory Action Type:
•
a
NI
Standard Permit
Nationwide Permit #
Regional General Permit #
Jurisdictional Determination Request
Pre -Application Request
Unauthorized Activity
Compliance
No Permit Required
Revised 20150602

10/19/21, 8:38 AM Submission Completed
DWR Pre -Filing Meeting Request Form
Contact Name*
Contact Email Address *
Project Owner*
Project Name*
Project County*
Owner Address:*
Gene Young, REHS
[e-mail]
Paul Nowell
Lot 253 Belvedere
Pander
Street Address
6924 Queensbury Drive
Address Line 2
City State 1 Province / Region
Charlotte NC
Postal / Zip Code Co-.. n!ry
28226 USA
Is this a transportation project?* Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Individual Permit
Shoreline Stabilization
Does this project have an existing project lD#?*
Yes No
NORTH CAROLINA
&grwan,td Quality
401 Water Quality Certification - Express
Modification
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information. *
This site is located at the comer of Lakeview Court and Lakeview Drive in Belvedere subdivision. The scope of this project
is to install a small wetland crossing for a driveway to access upland area for a home site.
By digitally signing below, I certify that 1 have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401
Certification Rule.
https://edocs.deq.nc.gov/Forms/Form/Submit 112

10/19/21, 8:38 AM Submission Completed
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting
location and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you
can submit an application.
Signature*
Qekte young, t €I/S
Submittal Date 10/19/2021
https:lledocs.deq.nc.govlForms/Fonn/Submit 212

AR
Geothermal, Environmental,
& Well Drilling
October 19, 2021
US Army Corps of Engineers
Wilmington District Office
Attn: Mr. Tom Charles
69 Darlington Avenue
Wilmington, NC 28403
RE: Lot 253 Belvedere
Pender County, North Carolina
Mr. Charles,
In an effort to further clarify the intent of the above referenced project, the following
documents for your review;
Project Narrative Letter
Jurisdictional Determination Request Form
Preliminary Jurisdictional Determination Form -Appendix 1
Wetland Determination Data Form -Wetland
Wetland Determination Data Form -Upland
Site Vicinity Map — Figure 1
Proposed Fill Impact Map — Figure 2
Surveyed Plat of property
EPCN form
If you have any questions, please do not hesitate to contact our office at [phone].
Sincerely,
( i
Gene Y
Environme - - cientist
g4
Applied Resource Management, PC
P. 0. Box 552, 257 Transfer Station Road, Hamp tead, NC 25443, 910.270.2919, Fax [phone]

October 19, 2021
US Army Corps of Engineers
Wilmington District Office
Attn: Mr. Tom Charles
69 Darlington Avenue
Wilmington, North Carolina 28403
RE: Project Narrative
Lot 253 Belvedere
Pender County, NC
Ms. Charles
Ag
'N/i,
Geothermal, Environmental,
& Well Drilling
On behalf of Paul Nowell, Applied Resources Management, P.C. is providing you with a project
narrative for the above referenced site.
The project is located along Lakeview Drive in Pender County. The site is currently undeveloped
and is located in an established neighborhood.
The proposed project consists of construction of a single-family residence. With the location of the
existing wetland area a small fill impact is proposed for the construction of a driveway. The fill area
is noted to be approximately 0.05 acres and is to be stabilized with a retaining wall to minimize the
amount of impact needed.
If you have any questions or require any additional information, please feel free to contact me at
[phone].
Sincerely,
Gene ung, RE S
Environm - ientist
Applied resource Management, PC
p.a. box 882, 257 Transfer Station Road, Hampstead, NC 25443, 910.270.2919, Fax [phone]

Jurisdictional Determination Request
US Army Carps
of Engineers
WNm ngmn pislncl
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.armv.mi I/Missions/RegulatoryPermitProgram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina28801-5006
General Number. [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number. [phone]
Fax Number. [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number (9I 0) 251-4610
Fax Number. [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number [phone]
INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalfofa
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all ID requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D -NCDOT REOUESTS: Property owner authorization/notification for
ID requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, • rior to startin work.
Version: May 2017
Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: Lakeview Drive
City, State: Hampstead, NC
County: Pender
Parcel Index Number(s) (PIN): 4203-95-6595-0000
B. REQUESTOR INFORMATION
Name: Gene Young, REHS
Mailing Address: 257 Transfer Station RD
Telephone Number:
Electronic Mail Address:
Select one:
0
El
0
Hampstead, NC 28443
910-617-4914
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other, please explain. _
C. PROPERTY OWNER INFORMATION2
Name: Paul Nowell
Mailing Address: 6924 Queensbury Drive
Telephone Number:
Electronic Mail Address:
Charlotte, NC 28226
[phone]
[e-mail]
t Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION3.4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: ❑ Owner ✓❑ Authorized Agents
10/19/21
D
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
• I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
Erocess.
�/ I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
▪ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
HA Corps JD is required in order obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
I believe that the site may be comprised entirely of dry land.
Other:
3 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
4 If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
3 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017
Page 3

Date: 10-19-2021
To Whom It May Concern:
RE: Agent and Access 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, reviews or permitting.
I furthermore authorize the US Army Corps of Engineers and/or the North Carolina
Division of Water Resources representative(s) to access my property as part of this
process.
Sincerely,
Printed Name: Paul Nowell
Property Address: Lots: 253 & 253A Lakeview Dr. Hampstead Dr, NC 28443

jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓❑ Size of Property or Review Area 0.89 acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H.
REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude: 34.389316
Longitude: -77.642293
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 1 Ix17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
• North Arrow
• Graphical Scale
• Boundary of Review Area
• Date
• Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
• Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
■ Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
✓❑ Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. ht+p:.`?www,saw.usace_arni, .mil/Missions/Regpintoru-Permit-
Prtr duris &tFan!
Version: May 2017 Page 5

Jurisdictional Determination Request
Completed appropriate Jurisdictional Determination form
• PJDss please complete a Preiiminary Jurisdictional Determination Form7 and include the
Aquatic Resource Table
• AJDs, please complete an Approved Jurisdictional Determination Form8
Vicinity Map
Aerial Photograph
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
Other Assessment Forms
7 www, w.asacc,arn+v.€nil/Pprtala.+491doc er smlgtocydre cs/JD:RGL 04.42 A A Prelim. 1 D Form iitlaj lq.pdf
8 Please see http://www.saw.usace.armv.milIMissions/Regulatory-Permit-Program/Jurisdiction.'
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department ofJustice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information isvoluntary; however, if information is not provided, the
request for an AJD cannot be evaluated norcan an AJD be issued.
Version: May 2017 Page 6

Appendix 1 - REQUEST FOR CORPS JURISDICTIONAL DETERMINATION (JD)
To: District Name Here
• I am requesting a JD on property located at: t.ot 253 Belvedere Lakeview Drive
(Street Address)
City/Township/Parish: Hempstead County: Pend•► State: NC
Acreage of Parcel/Review Area for JD: OM
Section: Township: Range:
Latitude (decimal degrees): 34.389318 Longitude (decimal degrees):-77.842293
(For linear projects, please include the center point of the proposed alignment.)
• Please attach a survey/plat map and vicinity map identifying location and review area for the JD.
• I• I currently own this property. — I plan to purchase this property.
f0 I am an agent/consultant acting on behalf of the requestor.
C7 Other (please explain):
• Reason for request: (check as many as applicable)
I intend to construct/develop a project or perform activities on this parcel which would be designed to
avoid all aquatic resources.
Q I intend to construct/develop a project or perform activities on this parcel which would be designed to
avoid all jurisdictional aquatic resources under Corps authority.
[J1 intend to construct/develop a project or perform activities on this parcel which may require
authorization from the Corps, and the JD would be used to avoid and minimize impacts to jurisdictional
a vatic resources and as an initial step in a future permitting process.
✓1 I intend to construct/develop a project or perform activities on this parcel which may require authorization from
the Corps; this request is accompanied by my permit application and the JD is to be used in the permitting process.
D I intend to construct/develop a project or perform activities in a navigable water of the U.S, which is
included on the district Section 10 list and/or is subject to the ebb and flow of the tide.
DA Corps JD is required in order to obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps confirm that
unsdiction does/does not exist over the aquatic resource on the parcel.
,D I believe that the site may be comprised entirely of dry land.
= Other:
• Type of determination being requested:
D I am requesting an approved JD.
I am requesting a preliminary JD.
1 am requesting a "no permit required" letter as I believe my proposed activity is not regulated.
I am unclear as to which JD I would like to request and require additional information to inform my decision.
By signing below, you are indicating that you have the authority, or are acting as the duly authorized agent of a
person or entity with such authority, to and do hereby grant Corps personnel right of entry to legally access the
site if needed to perform the JD. Your signature shall be an affirmation that you possess the requisite property
rights to request a JD on the subject property.
*Signature:
• Typed or printed nam
Gene
oung, ' HS
Date: ‘.0.1�ZL
Company name: Applied Resource Management
Address: 257 Transfer Station RD
Hampstead, NC 28443
Daytime phone no.: 9104317-4914
Email address: gene®armnc.com
'Authorities: Rivers and Harbors Act, Section 10 33 USC 403: Crean Water Act, Section 404. 33 USC 1344; Marine Protection, Research, and Sanctuaries Act,
Section 103, 33 USC 1413 Regulatory Program of the U S. Army Corps of Engineers; Final Rule for 33 CFR Parts 320-332,
Principal Purpose: The information that you provide will be used in evaluating your request to determine whether there are any aquatic resources within the protect
area subject to federal jurisdiction under the regulatory authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies, and the public, and may be
made available as part of a public notice as required by federal law. Your name and property location where federal jurisdiction Is to be determined will be included in
the approved jurisdictional determination (AJD), which will be made available to the public on the District's website and on the Headquarters USACE website.
Disclosure: Submission of requested Information Is voluntary; however, if information Is not provided, the request for an AJD cannot be evaluated nor can an AJD be
Issued.

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD:
B. NAME AND ADDRESS OF PERSON REQUESTING PJD:
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Pender City: Hampstead
Center coordinates of site (lat/long in degree decimal format):
Lat.: 34.389316 Long.: -77.642293
Universal Transverse Mercator:
Name of nearest waterbody: Nixon Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (Le., Section
404 or Section 10/404)
1
34.389316
-77.642293
0.31
wetland
404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) for that review area based on an
informed decision after having discussed the various types of JDs and their
characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction notification" (PCN), or requests verification for a non -reporting NWP or
other general permit, and the permit applicant has not requested an AJD for the
activity, the permit applicant is hereby made aware that: (1) the permit applicant has
elected to seek a permit authorization based on a PJD, which does not make an
official determination of jurisdictional aquatic resources; (2) the applicant has the
option to request an AJD before accepting the terms and conditions of the permit
authorization, and that basing a permit authorization on an AJD could possibly result
in less compensatory mitigation being required or different special conditions; (3) the
applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including whatever mitigation requirements the Corps has
determined to be necessary; (5) undertaking any activity in reliance upon the subject
permit authorization without requesting an AJD constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the
review area affected in any way by that activity will be treated as jurisdictional, and
waives any challenge to such jurisdiction in any administrative or judicial compliance
or enforcement action, or in any administrative appeal or in any Federal court; and (7)
whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. Part 331. if, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic
jurisdiction exists over aquatic resources in the review area, or to provide an official
delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD finds
that there "may be"waters of the U.S. and/or that there °may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
0 Maps, plans, plots or plat submitted by or on behalf of the PJD requestor
Map:
O Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
D Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
O U.S. Geological Survey map(s). Cite scale & quad name: Hampstead, NC 2019
❑ 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 Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter.
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signature an
person requesting
(REQUIRED, unless obtaining
the signature is impracticable)'
1 Districts may establish timeframes for requestor to retum signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site: Lot 253 Belvedere
Applicant/Owner.. Paul Nowell
City/County: Pender Sampling Date; 7/27/21
State: NC Sampling Point: upland
Investigator(s): Gene Young, REHS - Applied Resource Mngmnt Section, Township, Range: Hampstead, NC
Landform (hillside, terrace, etc.): side slope
Subregion (LRR or MLRA): LRR T
Soil Map Unit Name: pactolus
Local relief (concave, convex, none): linear Slope (%): 3-4
Lat: 34.389316N Long:-77.642293W Datum:
NWI classification: hardwood flat
Are climatic / hydrologic conditions on the site typical for this time of year? Yes x No (If no, explain In Remarks.)
Are Vegetation , Soll , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes x No
Are Vegetation , Soll , 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
Hydric Soil Present? Yes No x
Wetland Hydrology Present? Yes No x
Is the Sampled Area
within a Wetland?
Yes No X
Remarks:
does not appear to be a wetland.
HYDROLOGY
Wetland Hydrology Indicators:
Primary 141cators (minimum of one is required: check all that applvl
Secondary Indicators (minimum of two required)
Surface Soil Cracks (B6)
(B8)
(C9)
_
_Surface Water (Al) Aquatic Fauna (B13) ? Sparsely Vegetated Concave Surface
High Water Table (A2) Marl Deposits (B15) (LRR U) Drainage Patterns (810)
_ _
— Saturation (A3) Hydrogen Sulfide Odor (C1) Moss Trim Lines (B16)
_ _
Water Marks (B1) Oxidized Rhizospheres on Living Roots (C3) Dry -Season Water Table (C2)
_
_Sediment Deposits (82) —Presence of Reduced Iron (C4) Crayfish Burrows (C8)
Drift Deposits (B3) Recent Iron Reduction in Tilled Soils (C6) Saturation Visible on Aerial Imagery
_ —
_Algal Mat or Crust (B4) _Thin Muck Surface (C7) Geomorphic Position (D2)
Iron Deposits (B5) Other (Explain in Remarks) (D3)
_ShallowAquitard
Inundation Visible on Aerial Imagery (B7) Test (D5)
_FAC-Neutral
Water -Stained Leaves (B9) Sphagnum Moss (D6) (LRR T,U)
Field Observations:
Surface Water Present? Yes No x Depth (inches):
Wetland Hydrology Present? Yes
No
x
Water Table Present? Yes No x Depth (inches):
Saturation Present? Yes No x Depth (Inches):
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Amiy Corps of Engineers
Atlantic and Gulf Coastal Plain Region — Version 2.0

VEGETATION (Five Strata) - Use scientific names of plants.
Sampling Point:
upland
Absolute Dominant Indicator
Tree Stratum (Plot size: 30 ) % Cover Species? Status
1. Llquldarnbar styreciflua 10 Yes FAC
2. Pious taeda 30 Yes FAC
3.
4.
5.
6.
40 =Total Cover
50% of total cover. 20 20% of total cover. 8
Saolino Stratum (Plot size: )
1.
2.
3.
4.
5.
6.
50% of total cover:
Shrub Stratum (Plot size: )
1. Morella cerifera
2.
3.
4.
5.
6.
Herb Stratum
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
(Plot size:
50% of total cover.
)
=Total Cover
20% of total cover.
30 Yes FAC
30 =Total Cover
15 20% of total cover: 6
50% of total cover.
Woody Vine Stratum (Plot size:
1.
2.
3.
4.
5.
)
50% of total cover.
=Total Cover
20% of total cover.
=Total Cover
20% of total cover.
FACW
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 3 (A)
Total Number of Dominant
Species Across All Strata: 3 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: 100.0% (NB)
Prevalence Index worksheet:
Total % Cover of: Multiply by:
OBL species 0 x 1 = 0
FACW species 0 x 2 = 0
FAC species 70 x 3 = 210
FACU species 0 x 4 = 0
UPL species 0 x 5 = 0
Column Totals: 70 (A) 210 (B)
Prevalence index = BIA = 3.00
Hydrophytic Vegetation Indicators:
_ 1 - Rapid Test for Hydrophytic Vegetation
X 2 - Dominance Test is >50%
3 - Prevalence Index is s3.0'
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must be
present, unless disturbed or problematic.
Definitions of Five 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, �i , woody
plants, except woody vines, less than approximately 3
ft (1 m) in height.
Woody Vine - Alt woody vines, regardless of height.
Hydrophytic
Vegetation
Present? Yes X No
Remarks: (If observed, list morphological adaptations below.)
Site has been cleared
US Army Corps of Engineers
Atlantic and Gulf Coastal Plain Region - Version 2.0

SOIL
Sampling Point:
upland
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loc2 Texture
0-14 10YR 2/1
14-24 10YR 6/4
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
Remarks
Sandy uncoated sand grains
Sandy
Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.)
Histosol (Al)
_ Histic Epipedon (A2)
Black Hiatt (A3)
_Hydrogen Sulfide (A4)
_ Stratified Layers (A5)
Organic Bodies (A6) (LRR, P, T, U)
_ 5 cm Mucky Mineral (A7) (LRR P, T, U)
Muck Presence (A8) (LRR U)
_ 1 cm Muck (A9) (LRR P, T)
_ Depleted Below Dark Surface (A11)
_Thick Dark Surface (Al2)
Coast Prairie Redox (A16) (MLRA 150A)
_Sandy Mucky Mineral (S1) (LRR 0, S)
_Sandy Gleyed Matrix (S4)
_ Sandy Redox (S5)
— Stripped Matrix (S6)
Dark Surface (S7) (LRR P, S, T, U)
Polyvalue Below Surface (S8)
(LRR S, T, U)
Thin Dark Surface (S9) (LRR S, T, U)
_ Barrier Islands 1 cm Muck (S12)
(MLRA 153B,153D)
_Loamy Mucky Mineral (F1) (LRR 0)
_Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Marl (F10) (LRR U)
Depleted Ochric (F11) (MLRA 161)
Iron -Manganese Masses (F12) (LRR 0, P, T)
_Umbric Surface (F13) (LRR P, T, U)
_Delta Ochric (F17) (MLRA 161)
_ Reduced Vertic (F18) (MLRA 160A,1508)
Piedmont Floodplain Soils (F19) (MLRA 149A)
_Anomalous Bright Floodplain Soils (F20)
(MLRA 149A, 163C, 153D)
Very Shallow Dark Surface (F22)
(MLRA 138, 152A in FL, 154)
'Location: PL=Pore Lining. M=Matrix.
Indicators for Problematic Hydric Soils':
1 cm Muck (A9) (LRR O)
2 cm Muck (A10) (LRR S)
_Coast Prairie Redox (A16)
(outside MLRA 160A)
Reduced Vedic (F18)
(outside MLRA 160A, 160B)
_Piedmont Floodplaln Soils (F19) (LRR P,1)
_Anomalous Bright Floodplain Soils (F20)
(MLRA 163B)
_ Red Parent Material (F21)
Very Shallow Dark Surface (F22)
(outside MLRA 138, 162A in FL,154)
_ Barrier Islands Low Chroma Matrix (TS7)
(MLRA 153B, 163D)
Other (Explain in Remarks)
'indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No x
Remarks:
This data form is revised from Atlantic and Gulf Coastal Plain Regional Supplement Version 2.0 to include the NRCS Field Indicators of Hydric Soils,
Version 8.0, 2016.
US Army Corps of Engineers
Atlantic and Gulf Coastal Plain Region — Version 2.0

WETLAND DETERMINATION DATA FORM -- Atlantic and Gulf Coastal Plain Region
Project/Site: Lot 253 Belvedere City/County: Pender Sampling Date: 7/27/21
Applicant/Owner.. Paul Nowell
State: NC Sampling Point: wetland
Investigator(s): Gene Young, REHS - Applied Resource Mngmnt Section, Township, Range Hampstead, NC
Landform (hillside, terrace, etc.): side slope Local relief (concave, convex, none): linear Slope (%): 3-4
Subregion (LRR or MLRA): LRR T
Soil Map Unit Name: padolus
Lat: 34.389316N Long:-77.642293W Datum:
NWI classification: hardwood flat
Are climatic / hydrologic conditions on the site typical for this time of year? Yes x No (If no, explain in Remarks.)
Are Vegetation , Soil , or Hydrology significantly disturbed? Are `Normal Circumstances" present? Yes x No
Are Vegetation , Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, Important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Yes x No
Yes x No
Yes x No
Is the Sampled Area
within a Wetland? Yes X No
Remarks:
appears to be a wetland.
HYDROLOGY
Wetland Hydrology Indicators:
primary Indicators (minimum of one is required: check all that apply)
Secondary Indicators (minimum of two required).
Surface Soil Cracks (BB)
Surface (B8)
(C9)
_
_Surface Water (A1) Aquatic Fauna (B13) ? Sparsely Vegetated Concave
_High Water Table (A2) Deposits (B15) (LRR U) Patterns (B10)
_Marl _Drainage
_Saturation (A3) _Hydrogen Sulfide Odor (C1) Trim Lines (B16)
_Moss
Water Marks (B1) Rhizospheres on Living Roots (C3) Dry -Season Water Table (C2)
_Oxidized
_Sediment Deposits (B2) Presence of Reduced Iron (C4)
_
Crayfish Burrows (C8)
(C6) — Saturation Visible on Aerial Imagery
x Drift Deposits (a3) — Recent Iron Reduction in Tilled Soils
Algal Mat or Crust (134) Muck Surface (C7) Geomorphic Position (D2)
_Thin
_Iron Deposits (B5) Other (Explain in Remarks) Shallow Aquitard (03)
_ _
_ Inundation Visible on Aerial Imagery (B7) FAC-Neutral Test (D5)
_
x Water -Stained Leaves (B9) Moss (D8) (LRR T,U)
Field Observations:
Surface Water Present? Yes No x Depth (inches):
_Sphagnum
Wetland Hydrology Present? Yes X
No
Water Table Present? Yes No x Depth (inches):
Saturation Present? Yes No x Depth (inches):
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers
Atlantic and Gulf Coastal Plain Region — Version 2 0

VEGETATION (Five Strata) - Use scientific names of plants.
Sampling Point:
wetland
Absolute
Tree Stratum (Plot size: 30 ) % Cover
1. Llquidember styraciflua 10
2. Pinus taeda 30
3.
4.
5.
6.
Dominant Indicator
Species? Status
Yes FAC
Yes FAC
40 =Total Cover
50% of total cover. 20 20% of total cover. 8
Sapling Stratum (Plot size:
1.
2.
3.
4.
5.
6.
50% of total cover.
Shrub Stratum (Plot size: )
1. Morella cerifera 30 Yes
=Total Cover
2.
3.
4.
5.
8.
Herb Stratum
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
(Plot size:
50% of total cover.
}
20% of total cover
FAC
30 =Total Cover
15 20% of total cover. 6
50% of total cover.
Woody Vine Stratum (Plot size:
1.
2.
3.
4.
5.
=Total Cover
20% of total cover.
=Total Cover
50% of total cover. 20% of total cover.
FACW
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 3 (A)
Total Number of Dominant
Species Across All Strata: 3 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: 100.0% (A!B)
Prevalence Index worksheet:
Total % Cover of Multiply by:
OBL species 0 x 1 = 0
FACW species 0 x 2 = 0
FAC species 70 x 3 = 210
FACU species 0 x 4 = 0
UPL species 0 x 5 = 0
Column Totals: 70 (A) 210 (B)
Prevalence Index = B/A = 3.00
Hydrophytic Vegetation Indicators:
1 - Rapid Test for Hydrophytic Vegetation
X 2 - Dominance Test is >50%
X 3 - Prevalence Index Is 53.0'
.-_.. Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must be
present. unless disturbed or problematic.
Definitions of Five 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, and woody
plants, except woody vines, less than approximately 3
ft (1 m) in height.
Woody Vine - Ail woody vines, regardless of height.
Hydrophytic
Vegetation
Present? Yes X No
Remarks: (If observed, list morphological adaptations below.)
Site has been cleared
US Army Corps of Engineers
Atlantic and Gulf Coastal Plain Region - Version 2.0

Depth
(inches)
SOIL
Sampling Point:
wetland
Profile Description: (Describe to the depth needed to document the Indicator or confirm the absence of Indicators.)
Matrix Redox Features
Color (moist) % Color (moist) % Type' Loc2 Texture
0-12 10YR 211
12-24 10YR 6/4
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.)
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, U)
x Muck Presence (A8) (LRR U)
1 cm Muck (A9) (LRR P, T)
_ Depleted Below Dark Surface (A11)
_Thick Dark Surface (Al2)
Coast Prairie Redox (A16) (MLRA 150A)
Sandy Mucky Mineral (S1) (LRR 0, S)
Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
_ Stripped Matrix (S6)
x Dark Surface (S7) (LRR P, S, T, U)
`Palyvaiue Below Surface (S8)
(LRR S, T, U)
Thin Dark Surface (S9) (LRR S, T, U)
Barrier Islands 1 cm Muck (S12)
(MLRA 153B, 153D)
_ Loamy Mucky Mineral (F1) (LRR 0)
_ Loamy Gleyed Matrix (F2)
_Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
�Redox Depressions (F8)
Marl (F10) (LRR U)
_ Depleted Ochric (F11) (MLRA 151)
Iron -Manganese Masses (F12) (LRR 0, P, T)
Umbric Surface (F13) (LRR P, T, U)
Delta Ochric (F17) (MLRA 151)
Reduced Vertic (F18) (MLRA 160A, 150B)
Piedmont Floodplain Soils (F19) (MLRA 149A)
Anomalous Bright Floodplain Soils (F20)
(MLRA 149A, 153C, 153D)
Very Shallow Dark Surface (F22)
(MLRA 138, 152A in FL, 164)
Remarks
Sandy mucky
Sandy
2Location: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Sollss:
1 cm Muck (A9) (LRR O)
2 cm Muck (A10) (LRR 5)
_ Coast Prairie Redox (A16)
(outside MLRA 150A)
_ Reduced Vedic (F18)
(outside MLRA 150A,150B)
_ Piedmont Floodplain Soils (F19) (LRR P, T)
Anomalous Bright Floodplain Soils (F20)
(MLRA 153B)
_ Red Parent Material (F21)
Very Shallow Dark Surface (F22)
(outside MLRA 138, 152A in FL, 154)
Barrier Islands Low Chrome Matrix (TS7)
(MLRA 153B, 153D)
Other (Explain in Remarks)
'Indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (If observed):
Type:
Depth (inches):
Hydric Soil Present?
Yes x No
Remarks:
This data form is revised from Atlantic and Gulf Coastal Plain Regional Supplement Version 2.0 to include the NRCS Field Indicators of Hydric Soils,
Version 8.0, 2016.
US Army Corps of Engineers
Atlantic and Gulf Coastal Plain Region — Version 2.0

Project Review Area
Prellmlnary Wetland Boundary
JOB:
210354
'Topsail
Sound
Topsail Beach
Map adapted from USGS Tot, NC 2019 I
Lot 253 Belvedere
Site Vicinity
SCALE: DATE: I DRAWN BY:
1 "= 1000' 10/19/21 GY
FIGURE:

4,
Jo
41
0)
TRANS
TPED
IPF
KEVIEW DRIVE
''' R /W
83
20
/ AREA 1
I—
25' FRONT
SETBACK
N88'53'39"
91.09'
Preliminary Wetland Boundary
Proposed Fill Area (0.05 acres)
IPF
IPF'
Jo
h Proposed
Retaining Wall
1
of
co
c
LOT
DB
rG
2
0
IIN
CP
9�
IPF
N
1
Map adapted from previous survey by Dwight E Ashley, PLS dated Aug. 23, 2021
TITLE:
Applied Resource
Lot 253&253A Belvedere
Proposed Fill Impact
Management, P. C. JOB: SCALE: ' DATE: DRAWN BY:
Hampstead, NC 28443 210354 1 "= 50' 10/6/21 GY
FIGURE:
2

CERTIFICATION
I, DWIGHT E. ASHLEY, CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION FROM AN
ACTUAL SURVEY MADE UNDER MY SUPERVISION (DEED DESCRIPTION RECORDED IN DEED BOOK
4701, PAGE 1111 AND MAP BOOK 16 PAGE 20); THAT THE BOUNDARIES NOT SURVEYED ARE
CLEARLY INDICATED AS BROKEN LINES; THAT THE RATIO OF PRECISION 151: 10,000+; AND THAT
THIS MAP MEETS THE REQUIREMENTS OF THE STANDARDS OF PRACTICE FOR LAND SURVEYING
IN NORTH CAROLINA G.S. 47-30 AS AMENDED. WITNESS MY ORIGINAL SIGNATURE, LICENSE
NUMBER, AND SEAL THIS 23RD DAY OF AUGUST, A.D., 2021.
P 4
DWIGHT E. ASHLEY, PLS
L-5263
01111111llo,�
CARoil
S.
11 ! 1111110
WETLANDS/UPLANDS
ACRES
SQ. FT.
UPLANDS AREA 1
0.14
6,116
WETLANDS AREA 2
0.26
11,054
UPLANDS AREA 3
0.42
18,218
WETLANDS AREA 4
0 05
2,354
LOT 250
(
LOT 251
DB 2434 PG 183
MB 16 PG 20
TRANS
TPED O
IPF
•
LAKEVIEW DRIVE
60' R/W
/
/
AREA TABLE
ACRES
SQ. FT.
SUBJECT PARCEL
0 87
37,742
FLOOD HAZARD ZONE "AE"
(BFE=8')
. .r
FLOOD HAZARD ZONE "X"
IPF`
BELVEDERE HOLDINGS, LLC
DB 4715 PG 883
MB 23 PG 143
IPF
/
/
rya"/
43/ 3'
/ AREA 2
/ AREA 1
25' FRONT
SETBACK CPED
N88'53'39 W a
•
91.09' CP
LEGEND
© IRON PIPE FOUND (IPF)
® IRON REBAR SET (IRS)
Qo IRON PIPE SET (IPS)
O COMPUTED POINT (CP) NOT SET
X SPOT ELEVATION
O�
08"E
84.167-4'
CP
cb°j
AREA
4
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LOT 253 & 253A /
DB 4701 PG 1111
/ MB 16 PG 20 /
ZONED: PD
/ X /
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ti0
/441
8p �S 6
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IPF
BOUNDARY PARCEL
STREET RIGHT OF WAY
ADJACENT PARCEL
— — — SETBACK LINE
AEC LINE
CAMA BUFFER
— — — • — HIGH WATER LINE
EXISTING CONDITIONS SURVEY FOR:
PAUL & MARY ANN NOWELL
LOTS 253 & 253A
REVISION OF SECTION 1
BELVEDERE PLANTATION
LAKEVIEW DRIVE
HAMPSTEAD, NC 28443
PIN: 4203-95-6595-0000
50 0 50 100 150
SCALE: 1"=100' --- JOB: 086-001
TOPSAIL TOWNSHIP
PENDER COUNTY
\ n
6 \1X G�F'A-t�
16.7' f
CP
IPF
LOT 254 & 254A
DB 2977 PG 333
MB 16 PG 20
LOT 255
BELVEDERE
HOLDINGS. LLC
DB 4715 PG 883
MB 23 PG 143
ABBREVIATIONS:
DB - DEED BOOK
MB - MAP BOOK
/R/W - RIGHT OF WAY
TRANS -TRANSFORMER
CPED - CABLE PEDESTAL
TPED - TELEPHONE PEDESTAL
/
moms
1. THE PURPOSE OP THUS SURVEY I TO SNOW DOTING c000rnoNs ON was 2S1 AND 751A.
E. AREA BY COORDINATE COTAPUT ADON METHOD.
S. ALL DISTANCES ME US SURVEY SOOT IIORITONTAI GRID EAST ANCESEVNLESSOTNERNRSEHOTTDE
E. PROPERTY IS SUMO MANY AND All EASEMENTS, RIGHTS OF WAY, RESTRKTKINS, ANO AGREEMENTS OP RECORD
THAT MAT SE REVEALED IN A T1AL LIRE REPORT A fULE TITSE SWIOE WAS NOT PERFORATED AS PORT OF NM SURVEY
S. A PORTION OF THE SUSPECT PARCEL APPEARS TO SE MCA=IN A MOM EE000 HALM POHE. ROHE-sr0E.E1
AS SHOWN CPI EESAA TT000 INSURANCE RATE MAP 577O EUX11I. MAP MONO 0u1H70 W AND h"RsfAlhncAV.-
A WETEANOS FLAGGED ET APPLIEDRESWRCE MANAGEMOET AND SURVEYED 011 anvil.
7 SE7RACRSRREREI CEO IN PENWER=NTT WIPED DEV1LOPMENTDRDINRNCF 01110ISEOR0N 4.14 Fd17ONWG
pmT11ECE Po
LAND SURVEYOR:
DWIGHT E. ASHLEY, PLS
2017 OYSTER CATCHER DRIVE
HAMPSTEAD. NC 28443
TELEPHONE NO. [phone]
LICENSE: L-5263

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
Please note: fields marked with a red asterisk - below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN % 20Help % 20File % 202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Pender
Is this a NCDMS Project*
Yes No
Click Yes, only if NCDMS is the applicant or co -applicant.
Is this project a public transportation project?*
Yes No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
la. Type(s) of approval sought from the Corps: *
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization? *
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
lc. 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):
List all NW numbers you are applying for not on the drop down list.
Id. Type(s) of approval sought from the DWR:*
check all that apply
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
Pre -Filing Meeting Information
401 Water Quality Certification - Express
Riparian Buffer Authorization
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. Click here to read more information on when this form is needed prior to application submission or here to view the form.
Is this a courtesy copy notification?*
Yes No
ID# Version

Pre -fling Meeting or Request Date*
10/19/2021
Attach documentation of Pre -Filing Meeting Request here: *
Click the upload button or drag and drop files here to attach document
DWR Pre -Filing Meeting Request Form.pdf
File type must be PDF
1e. 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
If. Is this an after -the -fact permit application?*
Yes No
lg. 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 • No
Acceptance Letter Attachment
Click the upload button or drag and drop files here to attach document
FILE TYPE MUST BE PDF
lh. Is the project located in any of NC's twenty coastal counties?*
Yes No
li. 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
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Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
la. Who is the Primary Contact?*
Gene Young, REHS
1 b. Primary Contact Email:*
[e-mail]
ld. Who is applying for the permit?*
Owner
(Check all that apply)
1e. Is there an Agent/Consultant for this project? *
Yes No
2. Owner Information
2a. Name(s) on recorded deed: *
Paul Nowell
2b. Deed book and page no.:
4701 / 1111-1114
2c. Contact Person:
(for Corporations)
2d. Address*
Street Address
6924 Queensbury Drive
Address Line 2
City
Charlotte
Postal / Zip Code
28226
2e. Telephone Number: *
[phone]
lc. Primary Contact Phone: *
(xxx)xxx-xxxx
[phone]
Applicant (other than owner)
State / Province / Region
NC
Country
USA

2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address: *
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:*
Gene Young, REHS
3b. Business Name:
(if applicable)
Applied Resource Management
3c. Address*
Street Address
257 Transfer Station RD
Address Line 2
City
Hampstead
Postal / Zip Code
28443
3d. Telephone Number: *
[phone]
(xxx)xxx-xxxx
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:*
Gene Young, REHS
4b. Business Name:
(if applicable)
Applied Resource Management
4c. Address*
Street Address
257 Transfer Station RD
Address Line 2
City
Hampstead
Postal / Zip Code
28443
4d. Telephone Number: *
[phone]
(xxx)xxx-xxxx
4f. Email Address: *
[e-mail]
C. Project Information and Prior Project History
State / Province / Region
NC
Country
USA
3e. Fax Number:
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
USA
4e. Fax Number:
[phone]
(xxx)xxx-xxxx
1. Project Information
1a. Name of project: *
Lot 253 Belvedere
1b. Subdivision name:
(if appropriate)
Belvedere
lc. Nearest municipality / town:*
Hampstead, NC
2. Project Identification

2a. Property Identification Number:
(tax PIN or parcel ID)
4203-95-6595-0000
2c. Project Address
Street Address
Lakeview drive
Address Line 2
City
Hampstead
Postal / Zip Code
28443
2d. Site coordinates in decimal degrees
2b. Property size:
(in acres)
0.89
State / Province / Region
NC
Country
USA
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as appropriate, based on how the location was
determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude: *
34.389316 -77.642293
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Nixon Creek
3b. Water Resources Classification of nearest receiving water:*
SA/HQW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
White Oak
3d. Please provide the 12-digit HUC in which the project is located.*
030203020403
River Basin Lookup
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 site is in an established subdivision. The lot is currently undeveloped.
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:
0.31
4g. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
4h. Explain the purpose of the proposed project: *
The purpose is to install a small crossing for a driveway access for a proposed home in upland areas. The crossing will be for a driveway access only.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
Typical construction equipment such as backhoes, dump trucks, etc will be used. The site will only consist of fill for a driveway location and will be stabilized with retaining walls to further
reduce the impact. Culverts will be placed under the driveway to allow for surface flow under the driveway.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes
Comments:
No Unknown
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
Example: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?

Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
Gene Young, REHS
Applied Resource Management
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? This includes other
separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Wetlands
Open Waters
Streams -tributaries
Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be used in the table below to represent the word "wetland".
Buffers
2a. Site #* (?)
2a1 Reason * (?)
2b. Impact type*(?)
2c. Type of W.*
2d. W. name*
2e. Forested *
2f. Type of Jurisdicition *
(?)
2g. Impact
area*
1
fill
P
Hardwood Flat
wetland 1
No
Corps
0.050
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.050
2g. Total Wetland Impact
0.050
2i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The wetland impact cannot be avoided, however; the impact will be minimized by putting the driveway at the smallest crossing point.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques: *
The wetland impact will be stabilized with the use of retaining walls to further limit the fill amount. Other construction will occur in upland areas.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
Yes No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
this is below the required threshold.
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
*** Recent changes to the stormwater rules have required updates to this section ..***
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No

For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
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
To look up low density requirement click here 15A NCAC 02H .1003(2).
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? *
Yes No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (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 (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
This is the only impact proposed on this property and the adjacent property is already developed.
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
5d. Is another Federal agency involved?*
Yes
5e. Is this a DOT project located within Division's 1-8? *
Yes No
No Unknown
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
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?**
Yes No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.? *
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NC Natural Heritage 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? *
site is not in an aquatic environment or near a primary nursery area.
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 No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NC HPOWeb
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 No
8c. What source(s) did you use to make the floodplain determination?*
Pender County GIS Tax map
Miscellaneous
Comments
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
JD package.pdf
File must be PDF or KMZ
Signature
By checking the box and signing below, I certify that:
901.45KB
• 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:*
Gene Young, REHS
Signature*
Qeif e 120/5
Date
10/19/2021

DWR Pre -Filing Meeting Request Form
NORTH CAROLINA
Ertrlmnmerticl QueUy
Contact Name *
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address: *
Gene Young, REHS
[e-mail]
Paul Nowell
Lot 253 Belvedere
Pender
Street Address
6924 Queensbury Drive
Address Line 2
City State / Province / Region
Charlotte NC
Postal / Zip Code Country
28226 USA
Is this a transportation project?* Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - 401 Water Quality Certification -
Regular Express
Individual Permit Modification
Shoreline Stabilization
Does this project have an existing project ID#?*
Yes No
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.*
This site is located at the corner of Lakeview Court and Lakeview
Drive in Belvedere subdivision. The scope of this project is to install a
small wetland crossing for a driveway to access upland area for a
home site.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401
Certification Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting
location and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you

can submit an application.
Signature*
Qene fa 9, i?e .5
Submittal Date 10/19/2021

TRANS
TPED O
IPF
KEVIEW DRIVE
R /W
91.09'
83
Preliminary Wetland Boundary
Proposed Fill Area (0.05 acres)
IPF'
IPF
CP
CP
•
-9�
IPF
CP
4.am X -/ LOT
�h i 10.3' -mom DB
.h
Proposed
Retaining Wall
N
Map adapted from previous survey by Dwight E Ashley, PLS dated Aug. 23, 2021
Applied Resource
Management, F. C.
Hampstead, NC 28443
TITLE:
Lot 253&253A Belvedere
Proposed Fill Impact
JOB:
210354
SCALE:
1"= 50'
DATE:
10/6/21
DRAWN BY:
GY
FIGURE:
2