20221646 Ver 1_401 Application_20221117

Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
1a. Name of project:
1a. Who is the Primary Contact?
1b. Primary Contact Email:1c. Primary Contact Phone:
Site Coordinates
Latitude:Longitude:
Pre-Filing Meeting Date Request was submitted on:
County (or Counties) where the project is located:
Nearest Body of Water
Is this a NCDMS Project *
Is this project a public transportation project?
1a. Type(s) of approval sought from the Corps:
Has this PCN previously been submitted?*
1b. What type(s) of permit(s) do you wish to seek authorization?
1c. Has the NWP or GP number been verified by the Corps?
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
8530 S Old Oregon Inlet Road
Troy Murphy
[e-mail] [phone]
35.892374 -75.589104
A. Processing Information
11/17/2022
Dare
Yes No
Yes No
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Yes
No
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
Yes No
18 - Minor Discharges
401 Water Quality Certification - Regular 401 Water Quality Certification - Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual 401 Water Quality Certification
Yes No
For the record only for Corps Permit:
1f. Is this an after-the-fact permit application?
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
1h. Is the project located in any of NC's twenty coastal counties?
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
1j. Is the project located in a designated trout watershed?
1d. Who is applying for the permit?
1e. Is there an Agent/Consultant for this project?*
2. Owner Information
4. Agent/Consultant (if applicable)
Yes No
Yes No
Yes No
Yes No
Yes No Unknown
Yes No
B. Applicant Information
Owner Applicant (other than owner)
Yes No
2a. Name(s) on recorded deed:
2b. Deed book and page no.:
2c. Contact Person:
2d. Address
2e. Telephone Number:2f. Fax Number:
2g. Email Address:*
Cam Realty, LLC
DB 1891, PG 360
Susan MacDonald
City
Plymouth
State / Province / Region
CT
Postal / Zip Code
06782
Country
USA
Street Address
105 Carter Road
Address Line 2
[phone]
[e-mail]
4a. Name:
4b. Business Name:
4c. Address
4d. Telephone Number:4e. Fax Number:
4f. Email Address:*
Troy Murphy
Quible & Associates P.C.
City
Kitty Hawk
State / Province / Region
NC
Postal / Zip Code
27949
Country
USA
Street Address
PO Box 870
Address Line 2
[phone]
[e-mail]
C. Project Information and Prior Project History
1b. Subdivision name:
1c. Nearest municipality / town:
2a. Property Identification Number:2b. Property size:
2c. Project Address
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
3b. Water Resources Classification of nearest receiving water:*
3d. Please provide the 12-digit HUC in which the project is located.
3c. What river basin(s) is your project located in?*
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:*
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
4f. List the total estimated acreage of all existing wetlands on the property:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
1. Project Information
(if appropriate)
Nags Head
2. Project Identification
071909070001 0.32
City
Nags Head
State / Province / Region
NC
Postal / Zip Code
27959
Country
USA
Street Address
8530 S Old Oregon Inlet Road
Address Line 2
Roanoke Sound
SA-HQW
030102051502
Pasquotank
The site is currently undeveloped uplands and wetlands. Adjacent parcels include single family residences and undeveloped uplands and wetlands.
Yes No Unknown
NWP 18, Action ID: 200510080
0.23
No streams present
Fill of 0.03 acres of wetlands to accommodate a single family residential development. A fill permit was issued in 2005 for 0.10 acres of wetland fill, mitigation was paid, but only 0.06 acres
of wetlands were filled. This permit would be to complete the necessary fill to accommodate the proposed development and fill the remaining previously permitted fill.
The proposed project will consist of filling 0.03 acres of wetlands using dump trucks, skid steer, and silt fencing to contain the proposed fill.
Yes No Unknown
Preliminary Approved Not Verified Unknown N/A
Action ID: 200411585
Agency/Consultant Company:
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
6. Future Project Plans
6a. Is this a phased project?*
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?
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
2. Wetland Impacts
2a. Site #*(?)2a1 Reason *(?)2b. Impact type *(?)2c. Type of W.*2d. W. name *2e. Forested *2f. Type of Jurisdicition *
(?)
2g. Impact
area *
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
2g. Total Wetland Impact
2e. Comments:
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
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?
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT’s Individual NPDES permit NCS000250?*
2004, USACE Approved Determination
Yes No
D. Proposed Impacts Inventory
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
1 Residential
Development
P Estuarine Woody Wetland Wetland Yes Corps 0.030
(acres)
0.000 0.030
0.030
E. Impact Justification and Mitigation
The proposed fill area has been minimized to achieve the desired single family residential development of this lot. The existing uplands are being
utilized.
Silt fencing will be used to contain all fill proposed. All fill will be sloped in a manner that does not promote erosion.
Yes No
A fill permit was issued in 2005 for 0.10 acres of wetland fill, mitigation was paid for the full 0.10 acres, but only 0.06 acres of wetlands were filled.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
Yes No
No riparian buffers present within the Pasquotank River Basin.
Yes No
Comments:
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
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)?*
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
3b. If you answered “no,” provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
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?*
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
5d. Is another Federal agency involved?*
5e. Is this a DOT project located within Division's 1-8?
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
8b. If yes, explain how project meets FEMA requirements:
G. Supplementary Information
Yes No
Yes No
Yes No
Yes No N/A
Yes No
Yes No
Yes No Unknown
Yes No
NC Natural Heritage Program
Yes No
No surface water impacts are proposed.
Yes No
National Register of Historic Places
Yes No
This type of development is allowable within the AE flood zones, as long as the first floor elevation exceeds the base flood elevation.
8c. What source(s) did you use to make the floodplain determination?*
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.
Comments
*
· 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:*
Signature
Date
NC FRIS (Flood Risk Information System)
Miscellaneous
Click the upload button or drag and drop files here to attach document
NRCS_Soil_Map.pdf 443.38KB
USGS-ROANOKE ISLAND NE.pdf 1003.92KB
authorization owner 8530.pdf 34.53KB
P22160-NAT 18-LOT 1-111722.pdf 291.2KB
File must be PDF or KMZ
Signature
By checking the box and signing below, I certify that:
Troy Murphy
11/17/2022
SITE
Copyright (C) 2009 MyTopo
075° 36' 00.00" W
075° 36' 00.00" W
075° 35' 00.00" W
075° 35' 00.00" W
075° 34' 00.00" W
075° 34' 00.00" W
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SCALE 1:24000
0 1 MILE
0 1000 YARDS
0 1 KILOMETER
Declination
MN 10.85° W

MN
Location: 035° 53' 31.84" N 075° 35' 22.59" WName: ROANOKE ISLAND NE
Date: 11/11/22
Scale: 1 inch = 2,000 ft.
Copyright (C) 2009 MyTopo
Datum: NAD27
Soil Map—Dare County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
11/11/2022
Page 1 of 3
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446740 446770 446800 446830 446860 446890 446920
446740 446770 446800 446830 446860 446890 446920
35° 53' 36'' N
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Map projection: Web Mercator Corner coordinates: WGS84 Edge tics: UTM Zone 18N WGS84
0 50 100 200 300
Feet
0 15 30 60 90
Meters
Map Scale: 1:1,240 if printed on A portrait (8.5" x 11") sheet.
Soil Map may not be valid at this scale.
MAP LEGEND MAP INFORMATION
Area of Interest (AOI)
Area of Interest (AOI)
Soils
Soil Map Unit Polygons
Soil Map Unit Lines
Soil Map Unit Points
Special Point Features
Blowout
Borrow Pit
Clay Spot
Closed Depression
Gravel Pit
Gravelly Spot
Landfill
Lava Flow
Marsh or swamp
Mine or Quarry
Miscellaneous Water
Perennial Water
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
Sodic Spot
Spoil Area
Stony Spot
Very Stony Spot
Wet Spot
Other
Special Line Features
Water Features
Streams and Canals
Transportation
Rails
Interstate Highways
US Routes
Major Roads
Local Roads
Background
Aerial Photography
The soil surveys that comprise your AOI were mapped at
1:24,000.
Warning: Soil Map may not be valid at this scale.
Enlargement of maps beyond the scale of mapping can cause
misunderstanding of the detail of mapping and accuracy of soil
line placement. The maps do not show the small areas of
contrasting soils that could have been shown at a more detailed
scale.
Please rely on the bar scale on each map sheet for map
measurements.
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL:
Coordinate System: Web Mercator (EPSG:3857)
Maps from the Web Soil Survey are based on the Web Mercator
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Albers equal-area conic projection, should be used if more
accurate calculations of distance or area are required.
This product is generated from the USDA-NRCS certified data as
of the version date(s) listed below.
Soil Survey Area: Dare County, North Carolina
Survey Area Data: Version 23, Sep 8, 2022
Soil map units are labeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photographed: Data not available.
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor
shifting of map unit boundaries may be evident.
Soil Map—Dare County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
11/11/2022
Page 2 of 3
Map Unit Legend
Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
CrB Corolla-Duckston complex, 0
to 6 percent slopes, rarely
flooded
2.5 38.5%
DtA Duckston fine sand, 0 to 2
percent slopes, occasionally
flooded
3.4 51.5%
NeC Newhan fine sand, 0 to 10
percent slopes
0.7 10.0%
Totals for Area of Interest 6.6 100.0%
Soil Map—Dare County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
11/11/2022
Page 3 of 3

RE: Dare County Parcel # 007974000, PIN # 071909070001
8530 S. Oregon Inlet Rd., Nags Head, NC

As owner representative of Cam Realty, LLC (owner of the above referenced property) in Nags
Head, NC, I authorize Quible & Associates, P.C. to act as permitting agent for the purpose of
obtaining a Nationwide 18 Permit and 401 Water Quality Certification if necessary. And, I
authorize USACE and NCDWR to access the above referenced property as necessary for the
same purpose.

___________________________________________
Authorized Signature

Name: ________________________ Title: ______________________

Date: ____________