20220793 Ver 2_ePCN Application_20230119

DWR
Division of Water Resources
Initial Review
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
Pre -Filing Meeting Date Request was submitted on:
1/16/2023
BIMS # Assigned * Version#*
20220793 2
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Holley Snider:eads\hasnider:[e-mail]
Information for Initial Review
la. Name of project:
COURTESY COPY 706 5th Street
la. Who is the Primary Contact?*
Dana Lutheran
Reviewing Office*
Wilmington Regional Office - [phone]
lb. Primary Contact Email:* lc. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
1/19/2023
Nearest Body of Water
Carolina Beach Lake
Basin
Cape Fear
Water Classification
Cape Fear River
Site Coordinates
Latitude: Longitude:
34.028876 -77.902340
A. Processing Information
County (or Counties) where the project is located:
New Hanover
Is this a NCDMS Project
Yes No
Is this project a public transportation project? *
Yes No

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
Please provide the date of the previous submission.*
6/9/2022
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):
ld. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
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?
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
11. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes
401 Water Quality Certification - Express
Riparian Buffer Authorization
No Unknown
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
ld. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Vincent and Kim Losito
2b. Deed book and page no.:
6564/1745
2c. Contact Person:
Vince Losito
Yes No
Yes No

2d. Address
Street Address
607 Sumpter Ave
Address Line 2
City State / Province / Region
Carolina Beach NC
Postal / Zip Code Country
28428 US
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address: *
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Keith Bloemendaal
3b. Business Name:
Dutch Built Homes, LLC
3c. Address
Street Address
PO Box 407 Carolina Beach NC 28428
Address Line 2
City
Carolina Beach
Postal / Zip Code
28428
3d. Telephone Number:
[phone]
3f. Email Address: *
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Dana Lutheran
4b. Business Name:
Southern Environmental Group, Inc. (SEGi)
4c. Address
Street Address
5315 South College Road
Address Line 2
Suite E
City
Wilmington
Postal / Zip Code
28412
4d. Telephone Number:
[phone]
4f. Email Address: *
[e-mail]
C. Project Information and Prior Project History
State / Province / Region
NC
Country
US
3e. Fax Number:
State / Province / Region
NC
Country
US
4e. Fax Number:
1. Project Information
1b. Subdivision name:
(if appropriate)
NA
lc. Nearest municipality / town:
Carolina Beach
2. Project Identification

2a. Property Identification Number:
R09009-007-010-000
2b. Property size:
0.14
2c. Project Address
Street Address
706 S 5th Street
Address Line 2
City
Carolina Beach
Postal / Zip Code
28428
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Carolina Beach Lake
3b. Water Resources Classification of nearest receiving water: *
Cape Fear River
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300050704
4. Project Description and History
State / Province / Region
NC
Country
US
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 vacant land, with juvenile trees and shrubs. Two remnant areas, totaling 0.025-acre, of a Pocosin, wetland pocket can be found within the southeast and northeast corners of
the property (see proposed Site Plan). A Nationwide Permit 18 was issued on 6/30/22 and for a driveway (see attached). Fill for the driveway has been placed within the 0.025-acre impact
area, however no further development has taken place beyond that. Mitigation for the previously authorized impact was fulfilled (see attached MRT Form). Residential is the main land use
in the vicinity of the project site.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
Yes No Unknown
If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW-2022-01285 and 20220793 Ver 1
4f. List the total estimated acreage of all existing wetlands on the property:
0.025
4g. List the total estimated linear feet of all existing streams on the property:
0
4h. Explain the purpose of the proposed project: *
The purpose of this project is to construct a single family dwelling, with driveway large enough to store 4 vehicles, and maintenance corridor, for private use.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The project will entail filling 0.025-acre of wetlands, with clean earthen soil. RCP pipes (sizes TBD) will be installed under the driveway entrances, as required by the Town of Carolina
Beach. The fill is necessary to facilitate the construction of a 48' x 35' pile supported, two story dwelling, with 20' front entrance stairway, driveway and maintenance corridor. Front end
loaders, dump trucks and pile drivers will be used to complete the work.
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:
SAW-2022-01285
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Noah Dean
SEGi
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
6/9/22

6. Future Project Plans
6a. Is this a phased project?*
Yes • No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
This is a single lot, with independent access and utilities. A previous permit was obtained for a driveway, but that layout did not work for the prospective buyer, who is the applicant. Permits
are not needed, in the future, to make this a viable project.
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Wetlands
Open Waters
2. Wetland Impacts
Streams -tributaries
Pond Construction
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
Driveway Access
P
Pocosin
A
No
Corps
0.025
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.025
2i. Comments:
E. Impact Justification and Mitigation
2g. Total Permanent Wetland Impact
0.025
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Due to the configuration of the wetland being at the front of the lot, avoidance was not possible. Furthermore, to ensure adequate room to park and
navigate at least four vehicles (i.e., the number of parking spaces required by the Town of Carolina Beach), the driveway could not be reduced to one
lane. Therefore, minimization was not possible.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Prior to land disturbing activities, the applicant will have silt fence installed along the limits of disturbance (LOD) line. Additionally, a construction
entrance will be installed. The measure will be inspected weekly and repaired as needed and should ensure that sediment does not discharge outside
the LOD.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
Yes No
2c. If yes, mitigation is required by (check all that apply):
DWR Corps
2d. If yes, which mitigation option(s) will be used for this project?
Mitigation bank Payment to in -lieu fee program Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
LCFUMB
3b. Credits Purchased/Requested (attach receipt and letter)
Type:
Non -riparian wetland
3c. Comments
Quantity:
0.10
A credit reservation letter will be submitted upon receipt of the Corps acceptance of the proposed plan.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)

1. Diffuse Flow Plan
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
If no, explain why:
The project site is not within one of NC's Riparian Buffer River Basins.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
Comments:
A stormwater permit will be secured through the Town of Carolina Beach
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 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 a single family lot, with independent access and utilities. It will not provide access to currently landlocked property.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
4b. 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.
Town of Carolina Beach
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
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?
The project is located within a densely developed area. Thus, further evaluation was not warranted.
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? *
The project is not abutting or adjacent to a waterbody that would support EFH.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
The project site is in an area that has been mechanically altered over the years. Furthermore, there are no structures on the subject property.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8b. If yes, explain how project meets FEMA requirements:
Please see attached approval from the Town of Carolina Beach.
8c. What source(s) did you use to make the floodplain determination?*
New Hanover County GIS Flood Map
Miscellaneous
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
706 5th Street CB Dutch Built PCN Attachments 1-16-23.pdf 5.01 MB
File must be PDF or KMZ
Comments
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
I intend to electronically sign and submit the PCN form.
Full Name:
Dana A. Lutheran
Signature
Date
1/19/2023

706 5t" Street, Carolina Beach
Pre -Construction Notification Attachments
Prepared for:
Dutch Built Homes, LLC
Keith Bloemendaal
PO Box 407
Carolina Beach, NC 28428
910.305.4604
Prepared by:
Southern Environmental Group, Inc.
5315 South College Road, Suite E
Wilmington, NC 28412
910.228.1841
Date:
16 January 2023

706 51h Street PCN Attachments 1-16-23 SEGi
Appendices
Number
Description
1
Parcel Information and Aerials
2
Division of Water Resources Water Classification Map
3
Previously Issued PJD and NWP 18
4
Site Plan & Wetland Impact Map
5
Town of Carolina Beach Floodplain Approval
6
New Hanover County GIS Flood Map

706 5t" Street PCN Attachments 1-16-23 SEGi
Attachment 1
706 5t" Street Parcel Information and Aerial
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706 5th Street PCN Attachments 1-16-23 SEGi
Attachment 2
DWR Water Classification Map
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Surface Water Classifications:
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Stream Index:
18-{71)
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Cardina
Stream Name:
CAPE FEAR RIVER
n
Beach
Description:
From upstream
c e n°ng4ry
mouth of Toomers
creek to a line across
sue're,gr�ngve -
the river from Snows
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t,,w
Paint (through Snows
Marsh) to Federal
Point
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Classification:
SC
4 nr
Date of Class.:
August 8, 1981
What does this Class.
View
mean?
"rated S -
Wil inglon
each
P `ao
River Basin:
Cape Fear

706 5th Street PCN Attachments 1-16-23 SEGi
Attachment 3
Previously Approved PJD and NWP 18

SAW-2022-01285
Electronically Transmitted
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2022-01285 County: New Hanover U.S.G.S. Quad: NC -Carolina Beach
NOTIFICATION OF JURISDICTIONAL DETERNIINATION
Requestor: Vincent Losito
Address: 607 Sumter Ave
Carolina Beach, NC 28421
E-mail: vlosito(&outlook.com
Size (acres) 0.14 Nearest Town Carolina Beach
Nearest Waterway Atlantic Ocean River Basin Cane Fear
USGS HUC 03030005 Coordinates Latitude: 34.028808
Longitude:-77.902224
Location description: The project area is located at 706 N Fifth Street in Carolina Beach.
Indicate Which of the Following Apply:
A. Preliminary Determination
® There appear to be waters, including wetlands on the above described project area/property, that may be subject to Section 404
of the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). The
waters, including wetlands have been delineated, and the delineation has been verified by the Corps to be sufficiently accurate
and reliable. The approximate boundaries of these waters are shown on the enclosed delineation map dated 6/7/2022. Therefore
this preliminary jurisdiction determination may be used in the permit evaluation process, including determining compensatory
mitigation. For purposes of computation of impacts, compensatory mitigation requirements, and other resource protection
measures, a permit decision made on the basis of a preliminary JD will treat all waters and wetlands that would be affected in any
way by the permitted activity on the site as if they are jurisdictional waters of the U.S. This preliminary determination is not an
appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part 331). However, you may
request an approved JD, which is an appealable action, by contacting the Corps district for further instruction.
❑ There appear to be waters, including wetlands on the above described project area/property, that may be subject to Section 404
of the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403).
However, since the waters, including wetlands have not been properly delineated, this preliminary jurisdiction determination
may not be used in the permit evaluation process. Without a verified wetland delineation, this preliminary determination is
merely an effective presumption of CWA/RHA jurisdiction over all of the waters, including wetlands at the project area, which
is not sufficiently accurate and reliable to support an enforceable permit decision. We recommend that you have the waters,
including wetlands on your project area/property delineated. As the Corps may not be able to accomplish this wetland
delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by the Corps.
B. Approved Determination
❑ There are Navigable Waters of the United States within the above described project area/property subject to the permit
requirements of Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act
(CWA)(33 USC § 1344). Unless there is a change in law or our published regulations, this determination may be relied upon for
a period not to exceed five years from the date of this notification.
❑ There are waters, including wetlandson the above described project area/property subject to the permit requirements of Section
404 of the Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ We recommend you have the waters, including wetlands on your project area/property delineated. As the Corps may not be
able to accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that
can be verified by the Corps.
❑ The waters, including wetlands on your project area/property have been delineated and the delineation has been verified by
the Corps. The approximate boundaries of these waters are shown on the enclosed delineation map dated DATE. We strongly
suggest you have this delineation surveyed. Upon completion, this survey should be reviewed and verified by the Corps. Once

SAW-2022-01285
verified, this survey will provide an accurate depiction of all areas subject to CWA jurisdiction on your property which, provided
there is no change in the law or our published regulations, may be relied upon for a period not to exceed five years.
❑ The waters, including wetlands have been delineated and surveyed and are accurately depicted on the plat signed by the
Corps Regulatory Official identified below onDATE. Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ There are no waters of the U.S., to include wetlands, present on the above described project area/property which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (CAMA).
You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to determine their
requirements.
Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material, construction or
placement of structures, or work within navigable waters of the United States without a Department of the Army permit may
constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If you have any questions
regarding this determination and/or the Corps regulatory program, please contact Brad Shaver at 910-251-4611 or
brad.e.shaver(&usace.armv.mil.
C. Basis For Determination: Basis For Determination: See the preliminary jurisdictional determination
form dated 06/10/2022.
D. Remarks: This verification was made via desktop.
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination 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 request
a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B.
above)
If you object to this determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed
you will find a Notification of Appeal Process (NAP) fact sheet and Request for Appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Mr. Philip A. Shannin
Administrative Appeal Review Officer
60 Forsyth Street SW, Floor M9
Atlanta, Georgia 30303-8803
AND
PHILIP.A. SHANNINgUSACE.ARMY.MIL

SAW-2022-01285
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by Not applicable.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
Digitally signed Brad Shaver
Brad Shaver 1
Date: 2022.06.10 1:23:37
-04'00'
Corps Regulatory Official:
Date of JD: 06/10/2022 Expiration Date of JD: Not applicable
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete our Customer Satisfaction Survey, located online at
hiips://re ug lator,�.ops.usace.army.mil/customer-service-survey/.
Copy Furnished(electronic):
SEGI attn: Noah Dean

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
W JL REQUEST FOR APPEAL
Applicant: Vincent Losito File Number: SAW-2022-01285
Date: 06/10/2022
Attached is:
See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission)
A
PROFFERED PERMIT (Standard Permit or Letter of permission)
B
PERMIT DENIAL
C
APPROVED JURISDICTIONAL DETERMINATION
D
❑X
PRELIMINARY JURISDICTIONAL DETERMINATION
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.army.miUMissions/CivilWorks/RegulatoryProgramandPermits.asi)
ozilig Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL olkJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division
MR. PHILIP A. SHANNIN
Attn: Brad Shaver
ADMINISTRATIVE APPEAL REVIEW OFFICER
Wilmington Regulatory Office
CESAD-PDS-O
U.S Army Corps of Engineers
60 FORSYTH STREET SOUTHWEST, FLOOR M9
69 Darlington Avenue
ATLANTA, GEORGIA 30303-8803
Wilmington, North Carolina 28403
PHONE: [phone]; FAX [phone]
EMAIL: PHILIP.A.SHANNIN(aUSACE.ARMY.MIL
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15-day
notice of any site investigation, and will have the opportunit to participate in all site invest] ations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: Brad Shaver, 69 Darlington Avenue, Wilmington, North
Carolina 28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Philip Shannin,
Administrative Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

W&
Am
-It
L. i
Property Line
[] Wetlands - -
■ Data Point
0 ft 20 ft 40 ft 60 ft
Map Souree: 2019 NC Statewide 0rthoimagery
Field Sketch of Wetlands
706 N Fifth St
Carolina Beach, New Hanover Co., N.C.
06/07/2022 022-081.01
0
s
41
r�

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2022-01285 County: New Hanover U.S.G.S. Quad: NC -Carolina Beach
GENERAL PERNHT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Vincent Losito
Address: 607 Sumter Ave
Carolina Beach, NC 28421
E-mail: vlosito(&outlook.com
Size (acres) 0.14 Nearest Town Carolina Beach
Nearest Waterway Atlantic Ocean River Basin Cape Fear
USGS HUC 03030005 Coordinates Latitude: 34.028808
Longitude:-77.902224
Location description: The project area is located at 706 5th Street in Carolina Beach.
Description of projects area and activity: This verification authorizes the placement of fill into 0.025 of an acre of jurisdictional
wetlands for the construction of a single family residence.
Applicable Law(s): © Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Nationwide 18
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
Conditions, your application signed and dated 6/9/2022, and the enclosed plans Wetland Impact Map dated 6/24/2022. Any
violation of the attached conditions or deviation from your submitted plans may subject the permittee to a stop work order, a
restoration order, a Class I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide and/or regional general permit
authorization is modified, suspended or revoked. If, prior to the expiration date identified below, the nationwide and/or regional general
permit authorization is reissued and/or modified, this verification will remain valid until the expiration date identified below, provided
it complies with all requirements of the modified nationwide permit. If the nationwide and/or regional general permit authorization
expires or is suspended, revoked, or is modified, such that the activity would no longer comply with the terms and conditions of the
nationwide permit, activities which have commenced (i.e., are under construction) or are under contract to commence in reliance upon
the nationwide and/or regional general permit, will remain authorized provided the activity is completed within twelve months of the
date of the nationwide and/or regional general permit's expiration, modification or revocation, unless discretionary authority has been
exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (LAMA), prior
to beginning work you must contact the N.C. Division of Coastal Management Morehead City, NC, at [phone].
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits. If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of
Engineers regulatory program, please contact Brad Shaver at 910-251-4611or brad.e.shaver(&usace.army.mil.
Digitally signed by Brad Shaver
Brad Shaver 1
Date: 2022.06.30 0:2143
Corps Regulatory Official:-04'00' Date: 6/30/2022
Expiration Date of Verification: 3/14/2026

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 6/10/2022
B. NAME AND ADDRESS OF PERSON REQUESTING PJD, Vincent Losito, 607 Sumter Ave, Carolina
Beach
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District, 706 N 5th, SAW-2022-01285
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: 706 N Fifth St, Carolina Beach, NC
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County: New Hanover City: Wilmington
Center coordinates of site (lat/long in degree decimal format): Latitude: N 34.028797 Longitude: W 77.902198
Universal Transverse Mercator:
Name of nearest waterbody: Atlantic Intracoastal Waterway
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
® Office (Desk) Determination. Date:6/10/2022
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site Number
Latitude (decimal
degrees)
Longitude (decimal
degrees)
Estimated amount of
aquatic resources in
review area (acreage
and linear feet, if
applicable
Type of aquatic
resources (i.e.,
wetland vs. non
wetland waters)
Geographic authority to
which the aquatic resource
"may be" subject (i.e.,
Section 404 or Section
10/404)
1
34.028797
77.902198
0.05 ac
Wetland
Section 404
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:
® Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: Field sketch of wetland
® 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:
❑ 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.
® U.S. Geological Survey map(s). Cite scale & quad name: 1:24k Carolina Beach
® Natural Resources Conservation Service Soil Survey. Citation: Soil Survey of New Hanover Co.
❑ 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): 2019 NCOneMaps Orthoimagery
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.
Digitally signed by Brad
Shaver
Brad Shaver Date: 2022.06.10 11:21:30
-04'00'
Signature and date of Regulatory
staff member completing PAD
DATE
Signature and date of person requesting PJD
(REQUIRED, unless obtaining the signature is
impracticable)1
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester 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.

SAW-2022-01285
SPECIAL CONDITIONS
Nationwide 18 706 5tn Street.
a. In order to compensate for impacts associated with this permit, mitigation shall be provided in
accordance with the provisions outlined on the most recent version of the attached Compensatory
Mitigation Responsibility Transfer Form. The requirements of this form, including any special conditions
listed on this form, are hereby incorporated as special conditions of this permit authorization.
b. Fill slope boundary must maintain a 2:1 slope and must be permanently stabilized upon project
completion including the proposed retaining wall location.
Digitally signed by Brad
Shaver
Brad C J h a V e r Date: 2022.06.30 10:22:04
-04'00'

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: Vincent Losito Action ID: SAW-2022-01285
Project Name: 706 5th Street, Carolina Beach
County: New Hanover
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that Wilmington District Project Manager identified on page two is in receipt of a signed copy of this form before conducting
authorized impacts, unless otherwise specified below. If more than one Mitigation Sponsor will be used to provide the
mitigation associated with the permit, or if the impacts and/or the mitigation will occur in more than one 8-digit Hydrologic
Unit Code (HUC), multiple forms will be attached to the permit, and the separate forms for each Sponsor and/or HUC must
be provided to the appropriate Mitigation Sponsors.
Instructions to Sponsor: The Sponsor verifies that the mitigation requirements (credits) shown below have been released
and are available at the identified site. By signing below, the Sponsor is accepting full responsibility for the identified
mitigation, regardless of whether they have received payment from the Permittee. Once the form is signed, the Sponsor
must update the bank ledger and provide a copy of the signed form and the updated ledger to the Permittee, the Project
Manager who issued the permit, the Bank Project Manager, and the District Mitigation Office (see contact information on
page 2). The Sponsor must also comply with all reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted Impacts Requiring Mitigation* 8-digit HUC and Basin: 03030005, Cape Fear River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
0.025
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements: 8-digit HUC and Basin: 03030005, Cape Fear River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
0.10
Mitigation Site Debited: Lower Cape Fear Umbrella Mitigation Bank
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCDMS, list NCDMS. If the NCDMS
acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsibility for
providing the mitigation identified in this document (see the table above), associated with the USACE Permittee and Action
ID number shown. I also verify that released credits (and/or advance credits for NCDMS), as approved by the Wilmington
District, are currently available at the mitigation site identified above. Further, I understand that if the Sponsor fails to provide
the required compensatory mitigation, the USACE Wilmington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the mitigation requirements.
Mitigation Sponsor Name:
Name of Sponsor's Authorized Representative:
Signature of Sponsor's Authorized Representative Date of Signature
Page 1 of 2 Form Version 10 June 2020 updated

CESAW-RG (File Number, SAW-2022-01285)
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the District is in receipt of the signed form, the
Permittee is no longer responsible for providing the mitigation identified in this form, though the Permittee remains
responsible for any other mitigation requirements stated in the permit conditions.
• Construction within jurisdictional areas authorized by the permit identified on page one of this form can begin only after
the District is in receipt of a copy of this document signed by the Sponsor, confirming that the Sponsor has accepted
responsibility for providing the mitigation requirements listed herein. When NCDMS provides mitigation for authorized
impacts conducted by the North Carolina Department of Transportation (NCDOT), construction within jurisdictional areas
may proceed upon permit issuance; however, a copy of this form signed by NCDMS must be provided to the District
within 30 days of permit issuance. NCDOT remains fully responsible for the mitigation until the District has received this
form, confirming that the Sponsor has accepted responsibility for providing the mitigation requirements listed herein.
• Signed copies of this document must be retained by the Permittee, Mitigation Sponsor, and in the USACE administrative
records for both the permit and the Bank/ILF Instrument. It is the Permittee's responsibility to ensure that the District
Project Manager (address below) is provided with a signed copy of this form.
• If changes are proposed to the type, amount, or location of mitigation after this form has been signed and returned to
the District, the Sponsor must obtain case -by -case approval from the District Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios may be applied, as per current District guidance
and a new version of this form must be completed and included in the District administrative records for both the permit
and the Bank/ILF Instrument.
Comments/Additional Conditions: A letter from Lower Cape Fear Umbrella Mitigation Bank, confirming they are willing
and able to accept the applicant's compensatory mitigation responsibility, dated 6/8/2022 was included with the
preconstruction notification.
This form is not valid unless signed below by the District Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor should provide copies of this form along with an updated bank ledger to: 1) the Permittee, 2) the
District Project Manager at the address below, 3) the Bank Manager listed in RIBITS, and 4) the Wilmington District
Mitigation Office, 3331 Heritage Trade Drive, Suite 105, Wake Forest, NC 27587 (or by email to [e-mail] V.mil).
Questions regarding this form or any of the permit conditions may be directed to the District Mitigation Office.
USACE Project Manager: Brad Shaver
USACE Field Office: Wilmington Regulatory Office
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
Email: [e-mail]
Digitally signed by Brad Shaver
Brad Shaver Date: 2022.06.30 10:23:07
-04'00'
USACE Project Manager Signature
6/30/2022
Date of Signature
Current Wilmington District mitigation guidance, including information on mitigation ratios, functional assessments, and
mitigation bank location and availability, and credit classifications (including stream temperature and wetland groupings) is
available at http://ribits.usace.army.mi1.

7.5'
10'
T
A etlan N 0.05 ac PROPOSED 18.5' x 18" RC
ithin Proje Limits
.� 12
PROPOSED
RETAINING WALLS
7.5 � 20' �
P OPOSED DWECLINq.,,
•
PROPOSED TT VZ11 T
1110 SF % 0.02t OK
-..
.• receives •
../
A.'
Proposed Culvert Profile Proposed grade
qh*-.
Property Line J ' Existing grade c i mope wim
retaining walls
❑ Wetlands 18.51
Limit of wetland impact
0 ft 20 ft 40 ft 60 ft kA -"
j" = 271 Wetland Impact Map
706 S 5th Street
Map Source: 2019 NC Statewide Orthoimagery Carolina Beach, New Hanover Co., NC
6/24/22

706 51h Street PCN Attachments 1-16-23 SEGi
Attachment 4
Dutch Built Homes
706 51h Street Site Plan & Wetland Impact Map

i
Eqqqft�i��—
Property Line
v/ Wetlands i
Proposed Wetland Impact
Previously Approved & Filled
. ® Wetland Impact
Oft 20 ft 40 ft 60 ft
1"=27'
Map Source: 2019 NC Statewide Orthoimagery
R
Wetland Boundary and Impact Map
706 South 5th Street
Carolina Beach, New Hanover County, NC
1/16/23
T

706 5th Street PCN Attachments 1-16-23 SEGi
Attachment 5
Town of Carolina Beach Floodplain Approval

From:
Gloria Abbotts
To:
dlutheran(a seai.us
Cc:
Shaver. Brad E CIV USARMY CESAW (USA)
Subject:
RE: 706 S 5th Street
Date:
Tuesday, June 28, 2022 4:37:22 PM
Attachments:
imaae003.ona
Hi Dana,
I just spoke with Brad Shaver and got some clarification on what the USACE is looking for. There
should be no issue with placing fill in the wetlands at this property as long as the proper fill/grade
permits and new construction permits are obtained and are compliant with the town's ordinance
and flood requirements.
Hope this helps.
Thanks,
Gloria Abbotts
Sr Planner
Town of Carolina Beach
1121 N. Lake Park Blvd.
Carolina Beach, NC 28428
910-458-8380
www.carolinabeach.org
** Online Permitting Portal - For instructions on using Portal, click here**
From: Gloria Abbotts
Sent: Tuesday, June 28, 2022 9:05 AM
To: [e-mail]
Subject: RE: 706 S 5th Street
Dana,
Thanks for the clarification. Flood vents are required on opposing walls tin per sq ft of enclosed
space. The garage doors would not count. If the slab will be above BFE + freeboard flood vents
wouldn't be required but we would need to see that elevation.

Thanks,
Gloria
From: dlutheran ansegi.us <dlutheran( segi.us>
Sent: Monday, June 27, 2022 9:39 AM
To: Gloria Abbotts <gloria.abbotts ancarolinabeach.org>
Subject: RE: 706 S 5th Street
Be Advised: This email originated from outside of the Town of Carolina Beach, NC
Good morning, Gloria.
Yes, from a floodplain perspective. I don't see flood vents, but I was thinking the garage opening up on
both sides would meet the flow threw requirements. Is that not the case? If it is not, I will have the owner
revise the house plans. Do you need the elevation for the slab too?
Many thanks,
Dana
50utkem E_nvironmental Goup, Inc.
5315 South College Road,juite F
Wilmington, NC 2841 2
Phone: 9 1 OA52.27 1 1
Mokile: 91 0.228. 1 8+1 (Preferr,- J)
www.segi.us
From: Gloria Abbotts <gloria.abbotts ancarolinabeach.org>
Sent: Friday, June 24, 2022 4:46 PM
To: dlutheran( segi.us
Subject: RE: 706 S 5th Street
Hi Dana,
Are they asking from a flood zone perspective? I can confirm that it meets flood zone requirements
if flood vents are shown on the ground floor or the elevations for the slab are provided?
Thanks,
Gloria Abbotts
Sr Planner
Town of Carolina Beach
1121 N. Lake Park Blvd.
Carolina Beach, NC 28428
910-458-8380
www.carolinabeach.org

** Online Permitting Portal - For instructions on using Portal, click here**
From: dlutheran @segi.us <dlutheran aPsegi.us>
Sent: Thursday, June 23, 2022 1:11 PM
To: Gloria Abbotts <gloria.abbotts ancarolinabeach.org>
Subject: 706 S 5th Street
Be Advised: This email originated from outside of the Town of Carolina Beach, NC
Hello, Gloria.
Hope all is well with you. I'm not sure you are the person to whom I should be sending this email, but I
thought, if you are not, you would likely be able to direct me in the right direction.
I am working on behalf of the property owner, Mr. Vince Losito, who has enlisted us to secure a
Nationwide Permit (NWP), from the USACE, due to the need to impact wetlands (see attached site plan)
That being said, the property is within the 100 year flood zone, and as part of the NWP process, the
USACE has requested we seek the Town's approval of the project, from a FEMA perspective, to
complete their application and review.
Attached you will find the proposed building plans. Heated space will be no less than 2' above base flood
elevation. Since part of the ground floor is to be enclosed, garage doors will be on the front and back, to
allow for a flow through scenario. All other building techniques and materials will meet the requirements of
flood zone development.
If you have questions or need anything further, please feel free to call (910.228.1841).
Dana
`jouthem r_nvironmental Goup, Inc.
53 15 `joutl, College Koad, juite l—
Wilmington, NC 2841 2
Phone: [phone]
Mokile: 9 1 0.228.1 841
www.segi.us
This email has been checked for viruses by Avast antivirus software.
www.avast.com

706 5t" Street PCN Attachments 1-16-23 SEGi
Attachment 6
New Hanover County GIS Flood Map

706 5th Street PCN Attachments 1-16-23 SEGi
Attachment 7
Completed Mitigation Responsibility Transfer Form

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: Vincent Losito Action ID: SAW-2022-01285
Project Name: 706 5th Street, Carolina Beach
County: New Hanover
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that Wilmington District Project Manager identified on page two is in receipt of a signed copy of this form before conducting
authorized impacts, unless otherwise specified below. If more than one Mitigation Sponsor will be used to provide the
mitigation associated with the permit, or if the impacts and/or the mitigation will occur in more than one 8-digit Hydrologic
Unit Code (HUC), multiple forms will be attached to the permit, and the separate forms for each Sponsor and/or HUC must
be provided to the appropriate Mitigation Sponsors.
Instructions to Sponsor: The Sponsor verifies that the mitigation requirements (credits) shown below have been released
and are available at the identified site. By signing below, the Sponsor is accepting full responsibility for the identified
mitigation, regardless of whether they have received payment from the Permittee. Once the form is signed, the Sponsor
must update the bank ledger and provide a copy of the signed form and the updated ledger to the Permittee, the Project
Manager who issued the permit, the Bank Project Manager, and the District Mitigation Office (see contact information on
page 2). The Sponsor must also comply with all reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted Impacts Requiring Mitigation* 8-digit HUC and Basin: 03030005, Cape Fear River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
0.025
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements: 8-digit HUC and Basin: 03030005, Cape Fear River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
0.10
Mitigation Site Debited: Lower Cape Fear Umbrella Mitigation Bank
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCDMS, list NCDMS. If the NCDMS
acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsibility for
providing the mitigation identified in this document (see the table above), associated with the USACE Permittee and Action
ID number shown. I also verify that released credits (and/or advance credits for NCDMS), as approved by the Wilmington
District, are currently available at the mitigation site identified above. Further, I understand that if the Sponsor fails to provide
the required compensatory mitigation, the USACE Wilmington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the mitigation requirements.
Mitigation Sponsor Name: LCFUMB, LLC
Name of Sponsor's Authorized Representative: ion Vincent
7/5/2022
Signature of Sponsor's Authorized Representative Date of Signature
Page 1 of 2 Form Version 10 June 2020 updated

CESAW-RG (File Number, SAW-2022-01285)
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the District is in receipt of the signed form, the
Permittee is no longer responsible for providing the mitigation identified in this form, though the Permittee remains
responsible for any other mitigation requirements stated in the permit conditions.
• Construction within jurisdictional areas authorized by the permit identified on page one of this form can begin only after
the District is in receipt of a copy of this document signed by the Sponsor, confirming that the Sponsor has accepted
responsibility for providing the mitigation requirements listed herein. When NCDMS provides mitigation for authorized
impacts conducted by the North Carolina Department of Transportation (NCDOT), construction within jurisdictional areas
may proceed upon permit issuance; however, a copy of this form signed by NCDMS must be provided to the District
within 30 days of permit issuance. NCDOT remains fully responsible for the mitigation until the District has received this
form, confirming that the Sponsor has accepted responsibility for providing the mitigation requirements listed herein.
• Signed copies of this document must be retained by the Permittee, Mitigation Sponsor, and in the USACE administrative
records for both the permit and the Bank/ILF Instrument. It is the Permittee's responsibility to ensure that the District
Project Manager (address below) is provided with a signed copy of this form.
• If changes are proposed to the type, amount, or location of mitigation after this form has been signed and returned to
the District, the Sponsor must obtain case -by -case approval from the District Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios may be applied, as per current District guidance
and a new version of this form must be completed and included in the District administrative records for both the permit
and the Bank/ILF Instrument.
Comments/Additional Conditions: A letter from Lower Cape Fear Umbrella Mitigation Bank, confirming they are willing
and able to accept the applicant's compensatory mitigation responsibility, dated 6/8/2022 was included with the
preconstruction notification.
This form is not valid unless signed below by the District Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor should provide copies of this form along with an updated bank ledger to: 1) the Permittee, 2) the
District Project Manager at the address below, 3) the Bank Manager listed in RIBITS, and 4) the Wilmington District
Mitigation Office, 3331 Heritage Trade Drive, Suite 105, Wake Forest, NC 27587 (or by email to [e-mail] V.mil).
Questions regarding this form or any of the permit conditions may be directed to the District Mitigation Office.
USACE Project Manager: Brad Shaver
USACE Field Office: Wilmington Regulatory Office
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
Email: [e-mail]
Digitally signed by Brad Shaver
Brad Shaver Date: 2022.06.30 10:23:07
-04'00'
USACE Project Manager Signature
6/30/2022
Date of Signature
Current Wilmington District mitigation guidance, including information on mitigation ratios, functional assessments, and
mitigation bank location and availability, and credit classifications (including stream temperature and wetland groupings) is
available at http://ribits.usace.army.mi1.