20230598 Ver 1_PCN 4-21-23_20230425

4/21/23, 2:25 PM
Submission Completed
1 DW'R
111211
1014islon of Water ReSowrS4*
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
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.govlWaterResources/0/edocl6247041PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
Pre -Filing Meeting Date Request was submitted on: *
4/19/2023
If this is a courtesy copy, please fill in this with the submission date.
Is this project connected with ARPAfunding?*
Yes No
County (or Counties) where the project is located: *
New Hanover
Is this a NCDMS Project*
O Yes No
Click Yes, only if NCDMS is the applicant or co -applicant.
hftps://edocs.deq.nc.gov/Forms/Form/Submit 1 /15

4/21/23, 2:25 PM
Submission Completed
DO NOT CHECK YES, UNLESS YOU ARE DMS 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.
1a. Type(s) of approval sought from the Corps: *
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?*
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?*
Yes No
Nationwide Permit (NWP) Number: 18 - Minor Discharges
NWP Numbers (for multiple NWPS):
List all NW numbers you are applying for not on the drop down list.
1d. 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
401 Water Quality Certification - Express
Riparian Buffer Authorization
le. Is this notification solely for the record because written approval is not required?
*
For the record only for DWR 401 Certification: Yes No
https://edocs.deq.nc.gov/Forms/Form/Submit 2/15

4/21/23, 2:25 PM Submission Completed
For the record only for Corps Permit: Yes No
1f. Is this an after -the -fact permit application?*
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
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
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 No Unknown
1 j. Is the project located in a designated trout watershed?*
_ Yes No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-
Coord i nation/Trout.aspx
B. Applicant Information
1 a. Who is the Primary Contact?*
Dana Lutheran
1 b. Primary Contact Email:
[e-mail]
1d. Who is applying for the permit?*
Owner
(Check all that apply)
le. Is there an Agent/Consultant for this project?*
Yes No
1 c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
Applicant (other than owner)
https://edocs.deq.nc.gov/Forms/Form/Submit 3/15

4/21/23, 2:25 PM Submission Completed
2. Owner Information
2a. Name(s) on recorded deed:
Madison Smith
2b. Deed book and page no.:
BK 006570 PG 000504
2c. Contact Person:
(for Corporations)
Same
2d. Address*
Street Address
160 Beaumont Oaks
Address Line 2
Apt. 226
City
State / Province / Region
Wilmington
NC
Postal / Zip Code
Country
28412
us
2e. Telephone Number:*
(XXX)X oc-XXXX
[phone]
2f. Fax Number:
(XXX)X oc-XXXX
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name: *
Dana Lutheran
4b. Business Name:
(if applicable)
Southern Environmental Group, Inc. (SEGi)
https://edocs.deq.nc.gov/Forms/Form/Submit 4/15

4/21/23, 2:25 PM Submission Completed
4c. Address*
Street Address
5315 South College Road
Address Line 2
Suite E
City
State / Province / Region
Wilmington
NC
Postal / Zip Code
Country
28412
us
4d. Telephone Number:*
[phone] 4e. Fax Number:
(XXX)X oc-XXXX (XXX)XXX-XXXX
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1 a. Name of project:*
4337 Appleton Way
1b. Subdivision name:
(if appropriate)
Echo Farms
1c. Nearest municipality / town:*
Wilmington
https://edocs.deq.nc.gov/Forms/Form/Submit 5/15

4/21/23, 2:25 PM Submission Completed
2. Project Identification
2a. Property Identification Number: 2b. Property size:
(tax PIN or parcel ID) (in acres)
R07012-001-042-000 0.49
2c. Project Address
Street Address
4337 Appleton Way
Address Line 2
City
State / Province / Region
Wilmington
NC
Postal / Zip Code
Country
28412
US
2d. Site coordinates in decimal degrees
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: *
34.161536-77.917104
ex: 34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Bernard's Creek
3b. Water Resources Classification of nearest receiving water:
C;SW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
hftps://edocs.deq.nc.gov/Forms/Form/Submit 6/15

4/21/23, 2:25 PM
Submission Completed
3d. Please provide the 12-digit HUC in which the project is located. *
030300050504
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:*
Currently the project site is wooded, and Section 404 wetlands (i.e., Headwater Forest) encompass all but the
southeast corner of the subject property, which is located within the existing Echo Farms Subdivision. A 15'
drainage easement extends along the northern property line and conveys stormwater runoff, from the
subdivision, to an unnamed tributary that drains to Barnards Creek.
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:
0.337
4g. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
0
4h. Explain the purpose of the proposed project: *
The purpose of this project is to construct a single family dwelling with adequate maintenance corridor.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The project will entail removing woody vegetation and root mat from the limits of disturbance, after which the
area will be backfilled with clean earthen soil. Lastly, a retaining wall will be installed to contain the fall and
final grading will take place. The area will be stabilized with seed or sod when construction has been
completed.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes
Comments:
No
The Applicant is not seeking a JD with this action.
Unknown
hftps://edocs.deq.nc.gov/Forms/Form/Submit 7/15

4/21/23, 2:25 PM
Submission Completed
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved
Corps AID Number:
Example: SAW-2017-99999
Not Verified Unknown N/A
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant
Company:
Other:
David Scibetta
SEGi
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 includes other separate and distant
crossing for linear projects that require Department of the Army authorization but don't require pre -
construction notification.
This project is part of an existing subdivision, where a road system is already in place, and sewer and water
are available for connection, at the street.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands
Open Waters
Streams -tributaries
Pond Construction
Buffers
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland
area impacted.
https://edocs.deq.nc.gov/Forms/Form/Submit 8/15

4/21/23, 2:25 PM
Submission Completed
"W." will be used in the table below to represent the word "wetland".
2a. Site
#* (')
2a1 Reason*
M
2b. Impact
type* M
2c. Type of W. *
2d. W. name*
2e.
Forested
2f. Type of
Jurisdicition*
M
2g.
Impact
area
1
lF]ot fill
P
Headwater Forest
A
Yes
Corps
0.048
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.048
2g. Total Wetland Impact
0.048
21. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project: *
The applicant had a wetland delineation conducted prior to designing the project. Once
wetlands were identified and became apparent that avoiding impacting the resource was
not possible, the Applicant positioned the structure within the only available uplands (i.e.,
that area behind the city's building setbacks) and incorporated a retaining wall around the
fill, which removed the slope of the fill. The retaining wall will minimize impacts to
wetlands by approximately 700 SF (0.016 AC).
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques:*
Prior to land disturbing activities, the approved wetland impact line will be marked in the
field with construction fencing and silt fence will be installed, to ensure unauthorized
impacts do not take place.
https://edocs.deq.nc.gov/Forms/Form/Submit 9/15

4/21/23, 2:25 PM
Submission Completed
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:
Lower Cape Fear Umbrella Mitigation Bank (LCFUMB)
3b. Credits Purchased/Requested (attach receipt and letter)
Type:
Quantity:
Riparian wetland 0.10
3c. Comments
A credit reservation letter has bee requested, from the LCFUMB, and will be forwarded
upon receipt, to the Corps.
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)
*** Recent changes to the Stormwater rules have required updates to this section .***
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
https://edocs.deq.nc.gov/Forms/Form/Submit 10/15

4/21/23, 2:25 PM
Submission Completed
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
This project 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
To look up low density requirement click here 15A NCAC 02H .1003(2).
Comments:
This project will not generate more than 10,000 SF of built upon area.
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public
(federal/state) land?*
Yes No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland
Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC
213 .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
hftps://edocs.deq.nc.gov/Forms/Form/Submit 11 /15

4/21/23, 2:25 PM
Submission Completed
3b. If you answered "no," provide a short narrative description.
The project will not provide access to currently landlocked property, and the incorporation
of sediment and erosion control measures should ensure sediment is not discharged into
downstream receiving waters.
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.
CFPUA which is available at the street, for connection.
5. Endangered Species and Designated Critical Habitat (Corps
Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
Yes
No
5e. Is this a DOT project located within Division's 1-8?*
Yes 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
https://edocs.deq.nc.gov/Forms/Form/Submit 12/15

4/21/23, 2:25 PM
Submission Completed
5h. Does this project involve the construction/installation of a wind turbine(s)?**
Yes No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by
machines, such as jackhammers, mechanized pile drivers, etc.?*
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or
Designated Critical Habitat?*
IPaC and SLOPES information (see attached). Two species are of concern with this
project: the Northern Long -Eared Bat (NLEB) and the Red Cockaded Woodpecker
(RCW). There will be no percussive or blasting activities during the construction, and it
appears the project site is not with a RCW consultation area.
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? *
This project does not contain a waterbody that would support EFH.
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 HPOWEB2.0 (see attached). The project site is neither within an area designated as
National Historic Place nor are there any existing structures within the project limits.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
https://edocs.deq.nc.gov/Forms/Form/Submit 13/15

4/21/23, 2:25 PM
Submission Completed
8a. Will this project occur in a FEMA-designated 100-year floodplain?
Yes No
8b. If yes, explain how project meets FEMA requirements:
The project will take place within the 0.2 PCT ANNUAL CHANCE FLOOD HAZARD flood
zone. Floodplain approval will be secured when applying for a building permit, which will
not take place for some time. However, the site is not located within a flood zone that
regulates increasing existing ground elevations, such as the VE (High Velocity/Energy) or
the LiMWA (Limit of Moderate Wave Action) flood zones. The structure will be elevated to
a height where the heated floor area is at least 2' above the base flood elevation.
8c. What source(s) did you use to make the floodplain determination? *
New Hanover County GIS Flood Map (see attached).
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
4337 Appleton Way PCN Attachments 4-21-23 Final.pdf 90.54KB
File must be PDF or KMZ
Signature
*
By checking the box and signing below, I certify that:
https://edocs.deq.nc.gov/Forms/Form/Submit 14/15

4/21/23, 2:25 PM
Submission Completed
• 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.
• 1 have given true, accurate, and complete information on this form;
• 1 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");
• 1 agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC
General Statutes (the "Uniform Electronic Transactions Act");
• 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as
a written signature; AND
• 1 intend to electronically sign and submit the PCN form.
Full Name:*
Dana A. Lutheran
Signature*
Date
4/21 /2023
https://edocs.deq.nc.gov/Forms/Form/Submit 15/15