20150302 Ver 2_401 Application_20150515

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o� Office Use Only.
r Corps action ID no.
o r DWQ project no.
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Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps
Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: lk or General Permit (GP) number
1 c. Has the NWP or GP number been verified by the Corps?
eyes ❑ No
1 d. Type(s) of approval sought from the DWQ (check all that apply)
&'401 Water Quality Certification — Regular ❑ Non -404 Junsdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes (INo
For the record only for Corps Permit:
❑ Yes 2<0
1f. 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 [1] No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below
eYYes ❑ No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes No
2. Project Information
2a. Name of project
'p4�1V'3►��( �I�oSSI �D.O� AcRes
2b. County
1
2c. Nearest municipality town:
2d. Subdivision name:
MAY 1 3 2015 ;''
2e. NCDOT only, T.I.P. or state project no:
401 a �5rJ1�f�s �
3. Owner Information u suF;= ;� `; � Ls
Fv_Rnril-rg„ �
3a. Name(s) on Recorded Deed:
`.oym G . NtJu-ir A. LCwi S
3b. Deed Book and Page No.
'p15 t2►'S l — 5� S
3c. Responsible Party (for LLC if
applicable)
3d. Street address
11orj AS OG-1
3e. City, state, zip.
�'F��NV1 C Z-ieSe
3f. Telephone no..
'Z r7114 35S,ty�Co
3g. Fax no.:
a
3h. Email address:
G11>s G..Com
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is.
❑ Agent Mobther, specify. [.p 13gjV5
4b. Name-
WOOgi -*
-%,1—TVMSC31 t T
4c. Business name
(if applicable):
N
4d. Street address:
4e. City, state, zip
4f. Telephone no.:
4g. Fax no.:
iJ
4h. Email address:
E f:ag S e. Njpl-VIX CC--)Q . 0.011
5. Agent/Consultant Information (if applicable)
5a. Name:
V A,16 \N,
5b. Business name
(if applicable):
5c Street address:
5d. City, state, zip
G
2�
5e. Telephone no..
Z 52. 'T SC'. I39 p
5f. Fax no.:
5g. Email address.
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�� Cc Sol. AIJ�S CoM
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees):
Latitude. 3 5 ...Z.Q- 23.0V' Longitude: �(�� qr'j• 3 \. („��
1c Property size:
2. Surface Waters i
\ (',� \ acres "j��'A�.. 0. OS
2a. Name of nearest body of water to proposed project:
$AGK Gtr �K
2b. Water Quality Classification of nearest receiving water:
SG' t zls%j
2c. River basin:
T pk("�
3. Project Description
3a. Describe the existing conditions on the site and the general land use i the vicinity of the project at the time of this
application: %G.o k 6xx el) 1��C W 1�'� {' F�G� j 4 � S K I c 7
�. O, ot5 /a C-9:5. 1►-''F Iii'" t�' / -
3b. List the total estimated acreage of all existing wetlands on the property: d CAM Ac. IN Tetmr r AV%>EA.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: N IA1X%r1 \T
3d. Explain the purpose of the proposed project:
3e. Describe the overall project in detail including the pe of a uipment to be used: RL•��1
Go�.15'["RvcT �s 2A' G�AV�L. �pI I "" A►"ft-5 A VvrORE
3ciiI 0'f -MGIs, cR -26Ve W6U5 . Ey.t<wA-VSg��.L�'K :vot*'1it".
' .
4. Jurisdictional Determinations
4a. Have jurisdictional wetlarrd or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all nor phases) in the past?
❑Yes N' o ❑Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary inaI
4c. If yes, who delineated the jurisdictional areas?
Name (if known). NS-f scoss.
Agency /Consultant Company:
Other: k)SA.GL"-a
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinate ns and attach documentation.
��r>�� ad 3,4 -�s. � "� Am� %a(zi,
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Yes No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
[]Yes No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009
!6.

C. Proposed Impacts Inventory
1. Impacts Summary
Which
1 a. Which s ctions were completed below for your project (check all that apply) -
❑ Streams — tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e. 2f.
Type of jurisdiction Area of
Corps (404,10) or impact
DWQ (401, other) (acres)
� l
--AT-
W1 -
Choose one
Choose one
Yes /No
W2 -
Choose one
Choose one
Yes /No
W3 -
Choose one
Choose one
Yes /No
-
W4 -
Choose one
Choose one
Yes /No
-
W5 -
Choose one
Choose one
Yes /No
-
W6 -
Choose one
Choose one
Yes /No
-
2g. Total Wetland Impacts:
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 -
Choose one
- ,
-
S2 -
Choose one
-
-
S3 -
Choose one
_
S4 -
Choose one
-
-
S5 -
Choose one
_
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then indivii ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01 -
Choose one
Choose
O2 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments.
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
51. Expected pond surface area (acres).
5j. Size of pond watershed (acres) -
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number—
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet )
6g
Zone 2
impact
(square
feet
B1 -
Yes /No
B2 -
Yes /No
B3 -
Yes /No
B4 -
Yes /No
B5 -
Yes /No
B6 -
Yes /No
6h. Total Buffer Impacts:
6i. Comments,
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
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16 Specifically describe me ure taken to avoid or minimize the ropos d imp cts through �con S,tru 5tion techniques. G E
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2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
El Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type. Choose one
Quantity:
Quantity:
Quantity:
3c. Comments.
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested-
linear feet
4c. If using stream mitigation, stream temperature
Choose one
4d. Buffer mitigation requested (DWQ only)
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non- ripanan wetland mitigation requested-
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
S. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009
q_00R

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) —required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
Yes MeNo
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes eo
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
3% % AqM
2b. Does this project require a Stormwater Management Plan?
❑ Yes S No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
'�1S'ivREi �� %% I..ESS T1�J % AGAteg,
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan -
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
\ c+�1zw
❑ Phase II
3b. Which of the following locally - implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
El Yes ❑ No
attachedl
4. DWQ Stormwater Program Review
❑Coastal counties
❑HQW
4a. Which of the following state - implemented stormwater management programs apply
❑ORW
(check all that apply):
[]Session Law 2006 -246
❑ Other
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009
"1

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes
use use of public (federal /state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
El Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
E] Yes [2Vo
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application?
❑Yes 0<0
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes L7 No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a phort narrative description. �..
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4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non- discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
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Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑Yes No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes M<000' to
Impacts?
5c. If yes, Indicate the USFWS Field Office you have contacted.
-
5d. 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 essential fish habitat?
❑ Yes MIN o
6b. What data sources did you use to determine whether your site would Impact Essential Fish Habitat?
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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
❑ Yes to
status (e.g., National Historic Trust designation or properties significant in
rt Caro rLta history a d c e=
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
G o Jvhl. 'Tc D � o wl QE Rism- 'f
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA- designated 100 -year floodplain?
21es ❑ No
8b. If yes, explain how project meets FEMA requirements.
M�'R�
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8c. What source(s) did you use to make the floodplain determination?
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51�
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

Baldwm*Design
Consultants, Pa
SFE & SU601VISION DESIGN • SURVEYING • PLANNING
May 7, 2015
NC Division of Water Resources
Attn: Surface Water Section
1650 Mail Service Center
Raleigh, NC 27699 -1650
Mr. Gary Beecher
U.S. Army Corps of Engineers
2407 West 5t' Street
Washington, NC 27889
REF: Submittal package for USACOE Nationwide 14 Permit, Jefferson Property in
Bath, NC.
Dear Sirs:
Attached you will find the following relative to the above referenced property:
5 complete submittals containing the following information:
1. PCN submittal checklist dated 5/7/15.
2. Check No. 2002, $240.00, 401 Water Quality Certification Application Fee.
3. PCN form dated 5/7/15.
4. Agent Authorization letter dated 5/7/15.
5. Letter dated 3/26/15 from Mr. Robert Tankard, Division of Water Resources
Indicating wetland crossing area is not a blue -line stream.
6. "Bath" 7.5 minute quadrangle map with site depicted.
7. Beaufort County Soil Survey Map No. 14 with site depicted.
8. Pipe calculations for 25 year storm event.
9. Boundary survey map of 10.01 acres dated 02/12/15 to be purchased by my clients.
10. Wetlands survey plat dated 3/17/15 delineating wetlands adjacent to driveway
crossing.
11. Sheets 1 & 2 of driveway crossing plans.
12. Compliance with Wetland and Buffer Regulations form.
10,}���
MAY 1 3 2015
DENR
40
3740 -B EVANS STREET, GREENVILLE. NORTH CAROLINA 27834
TEL [phone] FAx [phone] wwwv .BALDWINDESIGNCONSULTANTS.com

NC Division of Water Resources
Page 2
Upon receipt and review of this information please contact me if you have any questions
concerning this permit application.
Sincerely,
Michael W. Baldwin, PLS
President
MWB /cb
Attachments
cc: George and Karen Jefferson

'W
)f �-Scd TTAek Version 1 4
5\ �1 \5 January 9, 2009
401 & Buffer Permitting PCN Submittal Checklist
eThe application fee (Checks may be made out to "N.C. Division of Water Resources"
$240.00 for 401 Water Quality Certification with minor impacts
- $570.00 for 401 Water Quality Certification with major impacts
- Express Review Fee (Amount requested on Acceptance Letter)
Four complete and collated copies of the PCN Application and supporting
documentation (instead of providing 4 copies of the full size plans you may provide two
copies of full size plans along with two copies of 11 X 17 plans)
..1� ❑ Stormwater Management Plan (if applicable — see PCN Form Help File Section E)
1) Please provide three (3) copies of the stormwater management plans along with all
supporting information pertaining to this project including the following:
a. Entire site development/layout plans delineating all drainage areas;
b. Design calculation sheets for all proposed BMP(s) sized for both on -site and
off -site drainage;
c. BMP supplements for each proposed BMP and Required Items Check List
(http: / /portal.ncdenr.org /web /Ir /bmp- manual) along with all required items;
d. A Notarized Operation & Maintenance Agreement for each stormwater
management facility;
e. Detailed construction drawing sheets shall include
(i) Erosion and sediment control plans;
(ii) Installation and planting schedules for the proposed BMPs;
(iii) Appropriately scaled plan views and cross sectional details of all
BMPs and associated components — inlet and outlet structures,
forebay, respective zones and pertinent elevations.
PJA ❑ If your project is located within a State implemented Riparian Buffer Rule Area, submit the
following along with site plans and PCN form:
1) Three (3) copies of the details for on -site diffuse flow provisions, (refer to
http: / /Portal.ncdenr.org /web /ir /bmp- manual).
010, ❑ DWR Stream Determination Forms for streams on property and DWR determination
letter for wetlands or streams (if applicable).
The following is the most critical of all the information that you must provide. The quality and
detail of the information will often determine the expeditiousness of the review. The following is
a checklist of the types of pertinent information required at a minimum:
Maps and Plans:
The most recent version of the 1:24,000 USGS Topographic Map - Please cleanly draw or
delineate the site boundaries on the topographic map.
The most recent version of the bound and published County NRCS Soil Survey Map -
(required for projects within the Neuse River Basin, Tar - Pamlico River Basin, Randleman
Lake Watershed and the Catawba River Basin, also recommended for all projects) -
Please clearly delineate the site boundaries, etc. on the map. If the delineation obscures
any of the features, it is recommended that a clean copy be provided. Copies of the

Version 1 4
January 9, 2009
Wetland Impacts:
M10"O' Precise grading and final elevation contours must be provided. Existing
vegetation and any clearing must be specified.
All subsurface utility lines must indicate the location of anti -seep collars.
Construction detail for anti -seep collars must be provided.
[r Roadway or other crossings of riparian wetlands may require floodway culverts to
maintain existing hydrological conditions.
Plans should show that the hydrology of remaining wetlands on the site will be
maintained.
Stream Impacts: O)A'
❑ Stream impacts must be clearly shown on the plans. The centerline as well as
the banks of the stream must be surveyed or located by GPS for the portion of
the stream to be impacted.
❑ The inlet and the outlet of all culverts should be aligned with the stream as
much as possible. Inlet and outlet elevations and streambed elevations should
be indicated. Any inlet or outlet protection must be shown and enumerated on
the impact map(s).
❑ For bottomless culverts or other spans, a vertical cross section should be
provided that shows the minimum distance from each span to each stream bank,
the stream cross section, the height of the span above the stream and the
minimum distance from the edge of each footer to each stream bank.
Additionally, please provide a signed and sealed geotechnical report of
subsurface soils at the proposed bottomless culvert location. The report must
comply with the Division of Highways — Guidelines for Drainage Studies and
Hydraulic Design, prepared by A.L. Hankins, Jr., State Hydraulics Engineer -
1999.
❑ Multiple culverts or sectioned box culverts typically require the use of sills, off-
setting or other means to match the cross section of the existing stream (in order
to maintain stream stability and provide aquatic life passage). A vertical cross
section of the culverts should be shown overlain with the up and downstream
stream cross section including the stream flood -prone area.
n
Impacts associated with dam construction must indicate and enumerate
associated with the dam
stabilization. The length
enumerated.
footprint, spillway and any bank stream
of stream impounded must also be indicate
dall fill
bank
and

Version 1 4
January 9, 2009
current soil survey and /or soil survey map sheets can be obtained from the local NRCS
County Office (http: / /www.nc.nres.usda.gov /). GIS soil layers are not acceptable.
evicinity map - Please clearly mark the location and approximate boundaries of the property
and project on the map. Please indicate north arrow and scale. Please include applicable
road names or State Road numbers.
M/The Site Plan - The most critical map to be provided is the site plan. You must provide full
sized plans. The following is the minimum list of plans that are typically needed.
Pre- construction /Pre- existing conditions - This sheet (or sheets) must include:
• All jurisdictional and non - jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Topographic contours with elevations
• Any existing structures and impervious areas
• Existing utility lines and easements
• Existing roads, culverts, and other pertinent features
• North arrow and the scale (1 ":50' scale is recommended).
5�-Oroposed conditions - This sheet (or sheets) must include:
• All jurisdictional and non - jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Lot layout (if a subdivision or commercial development is proposed) - lots must be
developable without further impacts to jurisdictional and non jurisdictional wetlands,
streams, water features, and State regulated buffers. Building envelopes must be
provided when streams, wetlands, riparian buffers, or water features exist on a lot
• All built -out structures and impervious cover
• Final grading contours with elevations
• All utilities and easements (including septic fields on all lots within 100 feet of stream,
wetland, or water features - if applicable)
• Impacted areas — these should correspond with the Impact numbers listed on your PCN
form.
[Drainage Plans - Final drainage plans must include the following:
• Locations and pertinent elevations and sizes of the stormwater collection system and
drainage ways
• All inlets and outlets must also be shown with pertinent elevations (All outlets to
wetlands must be at a non - erosive velocity, generally less than 2 ft/sec during the peak
flow from the 10 -yr storm)
• Scaled stormwater BMPs must also be indicated as required by DWR rules and policies
• In certain cases (see Section E of PCN form), final stormwater management plans must
also be provided (see Stormwater Management Plan Checklist)
[Proposed Impacts - All impacts to jurisdictional and non - jurisdictional wetland, stream,
water features, and State regulated buffers must be shown and labeled on the site plans at
a scale no smaller than 1" = 50'. All excavation, fill, flooding, stabilization, and other impacts
that will be conducted in or near jurisdictional and non jurisdictional wetland, stream, water
features, and State regulated buffers must be indicated. Please provide cross sectional
details showing the provisions for aquatic life passage (burial of culvert 20% for culverts _< 48
inches, and 1 -foot for culverts > 48 inches).

20 Pocosin Road
Washington, NC 27889
May 7, 2015
Mr. Roberto Scheller
NC Division of Water Resources
943 Washington Square Mall
Washington, NC 27889
Mr. Gary Beecher
U.S. Army Corps of Engineers
2407 West 5'r' Street
Washington, NC 27889
REF: Agent Authorization Consent
Dear Mr. Scheller and Mr. Beecher:
We hereby authorize Mr. Michael W. Baldwin to apply for a Nationwide 14 permit for
our 10.01 acres located on the south side of Back Creek, Bath, NC.
Sincerely,
Georg6 Way e JoRson
- C _
��aren T. JeVeAofi
7� f
A4AY 1 3 2015
401 !A
6

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
March 26, 2015
Baldwin Design consultants, PA
Mr. Mike Baldwin
3740 -B Evans Street
Greenville, NC 27834
Donald R. van der Vaart
Secretary
DWQ # 15 -0302
Beaufort County
Subject Property: Area Located at end of Brooks Road, Bath
Tar- Pamlico River Basin, Back Creek [TAR 07, 29- 19- 9 -(1); C, NSW]
On -Site Determination for Applicability to the Tar - Pamlico River Riparian Area Protection
Rules (15A NCAC 2113.0259)
Dear Mr. Baldwin:
On March 20, 2015, this Office received your stream determination request form. During a phone conversation
with you on March 24, 2015 it was determined that the subject site is not a stream but considered 404
wetlands. As discussed, the construction of a driveway that will impact wetlands will require a Nation Wide
(NW) permit from US Army Corp of Engineers and a General Certification (GC), for wetland impacts, from this
Office. You will be required to send 5 copies of the Pre - Construction Notification form (PCN), with related
plans and drawings and a check for $240.00, made out to NC DENR, to the Division of Water Resource
(DWR), 1650 Mail Service Center Raleigh, NC 27699 -1650.
This letter only addresses the requirements to obtain a General Certification for wetland impacts and does not
approve any activity. Nor does this letter approve any activity within Waters of the United States or Waters of
the State. If you have any additional questions or require additional information please call Roberto Scheller in
the Washington Regional Office at (252) 948 -3940.
Sincerely, �Z"
Robert Tankard
Assistant Regional Supervisor
Division of Water Resources
CC' Laserfiche
File Copy
Water Quality Regional Operations Section
943 Washington Square Mail
Washington, NC 27889
Phone 252 - 946 -6481 1 FAX 252 - 946 -9215
Internet -www ncwaterquality.orq M
An Equal Opportunity 1 Affirmative Action Employer

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Project Description
Worksheet
Circular Channel
Flow Element
Circular Channel
Method
Manning's Formul
Solve For
Channel Depth
Input Data
Mannings Coeffia 0 010
Slope
006500 ft/ft
Diameter
24 in
Discharge
19.88 cfs
Results
Depth
1 40 ft
Flow Area
24 ft'
Wetted Perime
397 ft
Top Width
1 83 ft
Critical Depth
1 60 ft
Percent Full
70.1 %
Critical Slope
0004773 ft/ft
Velocity
845 ft/s
Velocity Head
1 11 ft
Specific Energy
251 ft
Froude Numbe
1 32
Maximum Disc]
2550 cfs
Discharge Full
2371 cfs
Slope Full
0004570 ft/ft
Flow Type
3upercntical
Worksheet
Worksheet for Circular Channel
1�,&. 6�
7-7
(S?zs=l9.es

Date: May 8, 2015
COMPLIANCE WITH WETLAND & BUFFER REGULATIONS
In accordance with Title 15 A NCAC 21-1.0500, the following DEED NOTIFICATION
shall be recorded in the Beaufort County Registry prior to the
conveyance of lots. Said Deed Notification shall apply to name of subdivision, lot
numbers in Beaufort
County, North Carolina as shown on plans titled
Survey for George Wayne Jefferson & wife Karen T. Jefferson (10.01 acres on the
south side of Back Creek) prepared by Baldwin Design Consultants, PA
dated: 02/12/15
"A portion of this lot has been determined to meet the requirements for designation as a
wetland, stream or protected stream buffer. Any subsequent fill or alteration of this area shall
conform to the requirements of the state rules adopted by the State of North Carolina in force at
the time of the proposed alteration. The intent of this provision is to prevent additional wetland,
stream or buffer filling or draining, so the property owner should not assume that a future
application for filling or draining would be approved. The property owner shall report the name of
the subdivision in any application pertaining to said rules. This covenant is intended to ensure
continued compliance with all rules adopted by the State of North Carolina and therefore the
State of North Carolina may enforce benefits. This covenant is to run with the land and shall be
binding on all Parties and all persons claiming under them."
Signature. -
Louis C. Spell
Signature:
P i ip A. is
Owner's name: Louis C. Spell
Address: 905 E. Arlington Boulevard
City, State, Zip Code: Greenville, NC 27858
Phone Number. 252 - 355 -4166
Owner's name: Phillip A Lewis
Address: 905 E Arlington Boulevard
City, State, Zip Code- Greenville, NC 27858
Phone Number: 252 - 355 -4166

STATE OF North Carolina
A-'�+ County
1, t Al a Notary Public of the State of North Carolina,
County, herby certify that the owner(s), Louis C. Spell personally
appeared before me this day and executed the above certification.
Witness my hand and notarial seal, this day of I
E
X1
nary blic -
:
UB L!�
My commission expires. ��� y �� GI "''�,, �0uz'�
STATE OF North Carolina
'.-VN County
a Notary Public of the State of North Carolina,
County, herby certify that the owner(s), Phillip A. Lewis personally
appeared before me this day and executed the above certification.
Witness my hand and notarial seal, this P day of 1 S
\ \ \t \ \41701f i1lf /Jf/Pft " 1*10
ota Publi
TA \�
My commission expires:
US Ltd, '
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NCRI'AL HIGH WATER LINE OF
BACK CREEK IS THE PROPERTY LINE
WOODED
404 WETLANDS
AREA=0,048 ACRE
NORMA- HIGH WATER LINE OF
,--'BACK -,REEK IS THE PROPERTY LINE
Elf
C),
NORTH
PG �GS�LIDL 9-1
WOODED
DONALD E. AYERS
DB 1182, PG 619
t FSEE DETAIL "A. 1" 0
tiT S 01'30'37" E tT
A-111- 209.56' (TIE) DIP S SEE SHEET 2 OF 2
ZIL FOR DETAILED WETLAND
NPS EIP CONTROL --5L-4 CROSSING PLAN WOODED
",c
SAMULE-L F. BROOKS---- .20. '�o 7.4 CORNER
DB 029, PG 953 3 EX. NAIL �Cv
(0. C)
-E-NPS EX. L-1
LOUIS C. SPELL
TREE 0 ?,ANGH �4G C�,
Z�N 01'48 34 ?:,-", AND
172.01' 9, PHILLIP A. LEWIS
C/L OF 15'3;,- EIP DB 1295, PG 515
EASEMENT N 62'25'32'" E o IP
. ..... 171.11' (11E) -D' PLAT CABINET G, SLIDE 9-1
CZ4
S),
MELD
LOUIS C. SPELL
�Qltau �1 o
AND EX.
PHILLI P A. LEWIS PIP CONTROL
DB 1295, PG 515 CORNER
PLAT CABINET G, SLIDE 9-1
\`-BENCIOAARK Ek NAIL
RAILROAi,,, SPIKE IN PIP
/T- ELEV. 9 1;7' (NGVD 1985)
T
CONTROL
CORNER
EX. NAIL
GENERAL NOTES
1. THIS PROPERTY IS LOCATED IN A SPECIAL FLOC,� HAZARDOUS
AREA AS DETERMINED BY THE FEDERAL EMERGE]";CY MANAGEMENT
AGENCY. FLOOD ZONE AE, BASE FLOOD ELEVATI--N 9.0' (NAVD 1988)
REF: FIRM 3720664200) DATED: MAY 15, 2003
2. ALL AREAS CALCULATED BY COORDINATE GEOME-?Y.
3. REFERENCE: DEED BOOK 1295, PAGE 515 OF 7-iE BEAUFORT
COUNTY REGISTER OF DEEDS.
4. UNLESS OTHERWISE NOTED THERE ARE NO POIt,"S SET ALONG THE
NORMAL HIGH WATER LINE OF BACK CREEK.
\A C A Y
�- ffS S
0
SEAL
L-3082
G°S. 47--3 ENDED.
,W NESS MY D AND SEAL THIS --5th DAY
OF M 2015 .
404 WETLANDS TABLE
LINE
BEARI�,"G
LENGTH
Hl
L-1
N 08'132 W
55.93 J
L-2
S 81'5- 11" F
36.15
L-3
S 15 4 4 12' E
29.00
L-4
S 04`43 ", 7
31.04
L-5
=,,\,
E
"TIE"
"TIF"
-,-!S CERTIFIES THAT THIS COPY OF TIFIS PLAT ACCURATELY DEPICTS THE
ECUNDARY OF THE JURISDICTION 0r SECT!ON 404 OF THE CLEAN WATER
A -T IN THE AREAS IMPACTED By THE PRESENT PROPOSED ACTIVITY, AS
D--7ERMINED BY THE UNDERSIGNED ON TI -1:S DATE. OTHER AREAS OF
1%RISDICTION MAY BE PRESENT CN THF SITE BUT HAVE NOT BEEN DELINEATED.
G,,LESS THERE IS CHANGE IN TH-- LAW OR OUR PUBLISHED REGULATIONS, THIS
DE-ERMINATION OF SECTION 404 jURISOICTION MAY BE RELIED UPON FOR A
P-ERIOD NOT TO EXCEED FIVE YEARS 7'�CM THIS DATE. THIS DETERMINATION WAS
00E UTILIZING THE APPROPRIATE REG;ONAL SUPPLEMENT TO THE 1987 CORPS
07ENGINEERS WETLAND DELINEATION NIANJA-."
71EGULATORY OFFICIAL:
7 -LE:
C,. -"TE:
LIQACE ACTION ID NO.:
# 4
I
D. RICHARDSON
BEARING AND DISTANCES ALONG BROOKS ROAD ANDA FLORENCE
THE USAGE ROAD WERE TAKEN FROM PLAT AND
CABINET G, SLIDE 9-1 AND DO NOT REPRESENT
AN ACTUAL FIELD SURVEY BY BALDWIN DESIGN ROY C. BROOKS, JR.
CONSULTANTS, P.A. DB 171, PG 421
ESTATE FRIE, 96-361
Y
`
0
SO/4 J& 'yo
Qc- WID7;v
O,Y,l
R/W R/W
795' TO a
R:7177 77*-
R/W R/W
NC HWY 92
(60' R/W PAVED PUBLIC)
Z 20- EASEMENT
"A" TO "B"
D.B. 431, PG. 069
(L 16- EASEMENT
M.B. 23, PG. 20
0I
s0 4
o-
404 WETLANDS -4-.
AREA=0.048 ACRE
--�I-LIMITS OF
EX. WETLAND
TREE *— DELINEATION
6-- %
SCALE: 1"
BEARING
SIP
•
—S
76-52'38"
76'52'38"
E
NO POINT SET
IS
7=2 5 5=1 7
1
�Eii
NOT TO SCALE
S
_
��N
21-52'39
E
29.72'
N
32
E•
29,45*
---------- !��'5
30,24'
19'45 --
N
07*44'46"
E
E
IL—N
07*06'21
85
49.26'
3 6.33'
1
0 21 '
E
R
T9'"2 M1
5W3418"
E
66
N
65*31'27"
E
67,80'
N
68*3241 "
E
N
69'53'55"
E
(L 16- EASEMENT
M.B. 23, PG. 20
0I
s0 4
o-
404 WETLANDS -4-.
AREA=0.048 ACRE
--�I-LIMITS OF
EX. WETLAND
TREE *— DELINEATION
6-- %
SCALE: 1"
BATH
KGIR
):.J
0
A
J
q 15' EASEMENT
"C" TO "D"
m
•19
SIP
•
S
61;-ZZ47"
E
NO POINT SET
S
58*07 48
E
NOT TO SCALE
S
6-6---44 �46
��N
21-52'39
E
N
32
E•
---------- !��'5
N
1 V2
E
IL—N
07*06'21
E
49.26'
41 96
BATH
KGIR
):.J
0
A
J
q 15' EASEMENT
"C" TO "D"
m
•19
SIP
•
S
61;-ZZ47"
E
NO POINT SET
S
58*07 48
E
NOT TO SCALE
S
6-6---44 �46
��N
21-52'39
E
SHORELINE OF BACK CREEK
,L"El" TO "I"'
UP CREEK
•19
SIP
•
R/W
RIGHT-OF-WAY
NIPS
NO POINT SET
1 N
47'23'
—I,--
NOT TO SCALE
—s
7,3'56'04w
S
40*13'22"
E•
UP CREEK
EIS
Bearing
SIP
•
R/W
RIGHT-OF-WAY
NIPS
NO POINT SET
C/L
CENTERLINE
—I,--
NOT TO SCALE
EIS
EXISTING IRON STAKE
SIP
SET IRON PIPE
R/W
RIGHT-OF-WAY
NIPS
NO POINT SET
C/L
CENTERLINE
—I,--
NOT TO SCALE
200 100, 0 200 400' 600,
GRAPHIC SCALE: 1' = 200'
SHEET 1 OF 2
NATIONWIDE '14 PERMIT MAP PIN #15028826
(`FOR DRIVEWAY CROSSING) GPIN #6653-73-0922
C A
�s II "k0
CLOSURE CHECK BOUNDARY
--<-;�
L-,: JGG DATE: 03/'7/2015
GEORGE WAYNE JEFFERSON and wife,
KAREN T. JEFFERSQN
REFERENCE: PLAT CAE31NET G, SLIDE 9-1 OF THE
BEAUFORT COUNTY REGISTER OF DEEDS
BATH TOWNSHIP, BEAUFORT COUNTY, N.C.
FUTURE GEORGE WAYNE JEFFERSON
OWNER: and wife, KAREN T. JEFFERSON
ADDRESS: 20 POCOSIN ROAD
WASHINGTON, NC 27889 C�-01sowo- wl,
PHONE: [phone]
SURVEYED: BW APPROVED: MWB
DRAWN: JGG DATE: 05/07/15
CHECKED: MWB SCALE: 1 200'
-A

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