20231204 Ver 1_ePCN Application_20230831

DW R
DHlsloo of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Initial Review
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:
7/29/2023
BIMS # Assigned
20231204
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Robert Tankard:[e-mail]
Information for Initial Review
1a. Name of project:
COURTESY COPY KS OBX, LLC-Rampart Residence
1a. Who is the Primary Contact?*
Doug Dorman
1b. Primary Contact Email: *
[e-mail]
Date Submitted
8/31/2023
Nearest Body of Water
Atlantic Ocean
Basin
Pasquotank
Water Classification
SC
Site Coordinates
Latitude:
35.558807
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Dare
Is this a NCDMS Project
Yes No
Longitude:
75.467360
Version#*
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Is this project a public transportation project?*
Yes No

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
1b. What type(s) of permits) 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):
1d. 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:
401 Water Quality Certification - Express
Riparian Buffer Authorization
1f. Is this an after -the -fact permit application? *
Yes No
fig. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1h. Is the project located in any of NC's twenty coastal counties?
Yes No
1i. Is the project located within a INC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. 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. Nari on recorded deed:
Brian Susan Scott
2b. Deed book and page no.:
1653/0293
2c. Contact Person:
2d. Address
Street Address
1405 Shady Rise Glen
Address Line 2
City
Raleigh
Postal / Zip Code
27603
State / Province / Region
NC
Country
USA
Yes No
Yes No

2e. Telephone Number:
[phone]
2g. Email Address:"
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Mark & Joe Robert
3b. Business Name:
KS OBX, LLC
3c.Address
Street Address
2810 N Church Street#28283
Address Line 2
City
Wilmington
Postal / Zip Code
19802
3d. Telephone Number:
[phone]
3f. Email Address:
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Doug Dorman
4b. Business Name:
Atlantic Environmental Consultants, LLC
4c.Address
Street Address
PO Box 3266
Address Line 2
city
Kitty Hawk
Postal / Zip Code
27949
4d. Telephone Number:
[phone]
4f. Email Address:"
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Hatteras Colony
1c. Nearest municipality / town:
Dare County/Salvo
2. Project Identification
2f. Fax Number:
State / Province / Region
DE
Country
USA
3e. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2a. Property Identification Number: 2b. Property size:
065709074041 0.23

2c. Project Address
Street Address
26219 Rampart Street
Address Line 2
City
State / Province / Region
Salvo
NC
Postal / Zip Code
Country
27972
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Atlantic Ocean
3b. Water Resources Classification of nearest receiving water:
SC
3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
030102051505
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: "
Existing undeveloped residential lot in the Hatteras Colony Subdivision. General land use in the vicinity is residential development.
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:
8,250
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 the project is to construct a 3 bedroom single family residence on a vacant lot in the Hatteras Colony Subdivision.
Development of the property will impact 4,280 sq.f.t of wetlands.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The project is for the development of a 3 bedroom single family residence. The site work and fill will be completed first and then the house will be constructed on pilings with parking
underneath. A septic tank and pump tank will be installed on the property and wastewater will be pumped off site to a central wastewater system in the Hatteras Colony Subdivision. Dump
trucks will deliver clean fill and it will be distributed with a small tractor or backhoe.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
Not available at this time.
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Doug Dorman
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
Yes
Atlantic Environmental Consultants, LLC
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?
D. Proposed Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
2. Wetland Impacts
2a1 Reason (?)
2b. Impact type*(?)
2c. Type of W. *
2d. W. name
2e. Forested"
2f. Type of Jurisdicition *
29• Impact
area
House
P
Isolated Wetlands =E.
t-A
Corps
0.097
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.097
2i. Comments:
2g. Total Permanent Wetland Impact
0.097
E. Impact Justification and Mitigation O
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed house, septic tanks and storm water retention area have been placed as close as possible to the front of the property to avoid and
minimize wetland impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The proposed house will be constructed on pilings and located at the 25' minimum building setback line at the front of the property to help avoid and
minimize wetland impacts.
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):
D W R 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:
Hidden Lake Mitigation Bank
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Non -riparian wetland 0.19
3c. Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR) "
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
If no, explain why:
NC Riparian Buffer rules do not apply to this area.
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
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
Comments:
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 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.
No additional development proposed for this project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?
Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
Yes No Unknown
5e. Is this a DOT project located within Division's 1-8?
Yes No
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?
US Fish & Wildlife Service. IPaC ( Information for Planning and Consultation)
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?
Wetland area does not support Essential Fish Habitat.

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
Environmental review with NC State Historical Preservation Office pending. Submitted environmental review on 08/31/23 and response will be forwarded
when received.
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:
House construction will Dare County and FEMA flood plain requirements.
8c. What source(s) did you use to make the floodplain determination?
Recent survey and Dare County flood maps.
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
Robert Ventures Site Plan.pdf 497.11KB
Robert Ventures KS OBX LLC Agent Authorization.pdf 92.35KB
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 ACV');
• 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:
Doug Dorman
Signature
oors900t wezw
Date
8/31/2023