20160312 Ver 1_401 Application_20160316

WA
RI _ Office,Use Qnfy. ,' �
o �! � �'�O�"! ` J
(i l_JL�lVI 2 60 3s action,ID'no
2 DWQ project no---
Form Version 1.4 January 2009
Page 1 of 10
PCN Form – Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
la
Type(s) of approval sought from the Corps
[Section 404 Permit 3Section 10 Permit
1b. Specify Nationwide Permit (NWP) number. or General Permit (GP) number j 1-76oe
U (�
1c
Has the NWP or GP number been verified by the Corps'?
[Yes
❑ No
1d
Type( of approval sought from the DWQ (check all that apply)
401 Water Quality Certification – Regular❑ -404 Jurisdictional 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 No
For the record only for Corps Permit
❑ Yes [3"N0
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
[211No
1g.
1h
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
11Y
❑
0'�0
2.
Project Information
2a
Name of project
° 2 u N ,2" "419
20 Ig 1UU
2b
County
7 –
lidJ AT'S , M;
E=Es
2c Nearest municipality /town,
2d
Subdivision name.
2e
NCDOT only, T.I P or state project no
3.
Owner Information
3a
Name(s) on Recorded Deed
2,c�n,-
R-ok tgs-r 8G So ( 3
3b Deed Book and Page No
3c Responsible Party (for LLC if
applicable).
3d
Street address
3e
City, state, zip
W'" K. � �,,,,_41-L -L-7
3f.
Telephone no
L1-2. - q 7,,- - t 3q
3g.
Fax no
3h
Email address
r M v tj 41AM,..y.,
Page 1 of 10
PCN Form – Version 1.4 January 2009

.t � ;.,
i, I �

4. Applicant Information (if different from owner)
4a Applicant is.
❑ Agent [] Other, specify
4b Name
A141
4c Business name
(if applicable)
4d Street address
4e City, state, zip
4f Telephone no
4g Fax no
4h Email address
S. Agent/Consultant Information (if applicable)
5a Name
5b Business name
(if applicable)
5c Street address
5d City, state, zip:
5e Telephone no
5f. Fax no
5g Email address
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a. Property identification no (tax PIN or parcel ID)
SV
1b. Site coordinates (in decimal degrees)Latitude'
S S(o 4? Longitude 77 p 5 5-2 2
1c
Property size-
acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
LjL&Ol-
2b
Water Quality Classification of nearest receiving water
NSI✓ C ' S✓
2c
River basin
3.
Project Description
3a
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application OS2o j��S�y
�A�c f 5�„ sit A,19 we�� FOQ�dY21 l�%!(�D82(� UCh��i1 r9(fs7� J`>Akf` Af
3b
List the total estimated acreage of all existing wetlands on the property At*
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 100
3d
Explain the purpose of the proposed project
0 R -,E POL& A FAt 2LEM- e, Ts'(MQ/6 f� OLKe�I
3e
Describe the overall project in detail, including the type of equipment to be used
aF c G r2r4 fj C a�tit'T 1�N�
13 � � (�� � -)-t,2`� k�r�n,w+� n A � � �.,, /
�Z�M 'TQ GI�N� Cot. r, UYd ,
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project(including all priorphases) in thepast?
El Yes No Unknown
Comments
4b
If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c
If yes, who delineated the jurisdictional areas?
Name (if known).
Agency/Consultant Company
Other
4d
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5.
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Yes [dNo ❑ 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

C. Proposed Impacts inveniory
1. Impacts Summary
1a Which sections were completed below for your project (check all that apply)*
❑ Wetlands ❑ 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 2f
2a. 2b 2c 2d 2e
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Temporary,T
Choose one
Choose one
Yes/No
-
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 -
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 3b 3c 3d 3e 3f 39
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT) jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 -
Choose one
'
82 -
Choose one
-
"
S3 -
Choose one
-
S4 -
Choose one
-
"
S5 -
Choose one
-
S6 -
Choose one
3h Total stream and tributary impacts
31 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 indiv ualfy 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 -
�;2AM f4� i%1�
u JC044k*t>e
SIDWAse
02 -
-r QL
I� ( oiLi o`s onego� 1b(je
S.�t ose
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
Pi
Choose one
P2
Choose one
5f Total:
5g Comments
5h Is a dam high hazard permit required7
Yes No If yes, permit ID no
51 Expected pond surface area (acres)
51. Size of pond watershed (acres)
5k Method of construction
6. Buffer Impacts (for DWG)
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 outSeFction D of this form
6a. Project is in which protected basin?
Q Neuse ar-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
Bi ']
POLAC
t
Yes/
2 000
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
61 Comments.
Page 5 of 10

D. Impact Justification and Mitigation
I. Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
3ijky&IV-,>AIL:L&.r,.,
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ 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
Payment to in -lieu fee ro ram
❑ Mi m 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 -riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments,
5. 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

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the protect result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ❑-No
MW
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
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
15
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

Management and Diffuse Flow Plan (required by DWQ)
Flow Plan
project include or is it adjacent to protected riparian buffers identified
rEter
e of the NC Ri arian Buffer Protection Rules?n
Yes ❑ No
is a diffuse flow plan included? f no explain why
�.��m�pN�+�y
'7
A 7
.r,
❑ Yes [](No
f c "cam rte.
2. Stormwater Management Plan
2a What is the overall percent imperviousness of this project?
% N
2b Does this project require a Stormwater Management Plan?
❑ Yes ❑ No
2c If this project DOES NOT require a Stormwater Management Plan, explain why
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 localgovernment's jurisdiction is this project?
❑ Phase II
3b Which of the following locally-implemented stormwater management
❑ NSW
programs
apply (check all that apply)
USMP
® Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
Yes ❑ No
attached?
4. DWQ Stormwater Program Review
❑Coastal counties
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

F. Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes No
use of public (federal/state) land?
1b.
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
❑Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c.
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
tetter )
0 Yes ❑ No
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,
❑Yes MNo
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b.
Is this an after-the-fact permit application?
❑Yes ❑ No
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
El Yes Vo
addrtfonai 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 ashgort narrative description
L �wdla( �) I ak Nc,�b GaN9��fz�1 lig k'2141F Cd J� CXR �i�NF i-�[Y`G gVC1/, IZ(+7 lb
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
NY '
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
des
habitat?
❑ No
5b Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑ Yes
13/N o
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 habitats
Yes ❑ No
6b. What data sources did you use to determine whether your site would impact 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 (e g , National Historic Trust designation or properties significant in
❑Yes ❑ No
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA -designated 100 -year floodplain?
[]Yes ❑ No
8b If yes, explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination?
2, f MAeeJ( LoiF
Applicant/Agent's Printed Name
Applica Agent's Signature
Date
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

OPIS Print
Kitt Counter Government
Greenville, North Carolina 4,putt .
www.pittcountync.gov
Page 1 of 1
Parcel
50138
Physical Address
6791 CLARKS NECK RD
Owner Name
MURRAY RICHARD W. JR
OwnerAddress 1
MURRAY KIM A
ID
J
OwnerAddress2
6791 CLARKS NECK RD.
OwnerAddress3
, 7"� ,
City / State / Zip
WASHINGTON NC 27889
NC PIN
5666653596
Subdivision / Section /
Phase
� w
Prior Legal Description
CREEK VIEW
1,
Block / Lot
1
C,
Tract
h�
Building Number / Unit
ti
Acres
1.97
"'t
4
'
Current Owner
'
Deed/Document
001855 00686
X41417 UQMap
Book
MB39-93
2fi459 �;� N o
Deed / Document Date
01/2005
Deed / Document Sales
50138 F
Price
$245,000
F�.
Building Type / Use
SFR CONST(SFR)
Number of Buildings
1
09-92-M,Year
Built
1991
}.
Total Living Area
2326
Building Value
$160,472
o
Extra Features Value
$12,030
Land Value
$58,395
"
Total Current Market
-
Value
$230,897
Total 2015 Market Value
$206,555
f
Revaluation Year
2016
Municipality
743
Township
PACTOLUS
Fire Service District
STNECK FIRE SERVICE
74355
IDSARKRI
Census Tract
9
Neighborhood
005521
Elementary School
PACTOLUS
Middle School
PACTOLUS
Disclaimer. This tax record is prepared for the inventory of real property within Pitt County
High School
o 23 46
D H CONLEY HS
and is compiled from recorded deeds, plats, tax maps, surveys, and other public records.
92
138 184 Feet
Users of this data are hereby notified that the aforementioned public primary information
sources should be consulted for verification. Pitt County assumes no legal responsibility
for the information contained herein.
P!
Copyright ® 2015, Pitt County, north Carolina.
Parcel ownership information updated nightly.
Map printed 3/23/2016.
http://gi s. pittcountyne.gov/opi s/print.aspx?resetSession=true&x 1=2565948.553308825&y... 3/23/2016

3
ca
rK.
0
s
cD
CD
O

131
G)
0
Ki
R
O
Ol
C)
0
0
O
O
W
z
m
n
Wfldernoss to
I
C)
0
W
110
SD
UQ

u I I o5' 60.0000" W 077° 05' 30.0000" W
! Q!
Ln
4
a -
Alk
G`qj
„r
•
;� .,day..- ,�•. � .,.... � .co � t `• ?a � � � : + - -- _ ,
""" ,„„, .. f. ,,,,.„ t � ; r� . _ � •"ti's.
M irray Residence,
\°
6191 Clarks Neck
Z �_ Rad Washington, NC
CO ».
v y.
o ,
FClarks'Ne
e m - ,+ .ck
. Roa
' ,pch. Stip `
C CO
a.
04
Ob
OP
rr
v. + m•a � I
.t^�ra � „•,, ,.�„ � � ..,''+�..,,,_.� �`. ,.ham
e
€ '
SCALE 1:12000
0 1000 2000
3000
Feet