20170076 Ver 1_401 Application_20170117

ENVIRONMENTAL PROFESSIONALS, INC. LETTER OF TRANSMITTAL
Planning for a Better Environment
P.O. Box 3368
R © 1191fl
Kill Devil Hills, NC 27948
Telephone: [phone] J/4N 1 t� ZQ'1
Fax: [phone]
Email: [e-mail]
401E&B FFE PERMIR IN
G
2 0 1 7 0 0 7 6
10: North Carolina Division of Water Quality
401 Wetlands Unit
Attn: Ms. Karen Higgins
1650 Mail Service Center
Raleigh,NC 27699-1650
DATE: January 18,2017
JOB NO.: 016-058-PT
RE: Lot 28—Block 227
81 Duck Woods Drive
ATTACHED Southern Shores,North Carolina
COPIES DATE DESCRIPTION OF DOCUMENTS
4 1-17-17 Signed/Dated Pre-Construction Notification Form
4 12-1-16 Signed/Dated Authorization to Act as Representative Form
4 1-16-17 Letter to The Great Dismal Swamp Restoration Bank—Request for Confirmation of
Acceptance of Mitigation Credits
4 1-18-17 Confirmation Letter from the Great Dismal Swamp Restoration Bank
4 1-12-17 18 x24 Plat
THEARE SUBMITTED AS CHECKED BELOW:
For your approval ❑ Review& Comment
❑ For your use ❑ Signature/Notarization
❑ As requested
REMARKS:
COPY TO: Project File
SIGNED: i'r"-- //G✓�G H. Wood,CEP, PWS
Environmental Professionals, Inc.

I
o`'Of WA rF9Oc
Office Use Only:
r Corps action ID no.
y + DWQ fin.^ C• \/ _Form •L• �L� �'tt-
J/.\N 1 9 2017
Pre-Construction Notification (PCN) Form
DEQ-WATER RESUUKCts
A. Applicant Information
401&BUFFER PERMITTING
1. Processing
la. Type(s) of approval sought from the Corps: ❑X Section 404 Permit 0 Section 10 Permit
1 b. Specify Nationwide Permit(NWP) number: 18 or General Permit(GP) number:
1 c. Has the NWP or GP number been verified by the Corps? 0 Yes ❑X No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification—Regular 0 Non-404 Jurisdictional General Permit
0 401 Water Quality Certification—Express 0 Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 Certification:
❑Yes ❑X No ❑Yes ❑X No
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 ❑X Yes ❑ No
or in-lieu fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑x Yes ❑ No
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? 0 Yes ❑X No
2. Project Information
2a. Name of project: O'Toole
2b. County: Dare
2c. Nearest municipality/town: Southern Shores
2d. Subdivision name: Southern Shores-Blk 227
2e. NCDOT only, T.I.P. or state project no: N/A
3. Owner Information
3a. Name(s) on Recorded Deed: John & Leslie Burns
3b. Deed Book and Page No. Book 1377 - Page 0227
3c. Responsible Party (for LLC if N/A
applicable):
3d. Street address: 81 Duck Woods Drive
3e. City, state, zip: Southern Shores, NC 27949
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 10
PCN Form—Version 1.4 January 2009

'
4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑X Other, specify: Purchaser
4b. Name: Joanne O'Toole
4c. Business name
(if applicable):
4d. Street address: P.O. Box 332
4e. City,state,zip: Kill Devil Hills, NC 27948
4f. Telephone no.: 1-339-933-2070
4g. Fax no.:
4h. Email address: [e-mail]
5. Agent/Consultant Information(if applicable)
5a. Name: George H. Wood, CEP, PWS
5b. Business name Environmental Professionals, Inc.
(if applicable):
5c. Street address: 1404 S. Virginia Dare Trail (P.O. Box 3368)
5d. City, state,zip: Kill Devil Hills, NC 27948
5e. Telephone no.: 252-441-0239(Business) 252-423-1234(Cell)
5f. Fax no.: 252-441-0721
5g. Email address: [e-mail]
Page 2 of 10

•
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 986715533996
lb. Site coordinates(in decimal degrees): Latitude: 36.108 Longitude: -75.731
1c. Property size: +i- 0.695 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: man-made canal that joins Ginguite Creek
2b. Water Quality Classification of nearest receiving water: SC
2c. River basin: Pasquotank
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:
The property is an undeveloped wooded site in a residential community. There are residential structures to the north and south,Duck Woods Drive to
the east,and golf course to the west.
+1
3b. List the total estimated acreage of all existing wetlands on the property: 0.134
3c. List the total estimated linear feet of all existing streams(intermittent and perennial)on the property: 0
3d. Explain the purpose of the proposed project:
Fill in wetlands to prepare site for residential construction.
3e. Describe the overall project in detail, including the type of equipment to be used:
The site will be cleared and graded with bulldozers. Clean sand will be brought to the site and graded into the wetland area.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the ®Yes 0 No 0 Unknown
Corps or State been requested or obtained for this property/
project(including all prior phases)in the past? Comments.
4b. If the Corps made the jurisdictional determination,what type ❑ Preliminary ❑X Final
of determination was made?
4c. If yes,who delineated the jurisdictional areas? Agency/Consultant Company:Environmental Professionals,Inc.
Name(if known):George H.Wood,PWS Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Pending
5. Project History
5a. Have permits or certifications been requested or obtained for
['Yes Q No ❑Unknown
this project(including all prior phases)in the past?
5b. If yes,explain in detail according to"help file"instructions.
N/A
6. Future Project Plans
6a. Is this a phased project? 0 Yes © No
6b. If yes,explain.
N/A
Page 3 of 10
PCN Form—Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
la. Which sections were completed below for your project(check all that apply):
0 Wetlands 0 Streams—tributaries 0 Buffers 0 Open Waters 0 Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site,then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
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)
W1 P Fill Hardwood Flat
Yes Corps 0.05
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: 0.05
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. 3g.
Stream impact Type of impact Stream name Perennial(PER)or Type of Average Impact
number intermittent(INT)? jurisdiction stream length
Permanent(P)or 9
Temporary(T) width (linear
(feet) 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 0
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 individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact(acres)
Permanent(P)or type
Temporary(T)
01 - Choose one Choose
O2 - Choose one Choose
03 - Choose one Choose
04 - Choose one Choose
4f.Total open water impacts 0
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed,then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts(acres) Stream Impacts (feet) Upland
purpose of pond (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:
5i. 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. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number— mitigation impact impact
Permanent(P)or required? (square (square
Temporary(T) feet) 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
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The house,parking and drainfield moved to east to avoid impacts to the wetland areas to the west.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Only the area beneath the house to be filled.
2. Compensatory Mitigation for Impacts to Waters of the U.S.or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑X Yes 0 No
impacts to Waters of the U.S.or Waters of the State?
2b. If yes, mitigation is required by(check all that apply): 0 DWQ 0 Corps
❑X Mitigation bank
2c. If yes,which mitigation option will be used for this
project? ElPayment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:The Great Dismal Swamp Restoration Bank
Type: Non-riparian wetland Quantity: 0.10 acres
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached. 0 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 project result in an impact within a protected riparian buffer that requires Yes Egi No
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

1
•
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified 0 Yes ❑X No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes,then is a diffuse flow plan included? If no, explain why.
N/A
❑Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 11.3%
2b. Does this project require a Stormwater Management Plan? 0 Yes ❑x No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Low Density
2d. If this project DOES require a Stormwater Management Plan,then provide a brief, narrative description of the plan:
N/A
2e. Who will be responsible for the review of the Stormwater Management Plan? N/A
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? N/A
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs El NSW
MP
apply(check all that apply): ❑
❑Water
Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑Yes 0 No
attached?
4. DWQ Stormwater Program Review
'1Coastal counties
DHQW
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 0 Yes ❑X No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑X Yes 0 No
5b. Have all of the 401 Unit submittal requirements been met? ❑X Yes 0 No
Page 8 of 10
PCN Form—Version 1.4 January 2009

•
•
F. Supplementary Information
1. Environmental Documentation(DWQ Requirement)
I a. Does the project involve an expenditure of public(federal/state/local)funds or the
0 Yes 0 No
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 0 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
letter.) El Yes 0 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 ❑X No
or Riparian Buffer Rules(15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑Yes 0 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 Yes II 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 short narrative description.
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.
On-site ground absorption system
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 ❑X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ❑X Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Web Page
6. Essential Fish Habitat(Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
No open water impacts
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 ❑X No
status(e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
Web Page
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑X Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
AE-7 - House built on pilings
8c.What source(s)did you use to make the floodplain determination?
FEMA Flood Maps(Survey)
George H. Wood, PWS(Agent) 1-17-17
Applicant/Agent's Printed Name Api f ant/Agent's Sigma Date
(Agent's si• ature is valid only if an authorization
letter from the applicant is provided.)
Page 10 of 10

DocuSign Envelope ID:D59B93DF-5FF1-4D4E-AF11-13E3DB07353A
AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Landowner of record authorizes Environmental Professionals.Inc.to:
1. enter the property to gather anv roaatmtal and she inform tion,including delineation of
environmental regulatory jurisdictions;
2. enter the site with the regulatory agencies(Le.U.S.Army Corps of Engin.
North Carolina Division of Coastal Management,North Carolina Division of Water
Quality.etc.)as needed to review regulatory alignments)and/or to idea*additional
n1Nla yl s;
3. submit plata and other information to acquire regulatory agency confirmations,approvals.
and/or deserrnhardons(U.S.Army Corps of Engineers,North Carolina Division of
Coastal Management,North Carolina Division of Water Quality,etc.);and
4: act as agent for the purposes of obtaining environmental permits,aatboriatious,andler
determinations.
e—Docby: ..—DocuSianed by:
.766, INOUS LC.S(AI. f I*n&$ 12/1/2016
aEseaee os_-
John P.Burnlie K Burns Date
Client Date
Joanne O'Toole

1
Ap)....... ._=-
ENVIRON:1lENTAL
PROFESSIONALS
--IN('..-
PLANNING
NfPLANNING FOR
A BETTER
ENVIRONMENT
January 16,2017
The Great Dismal Swamp Restoration Bank,LLC
Attn: Ms.Beverly White
P.O.Box 6186
Chesapeake,VA 23323
Dear Ms. White,
This letter is to request confirmation of acceptance for mitigation credits for the Joanne O'Toole
application for proposed impacts to wetlands.
Corps' Project Number: Pending
Waterway: Non-Riparian
Permittee's Name: Joanne O'Toole
Location of Impact: Southern Shores,Dare County,North Carolina
Permit Action: Nationwide#18
Impacts(Acres/Linear Feet): 0.05 Acres
Impact NWI Classification: PF01/4Cd
Impact Hydrologic Unit Code: Pasquotank 03010205
Anticipated Mitigation: 0.10 Acres
Thank you for providing a letter of acceptance for these proposed impacts.
Sincerely,
Environmental Professionals, I c.
Geor H. Wood,CEP,PWS
P.O.BOX 3368 • KILL DEVIL HILLS,NORTH CAROLINA 27948
TELEPHONE: [phone] • FAX: [phone] • EMAIL: obxwood(alyahoo.com

The Great Dismal Swamp RestorationBank, LLC
P. 0. Box 6186 Phone[phone]
Chesapeake,VA 23323 Fax [phone]
January 18,2017
Mr.George Wood
Environmental Professionals,Inc.
P.O. Box 3368
Kill Devil Hills,NC 27948
RE: Joanne O'Toole
Southern Shores
Dare County, NC
Dear Mr.Wood:
The following price quote is given in reply to your request for the purchase of 0.10 wetland mitigation credits(HUC Code 03010205)
from The Great Dismal Swamp RestorationBank Timberlake Farm. These credits are currently available from our Timberlake
mitigation bank.
The cost will be Two Thousand, Three Hundred Dollars ($ 2,300.00). This quote will expire on April 30, 2017. You will need to
submit to the USCOE the necessary application for said mitigation, and receive USCOE permission to furnish said required credits
from our Timberlake bank.
To complete this transaction,we will require payment in full. Once payment is received, the credit sale will be reported to the US
Army Corps of Engineers.Please provide and/or confirm the following information:
Corps Project#:
Waterway: Non-Riparian
Permittee Name: Joanne O'Toole
Locality of Impact:Southern Shores,Dare County,NC
Permit action(i.e.,IP,NWP-39,enforcement,etc.)NWP 18
Impacts(acres/linear feet): 0.10
Impacts Hydrologic Unit Code:03010205
Mitigation Bank, Permittee, and Consultant agree not to discuss with any other party the details and/or pricing of this agreement,
unless necessary for regulatory matters. Information contained herein shall be held in the strictest confidence.
Thank you for allowing us to quote on this project. We look forward to working with you.
S% cerely,
Beverly M. �te
Manager— • ounting/Sales
GDSRB
CC:File