20170649 Ver 1_401 Application_20170525

Attachment 1 - Lot 90 Huehes Road PCN
OF WATFq
p Office Use Only
o-0
2 0 1 7 0 6 4 9 , tion ID no.
M
-, 77�1
/. tno.
F e January 2009
Pre -Construction Notification (PC pQU
A.
1.
Applicant Information
Processing c.
1 a.
Type(s) of approval sought from the Corps:
® Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑Yes ®No
1 d.
Type(s) of approval sought from the DWR (check all that apply):
❑401 Water Quality Certification - Regular ❑Non -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 DWR
401 Certification:
®Yes ❑No
For the record only for Corps Permit:
❑ Yes ® 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 or in -lieu fee
program.
® Yes ❑No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
®Yes ❑No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑Yes ®No
2.
Project Information
2a.
Name of project:
Lot 90 Hughes Road
2b.
County:
Pender
2c.
Nearest municipality / town:
Hampstead (see Appendix A)
2d.
Subdivision name:
Washington Acres
2e.
NCDOT only, T.I.P. or state project no:
NA
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Haas, Jon (see Appendix B)
3b.
Deed Book and Page No.
2889/051
3c.
Responsible Party (for LLC if applicable):
NA
3d.
Street address:
2215 HIGHLAND AVE
3e.
City, state, zip:
KNOXVILLE, TN 37916
3f.
Telephone no.:
Unknown
3g.
Fax no.:
NA
3h.
Email address:

Attachment 1 - Lot 90 Hughes Road PCN ,:�-)F C -1i
4. Applicant Information (if different from owner)
4a. Applicant is:
❑Agent ®Other, specify: Potential Buyer
4b. Name:
Kathy and Joseph Mattox (see Appendix C)
4c. Business name (if applicable):
NA
4d. Street address:
Site coordinates (in decimal degrees):
4e. City, state, zip:
1 c.
4f. Telephone no.:
910. 620.6191
4g. Fax no.:
Surface Waters
4h. Email address:
kathymattoxl2ta'�.email.com
5. Agent/Consultant Information (if applicable)
5a. Name:
Dana Lutheran
5b. Business name (if applicable):
Southern Environmental Group, Inc. (see Appendix C)
5c. Street address:
5315 South College Road, Suite E
5d. City, state, zip:
Wilmington, NC 28412
5e. Telephone no.:
910.452.2711
5f. Fax no.:
910.452.2899
5g. Email address:
dlutheranna,seei.us
B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
3282-90-5287-0000 (see Appendix B)
1b.
Site coordinates (in decimal degrees):
Latitude: 34.348101 ON Longitude: -77.709418 °W
1 c.
Property size:
0.71 -acre (see Appendix D)
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
Mill Creek (Betts Creek)
2b.
Water Quality Classification of nearest receiving water:
SA;HQW (Stream Index #18-87-14)
2c.
River basin:
White Oak (03020302)
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 site is an undeveloped, wooded lot located within the Washington Acres Subdivision.
3b.
List the total estimated acreage of all existing wetlands on the property: - 11,170 (0.26 -acre)
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: NA
3d. Explain the purpose of the proposed project:
The purpose of this project is to construct a single family dwelling on a lot within the existing Washington Acres subdivision, in
Hampstead, Pender County, North Carolina..
3e. Describe the overall project in detail, including the type of equipment to be used:
The project consists constructing a retaining wall along the limits of impact denoted on the attached site plan, filling the
proposed area with clean earthen fill, upon which a single family dwelling will be constructed (see Appendix D for details).
Dump trucks and bulldozers will be utilized to bring in the fill dirt and grade the lot to a specified elevation.
4.
Jurisdictional Determinations

Attachment 1 - Lot 90 Hughes Road PCN 1� F: C,i
4a. Have jurisdictional wetland or stream determinations
❑Yes ®No ❑Unknown
by the Corps or State been requested or obtained
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
for this property / project (including all prior phases)
Comments:
in the past?
2d.
Forested
4b. If the Corps made the jurisdictional determination,
❑Preliminary ❑Final
what type of determination was made?
Lot Fill
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Name (if known): David Scibetta
SEGi
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Emily Greer met with the potential buyers on the site. SEGi then delineated the wetlands. A jurisdictional determination
packet has been attached to this application (see Appendix E).
5. Project History
5a. Have permits or certifications been requested or
❑Yes ®No ❑Unknown
obtained for this project (including all prior phases) in
2175 SF / 0.05 AC
the past?
3. Stream Impacts
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.
NA
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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.
2a.
Wetland impact number
Permanent (P) or
Temporary (T)
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction Corps
(404,10) or DWR (401,
other)
2f.
Area of impact
(acres)
A (P)
Lot Fill
Bottomland Forest
Yes
USACE 404
2175 SF / 0.05 AC
A (T)
Construction Buffer
Bottomland Forest
Yes
USACE 404
442 SF / 0.01 AC
2g. Total Permanent Wetland Impacts:
2175 SF / 0.05 AC
2h. Comments: Please see Appendix D for details. The area denoted as Temporary Impact will be returned to its original
grade and contour and allowed to re -vegetate naturally.
3. Stream Impacts
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)
3h. Total stream and tributary impacts
NA
3i. Comments:
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 impact number
Permanent (P) or
Name of water body
Type of impact
Water body type
Area of impact (acres)
Temporary (T)
(if applicable)

Attachment 1 — Lot 90 Huehes Road PCN .`) F ( , i
01
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Due to the configuration of the wetlands within the project area and the need for septic to be at the front of the property,
avoiding impacts was not possible. Therefore, the Applicant, during the design phase, situated the dwelling as close to the back
4f. Total open water impacts
NA
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
(acres)
Flooded
Filled
Excavated Flooded
Filled
Excavated
P1
approved the mitigation proposal, a credit reservation letter will be submitted to their office.
2a. Does the project require Compensatory Mitigation for
®Yes ❑No
impacts to Waters of the U.S. or Waters of the State?
5f. Total:
NA
5g. Comments:
5h. Is a dam high hazard permit required?
❑Yes ❑No If yes, permit ID no: A
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWR)
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
6h. Total Buffer Impacts:
NA
6i. Comments:
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.
Due to the configuration of the wetlands within the project area and the need for septic to be at the front of the property,
avoiding impacts was not possible. Therefore, the Applicant, during the design phase, situated the dwelling as close to the back
property line as possible, while allowing for adequate access and egress into the garage, and incorporated a retaining wall, to
eliminate the slope of the proposed fill. The incorporation of the retaining wall minimized wetland impacts by approximately
2b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Silt fence, as well as other best management practices, will be utilized during the construction process. This is necessary to
ensure sediment does not discharge into the wetland and to mark the limits of authorized impact.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
The Applicant intends to offset the loss of riparian wetland functional value that will take place as result of filling 0.05 -acre of
wetlands, with compensatory mitigation, in the form of installing the retaining wall and payment to the Northeast Cape Fear
Umbrella Mitigation Bank (LCFUMB), at a 2:1 mitigation -to -impact ratio, for riparian wetland restoration credit. Due to the
fact that this site is not within the LCFUMB service area, a higher mitigation to impact ratio would be required. However, the
cost of installing the wall should be taken into consideration when assessing an appropriate compensatory mitigation
proposal. In addition, this site is approximately l mile from the LCFUMB service area limits and is the only available bank
from which the Applicant can choose. A higher ratio would make the project economically infeasible. Once the USACE has
approved the mitigation proposal, a credit reservation letter will be submitted to their office.
2a. Does the project require Compensatory Mitigation for
®Yes ❑No
impacts to Waters of the U.S. or Waters of the State?

Attachment ] -Lot 90 Hughes Road PCN r Cli
2b. If yes, mitigation is required by (check all that apply):
❑DWR ®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: Northeast Cape Fear Umbrella Mitigation Bank (LCFUMB)
3b. Credits Purchased (attach receipt and letter)
Type: Riparian
Quantity: 2:1 = 0.10 Acre
3c. Comments: A credit reservation letter will be secured for the proposed mitigation once the USACE has approved the
mitigation plan.
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
NA
4b. Stream mitigation requested:
Zone 1
4c. If using stream mitigation, stream temperature:
4d. Buffer mitigation requested (DWR only):
4e. Riparian wetland mitigation requested:
Zone 2
4f. Non -riparian wetland mitigation requested:
4g. Coastal (tidal) wetland mitigation requested:
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.
.NA
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer
mitigation?
❑Yes ®No
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
1.5
6f. Total buffer mitigation required:
NA
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).
NA
6h. Comments:
E.
Stormwater Management and Diffuse Flow Plan (required by DEMLR)
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
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
The site is not located within a river
basin with buffer protection rules.
2.
Stormwater Management Plan
2a.
What is the overall percent of impervious area of this project?
26%
2b. Does the project require a Stormwater Management Plan? I ❑Yes ®No

Attachment 1 — Lot 90 Hughes Road PCN ":�_)F C,
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
This is a single family dwelling with less than 10,000 square foot of proposed built upon area (BUA).
The proposed project will create 6,550
square
feet of BLIA. This site is not located within a Coastal Area Management Act Area of Environmental Concern (AEC).
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?
NC DEMLR
❑Phase II ❑NSW USMP
3b.
Which of the following locally -implemented stormwater management programs apply
❑Water Supply Watershed
(check all that apply):
❑Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been attached?
❑Yes NNo
4. DEMLR Stormwater Program Review
❑Coastal counties ❑
4a.
Which of the following state -implemented stormwater management programs apply
❑ORW []SLSL 2 2006-246
(check all that apply):
[-]Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑Yes NNo
attached?
5.
DWR 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
F.
Supplementary Information
1.
Environmental Documentation (DWR Requirement)
1 a.
Does the project involve an expenditure of public (federal/state/local) funds or the use of
❑Yes NNo
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 (North
❑Yes [:]No
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.)
❑Yes ❑No
Comments:
2.
Violations (DWR Requirement)
2a.
Is the site in violation of DWR Wetland Rules (15A NCAC 2H .0500), Isolated Wetland
Rules (15A NCAC 2H .1300), DWR Surface Water or Wetland Standards, or Riparian
[-]Yes NNo
Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑Yes NNo
2c.
If you answered "yes' to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWR Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes NNo
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 DWR policy. If you answered "no," provide a short narrative description.
The proposed project will not open access to adjacent properties for development, as
this site is in an existing residential
subdivision.
4.
Sewage Disposal (DWR 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 septic is the wastewater treatment method.
5.
Endangered Species and Designated Critical Habitat (Corps Requirement)

Attachment 1 — Lot 90 Hughes Road PCN F C, i
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.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
It is of SEGVs opinion, based upon the historical use of the project site and the overall development of the surrounding
properties, there is no concern for the existence of Endangered Species or Designated Critical Habitat within the project area.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑Yes ®No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat (EFH)?
While the site is adjacent to a tidal creek, no work is proposed below normal high water.
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
❑Yes ®No
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?
There are not existing structures located within the property boundaries. This site is located within an existing subdivision.
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:
The project is located within the FEMA AE flood zone (see Appendix F). The structure will be constructed to meet the specific
flood zone requirements.
8c. What source(s) did you use to make the floodplain determination?
Pender County GIS.
�
Dana A. Lutheran (SEGO
C -"
21 November 2016
Applicant/Agent's Signature
Applicant/Agent's Printed Name
Date

Attachment 1 — Lot 90 Hughes Road PCN F C,i
Appendix A
Vicinity Map

Attachment I — Lot 90 Hughes Road PCN F C7,i
Appendix B
Pender County GIS Property Tax Information

PIN: 3282-90-5287-0000
Owner: HAAS JON
2215 HIGHLAND AVE
KNOXVILLE, TN 37916
Deed Ref: 2889/051
Property
Address: HUGHES RD
Description: LT 90 PB 12/1 WASHINGTON ACRES SEC 8
Sale Price: $90,000
Sale Date: 2006-02-16
Plat: 00120001
Account No: 885111
Township: TOPSAIL
Subdivision: WASHINGTON ACRES
Tax Codes: G01 F29 R40
Acres: 0.71
Land Value: $200,586
Building Value: $0
Total value: $200,586
Deferred Value: $0
Exempt Amount:
PCL Class: R
Heated Sq Feet:
Pender County
1:1,269
0 0.0075 0.015
0.03 mi
0 0.015 0.03
0.06 km
1 inch = 106 feet
N
Wl
September 7, 2016
S

Attachment 1 — Lot 90 Hughes Road PCN F C,i
Appendix C
Agent Authorizations
10

Attachment 1 — Lot 90 Hughes Road PCN F C,i
SEGS
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: LT 90 PB 12/1 WASHINGTON ACRES SEC 8 &
LT 91 PB 12/1 WASHINGTON ACRES SEC 8
LOT NO. 90 and 91 PLAN NO. PARCEL I.D. 3282-90-5287-0000 &
3282-90-4291-M
STREET ADDRESS: HUGHES RD
Property Owner (Affected Party): Kathy and Jo Mattox
The undersigned, registered property owner of the above noted property, does hereby authorize
Southern Environmental Group. Inc. (SEGi) to act on their behalf, in matters regarding areas of
environmental concern.
Affect Party's Mailing Address (if different than property above):
ut�
Telephone:
P, Property Ow rAuthorized Signature
K&+Vi Mr -"to
V X
Print Name
II - 1g-��
Date
SEGi Authorized Signature
Dana A. Lutheran
Print Name
17 November 2016
Date
11

SURVEY FOR
JOE & KATHY MATTOX
LOT 90 WASHINGTON ACRES
TOPSAIL TOWNSHIP PENDER COUNTY
NORTH CAROLINA
DATE: 11/09/2016
REFERENCE: DB 2889 PG 051
Q
0j
� a
U? m
W CD
= a
fD
Z
TSM MAG.
NAIL SET
ELEV. 19.57'
NOTES:
1. AREA COMPUTED BY COORDINATE METHOD
2. ALL DISTANCES ARE HORIZONTAL
3. FOR REFERENCE SEE AS NOTED
LEGEND:
E.C.M.. EXIS7ING CONCRETE MONUMENT
E.I.P. . EMSTING IRON PIPE
I.S.. IRON SET
U.E. UTILITY EASEMENT
[91MARP-1 AMlim-GAMIGI:[.7ct.Nx
pm
FLOOD ZONE AE. BASE
LOT 90A
FLOOD 10.0' TAKEN FROM
MAP 3720/3282, J. EFFECTIVE
DATE 02/16/2007
PRELIMINARY FLOOD MAPS
( REVISE FLOOD ZONE AE
BASE FLOOD 12.0' & 13.0'
PROPOSED
ROUSE SITE
a
FILL TO ELEV. 8'
`
L►i
a-
S
24'21'00" E 220.37'
w
--,----,— 10' SIDE SETBACK
c
.
,—^
\
WETLAND
IMPACT
53.00'
`
0.05 ac.
1
Q WETLAND UNE
BY SEGI
BULKHEAD
1 x
`
IWi►
LOT 90 77 LF
25245 SF
z `
0.58 Ac.
C
N
v `
5 ' TEMPORARY:
t
WETLAND IMPACT N -Da
�y \
442 SF
�
PROPOSED DRIVE
, I
���•�``�, ICARO(
4'
SEAL
L-3391
suer! -.Q.
0
WETLAND LINE
BY SEGI
S
S 24'31'00" E 246.25' v 1
W 1
LOT 91 FLINEIBEARING I DISIANCE
1-1 IS 2-V31'00- E 21.00
L2 IS 24721'00- El 20.00
I CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION FROM AN ACTU
SURVEY MADE UNDER MY SUPERMSION (DEED DESCRIPTION RECORDED IN BOOK
PACE�L.,_OR OTHER REFERENCE SOURCE 1G THAT THE BOUNDARIES NOT
SURVEYED ARE INDICATED AS DRAWN FROM INR IN BOOK � PAGE '=—
OR OTNO REFERENCE SOURC MRATIO OR
POSITIONAL ACCURACY IS AT,
S THE REOUIREMENT9
OF THE STANDARDS OF FRAC FORAN
LD NG CAROLINA (21NCAC
56.' 600 Abel' 2018.
THIS �—SAY OF
ATHAN L 1MAYNE PLS 3391
30' 15' 0 30'
SCALE IN FEET
1 INCH - 30 FEET
THIS MAP IS NOT FOR RECORDATION
BUF�R
NORMAL HIGH
WATER LINE
FLAGGED BY
SEG

Attachment I — Lot 90 Hughes Road PCN r C, i
Appendix D
Lot 90 Hughes Road Wetland Impact Map
12

Attachment 1 — Lot 90 Hughes Road PCN C� F C1 i
Appendix E
Jurisdictional Determination Packet
13

PIN: 3282-90-4291-0000
Owner: HAAS KARA B
2215 HIGHLAND AVENUE
KNOXVILLE, TN 37916
Deed Ref: 1978/36
Property
Address: HUGHES RD
Description: LOT 91 PB 12/1 WASHINGTON ACRES SEC 8
Sale Price: $118,000
Sale Date: 2002-10-30
Plat: 00120001
Account No: 836786
Township: TOPSAIL
Subdivision: WASHINGTON ACRES
Tax Codes: G01 F29 R40
Acres: 0.82
Land Value: $230,345
Building Value: $0
Total value: $230,345
Deferred Value: $0
Exempt Amount:
PCL Class: R
Heated Sq Feet:
Pender County
1:1,269
0 0.0075 0.015
0.03 mi
0 0.015 0.03
0.06 km
1 inch = 106 feet
N
wf
September 7, 2016
S

., ,
Jurisdictional Determination Request
A. PARCEL INFORMATION
B.
C.
Street Address:
City, State:
County:
Directions:
Lots 90 and 91, Hughes Road
Hampstead, NC
Pender
From NC17, take Washington Acres to Circle Drive, left. Left onto Hughes Rd.,
site on right, east of 529 Hughes Road.
Parcel Index Number(s) (PIN): 3282-90-5287-0000, 3282-90-4291-0000
REQUESTOR INFORMATION
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address'
David Scibetta, SEGi
5315 S. College Road, Suite E., Wilmington, NC 28412
910-452-2711
[e-mail]
Select one:
❑ I am the current property owner.
❑✓ I am an Authorized Agent or Environmental Consultant
❑ Interested Buyer or Under Contract to Purchase
❑ Other, please explain.
PROPERTY OWNER INFORMATION
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address3:
1) Lot 90: Jon Haas, 2) Lot 91: Ryan Mattox et al
1) 2215 HIGHLAND AVE., KNOXVILLE, TN, 2) 4409 SOUTHFIELD DR., WILMINGTON, NC
17 Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
1 If available
2 Must attach completed Agent Authorization Form
3 If available
Version: December 2013 Page 3

0 ( I i
jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION'
I, the undersigned, a duly authorized owner of record of the property°properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and'or Section 10 of the Rivers and Harbors Act of
1899.
i�rlrc' 1-017 r
Property Owner (please print)
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
Date
1 am requesting that the Corps provide a Rmliminary JD for the property identified herein.
This request does include a delineation.
I am requesting that the Corps provide a ereliminary JD for the property identified herein.
This request does NOT include a delineation.
I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUSs and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
I am requesting that the Corps delineate the boundaries of all WoUS on a property/preject
area and provide an approved JD (this may or may not include a survey plat).
aI am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
`For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E
s Waters of the United States
Version: December 2013 Page 4

� • i
Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Property Owner (please print)
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
Date
I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
1 am requesting that the Corps investigate the property/project area for the presence or
absence of WoUS5 and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an approved JD (this may or may not include a survey plat).
I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
4 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
5 Waters of the United States
Version: December 2013 Page 4

9 k I at
Jurisdictional Determination Request
F. ALL REQUESTS
Map of Property or Project Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.
❑✓ Size of Property or Project Area 1.53
acres
❑ I verify that the property (or project) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.
G. JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests:
F-1Completed and signed Preliminary Jurisdictional Determination Formb.
❑ Project Coordinates: Latitude Longitude
Maps (no larger than 11x17) with Project Boundary Overlay:
❑ Large and small scale maps that depict, at minimum: streets, intersections, towns
❑ Aerial Photography of the project area
❑ USGS Topographic Map
❑ Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
6 See Appendix A of this Form. From Regulatory Guidance Letter No. 08-02, dated June 26, 2008
Version: December 2013 Page 5

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
Wetland Data Sheets
Tributaries:
USACE Assessment Forms
Upland Data Sheets F-1 Other Assessment Forms
(when appropriate)
Landscape Photos, if taken
Field Sketch overlain on legible Map that includes:
■ All aquatic resources (for sites with multiple resources, label and identify)
■ Locations of wetland data points and/or tributary assessment reaches
■ Locations of photo stations
■ Approximate acreage/linear footage of aquatic resources
(2) Approved JDs including Verification of a Delineation:
❑V Project Coordinates: N34.34825 Latitude W77.70951 Longitude
Maps (no larger than 11x17) with Project Boundary Overlay:
✓❑ Large and small scale maps that depict, at minimum: streets, intersections, towns
✓❑ Aerial Photography of the project area
✓� USGS Topographic Map
❑✓ Soil Survey Map
0 Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
1987 Manual Regional Supplements and Data forms can be found at:
http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits/res supp.aspx
Wetland and Stream Assessment Methodologies can be found at:
http://i)ortal.ncdenr.org/c/document library/set file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&groupld=38364 and,
http://www.saw.usace.army.miI/Portals/59/docs/regulatory/pubIicnotices/2013/NCSAM Draft User Manual 130318.pd
8 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 6

0 , .
Jurisdictional Determination Request
Delineation Infonnation (when applicable):
Wetlands:
❑✓ Wetland Data Sheets
Tributaries:
❑ USACE Assessment Forms
❑✓ Upland Data Sheets ❑ Other Assessment Forms
(when appropriate)
❑ Landscape Photos, if taken
❑✓ Field Sketch overlain on legible Map that includes:
• All aquatic resources (for sites with multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
• Approximate acreage/linear footage of aquatic resources
Supporting Jurisdictional Information (for Approved JDs only)
Approved Jurisdictional Determination Form(s) (also known as "Rapanos
Form(s)")
❑ Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc. to navigable waters.
9 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 7

j, 1 r
Attachment 1 — Lot 90 Hushes Road PCN F C,i
A,
t
Appendix F
Pender County GIS Flood Map
7- 1w,
Tv
.z„
' •'ol
. J
AW Waft N
.� V. _s.. �'....
-,.•w� �.MOM
a
14