20170643 Ver 1_401 Application_20170524

May 22, 2017
2 0 1 70 6 4�
Three Oaks Engineering, Inc.
324 Blackwell Street, Suite 1200
Durham, NC 27701
[phone]
James Lastinger Jennifer Burdette
Raleigh Regulatory Field Office NC Division of Water Resources
US Army Corps of Engineers 401 & Buffer Permitting Branch
3331 Heritage Trade Drive, Suite 105 512 North Salisbury Street
Wake Forest, NC 27587 Raleigh, NC 27604
SUBJECT: Nationwide Permit 29 Application for the Construction of a Residential Building and Bulkhead
Pinehurst (PIN: 855105190990)
SAW -2013-00125
Moore County, NC
Mr. William Frank proposes the construction of a residential building and bulkhead in Moore County, NC in the
Town of Pinehurst. The project consists of an approximately 2,880 square foot (sqft) residential building, a
bulkhead, and cut/fill operations resulting in approximately 0.04 acre of disturbed area.
Please find enclosed a PCN form, USGS quad map, Jurisdictional Determination documents, and Survey Platt with
and without the proposed building footprint.
The North Carolina Natural Heritage Database was checked for records of threatened and endangered species. The
US Fish and Wildlife Service lists four species for Moore County that have federal status. Cape Fear shiner (Notropis
mekistocholas), Red -cockaded woodpecker (Picoides borealis), American chaffseed (Schwalbeo Americana), and
Michaux's sumac (Rhus michauxii) are listed as endangered. The Bald eagle is protected in every county in North
Carolina under the Bald and Golden Eagle Protection Act. Suitable feeding/water source (Pinehurst Lake) is located
within one mile of the project study area, which could support Bald eagle. A review of the January 2017 North
Carolina Natural Heritage Program's (NCNHP) database of rare species indicates no known occurrences of Bald
eagle are found within 1.0 miles of the project area.
For the Cape Fear Shiner, designated critical habitat areas are defined as:
1. Chatham County, NC. Approximately 4.1 miles of the Rocky River from North Carolina State Highway 902
Bridge downstream to Chatham County Road 1010 Bridge;
2. Chatham and Lee Counties, NC. Approximately 0.5 river mile of Bear Creek, from Chatham County Road
2156 Bridge downstream to the Rocky River, then downstream in the Rocky River (approximately 4.2 river miles) to
the Deep River, then downstream in the Deep River (approximately 2.6 river miles) to a point 0.3 river mile below
the Moncure, North Carolina, U.S. Geological Survey Gaging Station; and,
Three Oaks Engineering

0
3. Randolph and Moore Counties, NC. Approximately 1.5 miles of Fork Creek, from a point 0.1 river mile
upstream of Randolph County Road 2873 Bridge downstream to the Deep River then downstream approximately
4.1 river miles of the Deep River in Randolph and Moore Counties, North Carolina, to a point 2.5 river miles below
Moore County Road 1456 Bridge.
Primary constituent elements are physical and biological features of the designated critical habitat essential to the
conservation of the species. Primary constituent elements are physical and biological features of the designated
critical habitat essential to the conservation of the species. The constituent elements for the Cape Fear shiner
include: clean streams with gravel, cobble, and boulder substrates with pools, riffles, shallow runs; slack water
areas with large rock outcrops; and side channels and pools with water of good quality and relatively low silt loads.
A review of the NCNHP database on March 22, 2017 revealed no known occurrences of Cape Fear shiner within 1.0
mile of the project area. The closest know occurrence is located approximately 20 miles north of the project area
in the Deep River. As no streams are present on the project area, the proposed project will have no effect on this
species.
The red -cockaded woodpecker (RCW) typically occupies open, mature stands of southern pines, particularly
longleaf pine (Pinus palustris), for foraging and nesting/roosting habitat. The RCW excavates cavities for nesting
and roosting in living pine trees, aged 60 years or older, which are contiguous with pine stands at least 30 years of
age to provide foraging habitat. The foraging range of the RCW is normally no more than 0.5 miles. A review of the
NCNHP database on March 22, 2017 revealed several element occurrences of this species within 1.0 mile of the
project area. During a site visit on March 23, 2017, the project area was checked for foraging trees, and none were
found. Therefore, the proposed project will have no effect on this species.
American chaffseed generally occurs in habitats described as open, moist to dryish Mesic Pine Flatwoods and
longleaf pine flatlands, Pine Savannas, Pine/Scrub Oak Sandhills, Sandhill Seeps, and other open grass/sedge-
dominated communities. This herb also occurs in the ecotonal areas between peaty wetlands and xeric sandy soils
and on the upper ecotones of, or sites close, to Streamhead Pocosins. The species prefers sandy peat or sandy
loam, acidic, seasonally moist to dry soils in sunny or partly sunny areas subject to frequent fires in the growing
season. The plant is dependent on factors such as fire, mowing, or fluctuating water tables to maintain its required
open to partly -open habitat. Most extant occurrences, and all of the most vigorous occurrences, are in areas
subject to frequent fire. This species is also known to occur on road cuts and power line rights-of-way that
experience frequent mowing or clearing. A review of NCNHP database on March 22, 2017 revealed no known
occurrences of this species with 1.0 mile of the project area, though there is an historical occurrence approximately
1.2 miles from the project area. As no habitat for this species occurs within the project area, this project will have
no effect on this species.
Michaux's sumac grows in sandy or rocky open woods in association with basic soils. Several populations in North
Carolina are on highway rights-of-way, roadsides, or on the edges of artificially maintained clearings. A review of
the NCNHP database on March 22, 2017 revealed no known occurrences of this species within 1.0 mile of the
project study area. The closest known occurrence is approximately 5.5 miles southwest of the project. Therefore,
the subject project will have no effect on this species.
A review of the HPOWEB GIS Service, a service maintained by State Historic Preservation Office (SHPO), on March
22, 2017 found several historic buildings within 1.0 mile of the subject project, but these properties would not likely
be affected by this project. There are no buildings
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Impacts to Waters of the United States
The project area is adjacent to an unnamed portion of Pinehurst Lake, which feeds Horse Creek. Horse Creek (DWR
WS -II; HQW) is on the USGS topographic map as a perennial stream. From Pinehurst Lake, Horse Creek flows
approximately 8.2 miles to Drowning Creek, which flows another 16.3 miles to Lumber River. Lumber River meets
the definition of a Traditional Navigable Water. For these reasons, we believe the unnamed portion to Pinehurst
Lake is a Relatively Permanent Water and is under the jurisdiction of the U.S. Army Corps of Engineers. In order to
construct the project, it will be necessary to impact waters of the United States in the Lumber River Basin (HUC
03040203). Specifically, Mr. Frank is requesting to construct a residential building. The impacts are listed in the
tables below:
Existing Condition Proposed Condition Net Impacts
Wetland (WA) Fill I Permanent: 0.04 acres
Avoidance and Minimization
The subject lot is in a distinctly low-lying area surrounded on two sides by houses and yards with considerable fill.
There are seepages throughout the lot in addition to the wetlands. Based upon discussions with the civil engineer
(Mr. Larry Graham), the house is expected to be raised a minimum of 6 -feet to be able to provide necessary
underdrains and diversions, thereby protecting the structure and shedding runoff around the proposed house.
Assuming a minimum 6 -foot fill from the house pad sloping back towards the lake at an 8:1 slope, the attached
drawing reflects and approximately 48 -foot toe of slope. However, a 4 -foot bulkhead will also be constructed,
which essentially has to taper back at a constant slope from the lake (also shown on the attachment). The
bulkhead fill slope then intersects the house fill slope, eliminating the chance to avoid/minimize any wetland
impacts.
Permits Requested
Mr. Frank is hereby requesting authorization under Section 404 of the Clean Water Act to proceed with the
construction project outlined above. We are also requesting a 401 Water Quality Certification from the North
Carolina Department of Environment and Natural Resources (DENR), Division of Water Resources (DWR).
If you have any questions or need additional information, please contact me by mail, by email at
[e-mail], or at [phone]. Your review and consideration are greatly
appreciated.
Sincerely,
�K� 6. hc�'2
Michael Wood, NCLSS
Principal
Three Oaks Engineering

A�TF9oG
C3 1;5� -'C
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
Pre -Construction Notification PCN Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1 c.
Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1 d.
Type(s) of approval sought from the DWQ (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 DWQ 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.
El 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:
Residential Building Construction at 20 Gingham Lane, Pinehurst, NC
2b.
County:
Moore
2c.
Nearest municipality / town:
Pinehurst
2d.
Subdivision name:
Mineral Springs
2e.
NCDOT only, T.I.P. or state
project no:
N/A
3.
Owner Information
3a.
Name(s) on Recorded Deed:
William and Susan Frank
3b.
Deed Book and Page No.
Map Book 10, Page 63
3c.
Responsible Party (for LLC if
applicable):
Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
3d.
Street address:
622 Grooms Road
3e.
City, state, zip:
Clifton, NY 12065
3f.
Telephone no.:
[phone]
3g.
Fax no..-
o.:3h.
3h.
Email address:
[e-mail]
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a. Applicant is:
® Agent ❑ Other, specify:
4b.
Name:
Michael Wood
4c.
Business name
(if applicable):
Three Oaks Engineering
4d.
Street address:
324 Blackwell Street, Suite 1200
4e. City, state, zip:
Durham, NC 27701
4f.
Telephone no.:
[phone]
4g.
Fax no.:
4h.
Email address:
j [e-mail]
5.
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 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
N/A
1 b. Site coordinates (in decimal degrees):
Latitude 35.177495 Longitude: -79.498349
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
0.33 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
UT to Pinehurst Lake
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS -II; HQW
2c. River basin:
Lumber River Basin (HUC 03040203)
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 project study area is comprised of hardwood forest and maintained roadway along Gingham Lane and nearby
residences. The property boundary is the unnamed portion of Pinehurst Lake.
3b. List the total estimated acreage of all existing wetlands on the property:
0.04
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
N/A
3d. Explain the purpose of the proposed project:
To construct a residential building.
3e. Describe the overall project in detail, including the type of equipment to be used:
The proposed project is the construction of a residential building along with a bulkhead on a UT to Pinehurst Lake. Due to the
low-lying area, grading of the property will be needed in order to provide suitable construction conditions and allow for water
access. Erosion and sedimentation control measures will be installed. Fill in 0.04 acre of wetland will be required. Drainage of
the property will be directed into ditches. Equipment to be used includes a track hoe, dump truck, paving equipment, pumps,
and various hand tools.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
® Yes ❑ No ❑ Unknown
ro ect (including all prior phases) in the past?
P 1 C 9 P� P )�
Comments: N/A
4b. If the Corps made the jurisdictional determination, what type
Preliminary ®Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: Stephen R. Sheffield &
Name (if known): Stephen R. Sheffield
s, P.A.
Other: Associates,
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
March 26, 2013; SAW 2013-00125
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
N/A
Page 3 of 11
PCN Form —Version 1.3 December 10, 2008 Version

S. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
N/A
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number -
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ - non -404, other)
(acres)
Temporary T
W1 ®P ❑ T
Fill
® Yes
® Corps
0.04
❑ No
❑ DWQ
2g. Total wetland impacts
0.04
2h. Comments: Impacts will be less than 0.1 acre of wetland.
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
Type of jurisdiction
Average
Impact
number -(PER)
) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ - non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total Permanent Stream and Tributary Impacts
3i. Comments: N/A
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 type
Area of impact (acres)
Permanent (P)
or Tem ora
01 ❑P❑T
M. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version

5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or purpose of
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
(acres)
number
pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments: There are no ponds created for this project
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.
❑ Neuse ❑ Tar -Pamlico ❑ Other: Jordan Lake
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P)
for
Stream name
mitigation
(square feet )
(square feet)
or Temporary
impact
required?
131 ❑ PEI T
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments: N/A
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 subject lot is in a distinctly low-lying area surrounded on two sides by houses and yards with considerable fill. There are
seepages throughout the lot in addition to the wetlands. Based upon discussions with the civil engineer (Mr. Larry Graham),
the house is expected to be raised a minimum of 6 -feet to be able to provide necessary underdrains and diversions, thereby
protecting the structure and shedding runoff around the proposed house. Assuming a minimum 6 -foot fill from the house pad
sloping back towards the lake at an 8:1 slope, the attached drawing reflects an approximately 48 -foot toe of slope. However,
a 4 -foot bulkhead will also be constructed, which essentially has to taper back at a constant slope from the lake (also shown
on the attachment). The bulkhead fill slope then intersects the house fill slope, eliminating the chance to avoid/minimize any
wetland impacts. There are no impacts to open waters as a result of the bulkhead construction.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work area to prevent
sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement of Best Management
Practices for the protection of surface waters, restrictions against the staging of equipment in or adjacent to waters of the US.
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
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:
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
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 7 of 11
PCN Form —Version 1.3 December 10, 2008 Version

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
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:
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 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 ® 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.
El Yes El No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
N/A %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The proposed project is not subject to a
Non -404 Jurisdictional General Permit, 3704, or 3705 General Certifications
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ 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
FYes ❑ No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
4a. Which of the following state -implemented stormwater management programs apply
❑ HQW
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
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 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
El Yes 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
❑ 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
letter.)
❑ 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 ® No
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
❑ Yes ® 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.
The construction of a residential building will not result in future impacts. The property is located in a neighborhood, and
most of the other home sites have been developed. Therefore, this building will not further impact the area.
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.
Wastewater generated from the proposed project will be connected to existing sewer lines in the City of Pinehurst.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
El ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
® Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
® Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NCNHP Database
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?
This building construction project takes place in Moore County which is not near any coastal or tidal habitat that would
support EFH (i.e. salt marshes, oyster reefs, etc.).
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
El Yes 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?
A review of the NC SHPO HPOWEB GIS service on March 22, 2017 found several historic buildings within 1.0 mile of the
subject project, but these properties would not likely be affected by this project. There are no buildings currently located
on the property.
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: N/A
8c. What source(s) did you use to make the floodplain determination? North Carolina Floodplain Mapping Program
Mr. Michael Wood, LSS
5/22/2017
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the
aDDlicant is rovided.
Page 1 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

0
20 Gingham Lane
11,1 ParcelBoundary
N
Prepared For:
XNAW, William Frank
r� 1
Nationwide Permit #29
Application
20 Gingham Lane
Pinehurst, NC
Moore County, North Carolina
Date. April 2017
Scale:
0 100 200 Feet
1 1
Job No.:
17-105
Drawn By:
Checked By.
NMS
I MGW
i'ti
i
f
Nationwide Permit #29
Application
20 Gingham Lane
Pinehurst, NC
Moore County, North Carolina
Date. April 2017
Scale:
0 100 200 Feet
1 1
Job No.:
17-105
Drawn By:
Checked By.
NMS
I MGW
Figure

S. ARMY VORPS OF ENGINEERS
t WIL GTON DISTRICT
Action id. SAW-2013-OOI25 ',
I County: Moore U.S.G.S. Quad: Pinghorst
NOTIFIC4 TION OF ilIMSDICTIONAL DETERMINATION
Property Owner: William F n '
Address: 622
i8 ,1
Telephone No. (51813b9-4dQ
f
Property description: Nearest Town andgmt
Size (acres) Rivet Basin Cape Fear River Basin
Nearest Waterway Pin 'u e
USGS HUC Coordinates N X5.1775 W -79.4
Location description: T 1 2 in h R d in Pinehurst..Moore County, N,orth Carolir
Parcel ID # is 855105190990.
A. Preliminary Determma on
_ Based on preliminary in na on, there may be
wetlands on the above described property. We strongly suggest you have
f Department of the Army (DA) jurisdiction. To be considered final, a
his property inspected to de ine the extent
determination ust be verified by
the Corps. This preliminary determination is not an appealable action
jurisdictional
under the Regulatory pro Administrative Appeal
be appeal
Process ( Reference 33 CFR Part 331). If you wish, you may
), by contacting the, Corps district for further instruction. Also, you may
request an approved JD (vth` may
new information for I n1lia consideration
by the Corps to reevaluate the JD.
provide
B. Approved DeteMin*ti n
There are Navigable Waters of the United S
10 the Rivers and Aarbors Act and S
within the above described property subject to the permit requirements of
xtion 404 of the Clean Water Act. Unless there is a change in the law or
Section of
our published regulations, the$ determination
y be relied upon for a period not to exceed five years from the date of this
notification.
We strongly suggest you have the wetlands on four property delineated. Due to the size of your property and/or our
present workload, the. Corps may not be able tc accomplish this wetland delineation in a timely manner. For a more timely
delineation, you may wish tolobtain a consultm it. To be considered final, any delineation must be verified by the Corps.
The waters of the U.S. includ' ng wetlands have been delineated and surveyed and are accurately depicted on the plat signed
by the Corps Regulatory Official identified be ow on. Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
There are no waters of the .S., to include we lands, present on the above described property which are subject to the
permit requirements of Secttpn 404 of the Clc n Water Act (33 USC 1344). Unless there is a change in the law or our
published regulations, this d termination may be relied upon for a period not to exceed five years from the date of this
notification.
Page 1 of 2

The property is located in oneo' the 20 Coastal C unties subject to regulation under the Coastal Area Management Act
(CAMA). You should contact a Division of co Istal Management in Morehead City, NC, at [phone] to
determine their requirements.
Placement of dredged or fill matt
constitute a violation of Section
determination and/or the Corps ri
C. Basis For
D. Remarks
E. Attention USDA
This delineation/detOrmination has
particular site identified in this reqs
provisions of the Food Security Ac
in USDA programs, you should re'
Conservation Service, prior to star
F. Appeals Information
a above)
within waters of the US and/or wetlands without a Department of the Army permit may
)f the Clean W Act (33 USC § 1311). If you have any questions regarding this
%tor.y program, p contact Chrisri Wicker at [phone].
een conducted identify the limits of Corps, Clean Water Act jurisdiction for the
st. The delin on/determination may not be valid for the wetland conservation
of 1985. If you your tenant are USDA Program participants, or anticipate participation
lest a certified w tland determination from the local office of the Natural Resources
ng work.
is information a6plies only to approved jurisdictional determinations as indicated in
This correspondence constkutes a approved jurisdi tional determination for the above described site. If you object to this
determination, you may request ar administrative al peal trader Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (N P) fact shed an request for appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA fb rm to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Revifw Officer
60 Forsyth Street SW, RoQo�m 1OM15
Atlanta, Georgia 30303-8801
In order for an RFA to be accepted by the Corps, to Corps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has bee received by the Division Office within 60 days of the date of the NAP.
Should you decide to submit an RFA form, it must received at the above address by April 7.2013.
• It is not necessary to submit an RFA form to the
correspondence.**
Corps Regulatory Official: -
Date: 2/6/2013
The Wilmington District is com ited to prov
do so, please complete the attach customer
complete the survey online.
Copy furnish: Elite Properties, �: Tom Col
Office if you do not object to the determination in this
Expiration Date: 2/6/2018
the highest level of support to the public. To help us ensure we continue to
action Survey or visit-h/y /bet2 nwa usaco army miUsurvev.html to
110 C Applecross Road, Pinehurst, NC 28374

i
I
U.. ARMY
WILM
Action Id. SAW -2013-00125
OF J U'
Property Owner:
Address:
Telephone No.
Property description:
Size (acres) 0.33
Nearest Waterway Pinel
USGS HUC 0304
Location description: The
Parcel ID # is 855105190990.
A. Preliminary
TRPS OF ENGINEERS
GTON DISTRICT
Moore U.S.G.S. Quad: Pinehurst
ICTIONAL DETERMINATION
Nearest Town Pinehurst
River Basin Cape Fear River Basin
Coordinates N 35.177 W -79.4984
_ Based on preliminary informatic n, there may be v etlands on the above described property. We strongly suggest you have
this property inspected to de;ermine the extent of epartment of the Army (DA) jurisdiction. Tobe considered final, a
jurisdictional determination mu t be verified by tl e Corps. This preliminary determination is not an appealable action
under the Regulatory Program Administrative A al Process ( Reference 33 CFR Part 331), if you wish, you may
request an approved JD (which ay be appealed) i by contacting the Corps district for further instruction. Also, you may
provide new information for further consideration by the Corps to reevaluate the JD.
B. Approved Determination
There are Navigable Waters of the United States ?within the above described property subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or
our published regulations, this determination ma}, be relied upon for a period not to exceed five years from the date of this
notification.
We strongly suggest you have the wetlands on your property delineated. Due to the size of your property and/or our
present workload, the Corps may not be able to accomplish this wetland delineation in a timely manner. For a more timely
delineation, you may wish to obtain a consultant To be considered final, any delineation must be verified by the Corps.
The waters of the U.S. including wetlands on yoi ir property have been delineated and the delineation has been verified by
the Corps. We strongly suggest you have this d lineation surveyed. Upon completion, this survey should be reviewed and
verified by the Corps. Once verified, this surve3 will provide an accurate depiction of all areas subject to CWA
jurisdiction on your propertyhich, provided t re is no change in the law or our published regulations, may be relied
upon for a period not to exaee4 five years.
our vublished re ulations t s determinatioin may oe reueu u us"u' A c• •� — - of this notification.
There are no waters of the U.S., to include wetlands, present on the above described property which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our
published regulations, this determination may br relied upon for a period not to exceed five years from the date of this
notification.
Page I of 2

The property is located in one of the 20 Coastal C
(CAMA). You should contact the Division of Co,
determine their requirements.
Placement of dredged or fill material within waters of
constitute a violation of Section 301 off the Clean Wab
determination and/or the Corps regulatory program, pl
C. Basis For Determination
D. Remarks
E. Attention USDA Program; Participants
This delineation/determination has ben conducted to
particular site identified in this reque t. The delineati
provisions of the Food Security Act f 1985. If you o
in USDA programs, you should requt a certified we
Conservation Service, prior to startingwork.
F. Appeals Information (Thii information ar
B. above)
This correspondence constitutes an approved jurisdic
determination, you may request an administrative apI
Notification of Appeal Process (NA�) fact sheet and
determination you must submit a co�pleted RFA for
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room l OM 15
Atlanta, Georgia 30303-8801
es subject to regulation under the Coastal Area Management Act
Management in Morehead City, NC, at [phone] to
e US and/or wetlands without a Department of the Army permit may
Act (33 USC § 1311), if you have any questions regarding this
[se contact Christy Wicker atA9101251-4637.
ientify the limits of Corps' Clean Water Act jurisdiction for the
,/determination may not be valid for the wetland conservation
your tenant are USDA Program participants, or anticipate participation
and determination from the local office of the Natural Resources
only to approved jurisdictional determinations as indicated in
final determination for the above described site. If you object to this
d under Corps regulations at 33 CFR Part 331. Enclosed you will find a
quest for appeal (RFA) form. If you request to appeal this
to the following address:
In order for an RFA to be accepted by the Corps, the S orps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has been teceived by the Division Office within 60 days of the date of the NAP.
Should you decide to submit an RFA form, it must bi received at the above address by May 25, 20.13.
**It is not necessary to submit an RFA form to the
correspondence.** , n ,
Corps Regulatory Official:
Date: 3/26/2013
sion Office if you do not object to the determination in this
Expiration Date: 3/26/2018
The Wilmington District is commi4ed to providing t ie highest level of support to the public. To help us ensure we continue to
do so, please complete the attached! customer Satisfaction Survey or visit http:*erg nwp usace army mil/survey.html to
complete the survey online.
Copy furnish: Elite Properties, attr{: To Coleman, 10 C Applecross Road, Pinehurst, NC 28374
Stephen R. Sheffield & Associates; 1680 NC Highly 5, Suite 170, Aberdeen, NC 28315

SKETCH < 0
UNLESS OTHERWISE DENOTED, \. `�%4'<(' \/
• EXISTING IRON STAKE
IN -EXISTING CONCRETE MONUMENT \
O -SET CONCRETE MONUMENT
O -SET IRON STAKE
SQUARE FOOTAGE
♦- POWER SERVICE STUB
19- SEWER SERVICE STUB
®- TELEPHONE SERVICE SIUB
O- - CABLE TV SERVICE STUB
®- WATER METER
' FIRE HPDR
IV- /
O- SANTIARY SEWER MANHOLE
1p- UTILITY POLE �\ y
--o—o—o-- FENCE (�
N CARO,
I,T_41iE WETLANDS BOUNDARY DEPICTED
THI IS A R T OF A FIELD SURVEY AND/OR
M EME1661LCONpl�C*SD BY S. R. SHEFFIELD PLS NO. 1365
DATE
CERTIFICATE FOR U.S. ARMY CORPS. OF ENGINEERS
A-141.10'
R-273.27'
I3R-N5T i 6'31 "E
C-139.54'
i
i
i
i
15,841 Sq. Feet
/ 0.36 Acre
`yo is
\\\
THIS CERTIFIES THAT THIS COPY OF THIS PLAT IDENTIFIES AS
WATERS OF THE U.S. OR WETLANDS ALL ARES OF WATERS OF THE
U.S., NdCCLUDING WETLANDS, REGULATED PURSUANT TO SECTION 404
OF THE CLEAN WATER ACT AS DETERMINED BY THE UNDERSIGNED ON
THIS DATE UNLESS THERE IS A CHANGE W THE LAW OR OUR
PUBLISHED REGULATIONS, THIS DETERMINATION OF SECTION 404
JURISDICTION MAY BE RELIED UPON FOR A PERIOD NOT TO EXCEED
FNE YEARS FROM THIS DATE. THIS DETERMINATION WAS MADE
340
-----------------
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OF
1,684 Sq. Feet = AREA IN WETLANDS ON LOT 339
0.04 Acres
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7
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mm NIDIDED m K Fftuv ED
MR NSOWTON N AOCNONRE
WM 0. S. 47-30 AS NLTCED.
CORPORATE 00064 NO. C-1017111
s e NC.
DATE: MARCH 11. 2013
SURVEY FOR E C ? T-- '
WILLIAM T. FRANK
do WIFE
SUSAN L. FRANK
MD
RICHARD L. MULLNOW, JR
k WIFE
ELIZABETH H. MULLNOW
LOT NO. 339, UNIT 12, PHASE 2
PINEHURST, INCORPORATED
MINERAL SPRINGS TOWNSHIP, MOORE COUNTY
PINEHURST, NORTH CAROLINA
LARCH 11, 2013--- SCA18 1-=40'
STSPHII1 R. SE10PULD k A360CIATES. P.A.
09
10 NC HWY, 6, SUM NO. 170N
Allnu , NORTH CAROU NA
0 40 80 120
MAR 18 2013
RF@. Wu ,
i
, c�

UNLESS OTHERWISE DENOTED,
• = EX61M IRON STAKE `� \
■= EXISTING CONCRETE MONUMENT
0=SET CONCRETE MONUMENT
O=SET IRON STAKE
= SOUARE FOOTAGE
♦= POWER SERAM STUB
®= SEWER SERVICE STUB
TELEPHONE SERVICE SR)8
:CABLE TV SERVICE STUB
WATER METER
'Q- FIRE HYDRANT
= SANITARY SEWER MANHOLE / 4'7 •�
UTILITY POLE /
- FENCE i (�
V
I, 1411 --lb, VH E WETLANDS BOUNDARY DEPICTED
YiIW IS .,RESwLT OF A FIELD SURVEY MND/OR
EMEANW-CON" BY S. R. SHEFFIELD PLS N0. 1385
1410. L-1
•.., w..a.w"` DATE
CERTIFICATE FOR U.S. ARMY CORPS. OF ENGINEERS
THIS CERTIFIES THAT THIS COPY OF THIS PLAT IDENTIFIES AS
WATERS OF THE U.S. OR 101LANDS ALL ARES OF WATERS OF THE
PUSUISHED REGULATIONS, THIS DETT]K8NAT10N OF SECTION 404
JURISDICTION MAY BE REUED UPON FOR A PERIM NOT TO EXCEED
FIVE YEARS
1IHNF�NO,9M THIS DATE THIS DETER AMTION WAS LADE
UTIUVMANUALNOGW1d 1tUO(30/DOLIOLiQ 1801i0Y103,P 11ON
t?CaL)1aecidid�(13
A-141.10' �
R=273.27'
BR=NST1g'31'E
C=139.54'
�o.
/ \ u
i
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0.3,6 Acre
46 L7
/
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Lf
340
-----------------------------
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/
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TIE UNE
--------`- 732.22'
ILt9 1b2J1uw W la." LAKE
3 41
1,684 Sq. Feet = AREA IN WETLANDS ON LOT 339
0.04 Acres
> iP
DATE. MARCH 11, 2013
1 arty «r Ili =•P rr arr, tatAr mr nrr.W. U.n ., .arts
ep
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SUSAN L. FRANK RFO W11"
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RICHARD L. MULLNOW, JR.
1111CAF
& RIFE
OQ�N
LOT NO. 339, UNIT 12, PHASE 2
0Eii
PINEHURST, INCORPORATED
1 Q
PINZHURST. NORTH CAROLINA
AMP EOOII 14 PILE u - SEAL
MARCH 11. 8013-0— SCALE 1«40'
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C«POMM UCOGE N0. C-1147
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DATE. MARCH 11, 2013
SURVEY FOR RE C r. r k.
WILLIAM T. FRANK MAR 18 2013
6538 `H`°
SUSAN L. FRANK RFO W11"
AND
RICHARD L. MULLNOW, JR.
& RIFE
ELIZABETH H. MULLNOW
LOT NO. 339, UNIT 12, PHASE 2
PINEHURST, INCORPORATED
MINERAL SPRINGS TOWNSHIP. MOORE COUNTY,
PINZHURST. NORTH CAROLINA
MARCH 11. 8013-0— SCALE 1«40'
STSPAII( B. INZFr=8 it ABBOMT98, P.A.
ISM NC M. 8, BUM M. 170
ASM. NOM CAROLINA
0 40 80 120
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UNLESS OTHERWISE: DENOTED. 06 \�- - - - - -
•=EXISTING IRON STAKE
■=EXISTING CONCRETE MONUMENT \
TIe SFT CONCRETE MONUMENT
ONSET IRON STAKE `
= SQUARE FOOTAGE
POWER SERVICE STUB
m- SEWER SERVICE STUB
TELEPHONE SERVICE STUB
CABLE TV SERVICE STUB `
BI= WATER METER
'Q'. FlRE HYDRANT /
SANITARY SEWER MANHOLE �
U-MITY POLE
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t 940. L--1
— DATE
CFRTIFlCATE FOR U.S. AF!MY COPPS. OF ENGINEERS
THIS CERTIFIES THAT THV; COPY OF THIS PLAT IDENTIFIES AC
WATERS OF THE U.S. OR WETLANDS ALL MES OF WATERS OF THE
�i u1�ict512AP113
_. -- (4�)
339-12PH2O13 UYJI;
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0.04 Acres
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TIe SFT CONCRETE MONUMENT
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= SQUARE FOOTAGE
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m- SEWER SERVICE STUB
TELEPHONE SERVICE STUB
CABLE TV SERVICE STUB `
BI= WATER METER
'Q'. FlRE HYDRANT /
SANITARY SEWER MANHOLE �
U-MITY POLE
--o---o---o FENCE
i
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I, '!Q�Q'', • T51Hr wrrLANDs BOUNDARY DEPICTED 1
1HIii 1dIW i5 lRr9JLT OF A FIELD SURVEY AND/OR
M UAFUE011PACONEI.IC-7W BY S. R. SHEFFIELD PLS 140. 1365
t 940. L--1
— DATE
CFRTIFlCATE FOR U.S. AF!MY COPPS. OF ENGINEERS
THIS CERTIFIES THAT THV; COPY OF THIS PLAT IDENTIFIES AC
WATERS OF THE U.S. OR WETLANDS ALL MES OF WATERS OF THE
�i u1�ict512AP113
_. -- (4�)
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Cm
432
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0.04 Acres
i o.,ay i,a w. m•v ia. d,aw, YndN m, w^=� nim w, iafiM M.4
d MAr )) w:: iM tlw Mru,dalM nst rd A YM.i11�
divan ham Mr,.WD. �T Nraa.v tl p 1M ,ill, of Fs•I,IY,
am,ery Y IPt to .; aM t MY map mii4 llr ,apMnwCV li.
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WILLIAM T. FRANK
S21rO7'00-W & W�
b5.38CHORD SUSAN L. FRANK
AND
RICHARD L. MULLNOW, JR.
k WIFE
.EQZABETH H. MULLNOW
T NO. 339, UNIT 12, PHASE 2
PINEHURST, INCORPORATED
MINERAL SPRINGS TOWNSHIP. MOORE COUNTY,
PINEHURST, NORTH CAROLINA
,
Ag 11, 2013•- SCALE 1"=40'
M1660 R. SHErFMJ) k ASSOCIATES. P.A.
NC MY. 5, SUNT NO. 170
ABERDEEN. NORTH CAROLINA
0 40 80 120
S 1
Mw goal to, wcc u_
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0
COIPORAw IX:Dw No. C -low
s
S A. 1Q I=
OATS MOM 11. 2013
SURVEY FOR
R E C F- ✓ E
WILLIAM T. FRANK
S21rO7'00-W & W�
b5.38CHORD SUSAN L. FRANK
AND
RICHARD L. MULLNOW, JR.
k WIFE
.EQZABETH H. MULLNOW
T NO. 339, UNIT 12, PHASE 2
PINEHURST, INCORPORATED
MINERAL SPRINGS TOWNSHIP. MOORE COUNTY,
PINEHURST, NORTH CAROLINA
,
Ag 11, 2013•- SCALE 1"=40'
M1660 R. SHErFMJ) k ASSOCIATES. P.A.
NC MY. 5, SUNT NO. 170
ABERDEEN. NORTH CAROLINA
0 40 80 120
S 1

AGEN1
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN
STREET ADDRESS: 20 Gingham F
Please print:
Property Owner: William Frank
Property Owner: Juste
RIZATION FORM
PARCEL ID. 855105190990
Pinehurst, Moore County, NC
The undersigned, registered property ¢wners of the above noted property, do hereby authorize
Michael G. Wood of Three Oaks Engineering, Inc.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and: take all actions necessary for the processing, issuance and acceptance
of this permit or certification and any i ind all standard and special conditions attached.
Property Owner's Address (if different than property above):
622 Grooms Road, Cliftdn, NY 12065
Telephone: [phone]
We hereby certify the above
the best of our knowledge.
7 -
Authorized Signature
Date: / f / /
submitted in this application is true and accurate to
Authorized Signature
Date:

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2013-00125 County: Moore U.S.G.S. Quad: NC -SOUTHERN PINES
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Three Oaks Engineering
Attn: Michael Wood
Address: 324 Blackwell Street
suite 1200
Durham, NC 27701
Telephone Number: 919-732-1300
Size (acres) 0.33 Nearest Town Pinehurst
Nearest Waterway Horse Creek River Basin Lower Pee Dee
USGS HUC 03040203 Coordinates Latitude: 35.1774785151245
Longitude: -79.4984021365869
Location description: Site is located at 20 Gingham Lane in Pinehurst. Moore County, NC.
Description of projects area and activity: This permit verification allows for 0.04 acre of permanent wetland impacts from fill
associated with the construction of a residential home and bulkhead. No mitigation is required for this proposal.
Applicable Law: 0 Section 404 (Clean Water Act, 33 USC 1344)
❑ Sections 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number or Nationwide Permit Number: NWP 29 Residential Developments.
SEE ATTACHED RGP or NWP GENERAL, REGIONAL AND SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application and attached information dated 04/21/2017. Any violation of the attached
conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration order, a Class
I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are
under construction) or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management in Elizabeth City, NC, at [phone].
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact James Lastinger at [phone] or James.C.Lastinger(a,usace.armv.mil.
LASTINGER.JAMES.
Corps Regulatory Official: C.1363642400 Date: May 11, 2017
Expiration Date of Verification: 03/18/2022

Action ID Number: SAW -2013-00125 County: Moore
Permittee: Three Oaks Engineering
Attn: Michael Wood
Project Name: 20 Gingham Lane/Bill Franks/Tom Coleman/*urisdictional determination
Date Verification Issued: May 11, 2017
Project Manager: James Lastinger
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Raleigh Regulatory Field Office
Attn: James Lastinger, Regulatory Project Manager
3331 Heritage Trade Dr., suite 105
Wake Forest, NC 27587
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee
Date

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEALS
Applicant: Three Oaks Engineering
Michael Wood
File Number: SAW -2013-00125
Date: May 11, 2017
Attached is:
See Section below
INITIAL PROFFERED PERMIT Standard Permit or Letter ofpermission)
A
PROFFERED PERMIT Standard Permit or Letter ofpermission)
B
PERMIT DENIAL
C
❑I APPROVED JURISDICTIONAL DETERMINATION
D
❑I PRELIMINARY JURISDICTIONAL DETERMINATION
_
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information maybe found athtt��: two a.a:�:.0 ,iim__nid �I1,�,1 nl�, ( i% 11,\ 01k,, lt. ii1_izort-l)ro21-aarWildllei zit>.a�x
or Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.

D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section 11 of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division,
Mr. Jason Steele, Administrative Appeal Review Officer
Raleigh Regulatory Field Office
CESAD-PDO
Attn: James Lastinger, Regulatory Project Manager
U.S. Army Corps of Engineers, South Atlantic Division
3331 Heritage Trade Dr., suite 105
60 Forsyth Street, Room 1OM15
Wake Forest, NC 27587
Atlanta, Georgia 30303-8801
919-5544884 ext 32
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportuni to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant oragent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: James Lastinger, 69 Darlington Avenue, Wilmington, North
Carolina 28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Administrative Appeal
Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]