20090911 Ver 1_401 Application_20090809

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Corps action ID no.

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Form Version 1.4 January 2009

Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps: ?X Section 404 Permit ? 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? ?X Yes ? No
1d. Type(s) of approval sought from the DWQ (check all that apply):
rX_1 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ
401 Certification:
? Yes ?X No For the record only for Corps Permit:

? Yes ?X No
If. 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 ?X No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. 0 Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes X? No
2. Project Information
2a. `Name of project: Retaining wall and fill
2b. County: Hyde
2c. Nearest municipality/ town: Fairfield
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state project no: N/A 0 `' • •-
3.. Owner Information LZ au
3a. Name(s) on Recorded Deed: Allan Ballance A U G 1 0 M1019
3b. Deed Book and Page No. Book 122 Page 294
3c. Responsible Party (for LLC if
applicable): N/A WETLANDS AND STORMYI!aTElt BRANCH
3d. Street address: 6033 N. Lake Road
3e. City, state, zip: Fairfield, North Carolina 27826
3f. Telephone no.: 252-925-4121
3g. Fax no.: None
3h. Email address: None
Page 1 of 10
PCN Form - Version 1.4 January 2009
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
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 10
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees): Latitude: 35.539033 Longitude: -76.174862
1 c. Property size: 8 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Lake Mattamuskeet
2b. Water Quality Classification of nearest receiving water: Sc
2c. River basin: Pamlico Sound
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:
My high ground property along the lake shore has weathered away over the years, and the lake level has receded. There are some residential homes
along the shore line and some storage and out-buildings. There are no structures on my property between the highway and the lake, but it is regularly
mowed.
3b. List the total estimated acreage of all existing wetlands on the property: 6
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:
I want to build a 60 foot long retaining wall and backfill 1,750 square feet of my property along the shore line.
3e. Describe the overall project in detail, including the type of equipment to be used:
Construction of a 60 foot long wooden retaining wall with earthen backfill. A dump truck and rubber tire-tractor will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
d
project incluin all prior phases) in the past? 0 Yes ? No ? Unknown

Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
E] Preliminary ?X Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Washington Field Office Agency/Consultant Company: Army Corps of Engineers
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
July 27, 2009
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ? Yes ?X No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ? No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.4 January 2009
! .
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
?X 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
DWQ (401, other) 2f.
Area of
impact
(acres)
W1 P Fill Non-Riverine Swamp Forest No Corps 0.04
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: 0.04
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.
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)
S1 Choose one -
S2 - Choose one -
S3 - Choose one _
S4 - Choose one -
S5 - Choose one
S6 - Choose one
3h. Total stream and tributary impacts
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 individual) 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
02 - Choose one Choose
03 - Choose one Choose
04 - Choose one Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a.
Pond ID number 5b.
Proposed use or
purpose of pond 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
Flooded Filled Excavated Flooded Filled Excavated
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 an impacts require miti ation, then ou 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
B 1 Yes/No
B2 Yes/No
63 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.
I have re-designed my project several times to make it as small as I could and still be able to have an area for a cabin or building. I am using existing
high ground for parking and the majority of the building foot print, but will need to go out into the area where I have lost land over the years.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
I originally wanted to fill an area of about 5,600 square feet, but have reduced it to 1,750 square feet. The wall has been shortened and I am only going
to go an average of 20 feet out to reclaim my land. I will only use small equipment and no work or equipment will go over the staked and flagged
project line for the alignment of the wall. I will stabilize the fill with grass seed right after the fill is put in.
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 ?X 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: Choose one
Type: Choose one
Type: Choose one Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Makin a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: Choose one
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
I am using avoidance and minimization as a form of mitigation since my fill area is small and has been significantly reduced in project scope.
Page 6of10
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
buffer mitigation? Yes OX 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 7 of 10
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
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.
? Yes ? No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 0.0001%
2b. Does this project require a Stormwater Management Plan? ? Yes 0 No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?

3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply): ? Phase II
? NSW
? USMP
? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached? []Yes ? No
4. DWQ Stormwater Program Review

4a. Which of the following state-implemented stormwater management programs apply
(check all that apply): []Coastal counties
?HQW
?ORW

[]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 8of10
PCN Form - Version 1.4 January 2009
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ?X 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
? Yes
? No
letter.)
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 ?X 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 ?X 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.
D
1
h
t
If I decide to build something with a bathroom, I
epartment (102
ave a permit from
he Hyde County Health
941).
Page 9 of 10
PCN Form - Version 1.4 January 2009
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5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or I El Yes OX No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act I El Yes p No
impacts?
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?
Corps of Engineers Heritage Data Base and USFWS Web Based Maps
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes QX No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Phone call to NOAA office. They said no EFH in Lake Mattamuskeet.
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 Z 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?
Corps of Engineers Heritage Data Base and Web Based SHPO Maps.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes nXX No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Hyde County Courthouse and NC Flood Maps Web Site
o l? A

Applicant/Agent s Printed Name Applicant/ g n Signature Date
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)
Page 10 of 10
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