20191115 Ver 1_401 Application_20190820

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
0 401 Water Quality Certification — Regular ❑ Non404 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 © 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.
❑X Yes ❑ No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
iX 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:
Abner Wayne Staples
21b.
County:
Camden
2c.
Nearest municipality / town:
Shiloh
2d.
Subdivision name:
Garrington (Garlingtons) Island
2e.
NCDOT only, T.I.P. or state project no:
N/A
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Abner Wayne Staples
3b.
Deed Book and Page No.
327/508
3c.
Responsible Party (for LLC if
applicable):
N/A
3d.
Street address:
1358 South 343
3e.
City, state, zip:
Shiloh, NC 27974
3f.
Telephone no.:
252-333-4100
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:
George H. Wood
5b.
Business name
(if applicable):
Environmental Professionals, Inc.
5c.
Street address:
1404 S. Virginia Dare Trail
5d.
City, state, zip:
Kill Devil Hills, NC 27948
5e.
Telephone no.:
Office: 252-441-0239 Mobile: [phone]
5f.
Fax no.:
5g.
Email address:
I [e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
1038974009160220000
11b.
Site coordinates (in decimal degrees):
Latitude: 36.303240 Longitude: -76.016858
1c.
Property size:
188 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
North River
2b.
Water Quality Classification of nearest receiving water:
Sc
2c.
River basin:
Pasquotank
3.
Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Farm Land
3b.
List the total estimated acreage of all existing wetlands on the property: 174
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:
(SEE ATTACHED)
3e. Describe the overall project in detail, including the type of equipment to be used:
(SEE ATTACHED)
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall riot phases)in the past?
❑ Yes © No ❑ Unknown
Comments:
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
®Preliminary Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known): George H. Wood, PWS
Agency/Consultant Company: Environmental Professionals, Inc.
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Pending
S.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ©No ❑ Unknown
5b.
N/A
If yes, explain in detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project? ❑ Yes ❑X No
61b.
N/A
If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

3d. Explain the purpose of the proposed project:
To obtain access to farmland from Garrington Island Road farm equipment. Traditional
access across adjoining property (campground) has been denied.
3e. Describe the overall project in detail, including the type of equipment to be used:
The road will be installed over wetlands with a top width of 25 feet (to allow for farm
equipment) and side slopes of 2:1 to the approximate height of 3 feet.

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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
DWO (401, other)
2f.
Area of
Impact
(acres)
W1 P
Fill
Hardwood Flat
Yes
Corps
0.20
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:
0.20
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
0
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Tem ora T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
0
4g. Comments:
S. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
(acres)
Flooded
Filled
Excavated Flooded
Filled Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments: N/A
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b,
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
81
Yes/No
132 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
0
0
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The road is located at the shortest distance from the existing Ganington Island Road to the property. The side slopes are planned at
2:1.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The top width of the road is proposed for that only necessary for farm equipment to pass. Side slopes are proposed at 2:1.
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):
❑X DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
© Mitigation bank
11 pa ment to in -lieu fee
y program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: The Great Dismal Swamp Restoration Bank
3b. Credits Purchased (attach receipt and letter)
Type: Non -riparian wetland
Type: Choose one
Type: Choose one
Quantity: 0.40
Quantity:
Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
Choose one
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
41h. Comments: N/A
S. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
N/A
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
E] 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 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
❑ Yes ❑X No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
N/A
❑ Yes ❑ No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
1 %
21b.
Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
Does not meet threshold.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative
description of the plan:
N/A
2e.
Who will be responsible for the review of the Stormwater Management Plan?
N/A
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
Camden
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
USMPWater
(check all that apply):
®apply Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program Review WJA
❑Coastal counties
❑HQW
4a.
Which of the following state -implemented Stormwater management programs apply❑ORW
(check all that apply):
❑Session Law 2006-246
❑Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review N
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 S of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes
❑X No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
©No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) N/A
❑ 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,
El Yes
❑X 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):
N/A
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
El 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.
No additional improvements are anticipated.
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.
N/A
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
Yes E] No
habitat?
5b. Have you checked with the t1SFWS concerning Endangered Species Act
❑x Yes ❑ No
impacts?
5c. If yes, indicate the LISFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
On Line
S. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
F ❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
No in water impacts
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
Yes No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
71b. What data sources did you use to determine whether your site would impact historic or archeological resources?
On Line
8. Flood Zone Designation (Corps Requirement)
8a. WIII this project occur in a FEMA -designated 100 -year floodplain?
❑X Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
No permanent structure improvements.
8c. What source(s) did you use to make the floodplain determination?
Surveyor
George H. Wood, PWS
8-2-19
Applicant/Agent's Printed Name
Date
pplicant/Agent's ignature
(AgenCe signature Is valid onl If an authorization
letter from thea licant isprovided.)
Page 10 of 10

August I, 2019
The Great Dismal Swamp Restoration Bank, LLC
Attn: Ms. Beverly White
P.O. Box 6186
Chesapeake, VA 23323
Dear Ms, White,
This letter is to request confirmation of acceptance for mitigation credits for the Abner Wayne Staples
application for proposed impacts to wetlands to Garrington Island.
Corps' Project Number:
Waterway:
Permittee's Name:
Location of Impact:
Permit Action:
Impacts (Acres/Linear Feet):
Impact NWI Classification:
Impact Hydrologic Unit Code:
Anticipated Mitigation:
Application Pending
Non -Riparian
Abner Wayne Staples
Garrington Island, Shiloh, Camden County, North Carolina
Nationwide #14
0.20 Acres
PFOI/2F
Pasquotank 03010205
0.40 Acres
Thank you for providing a letter of acceptance for these proposed impacts.
Sincerely,
Environmental Professionals, Inc.
George mood/CEP, PWS
P.O. BOX 3369 • KILL DEVIL HILLS, NORTH CAROLINA 27948
TELEPHONE: [phone]) • ENIAIL: uhxn uudo, ruhw.n,m

7r
ie Great DismaCSwamp Restoration Bank, LLQ'
1'. u. ":o nlNn
It'"IIIrtf6a', l -1 2;;_';
August 2, 2019
Mr. George Wood
Environmental Professionals, Inc.
P.O. Box 3368
Kill Devil Hills, NC 27948
RE: Abner Wayne Staples
Garrington Island
Shiloh—Camden County, NC
Dear Mr. Wood:
The following price quote is given in reply to your request for the purchase of 0.40 Non -Riparian wetland mitigation credits (HUC
Code 03010205) from The Great Dismal Swamp RestorationBank Timberlake Farm. These credits are currently available from our
Timberlake mitigation bank.
The cost will be Eighteen Thousand, Eight Hundred Dollars ($ 18,800.00). This quote will expire on October 31, 2019. You will need
to submit to the USCOE the necessary application for said mitigation, and receive USCOE permission to furnish said required credits
from our Timberlake bank.
To complete this transaction, we will require payment in full. Once payment is received, the credit sale will be reported to the US
Army Corps of Engineers. Please provide and/or confirm the following information:
Corps Project q: Pending
Waterway: Non -Riparian
Permittee Name: Abner Wayne Staples
Locality of Impact: Shiloh —Camden County, NC
Permit action (i.e., IP, NWP-39, enforcement, etc.) NWP 14
Impacts (acres/linear feet): 0.20
Impacts NWI classification: PF01/2F
Impacts Hydrologic Unit Code: 03010205
Anticipated Mitigation: 0.40
Mitigation Bank, Permittee, and Consultant agree not to discuss with any other party the details and/or pricing of this agreement,
unless necessary for regulatory matters. Information contained herein shall be held in the strictest confidence.
Thank you for allowing us to quote this project. We look forward to working with you.
Sincerely,
Beverly M. Wh e
Manager— unting/Sales
GDSRB
CC: File

AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Landowner of record authorizes Environmental Professionals, Inc. to:
I. enter the property to gather environmental and site information, including delineation of
environmental regulatory jurisdictions;
2. enter the site with the regulatory agencies (i.e. U.S. Army Corps of Engineers,
North Carolina Division of Coastal Management, North Carolina Division of Water
Quality, etc.) as needed to review regulatory alignment(s) and/or to identify additional
regulatory jurisdictions;
3. submit plats and other information to acquire regulatory agency confirmations, approvals,
and/or determinations (U.S. Army Corps of Engineers, North Carolina Division of
Coastal Management, North Carolina Division of Water Quality, etc.); and
4. act as agent for the purposes of obtaining environmental permits, authorizations, and/or
determinations.
91L AWLav
Landow r J ` Date r
Client Date

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: Garrington (Garlingtons) Island Road
City, State: Shiloh, North Carolina
County: Camden
Directions: (See Attached)
Parcel Index Number(s) (PIN): 038974009160220000
B. REQUESTOR INFORMATION
Name: Environmental Professionals, Inc./Attn: George H. Wood
Mailing Address: P.O. Box 3368, Kill Devil Hills, NC 27948
Telephone Number: Office: 252-441-0239 Mobile: [phone]
Electronic Mail Address: [e-mail]
Select one:
❑ I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultantz
❑ Interested Buyer or Under Contract to Purchase
❑ Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: Abner Wayne Staples
Mailing Address:
Telephone Number:
Electronic Mail Address3:
1358 South 343
Shiloh, NC 27974
252-333-4100
✓❑ Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
1 If available
r Must attach completed Agent Authorization Form
3 If available
Version: December 2013 Page 3

A. PARCEL INFORMATION
Directions: Go to intersection of Sandy Hook Road and Garrington Island Road —
turn left at campground on Garrington Island Road — then turn right
on Garrington Island Road. Project is on the right.

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION'
1. 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 hngincers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a detennination associated with Waters ofthe V.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of fife Rivers and Harbors Act of
1899.
Wan 56,jL%
Property O ner (please print)
a
Ma -1 Z 19
Dat — - ..--- -
F. JURISDICTIONAL DETERMINATION TYPE
Select One:
ElI ant requesting that the Corps provide a vrcliutinary JD fix the property identified herein
I his request does include a delineation.
1 am requesting that the Corps provide a preliminary JD lbr the property identified herein
I his request does NOJ include a delineation,
0 1 am requesting that the Corps investigate the property/prolect area for the presence or
absence of WOCIS` and provide an approved JD lix the property identified herein 'Phis
request docs NO f include a request for a verified delineation.
El1 ant requesting that the Corps delineate the boundaries of all Wal IS on a property%project
area and provide an approved JD (this may or nay not include a survey plat).
�I and requesting that the ('orps evaluate and approve it dclutcakon of W'ol S (Colldttl'tCd
by others) on a property,project area and provide an agproved JD inlay of ntav not
.Include a survey plat)
I°or NCDOT requests following rhe run ININC-?of/UtiArP protocolk. skq, to P31 IF
Waters of the united States
Version: December 61113 page. 4

Jurisdictional Determination Request
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- 188
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.
JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests:
❑ Completed and signed Preliminary Jurisdictional Determination Form.
❑ 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, L1DAR 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)7:
Wetlands:
F] Wetland Data Sheetss
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
(2) Approved JDs including Verification of a Delineation:
✓� Project Coordinates: 36.303240 Latitude -6.016858 Longitude
Maps (no larger than 11 x 17) 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
El Soil Survey Map
✓❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
7 1987 Manual Regional Supplements and Data forms can be found at:
http://www usace army mil/Missions/CivilWorks/RegulatoryProgramandPermits/reg supe asox
Wetland and Stream Assessment Methodologies can be found at:
http://portal.ncdenr.org/c/document library/get file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&groupld=38364 and,
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/publicnotices/2013/NCSAM Draft User Manual 130318 pdf
a Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 6

Jurisdictional Determination Request
Delineation Infonnation (when applicable):
Wetlands:
❑7 Wetland Data Sheets9
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

Jurisdictional Determination Request
1. REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT
Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps project manager for
review.
Due to storage limitations of our administrative records, the Corps requires that all hard-
copy submittals include at least one original Plat (to scale) that is no larger than 11"xI7"
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11 "x 17", may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Document Format (PDF) file. Upon verification, the Corps can electronically sign these
plats and return them via e-mail to the requestor.
(1) PLATS SUBMITTED FOR APPROVAL
RMust be sealed and signed by a licensed professional land surveyor
✓❑ Must be to scale (all maps must include both a graphic scale and a verbal scale)
P1 Must be legible
❑✓ Must include a North Arrow, Scale(s), Title, Property Information
Must include a legible WoUS Delineation Table of distances and bearings/metes
and bounds/GPS coordinates of all surveyed delineation points
✓❑ Must clearly depict surveyed property or project boundaries
Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)
When wetlands are depicted:
• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system
Version: December 2013 Page 8

Jurisdictional Determination Request
When tributaries are depicted:
• Must include either a surveyed, approximate centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) of tributary
• Must identify each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area (using approximate
widths or surveyed OHWM)
• Must include name of tributary (based on the most recent USGS topographic
map) or, when no USGS name exists, identify as "unnamed tributary"
❑ all depicted WoUS (wetland polygons and tributary lines) must intersect or tie -to
surveyed project/property boundaries
❑ Must include the location of wetland data points and/or tributary assessment
reaches
F] Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. "isolated wetlands", "non -
jurisdictional waters"). NOTE: An approved JD must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.
Must include and survey all existing conveyances (pipes, culverts, etc.) that
transport WoUS
Version: December 2013 Page 9

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site: Gadingtons Island City/County: Camden Sampling Date: 6-5-19
Applicant/Owner: Abner Wayne Staples State: NC Sampling Point: 5' SW #1A
Investigator(s): George H. Wood, PWS Section, Township, Range: Shiloh
Landform (hillslope, terrace, etc.): Terrace Local relief (concave, convex, none): Convex Slope (%): 2
Subregion (LRR or MLRA): Region T 1538 Let: 36.304 Long: -76.018 Datum: NWI
Soil Map Unit Name: Altavista NWI classification: None
Are climatic / hydrologic conditions on the site typical for this time of year? Yes ® No ❑ (If no, explain in Remarks.)
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ significantly disturbed? Are "Normal Circumstances" present? Yes ® No ❑
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes —I0t No M
IID�II Is the Sampled Area
Hydric Soil Present? Wetland Yes D No _II�pII within a Wetland? Yes No
Hydrology Present? Yes No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two reouired)
Primary Indicators (minimum of one is reouired
check all that apply)
❑ Surface Soil Cracks (136)
❑ Surface Water (A1)
❑ Aquatic Fauna (813)
❑ Sparsely Vegetated Concave Surface (88)
❑ High Water Table (A2)
❑ Marl Deposits (1315) (LRR U)
❑ Drainage Patterns (B10)
❑ Saturation (A3)
❑ Hydrogen Sulfide Odor (Ci)
❑ Moss Trim Lines (816)
❑ Water Marks (81)
❑ Oxidized Rhizospheres on Living Roots (C3)
❑ Dry -Season Water Table (C2)
❑ Sediment Deposits (B2)
❑ Presence of Reduced Iron (C4)
❑ Crayfish Burrows (C8)
❑ Drift Deposits (133)
❑ Recent Iron Reduction in Tilled Soils (C6)
❑ Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (84)
❑ Thin Muck Surface (C7)
❑ Geomorphic Position (D2)
❑ Iron Deposits (85)
❑ Other (Explain in Remarks)
❑ Shallow Aquitard (D3)
❑ Inundation Visible on Aerial Imagery (137)
❑ FAC -Neutral Test (D5)
El Water -Stained Leaves 139
Sphagnum moss DB LRR T, U
Field Observations:
Surface Water Present? Yes F j
ISI
M
No Depth (inches):
Water Table Present? Yes _II�pII
No Fj Depth (inches): 18
Saturation Present? Yes Jpi
No Depth (inches): 20
Ipl
Wetland Hydrology Present? Yes No _Ipt
includes ca illa fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region –Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Multiply bv:
Absolute Dominant
Tree Stratum (Plot size: )
% Cover Species?
1.
-Q
2.
QI--I
3.
species
4.
mn Totals: 20
5.
-Q
6.
Q _
7.
-Q _
8.
= Total Cover
50% of total cover:
20% of total cover:_x_
Sampling Point: 5' SW #1A
Indicator Dominance Test worksheet:
Status
Number of Dominant Species 2
That Are OBL, FACW, or FAC: (A)
Total Number of Dominant
Species Across All Strata: 2 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: 100 (AIB)
Saolino/Shrub Stratum (Plot size: .1 acre 1
1. Acer rubrum 10 FAC
S. _1
6.
7.
8. D
10 = Total Cover
50% of total cover: 20% of total cover:
Herb Stratum (Plot size: .1 acre 1
I Woodwardia areolata 10
6.
7.
8.
9.
0.
1.
10 = Total Cover
50% of total cover: 20% of total cover:
Woody Vine Stratum (Plot size; .1 acre )
1 Smilax bona-nox 2 -Q
2. -Q
3. _Q
4.
5.
2 = Total Cover
50% of total cover; 20% of total cover:_
OBL
FAC
Total %Cover of
Multiply bv:
species 10
x 1 = 10
W species
x2=
species 10
x3= 30
U species
x4=
species
X5=
mn Totals: 20
(A) 40 (B)
Prevalence Index = B/A = 2.0
Hydrophytic Vegetation Indicators:
1 - Rapid Test for Hydrophytic Vegetation
® 2 - Dominance Test is >50%
®
3- Prevalence Index is 53.0'
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must be
present, unless disturbed or problematic.
Definitions of Four Vegetation
Tree -Woody plants, excluding vines, 3 in. (7.6 cm) or
larger in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub- Woody plants, excluding vines, less
than 3 in. DBH and greater than 3.28 ft. (1 m) tall.
Herb -All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines, greater than 3.28 ft. in
height.
Hydrophytic
Vegetation
Present? Yes No�
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region-Vension 2.0

SOIL Sampling Point: 5' SW #1A
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of Indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Calor (moist) % Type' Loc2 Texture Remarks
0-6 10 YR 412
6-18 10 YR 614
'Type: C=Concentration, D=Depletion, RM=Retluced Matrix, CS=Covered or Coaled Sand Grains. 'Location: PL=Pore Lining, M=Matrix
Hydric Soil Indicators:
Indicators for Problematic Hydric Soilsr:
❑ Histosol (A1)
❑ Polyvalue Below Surface (S8) (LRR S, T, U)
❑ 1 cm Muck (A9) (LRR O)
❑ Histic Epipedon (A2)
❑ Thin Dark Surface (S9) (LRR S, T, U)
❑ 2 crrl Muck (A10) (LRR S)
❑ Black Histic (A3)
❑ Loamy Mucky Mineral (F1) (LRR O)
❑ Reduced Vertic (1`18) (outside MLRA 160A,B)
❑ Hydrogen Sulfide (A4)
❑ Loamy Gleyed Matrix (F2)
❑ Piedmont Floodplain Soils (1`19) (LRR P, S. T)
❑ Stratified Layers (A5)
❑ Depleted Matrix (F3)
❑ Anomalous Bright Loamy Soils (F20) (MLRA 1638)
❑ Organic Bodies (A6) (LRR P, T, U)
❑ Redox Dark Surface (F6)
❑ Red Parent Material (TF2)
❑ 5 cm Mucky Mineral (A7) (LRR P, T, U)
Q Depleted Dark Surface (F7)
❑ Very Shallow Dark Surface (TF12)
❑ Muck Presence (A8) (LRR U)
❑ Redox Depressions (F8)
❑ Other (Explain in Remarks)
❑ 1 cm Muck (A9) (LRR P, T)
❑ Marl (F10) (LRR U)
❑ Depleted Below Dark Surface (All)
❑ Depleted Ochric (F11) (MLRA 151)
❑ Thick Dark Surface (At 2)
❑ Iron -Manganese Masses (F12) (LRR O, P, T)
'Indicators of hydrophyfic vegetation and wetland hydrology
❑ Coast Prairie Redox (A16) (MLRA 160A)
❑ Umbdc Surface (F13) (LRR P, T, U)
must be present, unless disturbed or problematic.
❑ Sandy Mucky Mineral (S1) (LRR O, S)
❑ Delta Ochdc (1`17) (MLRA 161)
❑ Sandy Gleyed Matrix (S4)
❑ Reduced Vertic (F18) (MLRA 160A, 1606)
❑ Sandy Redox (S5)
❑ Piedmont Floodplain Soils (F19) (MLRA 149A)
❑ Stripped Matrix (S6)
❑ Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D)
Dark Surface S7 LRR P, S, T, U
Restrictive Layer (if observed):
Type:
[Hydric
Depth (inches):
Soil Present? Yes No
Remarks:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region —Version 2.0

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site: Gariingtons Island City/County: Camden Sampling Date: 6-5-19
Applicant/Owner: Abner Wayne Staples State: NC Sampling Point: 5' SW #2
Investigator(s): George H. Wood, PWS Section, Township, Range: Shiloh
Landform (hillslope, terrace, etc.): Depression Local relief (concave, convex, none): Concave Slope (%): 1
Subregion (LRR or MLRA): Region T 15313 Let: 36.304 Long: -76.018 Datum: NWI
Soil Map Unit Name: Dorovan Muck NWI classification: PF01/2F
Are climatic/ hydrologic conditions on the site typical for this time of year? Yes ®No ❑ (If no, explain in Remarks.)
Are Vegetation ❑ , Soil [-I , or Hydrology E] significantly disturbed? Are "Normal Circumstances" present? Yes ® No ❑
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes _M No D
IDI I^�
Is the Sampled Area
Hydric Soil Present? Wetland Yes JIIp�III No Il within a Welland? Yea No _❑
Hydrology Present? Yes Jpl No 11
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is reauire&
check all that aooly)
❑ Surface Soil Cracks (86)
® Surface Water (Al)
❑ Aquatic Fauna (B13)
❑ Sparsely Vegetated Concave Surface (68)
® High Water Table (A2)
❑ Marl Deposits (1315) (LRR U)
❑ Drainage Patterns (B10)
❑ Saturation (A3)
❑ Hydrogen Sulfide Odor (Cl)
❑ Moss Trim Lines (B16)
❑ Water Marks (B1)
❑ Oxidized Rhizospheres on Living Roots (C3)
❑ Dry -Season Water Table (C2)
❑ sediment Deposits (B2)
❑ Presence of Reduced Iron (C4)
❑ Crayfish Burrows (CB)
❑ Drift Deposits (B3)
❑ Recent Iron Reduction in Tilled Soils (C6)
❑ Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (134)
❑ Thin Muck Surface (C7)
❑ Geomorphic Position (D2)
❑ Iron Deposits (B5)
❑ Other (Explain in Remarks)
❑ Shallow Aquitard (D3)
Q Inundation Visible on Aerial Imagery (B7)
❑ FAC -Neutral Test (135)
LI Water -Stained Leaves B9
❑Sphagnum moss DB LRR T, U
Field Observations:
IDI
Surface Water Present? Yes JI
No �Fj Depth (inches): 1
Water Table Present? Yes �I�II
No _F—'Depth (inches):
Saturation Present? Yes _M
I'I No F1 Depth (inches):
Ip1 I --I
Wetland Hydrology Present? Yes Jpt No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region -Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: .1 acre ) % Cover Species? Status
1. Nyasa sylvatica 15 D� FAC
p Taxodium distichum 5 Q 0131.3. -F1
4. -a
5.
6.
7. �I
8. -o
20 = Total Cover
50% of total cover: 20% of total cover:_x_
Sapling/Shrub Stratum (Plot size: .1 acre )
1. Acer rubrum 10 _� FAC
2. -a
3. -a
4.
5.
6.
7. �.
8.
10 = Total Cover
50% of total cover: 20% of total cover:
Herb Stratum (Plot size: .1 acre )
1. Osmunda regalis 5
9 Woodwardia areolata 5
9
2.
F-1_II----II
Ed
10 = Total Cover
50% of total cover: 20% of total cover:
OBL
Sampling Point: 5' SW #2
worksheet:
Number of Dominant Species
That Are DEL, FACW, or FAC
Total Number of Dominant
Species Across All Strata:
Percent of Dominant Species
That Are OBL, FACW, or FAC:
4
(A)
4 (B)
100 (A/B)
Prevalence Index workshest:
Total %
Cover of:
Multiply bw
)BL species
15
x 1 = 15
ACW species
x2=
AC species
27
x3= 81
ACU species
x4=
IPL species
X5=
:olumn Totals:
42
(A) 96
1 - Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%
® 3 - Prevalence Index is 53.0'
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must be
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
(B)
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
larger in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub- Woody plants, excluding vines, less
than 3 in. DBH and greater than 3.28 ft. (1 m) tall.
Herb -All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines, greater than 3.28 ft. in
height.
Woody Vine Stratum (Plot size: .1 acre 1
1. Smilax bona-nox 2 _� FAC
2. -II
4.
5' �1 Hydrophytic
2 = Total Cover Vegetation
50% of total cover: 20% of total cover: Present?
Remarks: (If observed, list morphological adaptations below)
Yes M No _-1
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region -Version 2.0

Profile Description: (Describe to the depth needed to document the Indicator or confirm the absence of indicators.)
Depth Matrix
Redox Features
Color (moist) % Color (moist) % Type' Loc' Texture
6 YR 312
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, CS=Covered or Coated Sand Grains.
Remarks
21_ocetion: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
❑ Histosol (At)
❑ Polyvalue Below Surface (S8) (LRR S. T, U)
Indicators for Problematic Hydric Soils°:
❑ 1 cm Muck (A9) (LRR O)
❑ Histic Epipedon (A2)
❑ Thin Dark Surface (S9) (LRR S, T, U)
❑ 2 cm Muck (A10) (LRR S)
❑ Black Histic (A3)
❑ Loamy Mucky Mineral (Fl) (LRR O)
❑ Reduced Vertic (F18) (outside MLRA 160A,B)
❑ Hydrogen Sulfide (A4)
❑ Loamy Gleyed Matrix (F2)
❑ Piedmont Floodplain Soils (F19) (LRR P, S. T)
❑ Stratified Layers (AS)
❑ Depleted Matrix (F3)
❑ Anomalous Bright Loamy Soils (F20) (MLRA 1638)
❑ Organic Bodies (A6) (LRR P, T, U)
❑ Redox Dark Surface (F6)
❑ Red Parent Material (TF2)
❑ 5 cm Mucky Mineral (A7) (LRR P, T, U)
❑ Depleted Dark Surface (F7)
❑ Very Shallow Dark Surface (TF12)
® Muck Presence (A8) (LRR U)
❑ Redox Depressions (178)
❑ Other (Explain in Remarks)
❑ 1 cm Muck (A9) (LRR P, T)
❑ Marl (1710) (LRR U)
❑ Depleted Below Dark Surface (All)
❑ Depleted Ochric (F11) (MLRA 161)
❑ Thick Dark Surface (Al2)
❑ Iron -Manganese Masses (F12) (LRR O, P. T)
31ndicators of hydrophytic vegetation and wetland hydrology
❑ Coast Prairie Redox (A16) (MLRA 160A)
L] Umbdc Surface (F13) (LRR P, T, U)
must be present, unless disturbed or problematic.
❑ Sandy Mucky Mineral (St) (LRR O, S) ❑ Delta Ochric (F17) (MLRA 151)
❑ Sandy Gleyed Matrix (S4) Q Reduced Vedic IN 8) (MLRA 150A, 160B)
❑ Sandy Redox (S5) Piedmont Floodplain Soils (F19) (MLRA 149A)
❑ Stripped Matrix (S6) ❑ Anomalous Bright Loamy Soils (F20) (MLRA 149X 153C, 163D)
Type:
Depth
Remarks:
Soil Present? Yes M No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region -Version 2.0

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Excise Tax: $ -0- Exempt under NCGS Section 105-228.29
Parcel Identifier No.: 03-8972-00-43-1329-0000, 03-8971-00.82.1555-0000, 03-8974.00.91-0022-0000, 03-8974-00.63-2086-0000,
03 -8974 -00 -74 -9354 -0000,03 -8971 -00.49.9567 -0000,03-8971-00-48-5852-0000,03-8971-00-59-0049-0000,
03-8971-00-49-0108.0000, 03-8973.00-25.8166-0000, 03-8971-00-98-2645-0000, 03-8971-00-90-1294-0000,
03 -8971 -00 -77 -0633 -0000,03.8972 -00 -41-8742-0000,03-8962-00-05.5138-0000,03-8962-00-74.6971-0000,
03-8971-00-49-9567-0000, 03-8971-00-74-1228-0000, 03-8971-00-57-0087-0000, 03.8980-00-14-4070.0000,
14 5-1 S 4 40- /.a -a-(- - I q -14 KA4u - �i r�e¢�;��. 1VQ�
Prepared by: A. Vann Irvin - NO TITLE EXAMINATION AND NO TITLE CERTIFICATION
Mail after recording to: Hornthal, Riley, Ellis 8 Maland, L.L.P.
301 E. Main Street
Elizabeth City, NC 27909
NORTH CAROLINA GENERAL WARRANTY DEED
(CORRECTION DEED)
THIS DEED made this 111 day of June, 2014 by and between
GRANTOR GRANTEE
Abner Wayne Staples, Executor Abner Wayne Staples
Estate of Alvin N. Staples 1381 S. Hwy 343
1381 S. Hwy 343 Shiloh, NC 27974
Shiloh, NC 27974
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and
assigns, and shall include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, as Executor under the Will of Alvin N. Staples (deceased) and as directed by
such Will and for other valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged,
has and by these presents does grant, bargain, transfer and convey unto the Grantee in fee simple, all the
Grantor's interest in said property being all that certain lot or parcel of land situated in Shiloh Township, Camden
County, North Carolina and more particularly described as follows:
EXHIBIT "A" ATTACHED
Further reference is made to the Last Will and Testament of Alvin N. Staples on record in the office
of the Clerk of Superior Court, Camden County, File No. 11-E-48. Under the Will of Alvin N.
Staples, the above property was left to the Executor who was directed to form a trust for the benefit
of Betty Pugh Staples. However, before that trust was formed, Betty Pugh Staples died, Camden
County Estate File No. 12-E-3. As a result, pursuant to NCGS Section 28A-22-10, the Executor
deeded the property directly to the remainder beneficiary of the inoperative trust.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto
belonging to the Grantee in fee simple.

2) All easements, encumbrances, restrictions and covenants of record and all governmental and zoning
regulations and rights of way affecting the same.
N WITNESS WHEREOF, the Grantor has hereunto set his hand and seal the day and year first above written.
Abner Wayne
Estate of AI N.
kCKNOWLEDGMENT(S):
(SEAL -STAMP) NORTH CAROLINA, PASQUOTANK COUNTY
"11111111111111///// ,
,,o°,6j%aa G. Dai' I, a Notary Public of the County and State aforesaid, certify that Abner Wayne Staples as
.................. / Executor of the Estate of Alvin Staples, Grantor, personally appeared before me this day
% T
O``�J-'. = and acknowledged the execution of the foregoing instrument. Witness my hand and official
stamp or seal, this l)ttday of May, 2012.
o `•. AC! :r m`
r •. UAL\ v
d�� •.., ��. , y commission expires:
c
//,//,,,111,11,11„11•U"`'' /i
Notary Public
(Print or type name)
FAUsers\Venn\CGents\Staples, Abner WaynelConecUon Deed to AW.wpd

L
VICINITY MAP
N.T.S.
N/F
PATRICK k BEVERLY
BENGIES
D.B. 348, PG. 530
2
1�
n
WETLAND LINE
(TYP)
WETLAND LINE
(TYP)
25.0'
CL
CULVERT
SECTION A—A
i"= 10'
CULVERT V
N/F
ABNER WAYNE STAPLES
D.B. 327, PG. 508
WETLAND FLAG
(TYP)
PROJECT NOTES:
TOTAL FILL AREA= 8,708 S.F.
0 15 30 60
2
- GRAPHIC SCALE: 1" = 30'
FILL PERMIT
ABNER WAYNE STAPLES
PROPERTY DESCRIBED IN D.B. 327, PG. 508
GARRINGTON ISLAND ROAD
SHILOH TOWNSHIP, CAMDEN COUNTY, N.C.
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Planning for a Better Environment
1404 S. Virginia Dare Trak
P.O. BOX 3388 — KILL DEVIL HILLS, NC 27948
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ENVIRONMENTAL PROFESSIONALS, INC.
Planning for a Better Environment
P.O. Box 3368
DATE
Kill Devil Hills,
NC 27948
Telephone:
252-441-0239
Fax:
252-441-0721
Email:
[e-mail]
TO: North Carolina Division of Water Resources
401 Wetlands Unit
Attn: Ms. Karen Higgins
1617 Mail Service Center
Raleigh, NC 27699-1650
V ATFACHED
LETTER OF TRANSMITTAL
DATE: August 2, 2019
JOB NO.: 019-008
RE: Abner Wayne Staples
Garrington Island Road
Camden County, NC
COPIES I
DATE
DESCRIPTION OF DOCUMENTS
1
8-2-19Pre-Construction
Notification Form
1
7-31-19
I1 x 17 Plat
1
8-1-19 & 8-2-19
1 The Great Dismal Swamp Restoration Bank Correspondence
1
5-6-19
Signed/Dated Authorization to Act as Representative Form
1
8-2-19
Jurisdictional Determination Request Form (Pages 3 thru 9
1
July 2019
Wetland Survey
1
6-5-19
Wetland Determination Data Forms
1
Aerial Ma
1
6-28-19
U.S. Fish & Wildlife Service—National Wetlands Inventor
1
6-11-14
North Carolina General Warranty Deed
THESE ARE SUBMITTED AS CHECKED BELOW:
d For your approval ❑
❑ For your use
❑ As requested
REMARKS:
COPY TO: Project File
Review & Comment
❑ Signature/Notarization
SICNED:Wo6d
G rge H. Wood, CEP, PWS
Environmental Professionals, Inc.