20121031 Ver 1_401 Application_20121112

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DWQ project no.
Form Version 14 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
❑ Section 404 Permit ❑ Section 10 Permit
lb Specify Nationwide Permit (NWP) number. or General Permit (GP) number-
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑ No
1d
Type(s) of approval sought from the DWQ (check all that apply),
❑ 401 Water Quality Certification — Regular ❑ Non404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express © Riparian Buffer Authorization
1e.
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.
❑ Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below,
❑Yes ❑ No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)7
❑ Yes ® No
2.
Project Information
2a
Name of project.
512 Wildwood Drive
2b
County
Durham
2c
Nearest municipality /town:
Durham/Lebanon Township
2d
Subdivision name,
Lochaven Hills
2e
NCDOT only, T.I.P. or state project no.
3.
3a
Owner Information
Name(s) on Recorded Deed. Nu- Britt, LLC D
3b
Deed Book and Page No
7104, 157
3c
Responsible Party (for LLC if
applicable)
Anthony C. Johnson U ._t1l
3d
Street address
512 Wildwood Dr
Durham, NC 27712 L Wetland, a 5, sate, Bran
3e
City, state, zip,
3f
Telephone no:
919 - 846 -1932
3g
Fax no..
919 - 847 -5645
3h. Email address.
[e-mail]
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. AgentlConsultant Information (if applicable)
5a Name,
5b. Business name
(if applicable),
5c Street address
5d City, state, zip
5e Telephone no.*
Y 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)
PIN 0824 -01 -35 -2687
1b
Site coordinates (in decimal degrees):
I Latitude. Longitude -
1c.
Property size:
0.461 acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project:
Crooked Creek
2b
Water Quality Classification of nearest receiving water,
SD -IV; NSW, CA
2c.
River basin:
ENO ? Falls Basin
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:
This site is currently vacant with the central area of the site cleared and stabilized w/ temporary erosion control devices located in the area to receive
the new structure The area is residential with site and adjoining zoned residential -20.
3b
List the total estimated acreage of all existing wetlands on the property:
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property- 131
3d Explain the purpose of the proposed project.
construct (move) a single family residence on the lot
3e Describe the overall project in detail, including the type of equipment to be used:
Clear a construction area, dig footings and move an existing home on the lot. Equipment will consist of a rubber bra backhoe and a truck with house on
D
4.
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior 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): Lauren Witherspoon
Agency /Consultant Company.
Other- NC Division of Water Quality
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
8129/07 renewed XX/XX/XX (see attached letter)
5.
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
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
1 a. Which sections were completed below for your project (check all that apply)-
❑ Wetlands ❑ Streams — tributaries ❑X 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 -
Choose one
Choose one
Yes(No
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:
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
1 Comments,
Page 4 of 10
PCN Farm — 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 indivii ually list all open water impacts below.
4a
Open water
impact number
Permanent (P) or
Temporary 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
4g. Comments,
5. 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
50
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:
51 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
B1 P
House location
unnamed tributary of Crooked Creek
No
0
221
B2 T
construction zone
same
No
0
873
83 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h Total Buffer Impacts:
1,094
6i Comments. After placement of house, all areas impacted will be stabilized and planted. Site currently has erosion control measures in place
which will be removed following site stabilization. NO WETLANDS IMPACTED
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
Temporary erosion control measures / permanent cover & stabilization of site upon location or structure
1b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
See 1A
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 project? which mitigation option will be used for this
❑ Mitigation bank
11 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 Making a Payment to In4ieu 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.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
Yes No
buffer mitigation?
6b If yes, then identify the square feet of Impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
6c
6d.
6e.
Zone
Reason for impact
Total Impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
15
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,
permlttee responsible riparian buffer restoration, payment Into an approved In -lieu fee fund).
No wetland is impacted. Soils on site are indicated as Hemdon Sift Loam above unnamed tributary. This is an upland sods and
6h Comments: Nason Sift Loam above unnamed tributary and upstream to road this is an upland sod created on sloping woodland
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
lb 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?
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑ 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
0 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
HSession ORW
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?
O Yes 0 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)
la
Does the project involve an expenditure of public (federal /state/local) funds or the
[3 Yes
❑ 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
Oyes
❑ 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,
F]Yes
OX 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
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.
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
habitat
[] Yes ❑ No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑Yes ❑ No
5c If yes, indicate the USFWS Field Office you have contacted
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6. Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
0 Yes ❑ No
6b What data sources did you use to determine whether your site would impact Essentiai Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e g , National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
❑ Yes ❑ No
7b, What data sources did you use to determine whether your site would impact historic or archeological resources?
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
8c. What source(s) did you use to make the floodplain determination?
Nu -Britt, LLC
by: Anthony C. Johnson, Manager
Applicant/Agent's Printed Name
'
C
November 7, 2012
Date
Applicant/Ag nt's Signatu
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10