20221419 Ver 1_ePCN Application_20221011

DWR
Division of Water Resources
Initial Review
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
Pre -Filing Meeting Date Request was submitted on:
10/11/2022
BIMS # Assigned* Version#*
20221419 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Colleen Cohn:eads\cmcohn
Information for Initial Review
la. Name of project:
Brad West
la. Who is the Primary Contact?*
David Altman/Tingen Remodeling
Reviewing Office*
Raleigh Regional Office - [phone]
lb. Primary Contact Email:* lc. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
10/11/2022
Nearest Body of Water
Cemetery Branch
Basin
Neuse
Water Classification
From source to Pigeon House Branch
Site Coordinates
Latitude:
35.800122
A. Processing Information
County (or Counties) where the project is located:
Wake
Is this a NCDMS Project
Yes No
Is this project a public transportation project? *
Yes No
Longitude:
-78.62108

la. Type(s) of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
Yes No
Are you a federal applicant?*
Yes No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act. *
na
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
ld. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
If. Is this an after -the -fact permit application?*
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
Id. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Bradford West Allison Mcleod
2b. Deed book and page no.:
18790 2660
2c. Contact Person:
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
202 Myers Ave
Address Line 2
City State / Province / Region
Raleigh NC
Postal / Zip Code Country
27604 USA
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address: *
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
David Altman
3b. Business Name:
Tingen Remodeling
3c. Address
Street Address
180 Elvenia Circle
Address Line 2
City
Benson
Postal / Zip Code
27504
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
State / Province / Region
NC
Country
USA
3e. Fax Number:
1. Project Information
1b. Subdivision name:
(if appropriate)
Belvedere Park
lc. Nearest municipality / town:
Raleigh
2. Project Identification
2a. Property Identification Number:
1714263344
2b. Property size:
19
2c. Project Address
Street Address
202 Myers Ave
Address Line 2
City State / Province / Region
Raleigh NC
Postal / Zip Code Country
27604 USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Cemetery Branch
3b. Water Resources Classification of nearest receiving water: *
From source to Pigeon House Branch
3c. What river basin(s) is your project located in?*
Neuse

3d. Please provide the 12-digit HUC in which the project is located.
030202010804
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application: *
Current conditions are that of a backyard. There is an upper level separated from the lower level by a rock retaining wall. We will be putting a stone/concrete patio on part of the upper level
of the yard near the house. For construction, we will be building a master suite off of the second floor of the house above the concrete patio.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past? *
Yes No Unknown
4b(2). Is Any Portion of the Work Already Complete?*
Yes No
If yes, describe the completed work.
4c. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application. not related to the 404 or 401.
4f. List the total estimated acreage of all existing wetlands on the property:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project: *
Residential addition
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
We will grading the rear of the property in order to level out the upper level of the back yard. Our grader will be using a skid steer to flatten out this area. We already have erosion control in
place to prevent any silt contamination from our construction site.
4k. Will this activity involve dredging in wetlands or waters?*
Yes No
If yes, Describe the type of dredging, the composition of the dredged material and the location of disposal area.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
Yes No
• Unknown
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
7. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list)
8. Scheduling of Activity:
D. Proposed Impacts Inventory
1. Impacts Summary

la. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries
Open Waters Pond Construction
2h.Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
3i. Total cubic yard stream impacts:*
1
4g. Total cubic yard open water impacts: *
1
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
Neuse
Catawba
Goose Creek
Other
Tar -Pamlico
Randleman
Jordan Lake
Buffers
6b. Impact Type
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
None
T
Cemetery Branch
No
1
1
6h. Total buffer impacts:
Total Temporary impacts:
Total Permanent impacts:
Total combined buffer impacts:
6i. Comments:
Zone 1
1.00
Zone 1
0.00
Zone 2
1.00
Zone 2
0.00
Zone 1 Zone 2
1.00 1.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
We have silt fencing installed to avoid any impacts.
lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
We have silt fencing installed to keep any runoff from going into the creek in the back yard.
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 this project DOES NOT require Compensatory Mitigation, explain why:
We will not be impacting any waters near this property.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
If no, explain why:
2. Stormwater Management Plan

2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? *
Yes No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?*
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
There will not be any additional development upon completion of this project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
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
5d. Is another Federal agency involved?*
Yes
5e. Is this a DOT project located within Division's 1-8?
Yes No
No Unknown
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
None. There are no known endangered species in the area.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
None. There are no essential fish habitats nearby.
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?*
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
http://gis.ncdcr.gov/hpoweb/
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8c. What source(s) did you use to make the floodplain determination?*
https://msc.fema.gov/portal/search
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
File must be PDF or KMZ
Comments
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
I intend to electronically sign and submit the PCN form.
Full Name:
David Altman
Signature
Date
10/11/2022