20111109 Ver 2_401 Application_20120312

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Office Use Only
Corps action ID no
DWQ project no
Form Version 14 January 2009
Page 1 of 10
PCN Form — Version 14 January 2009
Pre - Construction Notification (PCN) Form
A
Applicant Information
1
Processing
la
Type(s) of approval sought from the Corps
❑ Section 404 Permit ❑ Section 10 Permit
1 b Specify Nationwide Permit (NWP) number or General Permit (GP) number
1 c
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑ No
Id
Type(s) of approval sought from the DWQ (check all that apply)
❑ 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ® (- Ripanan 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 ❑ No
For the record only for Corps Permit
❑ Yes ❑ No
If
Is payment into a mitigation bank or m lieu fee program proposed fon_ _
lmitigation of impacts? If so attach the acceptance letter from mitigation bank
or in lieu fee program)
❑ `Y s ®No}
� g
Is
Is the project located in an of NC s twenty
p j y M_ nty coastal counties If yes answer 1hi
❑tYes,� ®rN�
11 h Is the project located within a NC DC_M Area of Environmental_ Concern (AEC) ?)
❑LYeS ®`N]
2
Project formation
(_ a7 N_ ame _ of r_� dtl
Giles Landscaping 103 Cumulus Ct Cary
�2b
CouMy }
Wake
�2c
Nearest municipality / town j
Cary
(2­d
Subdiwswn name)
Weatherstone
2e
NCDOT only T I P or state project no
r Owner Inform t oiaorm
(3a
Name(s) on Recorded Deed j
Douglas Alan Giles & Kim C Giles
tab
Deed Book and Page No
6193 345 p U 1J
(3c Responsible Party (for LLCM
applicable) ;
012
(3d
Street address-,
103 Cumulus Ct
tae
City state zrp;
Cary NC 27513 rNgTER� rand+
919 -467 8974 Stan s
3f
Telephone no
3g
Fax no J
,_3h
Email address
giles@mmdspring corn
Page 1 of 10
PCN Form — Version 14 January 2009

t41 Applicant information (if dif_fe_rent from owner
4a Apphcant
❑ n) ❑Cgther_speafy
4b Name
(4c Business name
((if applicable) )
4d Street address
(4e City state zi j
4f _Telephone n�o
(4g Fax no �
C4h Email ddress
i Agent/Consultant Information (if appllcable)�
5a NName
(5b Business name}
((d applicable))
c Ea ddress
5d City state zips
5e Telephone n
5 Fax no
5g Email addre
Page 2 of 10

LB Project Information and Prior Project History
,Property Identification`
1a Property identification no (tax PIN_or parcel ID j
PIN #0754316994
1b Site coordinates (in decima(degrees)
I Latitude 35 788518 Longitude; 78 819139
t1c Property siz
0 31 e
n Surface Waters)
Na Nam_e_ of nearest body of water to proposed project)
Bond Lake
(2b Water Quality Classification of nearest receiving water
,2c R ver basin
Neuse
n Pro ect Descriptlon
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 .�.� _ � —� —
Grass backyard
3b List the total estimated acreage of all existing wetlands on the property
(3c Ust the total estimated linear feet of all existing streams (intermittent and perennial) on the property) 30
LM _Ex plain (e purpose of the proposed project.)
Reduce flooding
u Oescnbi the overall project in detail indudmg the type of egwpment to be used,
Regrading yard siopng towards stream --
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 nor phases) in the past'?
®YeS� [](No) ❑(Unk Own n1
Comments ,I„auren w�iherspoon cvuQ
4b If the Corps made the jurisdictional determination what type
of determination was made?
Preliminary ❑ Final
4c �If yes who delineated the junsdidional areas?
Name (if known))
(Agency /Consultant Company
(Other)
4d (If yes list the dates of the Corps junsdictional determinations or State determinations and attach documentation I
Amy Chapman 1/6/2012 —� �—
5 Prooject Histo lry
, - - -- - - -- — - — r
i5a Have permits or certifications been requested or obtainedfor�
tthis project (including all prior phases) in the past? _ l
_
� —,
❑Y� J@Ko [].Unknown)
5Eb If yes explain in detail according to help file instructions
6 (Future Project Plans)
6a Is this a phased proje t
❑ Yes ® No
6b (If yes explain
CPagg 3 of 10�___ __ _
�PCN Form - version 14 January 2009

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ❑ Streams —tributaries ® �AufFers ❑ 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
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
VV2
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
31 Comments
Page 4 of 10
PCN Form — Version 14 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 indi ually list all open water impacts below
4a
Open water
impact number
Permanent (P) or
Temporary
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
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
51 Expected pond surface area (acres)
51 S¢e of pond watershed (acres)
5k. Method of construction
I Buffer Impacts (for DWQ)
If p�o�edt Hill 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
E6a Projedt is in which protected —basin?)
® Neuse ❑ Tar Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b — _�
(Buffer Impa�
lnumber -1
(Permanent (P) j
(Tem ora
6c — - -�
`Reason for impact
6d �_ —�
Stream name
6e _
Buffed
`1
mitigation
required
6f
Zone 1
impact
(square]
7feet
6g—
Zone 2
'impact
((square
(feet
B1 P
Grading
Drainage Easement
No
2 850
1900
B2
Yes/No
133
Yes/No
134
Yes /No
65
Yes/No
136
Yes/No
6h Total Buffer Impacts
2850
1900
61' Comments
Page 5 of 10

D Impact Justification and Mitigation
1 (Avoidance and Minimization)
1 a Csp-ecifici liy describe measures taken to avoid or minimize the proposed impacts in designing probe
This project is to protect an existing back yard
1 b '-Specifically describe measures taken to avoid or minimize the proposed impacts through construction tec
Silt fendng
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes ❑ No
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
project?
❑ Mitigation bank
Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type Choose one
Type Choose one
Type Choose one
Quantity
Quantity
Quantity
3c Comments
4 Complete if Makina 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
Page 6 of 10
PCN Form — Version 14 January 2009

6 u 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 ?) _ J
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 1
Zone
�6cJ _
(Reason for impa�
_
(6d 1
Total impact
(square feet)/
�_
;Multiplier)
4j ___
Required mitigation
((square feet)
Zone 1
3 (2 for Catawba)
Zone 2
15
6f Total buffer mitigation regw
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank)
permittee responsible riparian buffer restorabon_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
®Yes ❑ No)
(1a Does the project include or Is it adjacent to protected riparian buffers Identified)
(within one of the NC Riparian Buffer Protection Rules? I
1 b If yes then Is a diffuse flow plan included? if no explain why
Storm water will sheet -flow off the completed project!
® 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 governments 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 8 of 10
PCN Form — Version 14 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
❑ No
use of public (federal/state) land?
lb 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)?
1 c 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) Isolat-e--d)
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards i
f
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b Is this an after the fact permit application?
Ely—es
® No
�2 If you answered yes to one or both of the above quash nosrprovide an explanation of the violabon(s)
3 Cumulative Impacts (DWQ Requirement)
3a Will this project (based on past and reasonably anticipated future impacts) result 1
❑ 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 descnption j
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 14 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?
❑ Yes ❑ No
6b What data sources did you use to determine whether your site would Impact Essential 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 W►11 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?
Douglas A Giles / Kim C Giles
�', _ �J
Applicant/Agents Signature',
Nenrs signature is valid only if an authonzabon
f letter from the applicant is provided))
03 11 2012
Patel
`Ap ►Ip cant/Agents Printed Name
Page 10 of 10

VT_CINITY MAP
NOT TO SCALE
MANHOLE AT CORNER /
72-25-46 jV
t RON To 1 8 �E 7`
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1
WATER METER
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o �j J �j•.r w
LOT 25
Q L
103 CUMULUS COURT
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LOT 24
® 0.1101 ACX
(BY COQRDINAT6)
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UNCOVERED
LANDING
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�l
Cl
ILLJ
0 0
v
CUMULUS COURT
40' R/W
l
i
AEGA
r-e--5 e-'A dl
LOT 23
iLINE DISTANCE
Li 8.42 '
L2 9.38
° C^AI {'
r L -28221 r,
rt
c
THIS PLAT IS OF A SURVEY OF AN EXISTING PARCEL OR PARCELS OF LAND NOT FOR RECORDATIOPd
BoM 1992 PAGE 1430 DEED BOOK 6193 PAGE 346 qA _ 0 T
LOT 24 PHASE 1 SECTION A WEATHEASTONE SUBDIVISION
I HEREBY CERTIFY THAT THIS MAP IS CORRECT AND THAT THE BUILDING FO A' N L _ ON THE LOT AND THAT
THERE ARE NO ENCROACHMENTS ON SAID LOT EXCEPT AS SHOWN.
SURV'O HAS DRAWN LYNNIE CHK'O.LHS JOB 4035801 r 11 APRIL 20t17 SCALE: 1 30 '
SULLIVAN SURVEYING SURVEY FOR:
LAND SURVEYORS DOUGLAS ALAN GILES
1143 -0 EXECUTIVE CIRCLE
CARY, NORTH CAROLINA 27511
TELEPHONE: [phone] KIM C. G I L E S