20120311 Ver 1_401 Application_20120312

buffer application form http //mail aol com /35810 111 /aol 6 /en us /mad/PnntMessage aspx
From Witherspoon Lauren <lauren witherspoon @ncdenr gov> 2 0 1 2 0 3
To lannaboots <lannaboots @aol com>
Subject buffer application form
Date Fn Mar 23 2012 3 41 pm
Attachments PCN_ buffers pdf (525K)
Brian
Attached Is the buffer application form Please let me know if you help filling this out
When complete you will need to make 3 copies of application and 3 copies of survey and either send WeBSCaPe
Unit Attn Laurie Dennison 1650 Mail Service Ce NC 27699 or you can drop it off at their office
downtown at the Archdale Building 9th floor 512 N Salisbury Street Raleigh North Carolina 27604)
If you want to email me a copy before you mad it in I can look it over and give you feedback
Thanks
Lauren Witherspoon
NC Division of Water Quality Surface Water Protection Section Raleigh Regional Office
3800 Barrett Drive Raleigh NC 27609
(919) 7914251 (office)
[phone] (fax)
E mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may
be disclosed to third panes
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Corps action ID no
DWQ project no
Form Version 14 January 2009
Page 1 of 10
PCN Form — Vernon 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
lb Specify Nationwide Permit (NWP) number or General Permit (GP) number
1c
Has the NWP or GP number been venfied by the Corps?
❑ Yes ❑ No
1 d
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 ❑X Riparian Buffer Authorization
le
Is this notification solely for the record
because wntten 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
1 g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
below
❑Yes Q No
1h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes © No
2
Project Information
2a
Name of project
Mullins
2b
County
wake 0
2c
Nearest municipality /town
Cary
2d
Subdivision name
Preston Oaks at Preston HAD 6) In1l)
2e
NCDOT only T I P or state project no
3
Owner information DENR WATER QUALITY
3a
Name(s) on Recorded Deed
Allan & Karen Mullins
3b
Deed Book and Page No
1994 page 874
3c
Responsible Party (for LLC if
applicable)
3d
Street address
109 Wohler Ct
3e
City state zip
Cary NC 27513
3f
Telephone no
919 467 0540
3g
Fax no
3h
Email address
ozzrewoo @aol corn
Page 1 of 10
PCN Form — Vernon 14 January 2009

4
Applicant Information (if dWeerent from owner)
4a
Applicant is
❑ Agent Other specify GC
4b
Name
Brian Fisler
4c
Business name
(if applicable)
Fisler Framing Inc
4d
Street address
100 Meadowstone Ct
4e
City state zip
Cary NC 27513
4f
Telephone no
919 422 2929
4g
Fax no
919 380 9332
4h
Email address
lannaboots @aol com
5
Agent/Consultant Information (if applicable)
5a
Name
5b
Business name
(if applicable)
5c
Street address
5d
City state zip
5e
Telephone no
5f
Fax no
5g
Email address
Page 2of10

B
Project Information and Prior Project History
1
Property Identification
1a
Property identification no (tax PIN or parcel ID)
d YY 32 /1070
1b
Site coordinates (in decimal degrees)
Latitude 9p y Longitude —/y 8Z0,?
1 c
Property size
0 331 acres
2
Surface Waters
2a
Name of nearest body of water to proposed project
7j_4,,/ LOece /G
2b
Water Quality Classification of nearest receiving water
&61AISul - 17 -13- -2
2c
River basin
t
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
stone patio grass natural vegetation
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
3d Explain the purpose of the proposed project
extend existing wood deck 711
3e Describe the overall project in detail including the type of equipment to be used
extend existing deck along house installing one 4x6 10 tall wood post needed for support on 16x16 pier
4
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project include i all nor phases) in the past?
❑ Yes ❑ No Q 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)
Agency /Consultant Company
Other
4d
If yes list the dates of the Corps junsdictional determinations or State determinations and attach documentation
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?
❑(es ❑ No
6b
If yes explain
Page 3of10_
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 Q 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
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 Form — Vernon 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 indiv 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
Sf 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 wnil 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
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required?
6f
Zone 1
impact
(square
feet )
6g
Zone 2
impact
(square
feet
61 P
Pee k-
147 %P It dzell-
Yes/No
!�!
B2
f
Yes/No
133
Yes/No
B4
Yes/No
135
Yes/No
136
Yes/No
6h Total Buffer Impacts
61 Comments
rage 5 of l o

D Impact Justification and Mitigation
1 Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
NO pjo&4y deb j7 d,-OA W.11 , C bAtOVed
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
& If h4n40( /ave cv.11 be ccsed
2 Com ensato Mtti ation for Impacts to Waters of the U S or Waters of the State
2a Does the protect require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes 21No
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
pro�ect�
❑ Mitigation bank
❑ Mitigation
Payment to in lieu fee ro ram
m 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 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 Permtttee 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 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
Yes 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
la Does the project include or is it adjacent to protected npanan buffers identified
within one of the NC Ri anan Buffer Protection Rules? Q Yes ❑ No
1 b�1If yes then is a diffuse flow plan included? If no explain why
/�O /Jw[a���e�uz� )Ntppi ✓�Di,cS - 3�i�/�P
Ao �2e�lc, /e Sr�l Wa 1�PP Aft 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 governmentslunsdiction is this oroiec t?
3b Which of the following locally implemented stormwater management programs
apply (check all that apply)
3c Has the approved Stormwater Management Plan with proof of approval been
attached?
4 DWQ
4a Which of the following state - implemented stormwater management programs apply
(check all that apply)
4b Has the approved Stormwater Management Plan with proof of approval been
5 DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements?
5b Have all of the 401 Unit submittal requirements been met?
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other
❑ Yes [I No
E]Coastal counties
❑HQW
❑ORW
❑Session Law 2006 -246
❑Other
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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
[I Yes
[�No
use of public (federal /state) land
1 b
If you answered "yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes
9l0
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
Q No
additional development, which could impact nearby downstream water qualms
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 — Vernon 14 January 2009

6 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 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?
Brian Fisler
Applicant/Agent s Printed Name
2;l L���
03/23/2012
Date
ApplicantlAgents Signature
(Agents signature is valid only d an authorization
letter from the applicant is provided
Page 10 of 10