20130114 Ver 1_401 Application_20130213

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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
1b. 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 ❑ Non -404 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 ❑ 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 I�rycto
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
❑Yes 9<0
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes No
2. Project Information
2a. Name of project:
-1q17 00 OD tArj&
2b. County:
2c. Nearest municipality / town:
2d. Subdivision name:
S t X Foal& vet+
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
J* -C.OSS ZU 1 Lblf l& `ID.
3b. Deed Book and Page No.
bb 1"30 Z302. 5
3c. Responsible Party (for LLC if
a piicable):
-�Vtep Sj►�p rZ• s, rat" W� - g'A
3d. Street address:
q qoq ,per ltt.�-ZkT- C r- Ana,
3e. City, state, zip:
WL444 (NI C, 2-1605
3f. Telephone no.:
qlq qZj
3g. Fax no.:
T9 I- Z 2.7- Z
3h. Email address:
e - q 65 SAC, i . CO
�J
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner) ,
4a. Applicant is:
[D- ,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:
5b. Business name
(if applicable):
'5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
,5f. Fax no.:
5g. Email address:
Page 2 of 10

(B. Project Information and Prior Project Hlstory�
1. Property Identification
le. Property identification no. (tax PIN or parcel ID)-)'
I 4i Zq (P
'1 b. Site coordinates (in decimal degrees):
(Latitude:; (Longitude:, . 4'r Q
;1 c. Property size:
'2. Surface Waters
2a. Name of nearest body of water to proposed project:
LtT Tv iof- a "L, S1tE1.LY ( �
2b. Water Quality Classification of nearest receiving water:
C C 544
2c. River 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: LOT l 5 w T- 4 WUO w%Jh %A St aDEV E" >Q,
S1n1L�tE F>�l L`4 jZ,��l Dirl� CE S
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: orat =.
3d. Explain the purpose of the proposed project: o4 6TZIL*rT04 O F A. 5 i a L -k* F-/4rA4 L-,q
3e. Describe the overall project in detail, including the type of equipment to be used: CON 6,TvA.drto4 v ;c a~
S I* ee— Fv*v4% L`{ c c-E . " r'Z a c, TID 6�RADf R�+t� D 14 Feoo r rNC.S . 'gor3cA r
T-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 ast?
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): f4o Wr1 j�jct}r�oa�
'Agency /Consultant Company:
Other. D WO
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
1!51
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
,�_.,�
❑ Yes [ o ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes o
6b. , If yes, explain.
Page 3 of 10�
i PCN Form — Version 1.4 Janus 2009)

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (�k all that apply):
❑ 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
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
I 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
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
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 Droposed, 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:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
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. an 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
Tem ora
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet )
6g.
Zone 2
impact
(square
Jeet
B1
B2
IL0,pit,- d f
Y o
D
480
1'ejo<tV Tk
Yes/No
B
1 t�D
Yedjo
p -,
64
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
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.
U c%,W ►t iNo tJ ft.JCUf4 Ca- w i u— 751` 1+4 ?L6 -f-- Ac, -M No r 0" I rJ
-ttt(,- 2&40 W'A' ,
1b, Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Cr.r%', oT 1 mac.+,(- wIta— 8� WT- JA ?L-151,� 7)%LQ1,4J- Ootasr¢kcnoN-
�0Nje ( I yv'p 5 D 0 Se%L vJ t"- ?A— ze*ebab .
2. Compensatory Midaation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes ❑ No
impacts to Waters of the U.S. or Waters of the State?
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 In4ieu Fee Pro ram
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:
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.
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?
yes RONo
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
1a. Does the project include or is it adjacent to protected riparian buffers identified
[](No,
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why."
01 UL, 1U 0-11LA Z� . D0 06fogl
G14es ❑ No
01%*GrfJD TU
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project?
%
2b. Does this project require a Stormwater Management Plan?
❑ Yes UKO
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 ovemment's jurisdiction is this project?
❑ Phase II
3b. Which of the following locally- implemented stormwater management programs
❑ NSW
USMP
apply (check all that apply):
8 Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program Review
❑Coastal counties
❑HOW
4a. Which of the following state - implemented stormwater management programs apply
ORW
(check all that apply):
HSession Law 2006 -246
❑Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
6. 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 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 ❑ No
use of public (federallstate) 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.)
❑ 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 No
or Riparian Buffer Rules (15A NCAC 2B.0200)?
2b. Is this an after - the -fact permit application?
❑ Yes o
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 o
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?
❑ 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?
3c6mo- F, . �kwT,S,
Applicant/Agent's Printed Name
4
Applican Agent's S' nature
( gent's signature is valid only if an authorization
letter from the applicant is provided.)
1—q-13
'Date
Page 10 of 10

� wh
w�
CCDEFR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, PE Dee Freeman
Governor Director
Secretary
January 2, 2013
JACOBS BUILDING CO INC
4909 OLD MILLCREST CT
RALEIGH NC 27609 -5379
Subject: Surface Water Determination Letter
NBRRO# 12 -239
Wake County
The Raleigh Regional Office of the NC Division of Water Quality/Surface Water Protection Section conducted a
site visit at the subject property and is providing the below- listed determination pursuant to your request for a formal
surface water determination:
BASIN:
®Neuse (15A NCAC 2B .0233) ❑ Tar- Pamlico (I 5A NCAC 2B.0259)
❑ EphemeraVIntermittent/Perennial Determination ❑ Isolated Wetland Determination
Project Name: 7412 Edenwood Dr Raleigh
Location/Directions: Subject property is an existing private residence located at the project
address
Subject Stream: UT to Mine Creek (Shelly Lake)
Date of Determination: November 15, 2012
Lw.fI — iprrrmeraufnrermirrenurerenntat
Explanation: The feature(s) listed above has or have been located on the Soil Survey of Wake County, North
Carolina or the most recent copy of the USGS Topographic map at a 1:24,000 scale. Each feature that is checked
"Not Subject" has been determined not to be a stream or is not present on the property. Features that are checked
"Subject" have been located on the property and possess characteristics that qualify it to be a stream. There may be
other streams located on your property that do not show up on the maps referenced above but, still may be
considered jurisdictional according to the US Army Corps of Engineers and/or to the Division of Water Quality.
This on -site determination shall expire five (S) years from the date of this letter. Landowners or affected parties that
dispute a determination made by the DWQ or Delegated Local Authority may request a determination by the
Director. An appeal request must be made within sixty (60) days of date of this letter or from the date the affected I a
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
IMemet www.ncwaterqual4.org 1628 Mail Service Center Raleigh, NC 27699 -1628 FAX [phone]
An Equal 0W0rtunWAtiama&9 Action Empbff - 50% Recyc1900% Post Cwsu w Paper
Feature
A
E/I/P*
Not
Subject
Subject
X
Start@
Throughout
Stop@
Stream
Form Pts.
Soil
Survey
X
USGS
To o
tr /r /D _ r- L
Iir__.
__..
Lw.fI — iprrrmeraufnrermirrenurerenntat
Explanation: The feature(s) listed above has or have been located on the Soil Survey of Wake County, North
Carolina or the most recent copy of the USGS Topographic map at a 1:24,000 scale. Each feature that is checked
"Not Subject" has been determined not to be a stream or is not present on the property. Features that are checked
"Subject" have been located on the property and possess characteristics that qualify it to be a stream. There may be
other streams located on your property that do not show up on the maps referenced above but, still may be
considered jurisdictional according to the US Army Corps of Engineers and/or to the Division of Water Quality.
This on -site determination shall expire five (S) years from the date of this letter. Landowners or affected parties that
dispute a determination made by the DWQ or Delegated Local Authority may request a determination by the
Director. An appeal request must be made within sixty (60) days of date of this letter or from the date the affected I a
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
IMemet www.ncwaterqual4.org 1628 Mail Service Center Raleigh, NC 27699 -1628 FAX [phone]
An Equal 0W0rtunWAtiama&9 Action Empbff - 50% Recyc1900% Post Cwsu w Paper

7412-Edenwood Lane Raleigh
Wake County
January 2, 2013
Page 2 of 2
party (including downstream and/or adjacent owners) is notified of this letter. A request for a determination by the
Director shall be referred to the Director in writing c/o Ian McMillan, DWQ Wetlands /401 Unit, 1650 Mail Service
Center, Raleigh NC 27699 -1650.
If you dispute the Director's determination you may file a petition for an administrative hearing. You must file the
petition with the Office of Administrative Hearings within sixty (60) days of the receipt of this notice of decision. A
petition is considered filed when it is received in the Office of Administrative Hearings during normal office hours.
The Office of Administrative Hearings accepts filings Monday through Friday between the hours of 8:00 am and 5:00
pm, except for official state holidays. To request a hearing, send the original and one (1) copy of the petition to the
Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699 -6714. The petition may also be
faxed to the attention of the Office of Administrative Hearings at (919) 733 -3478, provided the original and one (1)
copy of the document is received by the Office of Administrative Hearings within five (5) days following the date of
the fax transmission. A copy of the petition must also be served to the Department of Natural Resources, c/o Mary
Penny Thompson, General Counsel, 1601 Mail Service Center, Raleigh, NC 27699 -1601.
This determination is final and binding unless, as detailed above, you ask for a hearing or appeal within sixty (60)
days.
The owner /future owners should notify the Division of Water Quality (including any other Local, State, and Federal
Agencies) of this decision concerning any future correspondences regarding the subject property (stated above). This
project may require a Section 404/401 Permit for the proposed activity. Any inquiries should be directed to the
Division of Water Quality (Central Office) at (919)-807 -6301, and the US Army Corp of Engineers (Raleigh
Regulatory Field Office) at (919 )-544 -4884.
�Respectfully,
Martin chmond
Environmental Specialist
cc: RRO /SWP File Copy

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LOT 256
EDENWOOD LANE
40' R/W
CITY OF RALEIGH
DB 5642 PG 344
REFERENCES
BOOK OF MAPS 1972 PAGE 284
ZONING, R -4 REVISED 01 -31 -13 SHOW PROPOSED HOUSE
REVISED 01 -15 -13 TO SHOW CREEK TOP OF BANK AND ZONES
LANDS OF
JOEY JACOBS
PLOT PLAN
SIX 7412 EDENWOOD LANE
FORKS NORTH SEC IV B
PRELIMINARY PLAT
NOT FOR RECORDATION,
CONVEYANCES OR SALES
WAKE COUNTY RALEIGH NORTH CAROLINA
DATE+ 11 -26 -02
BERNARD & A&MIAMS
PROMMOMAL Lam smYSYOBS
324 DIMOCK WAY
SCALE; 1' =20'
WAKE FOREST. NORTH CAROLINA 27587
SFN255
(919) 41401