20130819 Ver 1_401 Application_20130813

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Office Use Only:
Corps action ID no.
DWQ project no.
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
1 b. Specify Nationwide Permit (NWP) number: or General Permit (GP) number:
1c. Has the NWP or GP number been verified 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 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 flee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes [lo
1g. Is the project located in any of NC's twenty coastal counties. if yes, answer 1 h
below-
❑ Yes No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
2. Project Information fth
2a. Name of project:
2b. County:
�„ ° G
2c. Nearest municipality / town:
13
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
eze LAY
IAI RA6 19 21A&
3b. Deed Book and Page No.
3c. Responsible Party (for LLC_if
applicable):
3d. Street address:
e.
3e. City, state, zip:
6 A 01 m 9
3f. Telephone no.:
39. Fax no.,
3h. Email address:
t
Page 1 of 10
PCN Form — Version 1.4 January 2009
1

4. Applicant InfbmwMon (if different from owner)
4a. Applicant is:
Agent ❑ Other, spedfy:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
�7 S
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
6. AgenMonsultent Intonation (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:
• ' `' . £= .a> page 2 of 10

B. Project Information and Prior Project N- Mori,
1. Property identification
1 a. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees): I Latitude: Longitude :'
1c. Property size:
acres;
Z Surface Waters
2a. Name of nearest body of water to proposed project:'
2b. Water Quality Classification of nearest receiving water.
2c. River basin:
uere
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the pro ject at the time of this
application:
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:
3e. Describe the overall project in detail, including the type of equipment to be used:
do
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
Yea ❑ No ❑Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
preliminary (Zv Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency /Consultant Company:
Omer
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.,
6. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Y� 'N"' o 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
VX

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑ Streams — tributaries d 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
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
(fit)
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 indivi 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
O4 -
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:
5i. 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?
[Meuse [] Tar - Pamlico 0 Catawba [] Randleman [] Other.
6b.
Buffer Impact
number —
Permanent (P) or
Temp2rary M
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet )
6g.
Zone 2
impact
(square
feet
61 -
e
Yesmo
B2 -
J
Yes/No
B3 -
917-4
YeslNo
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
61. 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.
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1 b. Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques.
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2. Com e satory 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
0 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 In4leu 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:
b. 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 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
1 a. Does the project include or is it adjacent to protected riparian buffers identified
Ea4e
❑ No
within one of the NC Ri 'an Buffer Protect Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
'5 01P \tq 13 L Nth I To -T 'A 1
❑ 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?
❑ Phase 11
❑ NSW
3b. Which of the following locally- implemented sormwater management programs
USMP
apply (check all that apply):
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):
Session Law
2006 -246
Other.
4b. Has the approved Stormwater Management Plan with proof of approval been
[]Yes
❑ No
attached?
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 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑Yes ❑ No
use of public (federal/state) land?
ib. If you answered ° yes° to to 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 Ad (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), Isolates
%bband Rules (15A NCAC 2H .1300), DWQ Surface VOater or Watiand Standards,
[]Yes QNo
or Riparian Buffer Rules (15A NCAC28.0200)?
2b. Is this an after- the -fad 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. VM t* W*d Mased on pad aW MMmaMy 060pated f e} result in
❑Yes [21 I4o
additional development, which could impact nearby downstreaality?
m er 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 fbc friY.
Page 9 of 10
PCN Form — Version 1.4 January 2009

M
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
[]Ye r. s 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?
S. 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 floodpiain?
Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
S ear, -D- 'nzc C'I
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Applicant/AgenYs Printed Name
. - go,-
plicanUAgent's Signature if
(Agenft soneture Is vabd only Nan authorization
letter from ffwappUcwt is ided.
I -a l— 13
Date
Page 10 of 10

NOTES:
1.SURVEY COMPLETED 7- 17 -13. N
27HIS SURVEY WAS PERFORMED WITHOUT BENEFIT OF A TITLE REPORT.
3. ADJOINING OWNERS TAKEN FROM DEEDS OF RECORD, AND TAX RECORDS.
4. THIS PROPERTY MAY BE SUBJECT TO EASEMEN75 OR OTHER
ENCUMBRANCES THAT A DETAILED TITLE SEARCH MAY DISCLOSE
5. ALL MEASUREMENTS SHOWN ARE HORIZONTAL GROUND DISTANCES.
6. AREA CALCULATED BY COORDINATES 4�
ATE NSF EL GEND: a
Aq.•r IKH J ESCOBAR PF IRON PIPE FOUND
LOT 163 NIF NO IRON FOUND o.
DB8707 PG481 E PROPERTY LINE y
BM1994 PG791 R/W RIGHT OF WAY
REID#0209334 E ELECTRIC BOX
M ` * LIGHT POLE
R S 38'46'59" E a CABLE PEDESTAL
7.55' m TELEPHONE PEDESTAL
VICINITY MAP SANITARY MANHOLE
(NOTTO SCAM ® L CATCH BASIN a
CO TRO
Swale / CO NER P S 20' SEWER
SS4\ EASEMENT i
flared \ E 74 0 0
end �� z y
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LOT 152
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REID#0219852
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48" RCP // proposed AREA OF NEW CONSTRUCTION Bg
/ deck ZONE 2= 498 SO FT
DECK m
AREA OF EXISITING HOUSE IN F a
�Tri?o�
// propose ZONE 2= 23 SO FT a
4:/ screen CO d
porch TOTAL AREA IN 00
/ 2 STORY 7S ZONE2= 521 SO FT a v
Qb
py BRICK N F 20' DRAINAGE -e} MOORS = o
EASEMENT LOT 154 =o
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—31-13 ADDRESS: 105 GREYFRIARS LANE m`'°
�N CA 00 CARY NC, 27518 <z o
2 <�7 CURVE TABLE a F
SEAL CURVE I LENGTH I RADIUS I CHORD DIRECTION DELTA
L - 3967 Cl EL37 24L71 EL37 S 72.4075' E 5.4'0' LAB
xa
9244K ��� I, Anthony S. DiBono, certify that this plat was drawn under my direct supervision from an
yOIVY S ��0
actual u0� y made under my supervision. that the ratio of precision as calculated Is p
Witness my original signature, registration number and seal this 31st day of July, 2013. 14053.01
FOR THE FIRM I
BOUNDARY ZONE, INC. SHEET
FIRM NUMBER: C -3534 Anthony S. Dona, PLS L -3967 I OF I
APEX
PLOT PLAN LOT 153 WYNDFALL S/D gpu pq APEXNO THDRIVE. INAri23
PREPARED for AMY & SEAN BARCLAY ZO(IQI(1C u.owmFra+�s�mnces 235 PEACHTREE ST. NE. STE.400
WHITE OAK TOWNSHIP APEX: (919) 363 -9226 ATLANTA, GEORGIA 30303
FAX' [phone] BUFORD
WAKE COUNTY, NORTH CAROLINA - 7/31/13 W W W BOUNDARYZONE COM 4195 SOUTH LEE ST., STE.1
BUFORD. GEORGIA 30319

EXIST PHOTO
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