20131032 Ver 1_Application_20130930

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a DWQ project no.
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. 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 X❑ 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 ❑ No
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 .® No
2. Project Information
2a. Name of project
r
r,
Ki s Ice"t'+`rtMGv\+ cYtl►'tduvir
2b. County:
0 k e,
2c. Nearest municipality / town:
6'h4 of 2a( e4�In
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state project no:
3, owner Information
3a. Name(s) on Recorded Deed:
�
,��g fZ�- �+'sevue (Icvn►viu��` ALL'
3b. Deed Book and Page No.
1 539 D 09
3c. Responsible Party (for LLC if
applicable):
11 I
EL / --' % !r
3d. Street address:
gp o `(glue.
3e. City, state, zip:
[—
� vie-* 1`1 vj G $
1—; vie-* 51(a
3f. Telephone no.:
4 p2 ZO
3g. Fax no.:
t4o 2 4w •- .9- s 24-
3h. Email address:
G c tk T L L nr] yl 11 I
Page 1 of 10
PCN Form —Version 1.4 January 2009

®,
4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
Of applicable):
4d. Street address:
4e. City, state, zip.
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. AgentlConsultant Information (if applicable)
5a. Name:
L06-vte-VI, F
5b. Business name
(if applicable):
Tr�GV+ 12 S�` e r'�✓► LLG
5c. Street address:
A-00 Lo `6ar
5d. City, state, zip:
(a C Ci
5e. Telephone no.:
Cl 9 SS 3 - (o S 7C
5f. Fax no.:
5g. Email address:
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
O'710_ gp — 4110
1b. Site coordinates (in decimal degrees):
I Latitude: 3!5. 9fig2 Longitude: — 7� , tagb 15
1c. Property size: �Oj
j (,a acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
TtAvG yte` e. C(X e-k a -- 33-- IZ -6)
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
I�er eS
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: 1� I I �( 1
toot_' Jed ��Eu 1_"Y1 eV A� ped) tot-A Gk yi M,'SPV� ULAW r1Mra[''eK
3b. List the total estimated acreage of all existing wetlands on the property: p
3c. List the total estimated linear feet of ali existing streams (intermittent and perennial) on the property: lo 4 �T
3d. Explain the purpose oft, a p{roposed project: ` , ,
�ro�2r tn9i l O>' deUL�o�ev( Gt 5 irl 1 d,,O2YiO�e r1� %iJ r/Il�. L'Q/iill�ttd l Zt 1�
3e. De ibe the ovQrall p o'ect In detail, 'n udi g the of quipment t$ be used: `,�
W l eytpllm A SS O C' . -tip ddeg1 OP get�- 0 � �N.,e 1
��
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property 1
project (including all prior phases) in the past?
&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): v E(�{ S� let2 i°�r/'
Agency/Consultant Company:
Other: Sot' ` Se�ry �` Cpl , Pao
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
1zh I2
S. 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
fia. Is this a phased project? ❑ Yes No
Sb. If yes, explain.
Page 3 of 10
PCN Form —Version 1.4 January 2009

C. Proposed Impacts Inventory
Z. Impacts Summary
1a. Which sections were completed below for your project (check 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. �!lk
!
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
N/4 -
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 W l4
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
$a.
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)
39•
Impact
length
(linear
feet)
S1 -
Choose one
-
-
32 -
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' g 10k
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
O2 -
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)
Be.
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 m1fi ation, 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?
61.
Zone 1
impact
(square
feet
69.
Zone 2
impact
(square
feet
B1 � -
n r ' q
Rofie( W�G� A?
("
1 e- Cre-e•
Yes/No
j ol0
i ZIoO
B2
YeslNo
B3
YeslNo
B4
Yes /No
B5
Yes /No
B6 -
Yes /No
6h. Total Buffer Impacts: 1
2, p I D
1 240
61. Comments:
Ts14��GT5 GisSoteef't'�f tAi`4'�/j '� l�o�t(• (,JrGi�attrd�
Page 6 of 10

..... n............, r.....•. �.,... w...... .m.�..vvnrv.v.u...a....,.u.rvxa aua vr... u....... vn. w.. nrnu. nwnwuuu. a. �...+ n...... s.. �.. r...... u.. uvn..- ...........:.:.........: v.: ev_ v..-r: v�. n..,.............,. ..- ...�...:.l...u.....- ...:.... _a_ ____
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid gr minimize the proposed impacts In designing project. ��!!
- t�c�rlceo( tall NeAccT any( G' o n(t.'SA) 74a &,Ue4 /' �sirrvt auClv.ett '"
Sei%vt_ya�c�/ aas�e/ -s.Qcwa(� loE„ytG /c 67cfrr(�
1b. Specifically describe measures taken Jto avoid or minimize the proposed Impacts through con truction techniques.
- �Or"'15 1'n'0 �C. �YvL,�fc� 1. f2rry -e
,4. r','�Ct
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 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:
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 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Huffer 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 Plow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Suffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain/ why.
�%2�+
Or)-5i`/ i2�JroVi"t%tt` S �,,e °u i��•br� tru Gv
❑ Yes ®. No
roadu�A, y Gl' ✓oui�/�t��.. /�v�yr -dvKrH P.U'�s c n 12- %ra �c�'2 ��i%t X24.,. '
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
34,5%
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,
^�',� s,,n^ Wyss 4re �0��,�re� k,,<<�
2e. Who will be responsible for the review of the Stormwater Management Plan?
6' W
u
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
Phase It
3b. Which of the following locally - implemented Stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
0 Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
,.Yes ❑ No
attached?
4. DWQ Stormwater Pra ram Review
ElCoastal counties
❑HQW
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
to Yes ❑ No
attached?
S. 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
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal /statefiocal) funds or the
❑ Yes
K No
use of public (federal /state) 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
[I 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
❑ Yes
❑ No
letter.)
Comments:
2. Vioiations.(DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 21-1.1300), DWQ Surface Water or Wetland Standards,
❑ Yes
tZ No
or Riparian Buffer Rules (15A NCAC 213 .0200)?
2b. Is this an after -the -fact permit application?
❑ Yes
TZ 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
E[ 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 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

r
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 [I 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. Essehtlai Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes j$ 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 Trost 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 40(3 -year fioodplain?
❑ Yes KNo
8b. If yes, explain how project meets FEMA requirements;
8c. What-source(s) did you use to make the floodplain determination?
ApplicanYAgent's Printed Name
Date
Applt nt/Agent's Sign ra
(Agent's signature Is valid only if an uthorizatlop
IoIW from Ilia applicant Is provided.)
Page 10 of 40

North -,Carolina, Department of Ehvironmont and Natural Resources-
Division of Water Quality Dee Freeman
Bevefly-Eaves FeIrclue Charles Vlakild, PE
November 2,
sar,&Alheeler
SoiV Services,, PLLC
,,"5�,, ,
_-&PumeII'Rd
Wake Forest, Nt-1`27587
Subject-.' su'rfaeb Water Determinatioll Letter
NfVR116412-212
wale -Courdy
'f" be Suit, ce, Sectilon
NC of,Wawr Qua i e
The Rateii0,11qi0nal Off'Mo -mination pursuant,to your U f r fO I a conducted a
Ur req est 0 a, ri� I
site visit at the subject property and is the below- listed ddtei
surface water delermin'UtioA'.
6ASIN:
Meuse (I 5A, NCAC 28-0233) ❑ Tar- Pamlico (15A N(�AC 2B .0
5Z
[:] EphemeraUintermittenVPerenhiaI Determination M lsalated-Wetland Determination-
Project,Name: Retirement Home),"—
71, a
is a T,,pr()xijijate 9, acre McHocated at the project
LocationiDirections: property Proper 1
address -
Subject'Sm Uj, arn: � to 1d�r Sniin
Date of Determin;ItiOM bciober 25! 2012
F 7Feature Nbbot cc t t
11 �Subject sta<,
stog —T--Str4.M� S61 ,
-Usc,
Su— _ Form Pis. Saryev Tpis
X Flag 21
X
Fxplartatibn:-=The feature(s) listed-above-has,or have been located on,thc,Soil Survey of,Wakc Coulity.-North
Cafblida or the mast rucunt cooy of the I j
S(YS Topogphic m3l5 it'u 1:24'00 e, ,Hch feature that is checked
, "Not Subject" has buci determined'not to be a stream Or is not pruseiton the property. an, ch k
Characteristics thafq�,alify it t6 be a stream. Thin niaY be-
.1subject"' have been located on Jhe,-pTOP��-ty and Possess
other'Strein'ns l6`c'aLed'0'II,'­ " that do,not,show,up on.the maps referent above but"stil'i InavIbu
, YOUT prof PCrt2y 1 11 ' ' H
cohsid�re'8 jun'isdictibna'I ac,cording to the US Army Corps of,Engi6eers and/,,br,to the Division of-Water Qua ltY.
This'on-site determination shall expire rive (5) years froi I it, the" date of this letter. Landor�'ners(iraffee-ted=palrties,that
di pu e'a determinAtion m' ade by t eD W C),6rDelegated Lkal -Authority may request
a d ete i" at" o n, by
the
N
vhCarol'
Wly
Surface WULLT PILje�,tjr.,n Phan �09)791-4100 Custo:n�r S�fv jix
`,ofth Cwulinu D' of QUWity Raleigh Rcgionat Officc' q
�VISMn , I ' I igh, \C,27 fAN." {919} '571-47IN 1-107-�621-6748
IwBmEt wePA%AWterq0!�t/rr9 1628 MailScnlicc C,:nw' RaIc
An Employer— 50% Recyded;j(y-,'a post ',onsurn6r7rapei,

64918:1tay Rd, (Leesvill,c: Rd R ctircment 11OMe),'
Wake County
Novtmbt,r 2, 2RI I
Page ,2,of 2
within sixty (60) -days of date of,tbis lette']; or from •the date the affected
Director, An appeal request must, he made
notified of this letter., A reqiIest for a'dete.rinination bythe
party (including downstream and,lor adjacent ownem) is 0
in WQWctiatidsP40
cMillan.D1' U"p'iti -
Director shall be,refcrr�d to the -Director ,, 1650 Mail Service
ceniirl Raleigh NC 27699-1656;
a' 'administrative hearing, You must-hi 0 the
If �ou dispiareAhe Directors. determination yuu in y,file a-lotiti(iii,for,an
petition with the Offi cc of Administrative Hearings within sNty'(60) days of the receipt of this notice of decision. A
petition is,cons . idered filed when it is.received_in the office of Administrative Aearin} s during,normaLoffice hours
h
'throug Friday between the ours of 8-06 am and 5.00
'The Office,of Ad in inistrativeRea rings" pLs filings Monday li
}cop} Of the petition to the
pin,dxceoffor, official state holidays. To request a hearing, send the oll 14. The petitiol
rV_Icc Cenfer,,galeigh, NC 27690-67 a-may also be
Office tit Administrative Flea J 4,Slail Se
id one (1),
d '3478, provided thc,orlig.inal'a,
faxed to the attention of the Office ofIA ministrittil Heilrins, at (919) 7�3- 1
days following the date " f
copy Of the document is received by the Office 6f,Adrirtinistrative Hearings, within five (5) o
the tax,,transmission. A copy of the petifi()Wfiiustals'6.be seirvcd tb'theDe partment'of Natural Resourc es
Penny Thompson, General C6unsC l, 1i 661 Mail S6 v,ice,Centcr,,Ra "Icig , NC 27 699-1601.
ThisActerminition',is , final'and bihding u n less;- as,detailed, above;

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V.S: A_ ,RMY CORPS OF ENGINEERS
WTLMINGTON DISTRICT
Action Td. SAW- 20)12 -01 %7, County- wake US.G.S. Quad: NC- RAJLEIGH NV1EST
NOTIFICATION, OF JURISDIC';('IXONALDETERNIINATION
ProMrty Qwner: Evelyn Stanley
clo Ken_ Stan
lev"
Address: 3524 #3 New Bern Avenue,
Raleigh, Porth'Csrolina; 27610
Property " description: ,
Size (a&C- ) 12.16
Nearest, esnly tr k
USGS "YIUC 3020201
Location description:' Tth'esubject oroa
Indicate Which of the Followin1g,Appiy:
A. Preliminary Determination
Asent: Soil Sirvices PLLC
Sarah Wheetee
Address: Past Offi -e-Box 41115
Raleiah, North Carolina, Z767S
'Dearest Town RaEer
River Basin , Neuse:
Coordinates Latitud,
X Based'on preliminary information, there may be waters of the U,S, an the above deseribedpropetty. We strongly suggest
you,have this property inspemd,to determine'the'exbentofDepar*nt ofthe Army (DA} jurisdiction. To-be considered,
final, a jurisdictional determination must be- verified by the Corps. This preliminary determinationJs not an appealable
action ,under the Regulatoiy.Fiogram Administrative Appeal Process`( Reference 33'CFR Part 33.1). if you wish, you may
request an approved JD (which rnay. be appealed), by eontaciing "the Corps di strict for further -instruction. Also, ybu may
provide new information for further consideration by the Corp' s to reevaluale the JD,
B. Approved Determination.
_ There are navigable Waters of the United States within the above described property subject to -the permit requirements•of
Section 10 of the Rivers and lgarbors Act and Section 404 of t}ie Clean Water A:& Unless th=,is a change in the law-or
our published regulations', this determination may be relied upon for a;pe6od not to exceed'five yeam'from the date of this
notification.
'Thcrc,are,wators of the U.S.' including wetlands on the above described property subject to #be permit requirements of.
Secdon,404,of the Clean.Water Act (CWA)(33 USC §:1344),' Unless,there is a change in the law or pear published
regulativns,'this determination may' „be relied upon for a,period not to exceed,fve years from the date of this riottfrcatian.
We strongly suggest you,have'the wetiands'on your property'delineated. Due to the size of your property and/or our.
present workload, the Corps may nocbe•able io'aceomplish this wetland delineation in a timely manner.' For a more timely”
delineation; you may wish to obtain a consultant. To lie considered final, any delineation must be verified by the Corps.
_ The waters of the U.S. including wetlands on your. project area have been deflneated,and the delineation has bten.
vcrifiod by the Corps, We strongly suggest yowhave this delineation surveyed. Upon completion; this survey should be
reviewed and verified by the Corps. Once verified, this survey will provide an accuratc 'dcpiction of all areas subject "to
CiVA jurisdiction on your property,whioh, provided there is no change -in the lava or our published regulations, Inay'be
rclicd upon for a period not to 6xccod five )cars.
The waters of the LLS. "including wetlands have been delineated and "sorvtiyed aitd'areacdurately depictad.onthe olat
signed by the Corps Regulat"ory'Official identified below on Unless then is a change in the law o?, our pubEished
,regulations, this determination Qtay "be "relied upon'for a period not toexceed five years',frorn the date of this.not.ifi6dion,.
There are no waters of the V.S., "to include wetlands, present on thc.above described -project area which are"subject'to the
permit requhtruents.of Section "404 of the .Clean,V►aterAct (33'USCJ1344). UnTess•there is a change in the lawor our
,published regulations, this determination,may be relied upon for a period not to exceed five years from the date of this
"notification.
Page 1 of 2

The property, is- located.in one of the.20'Coastal C.ounnes subject to regulation-under.tlie Coastal' Area -Management Act
(CAMA). You should eontact the Division of Coastal Management in MoreFiead'C�ty, ti1C; at {252} 808 -2848 to'.
determine their rrquiieinents.
' Placementof dredged ,orfiil•niaterial within waters oftheUS'andlor wetlands withotrt a Department ofthe Army permitmay'
oonstitute;a yiolati6mof section 301 ofthe.Clcan water Aat(33 -US C 1311); If you have atfy,6estiotis revs ding�this
determination and/orthe'Corps regulatory program, plcase'coatact ))avid L.'Shaef % nat.919- 534 -48$4 ext. 31; or by,e -mail at
daAcLU6aef7er usaee:artn .rnil,
C. Basis For-Determination:.
D. Remarks.See tite cnclosed prel iminar ' urisdictional determination farm dated Deeeinber7, 2012.
,E. 'Attention USDA Program, Participants
'this delineationlde'termiriation has,been condumcd,to identify the lirtiits of Corps' Clean Water Act jurisdiction for the;
particular site identified ia`this•reguest. The dctineationfdetermination -may not be yalid for the' wetland conservation
provisions of the Food Security Act 6f -1985, Tf you or your tenant are GSDA Program participants, or anticipate participation
'in USDA psvgratns, ybu should regu6st,a certified- ,;A*Iand determination from the local office of the Irlatural Resaurees
Conservation seryloo, prior to starting work.
F, App catls Information (This information sipH6 only to approved jurisdictional determinations as,indicated in
S. above)
This correspondence constitutes.an.approyed jurisdictional determination for the above described site. If you objectto thin
determination, you may request an i dministrative appeal under ;Carps, regutations at 33 CF'R Part 331- - Enclosed you will find 'a
Notification of-Appeal Process:(NAP) fact sheet and,regocst for appeal,(RFA),O,n ., if you request tv appeal this
determination you must submii a completed •RFA form to the follow address:
US Army Carps of Engineers
South Atlantic Division
Attu: Jason Steele, Reviinv Officer
60 Forsyth Strout SW, Room 10415
Ailanta, Georgia 34303 -8801
In order for an RPA'to be accepted by the Corps,-the Corps must determine that it is complete, that'it meeti the criteria for
appeal under 33 CF, part 331,5, and,that i has been received by the Division Offieo within'60 days of the`dat� of the NAP:
Should you decide to submit an RFA form; it -must be received at the above address,by
"Tt 'is not necessary to submit an RFA farm to the Division Office if you do not,object to the determination in;this
correspondence, *' rh9�iag Svc �Y �6FER17h11G.ltIGlL1Z6QJSOSi3
D(�:C= USo -us. rmavamenLa�Ja0. ou�10
` oa -USA. v "ff-FR0AW LLEG4.u2 G750673 .
Corp R.egulatoryOffici,al: [eEe7L1212077439A7 -0800
Date: 12M2412
The.wilmingtan Distriavis committed w providing the highest level'of support to the puhlic. To held us ertsure ivc "c>rtn`tinue.ta:
do so ,,,please complete the - attached customer Satisfaction Survey.

PRELIMINARY JLiRISDICTTONAL DErERAIINATIO, l FORM
BACKGR9_UNT) INFORA-11 I ION
A. REPORT, CONIPLETION. DATEr ORPREL1MINARVHRUSDiCtI ON ALI)ETERMiNATION(Jll):December7.
2412
B. NArv11E.i. D ADDRESS OF,PERSON "QUESTING PRET ]MINAltY iD: Sarab,Whecler, Post Office Sax 911]5,
VPrth,CaxoIiug,' 276'
C. D lSTRIC• 1 '.OFFICE,`FiF.ENAN7E, AND NUMBER wil mingtUU',b islri4, Raleigh Regulatory FieltLOflice ;Staalev,
Hare Snipe CrL-&, Leesville Road Retiromcnt Homc, SAW- 2012;61967
D. PROJECT I.00ATIOJI(S) AND BACKGROUND Nr:ORMATION:
(T J$lE tlit'ATrACiiED'F"LE TO DOCGN7FNT MI)L7'I FLE W,kTER'BoDi ES A'I. DIFFEREYi STT.ES)
State: NC Countylparisliiborough, ;Waite, City: Ttaleigh ,
Ccntt:r wore- inat*S'of site jlatrlong in dcgrie'deimal format }: Lat 35,86829 N, Lang- - 78'6965° W__
universal liauwme Mercator ;,NADU
Naine of nearesf water' body:, Here Snipe Creek
Tdcnofy (estimate) amount of waters in the review area:
Nch- wetland waters:' 1691incur feet' 2- 4,+viath,01) a[ dicr acfts-
CowaT�in Chm: Rir'ertne
Stream Flow: Itnt=ittent
R'ctlands: Mont: acTec•
Cowerdir Class=
NaIine of any water bodies oti,the site dtarhaye been'Ncntif it:d as Sectbn,,10 Waters;
Tidal: ?none
ltine- Tidal: None
E. REVIEW PERFORMED 17OR S1TE'EVALUAT ION (CHECK ALL THAT APPLIES):.
C] pfrirc{T7zslc }Determutaotion. Date: '�
® Field lletetmination.- llisle(s): IQ�?5f2U12
1. ,Thc Cotes of T ngineers believes tbat d=c may ba jurisdictional waters of the United States on the suhjcct,sitc, and the permit
applicant or other affected pa ily who requested this pmliminary JD iS hereby advised of his or her option to rcq st anti ahiain an
appruvrd juresdicli66al dett:rmination (JD) for that site_ ;leverihelcss .the permit applicant or othcr,per�nn who requesrod this
preliminary 1D'has declined tu exercise the option to,obtain an approved JD in this instance gnd at this•tinte;
2. In any circumstance •where a permit applicant obtains an individual permit, or a Nauonw'ide General Pcrmit,(NWP)`or other
gcncial permit +erilication re4uiring'-pt+o- ennstructiun notification "'(PC.N), or requests verification For a nun - reporting N WP or
ntltei• general permit, and fhc permit applicant has not rcyuesleii an approved JD for•the activity, the Perm-
ermit applicant is hereby
made a%wc liNbc iullowing: (1) the - permit applicant hos elei wdto sock a permit au tliarizationbascd on a preliminary J17, ?vhioh
docs.not make an aCGcial "deterinination of juiisdictioriai waftrs, (2) that the apphcahl h as
the option, rcyues[ an approved JD
before acccpting thc,tnriris and conditions of the permit authoriation, and that basing a permit audtorization on an approved J
could possibly result in less compensatory mitigatioe being required or dif trerf Special Conditions. (3) ihat tjte applicant bas tltc
right to regucsr an individual permit rather, thanacacptutg (fie and,conditiomsoP(beN',VP orpthcr'gimesal*MIT`
arrthgrization; (4) that fife appliCAnE can aeoept a permit authorization „Wi'thereby agnC to eomply'with all the tctins and
,conditions of that permit, including whatever Mitigation tcquirCmcnts die Corps has determined to.he necessary; (5 }that
6adcrtakline, any activity in reliance upon thn ,UbjcU1 permit authorization without requesting an approved JD constitutes the
applicant's aeooptance of-the use of the prrliminury JD, but that either form nfJD will be proecssnd as soon as is practicahIa;
(6} accepting a peririit authorirtian (e g , sting,a, proffered individual permit) or undertaking any activity in rr lianrz nn any
form of Corps pentttt,suthorization based on a prel iminary']ll eonstituia:s a gr"inent that all v.ctlanils and other waici bodies vet
thb site uffected,m ail' Nvay by that:tciivity are judsdicrional waters of.the United States; and precludes any challcngc;tn such'
jurisdiction in any administrxiive,or judicial compliance or enforcement action. or in art} administraiivc Appeal or in any Feticral
court; and (7) whither' die applicant clefs w use either apt appmvod JD or, a preluninuy JD, ,that JD will be processed "mxm as
is priicavable. Further, an approved JD, a proffe`r'ed individuA permit (rurd;atl trims and conditions ooataincd llierein }, or
'individuat permil denial can be adri3tnistratiYely appcjled pursuant to 33 C.F.R: Part 331, and that in amyadministrativc appeal;,
4,
raised (see 3' ,tF,R, 331.5(a)(2) }. If,,duringthat administrative appcitl, itbeoomes necessary,to,make,
an pt7iciai deteemifiation whctheT C W.A jurisdiction exists;dver a site, orto provide m of Leial diilincation of Jurisdictioriaf wahxs
on the site, the Corps will provide an gppT6vcd7D,t6"a6nomp1ish Ehat `result, as soon 35 is praCritiablc.

This preliminary JD,fineis shut there-'jnQy bv" waxers of thc'United States on the subject project site, and Edentlfies all aquatic
features on the site the[ could be affcctcd by =thc pruposed activity-, bascd-on the fo11oWi7ig information:
SUPPORTIItiG DATA- Data reviewed for'preliminaD -JD (e heck all thatapply - checked Ltemsshould be inciudcd in Case
Flc and :vltere checked and iequ�sttod, apprupriutely,ieferenca sources below)
® Maps, plans, plots or plat submitted by or an behalf oF4iG applicanticonsuEt>3nt: Slicct I.oF I,duled l7ecember•7; 2012.
❑ Data slir�ots pieparedlsnbinitied liy or on bebalfofthe appllcant!lconstiltani.
❑ Office oonctJrs with data shot ldelineat on report,
0 bfftcc�'docs not concur.,•ith,data shw&delincatlon report
Q T7ata sheets prepared by "t1ie.Cozps;
❑ Carps navigatil�'v<aters' study_
❑ IJ.S. Geological.Suryey Hydrologic 4Uat:
0 USGS NHD data.
❑,Ust'rS 8 and 12 digit HUC mops.
❑ U.S.'Gcojog'wai. Survey rtiap(s)_ Cite scale & quad name:
'USDA Natural•Resoumcs,Conscrvatipn Service SMI Survey. Citation;
❑ National wetlands inventory inap(6'- Qte'riame_'
[� StaWLocai 7dna d inventory maps }:
El FEtNkFilim maps,
❑ ;100 -year Floodplain Elcvatiun is: tNaAonal Geodetic Vprlical Datum of 1929)
0 .PhatograpEs: ] Acrial•(Nume & Date)_
or [] othor;(Name Uati)`.
❑ Previtrus dnlarmintttion(s }_: File no. and date of respunse letw-
® .Other information (please specify); NCDWQ Stream Assessment and Curps StreIwn Assessment Forces_
IM ORTANT NQT'R• The informntion recorded on this fnrm has dot necessarily been verified by the'Car and shavld
not: be,relied unan for later iurisdictloiRl da }erminstioM
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Sitnatum ana'dute'a r Siguatutt anti date Of
Regulatarv'16ject Manager trcmn.reguesiing preliminary >D
(RF.QUIRFD) (RCQUIRF.D.. nless obtaining the signuifzm is
impracticable.)
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