20160257 Ver 1_401 Application_20160316

Montalvo, Sheri A
From: David Vines <[e-mail]>
Sent: Tuesday, March 15, 2016 11:34 AM
To: Montalvo, Sheri A
Cc: [e-mail]
Subject: Re: 625 Mason Rd
Attachments: Agent Authorization.pdf; Signature Page.pdf
Hi Sheri,
Sorry about that. I've attached both here. Let me know if you need anything else.
Thanks,
David Vines
On Mon, Mar 14, 2016 at 2:49 PM, Montalvo, Sheri A <[e-mail]> wrote:
David
We have received the application and fee for the above project. However the signature page with your name on
it was not signed. We will need you to email a copy of that page to [e-mail] with your
signature on it and some sort of authorization from the owner for you to apply on their behalf. I have attached
an agent auth form you can use for this. Once we are in receipt of these two items I can take the project off
hold and forward it through the review process.
Thanks
sherL MDIAtaLvo
401 & Buffer Permitting Unit - Administrative Assistant
Department of Water Resources
Division of Environmental Quality
919-807-6303 (office)
sheri.montalvonn,ncdenr.gov

512 N. Salisbury St., Ste 942-G1, Raleigh, NC 27604
1617 Mail Serive Center
Raleigh, NC 27699-1617
,.Nothing Compares
i
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
K. David Vines
President,
Grayson Dare Homes, Inc.
www.graysondare.com
0)919-489-5880 F)919-419-9252

Montalvo, Sheri A
From: Montalvo, Sheri A
Sent: Monday, March 14, 2016 2:50 PM
To: [e-mail]
Cc: [e-mail]
Subject: 625 Mason Rd
Attachments: Agent Authorization Form.pdf
Importance: High
Follow Up Flag: Follow up
Flag Status: Flagged
David
We have received the application and fee for the above project. However the signature page with your name on it was
not signed. We will need you to email a copy of that page to [e-mail] with your signature on it and
some sort of authorization from the owner for you to apply on their behalf. I have attached an agent auth form you can
use for this. Once we are in receipt of these two items I can take the project off hold and forward it through the review
process.
Thanks
cher% MovutnWo
401 & Buffer Permitting Unit - Administrative Assistant
Department of Water Resources
Division of Environmental Quality
919-807-6303 (office)
sheri.montalvoPncdenr.gov
512 N. Salisbury St., Ste 942-G1, Raleigh, NC 27604
1617 Mail Serive Center
Raleigh, NC 27699-1617
--'"' Nothing Compares,-,,
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties

ot WArF9pc
O
PAS
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification CN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from theLq
®Section 404 Permit El Section 10 Permit
v
Corps:
1b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
MM I 4 2nig
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes
o
Id. Type(s) of approval sought from the DWQ (check all that apply):
-mulp BUFFER PERM RT'
® 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
For the record only for DWQ 401
For the record only for Corps Permit:
because written approval is not required?
Certification:
® Yes ❑ No
® Yes
❑ No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
❑ Yes
® No
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
❑ Yes
® No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
625 Mason Road
2b. County:
Durham
2c. Nearest municipality / town:
Durham—=
-
b
2d. Subdivision name:
;,n
2e. NCDOT only, T.I.P. or state
;
project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
Gregory and Theresa Quintano
nr
_3
3b. Deed Book and Page No.
p• �'
�a
3c. Responsible Party (for LLC if
applicable):
' o
3d. Street address:
4103 Riceland Drive
$
3e. City, state, zip:
Durham, NC 27705
3f. Telephone no.:
919-451-9344
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: Builder
4b. Name:
David Vines
4c. Business name
(if applicable):
Grayson Dare Homes, Inc.
4d. Street address:
3708 Lyckan Drive, Suite 206
4e. City, state, zip:
Durham, NC 27707
4f. Telephone no.:
919-489-5880
4g. Fax no.:
919-419-9252
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
Kate Sevick
5b. Business name
(if applicable):
Three Oaks Engineering
5c. Street address:
1000 Corporate Drive, Suite 101
5d. City, state, zip:
Hillsborough, NC 27278
5e. Telephone no.:
919-732-1300
5f. Fax no.:
919-732-1303
5g. Email address:
[e-mail]
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
0826-03-42-5565
1 b. Site coordinates (in decimal degrees):
Latitude: 36.12045 Longitude: - 78.91693
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
6.92 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
UT to Little River
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS -II; HQW, NSW, CA
2c. River basin:
Neuse
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:
The site is currently forested, and there are residences, forested areas, and pastures in the surrounding area.
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
496
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to provide access to the parcel from Mason Road, which will require a crossing of
the UT to Little River, in order to construct a residential building.
3e. Describe the overall project in detail, including the type of equipment to be used:
Erosion and sedimentation control measures will be installed. Water will be diverted around the crossing construction. A
culvert pipe will be placed in the stream. The channel will be excavated and realigned for low flow shaping. Water will be
pumped around the work area during construction by installed impervious dikes upstream of the proposed crossing.
Equipment to be used includes a track hoe, dump truck, paving equipment, pumps, and various hand tools.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes No Unknown
project (including all prior phases) in the past?
Comments: N/A
4b. If the Corps made the jurisdictional determination, what type
El Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: N/A
Name (if known): N/A
Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
N/A
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

16. Future Project Plans_
6a. Is,this a phased project?",- Dyes ®No
6b. If yes; ezplaih:
' N/A
�- Page 4 of ill"'
PCN Form— Version 1.3 December, 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 ❑ P [-IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments: N/A
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.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -(PER)
) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 SPOT
Culvert, temporary
pipe, and
LIT to Little River
PER
❑ INT
®Corps
® DWQ
2-6
P: 15'
T:
impervious dike
10'
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 [:]PDT
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
25'
3i. Comments: Of the 25 LF of stream impacts, only 15 LF are associated with permanent impacts to the stream for the
purpose of stream alignment with respect to the culvert installation. The 10 LF of temporary impacts are associated with the
impervious dike that will be used upstream of the proposed crossing. The dewatering of the stream will run concurrently with
the construction activities (i.e. the temporary impacts associated with dewatering are within the permanent impacts footprint).
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody type
4e.
Area of impact (acres)
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4L Total open water impacts
4g. Comments: N/A
5. Pond or Lake Construction
If pond or lake construction proposed, then 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
Flooded
P1
P2
5f. Total
5g. Comments: N/A
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:
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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.
❑ Neuse ❑ Tar -Pamlico ❑ Other:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary
impact
required?
B1 ®P ❑ T
Road
fill and
UT to Little River
❑ Yes
® No
633
421
clearing
B2 ❑P❑T
El Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
633
421
6i. Comments: The impacts associated with the driveway crossing and culvert installation fall under the "exempt" category per
the Neuse River Buffer Rules Table of Uses {15A NCAC 02B .0233 (6)}
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The proposed project is to install a driveway and associated culvert crossing a UT to Little River. As the stream runs the
length of the property, the only way to access the buildable area is to cross the stream. Impacts are expected to be minimal,
as the crossing will be done perpendicular to the stream. Impacts to the associated protected riparian buffers have also been
reduced by promoting sheet flow as well as providing grass shoulders to promote infiltration.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work area to prevent
sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement of BMPs for the protection
of surface waters, restrictions against the staging of equipment in or adjacent to waters of the US and coordination with
appropriate agency personnel.
2. Compensatory Mitigation 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
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
❑Payment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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:
❑ warm ❑ cool ❑cold
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.
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).
N/A
6h. Comments: N/A
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: The proposed project is a 15 foot pipe crossing of a UT to Little River.
❑ Yes ® No
There is will be an insignificant increase of increase in impervious surface as a
result, since the driveway will not be ditched and will follow the natural contours of
the area. Therefore, treatment is not required.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
3.6%
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The proposed project is a driveway
crossing of a stream, and any increase in stormwater runoff will be negligible.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ Phase II
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
❑ 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
4a. Which of the following state -implemented stormwater management programs apply
❑ HQW
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
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 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ 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)?
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. 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 ® 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 ® 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.
The driveway crossing of UT to Little River is being constructed in order to access a new single-family residence. There
will be no other development as a result of this project.
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 10 of 11
PCN Form —Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
El Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC NHP
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?
This project takes place in Durham County, which is not near any coastal or tidal habitat that would support EFH (i.e. salt
marshes, oyster reefs, etc.).
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
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC SHPO HPOWEB GIS Service
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
FID es ❑ No
8b. If yes, explain how project meets FEMA requirements: MOA
8c. What source(s) did you use to make the floodplain determination? NC Floodmaps
David Vines
3/4/16
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ Yes No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ yes ®No
impacts
[I Raleigh
5c If yes, indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC NHP
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?
This project takes place in Durham County, which is not near any coastal or tidal habitat that would support EFH (i e. salt
marshes, oyster reefs, etc.).
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
El Yes No
status (e g , National, Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC SHPO HPOWEB GIS Service
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: MOA
8c What source(s) did you use to make the floodplain determination? NC Floodmaps
David Vines
z_
3/4116
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is nrnviripri
Page 1 l of 11
PCN Form — Version 1 3 December 10, 2008 Version

U_ \rvl,V
V
Li
J�J
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
IN
LOT NO. Z PLAN NO. 1`6- PARCEL ID: 09 Z(- 03- y Z ' 5S65'
STREET ADDRESS: 64?5-- r r �7'j FC4' /y L
Please print:
Property Owner:
Property Owner: r' r >`en g7-=�
The undersigned, registered property owners of the above noted property, do hereby authorize
of
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
-q/03 ,l �� L-,��6 '- 1� �, NC 2 70 5
Telephone: 919'
We hereby certify the above information submitted in this application Is true and accurate to the
best of our knowledge.
Authorized Si na re \
Date:
Authorized Signature
Date: 311YI/.

March 3, 2016
To: Eric Alsmeyer
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
[e-mail]
From: Kate Montieth Sevick, Environmental Specialist
Three Oaks Engineering, Inc.
1000 Corporate Drive, Suite 101
Hillsborough, NC 27278
RE: Jurisdictional Determination Package for 625 Mason Road, Durham, NC
Mr. Alsmeyer
'aletgt► Pegic at Gtfitct;
t NC �E
David Vines, President of Grayson Dare Homes, is proposing a crossing of an Unnamed Tributary (UT) to Little River to
provide access to the southern portion of the parcel (Figure 1).
The project is located on an approximately 6.9 acres parcel at 625 Mason Road, Durham, North Carolina (PIN: 0826-03-42-
5565) (Figure 1). A UT to Little River flows perpendicular across the property for approximately 250 feet. The parcel is
located within the Neuse River Basin; therefore, any intermittent or perennial streams mapped on either the USGS
topographic map (Northwest Durham Quadrangle, 1987) or the USDA-NRCS Durham County Soil Survey will require
buffers, unless a site evaluation results in a non -jurisdictional stream determination. The UT to Little River is shown on
both of the above maps.
On February 17, 2016, Three Oaks Engineering staff members conducted a site investigation (Figure 1). Two jurisdictional
streams were identified (Tables 1-2) (Figures 1 and 2). NC Department of Water Resources (NCDWR) Stream Identification
Forms, are included for each stream feature. No jurisdictional wetlands were identified.
Table 1. Water resources in the studv area.
Throe Oaks Enghwerinq , threeoaksengmeerinq tom
Best Usage
Stream Name
Map ID
NCDWQ Index Number
Classification
UT to Little River
SA
27-2-21-(3.5)
WS -II HQW
NSW CA
UT to SA
SB
27-2-21-(3.5)
W5 -II HQW
NSW CA
Throe Oaks Enghwerinq , threeoaksengmeerinq tom

Table 2. Jurisdictional characteristics of water resources in the studv area.
Map ID Length (ft.) Classification Compensatory Mitigation River Basin
Required Buffer
SA 260 Perennial Yes Subject
SB 236 Intermittent Yes Not Subject
Total 496
Please let us know if you have any questions or require additional information. We appreciate your assistance on each of
these projects.
cc: Ms. Cherri Smith, NCDWR
-------------------------------------- -------------------------------- ---
Three Oaks Engtneerinq # threeoaksengmeerinq.com -- --- v --' _ -- -- —�

ATTACHMENT
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Kate Montieth Sevick
Three Oaks Engineering
1000 Corporate Drive, Suite 101
Hillsborough, NC 27278
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: Project
located at 625 Mason Road, Durham NC
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES
AT DIFFERENT SITES)
State: NC County/parish/borough: Durham City: Durham
Center coordinates of site (lat/long in degree decimal format): Lat.
36.120454° N, Long. -78.9170540 W.
Universal Transverse Mercator:
Name of nearest waterbody: Little River
Identify (estimate) amount of waters in the review area:
Non -wetland waters: 469 linear feet: width (ft) and/or acres.
Cowardin Class: Riverine
Stream Flow: Perennial and Intermittent
Wetlands: acres.
Cowardin Class:
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal:
Non -Tidal: None
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
❑ Office (Desk) Determination. Date:
0 Field Determination. Date(s):

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre -construction notification" (PCN), or requests verification for a non -reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.
This preliminary JD finds that there "may be" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
2

SUPPORTING DATA. Data reviewed for preliminary JD (check all that apply
- checked items should be included in case file and, where checked and
requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant:
❑ Data sheets prepared/submitted by or on behalf of the
applicant/consultant.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: Northwest
Durham Quadrangle, 1987.
® USDA Natural Resources Conservation Service Soil Survey. Citation:
Durham County Soil Survey
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100 -year Floodplain Elevation is:
of 1929)
®Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
(National Geodectic Vertical Datum
❑ Previous determ !nation (s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified by the CorDs and should not be relied upon for
later iurisdictional determinations.
Signature and date of
Regulatory Project Manager
(REQUIRED)
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)

Estimated amount
Class of
Site
Cowardin
of aquatic resource
aquatic
number
Latitude
Longitude
Class
in review area
resource
Non -section
SA
36.120393
-78.91686
Riverine
260 linear feet
10 — non -
tidal
Non -section
SB
36.120687
-78.916733
Riverine
236 linear feet
10 — non -
tidal

Prepared For.
0
ycz Graysoonkl
CUSTOM HOMES
625 Mason Rd, Durham
(PIN 0826-03-42-5565)
Aerial Photography
Durham County, North Carolina
Date March 2016
Scale 0 40 80 Feet
,.,
Job No 16_202
Drawn By.
Checked By
KMS
Figure

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— SB - Intermittent Stream �.
Parcel Boundary
6\hEf fte Prepared For.
A ' , A
4% Gray�son[.Lir
rayb33N1^' CUSTOM HOMES
625 Mason Rd, Durham
(PIN 0826-03-42-5565)
Topographic Map
Durham County, North Carolina
Date. March 2016
Scale 0 40 80 Feet
Job No 16_202
Drawn By.
Checked By.
KMS
Figure

Prepared For.
GMMDar,�A
CUSTOM HOMES
625 Mason Rd, Durham
(PIN 0826-03-42-5565)
USDA-NRCS Soils
Durham County, North Carolina
Date March 2016
Scale 0 40 80 Feet
1 � 1
Job No.. 16-202
Drawn By: KMS
Checked By.
Figure

�5�� AEIR/yC& Prepared For
W
s Graysonr,
9*1&NO CUSTOM HOMES
625 Mason Rd, Durham
(PIN 0826-03-42-5565)
National Wetland Inventory Map
Durham County, North Carolina
Date March 2016
Scale 0 150 300 Feet
t r
Job No 16-202
Drawn By.
KMS
Checked By
Figure

�5����NEN�yCy
(PIN 0826-03-42-5565)
Grayson l) ,ii
Durham County, North Carolina
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PIN 0826-03-5 I - 1943
SA -Perennial Stream DB 7577 PG 208
2 9,82'
SB -Intermittent Stream H 86--
'52b4- W
Parcel Boundary
2r4-03-41-274 I
Prepared For
date:
625 Mason Rd, Durham March 2016 Figure
Scale 0 50 100 Feet
t
Job No.. 16-202
CUSTOM HOMES Site Plan
raw
Dn By:
KMS
Checked By.

Sk- UT 40 "t+l-f
NC DWO Stream Identification Form Version 4.11 2tjf,
Date:�u/Z
Projecusite: (rnQ aei !r+!/
Latitude: 3 to 1 Z�3 T;
Evaluator: �h Se A L Ic
County: Qx I her
Longfdider
Total Points:
Stearn at least rntemtlt
Stream Determination (dr�de
Other AIW O -e/ 1i N1
Ira 19 oar rennlalC2 90•* 1
r
Ephemeral Intermittent Rtal
e.g. Quad Name:
A. tseomo I (Subtotal=
Absent
weak
Moderate
strwig
1' Continuity of channel bed and bank
0
1
2
1.5
2. Sinuosfty of channel along thatywo
0
1
2
0.5
3. In -channel stricture: ex riffle -pool, step-pooi,
ri ool sequence
0
1
2
1.5
4. Particle size of stream substrate
0
1
2
26 Wetland plants in streambed
5 Act wkelict flood in
0
1
029
3
6. Depositional bars or benches
0
1
2
7. Recent alluvial deposits
0
1
b ,
bBedrock
8 Headcuts
0
2
3
9 Grade control
1 0
0.5
1.5
10. Natural valley
0
0:5
1.5
11. Second n nater order channel
No = 0
Yes
artificial annus are not rated, see dns in manual
B. Hvdroloov (subtotal= or t
12. Presence of Basedow
0
1
2
13 Iron oxidizing bacteria
U
1
2 3
14 Leaf litter
1.5
1
05 0
15. Sediment on plants or debris
0
0.5
1.5
16. Organic debris lines or piles
0
0.5
1.5
17. Soil- -based evidence of high water table?
25. Algae 0
No = 0
Yes
C. Biology (Subtotal= )
18 Fibrous roofs in streambed '
2 1
0
19. Rooted upland plants in streamed 3
2 1
0
20. Macrobenthos (note diversity and abundance)
1 2
3
21. Aquatic Mollusks
1 2
3
22 Fish
0.5 1
1.5
23. Crayfish 0
1 I
1.5
24, Arnphlbians
1,5
25. Algae 0
.5 1 1
1.5
26 Wetland plants in streambed
FACW = 0.75: OBL =1.5 Other = 0
'perennial streams may also be identified using other methods. See p. 35 or manual.
Notes:
Sketch: Mus.
- -^-'
_Channel
�p�
tF`_�
+ ¢
Bank Height (h): �
Bankfuil width (ft): 2. -
Water depth (in): (p- l 'f
substrateeja�iTt , r-iv1l,
Velocity -fast, era , slow
Clarity -clear, slightlyturbid,;bid
b ,
bBedrock

NC DWQ Stream Identirw2tinn Rare. Varainn s 111 S
Dace: Z 11-4 I
as
ProjectiSite: AAate Ai/'
Latidrde: 3b • 12 Oji,
Evaluator: �� . M 4A (evi CJL
County L)Aj h,'+
LOngItude- -11• • 1 ��
Total Fomes:
Sbsam is at !Best Ittterndttenft �% II��
Stream Determ r+de one )
Other N i..� �
d219or rdaflf230• /� v'.
Ephemeral Perennial
e.p.QuadNemo:
A f%��om i
Subtotal =
_. _..6
Absent
Weak
Modelrate
Strong
1' Continuity of channel bed and bank
0
1
14. Leaf War
1.5
2 Sinuosity of channel along thalweg
0
1
0
3
3. In -channel structure: ex. riffle -pool, step pool,
16.Organic debris lines or
0 A5
0.5 1
3
ril Ise uence
0
n
'V
2 u
3
4 Particle size of stream substrate
0
1
25. Algae
0
5. Acttvehefid floodplain
1.5
1
2
3
6 Depositional bars or benches
'perennial dreams may also be identiW using other methods. See p. 35 of manual.
1
2
3
7. Recent alluvial deposits
-
1
2
3
8 Headcuts
1
2
2
3
9. Grade control
0.6
1
3
1.5
10. Natural va0e
0
ry
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
. �..�..�.. ... vwwaaiuua m manual
B. H drol Subtotal = 77t S
12. Presence of Baseflow
0 1'
2
3
13. Iron oxidizin bacteria
0
2
3
14. Leaf War
1.5
0.5
0
15. Sediment on plants or debris
0
1
1.5
16.Organic debris lines or
0 A5
0.5 1
'1.5
17. Soll-based evidence of high water table?
No.= 0
Yes =
C. 00Subtotal =
18. Fibrous roots in streambed
3
2
0
19. Rooted upland plants in streambed
3
1
0
20. Macrobenthos (note diversity and abundance) "
0
1
3
21. Aquatic Mollusks
1 2
3-
22. Fish
0.5 1
1.5
23 Crayfish1.6
24. Amphibians
0.5 1
1.5
25. Algae
0
0.5
1.5
26. Wetland plants in streambed
FACW = 0.75: OBL =1.5 Other = 0
'perennial dreams may also be identiW using other methods. See p. 35 of manual.
Notes:
-
Sketch:
Bank Height (ft): D •) - 1.
Bankfull width (ft): Z
Water depth (in): i6 - I? -
Channel substrate @k, so q a 1, Cobble, Bedrock
Velocity -fast, moderate, 1i
Clarity -clear, slightly turbi to i
53

NC DWO Stream Identificsiltinn Farm Vnrainn A t t
SC
Date: 2--1 - 1 b
Pn*ect/Sff:e: ^ IV
latitude: 3 �. (Zo gr
Evaluatorl. LeTl Sev+ilk
county;
-A AN°
Longitude: -411, 1/ ?V51
Total Points:
Sbaam 1s at least lnteir►dlter►t r
Stream Determination (drde one)
Perennl81
00w /V t-✓
Y219or r8tnrafBx30• •
r nent
e.g. Quad Name:
A. veomo hot Subtotal A
1' Continuity of channel bed and bank
Absent
0
Weak
1
Moderate
Strong
3
2. Sinuosity of channel along thalweg
0
1
14. Leaf litter
3
3. in -channel stricture: ex. riffle -pool, step -pool,
ripple -pool sequence
®
1
2
3
4 Particle size of stream substrate
0
1
2
3
S. Active/refict flood Iain
No = 0
1
2
3
6. Depositional bars or benches
1
2
3
7. Recent alluvial deposits
Eli
1
2
3
8. Headcuts
00
Bank Height (ft):
eankfull width (ft):
Water depth (in):
Channel substrate - Clay, Silt, Sand, Gravel, Cobble, Bedrock
Velocity -fast, moderate, slow
Clarity -clear, slightly turbid, turbid
2
3
9. Grade control
QD
0.5
1
1.5
10. Natural valley
0.5
1
15
11 Second or greater order channel
___No ­t_
Yes = 3
arunmi uncles are not rated; tee cisaimsions in marRal
B. Hvdroloav (Subtotal= 3 • Sr )
12. Presence of Saseffow
1
2
3
13. Iron mddtdng bacteria
1
2
3
14. Leaf litter
1.5 1
0.5
3
15. Sediment on plarft or debet
0.5
1
1.5
16. Organic debris lines or piles
0
1
1.5
17 Soil -based evidence of high water table?
No = 0
Yes
1.5
U. M010QV (Subtotal = 5 )
18. Fibrous roots in strearribed 3
2 1
0
19. Rooted upland plants in streambed 3
1
0
20 Macrobenthos note diversity and abundance)
1 2
3
21. Aquatic Mollusks
1 2
3
22 Fish
0.5 1
1.5
23 Crayfish
0.5 1
1.5
24. Amphibians Op
0.5 1
1.5
25. Algae
05 1
1.5
28. Wetland plants in streambed
FACW = 0.75; OBL =1.5 Other = 0
'perennial streems may also be Identified usng other methods. See p. 35 of manual
Notes:
Sketch:
Bank Height (ft):
eankfull width (ft):
Water depth (in):
Channel substrate - Clay, Silt, Sand, Gravel, Cobble, Bedrock
Velocity -fast, moderate, slow
Clarity -clear, slightly turbid, turbid