20140610 Ver 3_401 Application_20180218

E -PCN Submittal
DWR
Division of water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ansmred.
Also, if at any point you wish to print a copy of the E -PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https:lledoes.deq. nc.govfWaterResources101edoci624704iPCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County (or Counties) where the project is located:
Wake
Is this project a public transportation project?
r Yes r No
1a. Type(s) of approval sought from the Corps:*
Pr Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
17 Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 29 - Residential Developments
NWP Number Other:
List all NN nunbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
W 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit W Riparian Buffer Authorization
....................................
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
O Yes G No
For the record only for Corps Permit: O Yes r No

le. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter fromnitigation bank or in -lieu fee program
r Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
r Yes r No
1h. Is the project located in a designated trout watershed?*
r Yes r No
Link to trout information: http://wwvv.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx

B. Applicant Information
B. Applicant Information
1a. Who is the Primary Contact?*
Andrew Sandman
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
[phone]
1d. Who is applying for the permit?
W Owner r- Applicant (other than owner) W Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
MBA Land Group, LLC
2b. Deed book and page no.:
016415 01569
2c. Responsible party:
(for Corporations)
Andrew Sandman
2d. Address
Street Address
7101 Creedmoor Road
Address Line 2
Suite 122
City State / Province / Fbgion
Raleigh North carolina
Postal / Zip Code Country
27613
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Jeff Harbour
4b. Business Name:
(if applicable)
Environmental Services, Inc
4c. Address

Street Address
4901 Trademark Drive
Address Line 2
aty
Raleigh
Rbstal / Zip Code
27610
4d. Telephone Number:
[phone]
(XXX)XXX-XXXX
4e. Fax Number:
4f. Email Address:*
[e-mail]
State / Province / Legion
NC
Country
Agent Authorization Letter*
Rease provide the Agent Author¢ation Letter if you are subnitting this docunent.
signed agent letter.pdf 98.64KB
RLETYFE MHr BE RDF

C. Project Information and Prior Project History
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Stonewater-Phase 5
1b. Subdivision name:
(if appropriate)
Stonewater
1c. Nearest municipality / town:
*
Wake Forest
1d. Driving directions*
If it is a new project and can not easily be found in a GPS napping system Rease provide directions.
11109 Ivy Creek Trail is street address for Phase 5 parcel. The main entrance to Stonewater is at 1521 YARDLEY DR off Forestville Road
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
1749848176
2b. Property size:
(in acres)
37
2c. Project Address
Street Address
11109 Ivy Creek Trail
Address Line 2
City State/ Province/ Region
Wake Forest North carolina
Postal/Zip Code Country
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as
appropriate, based on how the location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
35.9320 -78.4970
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Sanford Creek
3b. Water Resources Classification of nearest receiving water:*
C; NSW
Surface Water Lookup

3c. What river basin(s) is your project located in?*
Neuse
River Basin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
Undeveloped land containing planted pine and native pine/hardwood forest. Residential and undeveloped land
occur in the vicinity of the project
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Cick the upload button or drag and drop files hereto attach docurrent
topo.pdf 3.03MB
File type rrust be pdf
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Click the upload button or drag and drop files here to attach docurrent
DOC117.pdf 460.47KB
File type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
4.5
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
1500
4f. Explain the purpose of the proposed project:*
Project purpose is to provide additional single-family units for the Stonewater subdivision by developing Phase 5.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:
The project will entail one stream crossing that will allow access to usable land. Typical construction equipment will
be used for the project.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
DOC118.pdf 527.71 KB
DOC117.pdf 1.26MB
File type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
F Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
G Preliminary r Approved r Unknown r N/A
Corps AID Number:
Exarrple: SAW2017-99999
SAW -2015-02545

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Jeff Harbour
Agency/Consultant Company: Environmental Services, Inc
Other:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
December 4, 2015 for USACE. January 21, 2015 for DWR which covered Phase 4, upstream of Phase 5
5d1. Jurisdictional determination upload
Cick the upload button or drag and drop files hereto attach docurrent
DWR Buffer Ietter.PDF 2.77MB
DOC119.pdf 495.99KB
File type rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
F Yes r No r Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW -0000-00000).
SAW -2013-01351 and DWR 14-0610 v2
Project History Upload
dick the upload button or drag and drop files here to attach docurrent
404 permit.pdf 336.97KB
DWR 401 WQC.pdf 1.57MB
File type must be FDF
7. Future Project Plans
7a. Is this a phased project?*
r Yes r No
7b. If yes, explain.
Phase 1-4 only incurred minor impacts as authorized by SAW -2013-01351 and DWR 14-0610 v2
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre -construction notification.

D. Proposed Impacts Inventory
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
PF Wetlands rJ Streams -tributaries V Buffers
F- Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted
2a. Site # - Reason for impact*
2b. Impact type * 2c. Type of wetland *
2d. Wetland name *2e. 2f. Type of
2g. Impact
Type* Jurisdiction*
width* length*
Forested* Jurisdicition*
area*
Road Crossing Impact Map 1
P Bottomland Hardwood
W1 Yes Both
0.027
Ivt3p label (e.g. Pmad Crossing 1 - Culvert,
Permanent (P) or Forest
(404, 10) or D \R(401,
(acres)
dewatering, etc)
Temporary (T)
other)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.027
2g. Total Wetland Impact
0.027
2h. Comments:
Previous wetland impacts associated with this project are: 0.18 acre temporary wetland impacts and 0.02 acre of
permanent wetland impact. With this new application total permanent wetland impact would be 0.047 acre.
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. Site # - Reason for 3b.lmpact 3c. Type of impact* 3d. Stream name *
3e. Stream 3f. Type of
3g. Stream 3h. Impact
impact* type*
Type* Jurisdiction*
width* length*
Road Crossing P Culvert UT to Sanford Creek
Perennial Both
4 108
Impact Map 1 Permanent (P) or
Perennial (PER) or
Average (feet) (linear feet)
Nep label (e.g. Ibad Crossing 1) Temporary M
intermittent (IID
*' All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
108
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
108
3j. Comments:

Previous stream impacts associated with this project include 43 feet of temporary stream impact for a sewer line
installation.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below
6a. Project is in which protect basin(s)?*
Check all that apply.
Pr Neuse r Tar -Pamlico
F Catawba r Randleman
r Goose Creek r Jordan Lake
F Other
6b. Impact Type *
Road Crossing Impact Map 1,
Allowable
Location and Exerrpt, Allowable, allowable w/
mtigation
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6i. Comments:
6c. Per or 6d. Stream name * 6e. Buffer mitigation 6f. Zone 1 6g. Zone 2
Temp* required?* impact* impact*
P UT to Sanford Creek No 8,760 5,905
R:rrrenent (F) or (square feet) (square feet)
Temporary (T)
Zone 1
0.00
Zone 1
8,760.00
Zone 1
8,760.00
Zone 2
0.00
Zone 2
5,905.00
Zone 2
5,905.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files here to attach document
DOC118.pdf 527.71 KB
DOC117.pdf 1.26MB
File must be FDF

E. Impact Justification and Mitigation
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Road crossing uses narrow point of the wetland to minimize impact. Larger areas of wetlands on-site will remain
undisturbed.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Head walls are being used to minimize both stream and wetland impacts. Stringent ESC measures will be employed
during all phases of construction and the devices will be monitored regularly.
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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Permanent wetland impacts less than .1 acre and permanent stream impacts less than 150 feet
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
r Yes r No
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
r Level Spreader
r— Vegetated Conveyance (lower SHWT)
r— Wetland Swale (higher SHWT)
W Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diff us Flow Documentation
dick the upload button or drag and drop files here to attach docurrent
Phase 5 PCN1 -4-2009. pdf
File type rrust be FDF
2. Stormwater Management Plan
57.69 KB
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes G No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*

r Yes
r No
To lookup low density requirement click here 15A NCAC 02H .1003(2)
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -
approved local government stormwater program?*
r Yes
f No
Fant: projects that have vested rights, exemptions, or grandfathering from state or locally irrplerrented storrrwater program or projects that satisfy state or locally -implemented storrrwater program
through use of conTrunity irrlieu program should answer no to this question.
2d. Which of the following stormwater management program(s) apply (check all that apply):*
Pr Local Government
F State
Local Government Stormwater Programs*
Phase II
r NSW
F' USMP
F- Water Supply
Please identifywhich local government stormwater program you are using.*
Town of Rolesville

G. Supplementary Information
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
All required preventative measures will be taken as required to prevent degradation to downstream water quality
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
r Yes r Nor N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
The project will be covered by municipal sanitary sewer service
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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
r Yes r No
5g. Does this project involve bridge maintenance or removal?*
r Yes r No

Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?*
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NCNHP records and onsite habitat assessment conducted by qualified ESI biologists
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
EFH Mapper linked to on Corps website
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NCSHPO GIS
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach docurrent
File rust be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
F Yes r No
8b. If yes, explain how project meets FEMA requirements:
The northeast corner of the site lies within the 100 -year flood zone. However, no development will occur in this
area.
8c. What source(s) did you use to make the floodplain determination?*
NC Floodmaps
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
File rust be FDF

Signature Page
Signature
m By checking the box and signing below, I certify that:
■ I have given true, accurate, and complete information on this form;
■ I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
■ I intend to electronically sign and submit the PCN form.
Full Name:*
Jeffery W Harbour
Signature

Initial Review
Is this project a public transportation project?*(?)
r Yes r No
Change only iF needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
BIMS # Assigned *
20140610
Version#*
3
Reviewing Office*
Raleigh Regional Office - [phone]
Select Project Reviewer*
Stephanie Goss:eads\szgoss
Is a payment required for this project?*
r No payment required
f Fee received
G Fee needed - send electronic notification
What amout is owed?
* $240.00
r $570.00

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ENVIRONMENTALSERVICES, INC.
Path: P:\GeoGra\Projects\2014\183\01\GIS\topo.mxd Date: 8/10/2015 1:20:24 PM
4901 Trademark DriveRaleigh, North Carolina 27610(919) 212-1760(919 212-1707 Fax
0 20001000
Feet
Project Study Area
www.environmentalservicesinc.com Figure:
Project:
Date:
Drwn/Chkd:
1
Disclaimer: The information depicted on this figure is forinformational purposes only and was not prepared for, and isnot suitable for legal or engineering purposes.
Sources: 2011 National GeographicSociety/ESRI, i-cubed seamless USGSquadrangles (Wake Forest and Rolesville, NC);Parcels acquired from Wake County GIS, 2015.
E
Project Location Stonewater-Phase 5
Wake County, North Carolina

Page 8 of 10
PCN Form – Version 1.4 January 2009
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
within one of the NC Riparian Buffer Protection Rules? Yes No
1b. If yes, then is a diffuse flow plan included? If no, explain why.

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?
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply):
Phase II
NSW
USMP
Water Supply Watershed
Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached? Yes No
4. DWQ Stormwater Program Review
4a. Which of the following state-implemented stormwater management programs apply
(check all that apply):
Coastal counties
HQW
ORW
Session Law 2006-246
Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? Yes No
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

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2013-01351 County: Wake U.S.G.S. Quad: NC-WAKE FOREST
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee:
Address:
Telephone Number:
Size (acres)
Nearest Waterway
USGSHUC
MBA Land Group LLC
Attn: Andrew Sandman
7101 Creedmoor Rd.
suite 122
Raleigh, NC, 27613
Sanford Creek
03020201
Nearest Town Wake Forest
River Basin Neuse
Coordinates Latitude: 35.933135955258
Longitude: -78.501451923839
Location description: The project site is approximately 38 acres located adjacent to Forestville Rd., near the town of Wake
Forest, Wake County, North Carolina. Aquatic features on site drain to Sanford Creek in the Neuse River basin.
Description of projects area and activity: This permit verification allows for 0.02 acre of permanent wetland impacts from fill
associated with the construction of a recreational facility for the Stonewater residential subdivision. No mitigation is required
for this proposal. Total impacts for the project are as follows: 0.18 acre of temporary wetland impacts, 0.02 acre of permanent
wetland impacts, and 43 linear feet of temporary stream channel impacts for the installation of a sewer line/associated
infrastructure for the Stonewater subdivision.
Applicable Law: [8J Section 404 (Clean Water Act, 33 USC 1344)
0 Sections 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number or Nationwide Permit Number: NWP 29 Residential Developments.
SEE ATTACHED RGP or NWP GENERAL, REGIONAL AND SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application and attached information dated 01/10/2017. Any violation of the attached
conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration order, a Class
I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are
under construction) or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management in Elizabeth City, NC, at [phone].
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact James Lastinger at [phone] or James.C.Lastinger(a),usace.army.mil.
Corps Regulatory Official· =J~~~-'=~~-:t:it_~~..,L
Expiration Date ofVeri c f on: 03/18/2017
Date: January 31,2017
SAW-2013-01351
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete our Customer Satisfaction Survey, located online at
http://corpsmapu.usace.army.mil/cm apex/f?p=136:4:0.
Copy furnished:
Agent:
Address:
Environmental Services, Inc.
Jeff Harbour
4901 Trademarl{ Drive
Raleigh, NC, 27610
Action ID Number: SAW-2013-01351 County: Wake
Permittee:
Project Name:
MBA Land Group LLC
Attn: Andrew Sandman
Stonewater Subdivision/Powell Tract/Forestville Rd./Wake Forest/Wake County
Date Verification Issued: January 31,2017
Project Manager: James Lastinger
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Raleigh Regulatory Field Office
Attn: James Lastinger, Regulatory Project Manager
3331 Heritage Trade Dr., suite 105
Wake Forest, NC 27587
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee Date
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. Ifyou received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
If you have questions regarding this decision and/or the If you only have questions regarding the appeal process you may
appeal process you may contact: also contact:
District Engineer, Wilmington Regulatory Division, Mr. Jason Steele, Administrative Appeal Review Officer
Raleigh Regulatory Field Office CESAD-PDO
Attn: James Lastinger, Regulatory Project Manager U.S. Army Corps of Engineers, South Atlantic Division
3331 Heritage Trade Dr., suite 105 60 Forsyth Street, Room 10Ml5
Wake Forest, NC 27587 Atlanta, Georgia 30303-8801
919-554-4884 ext 32 Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the o portunity to participate in all site investigations.
Date: Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: James Lastinger, 69 Darlington Avenue, Wilmington, North
Carolina 28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Administrative Appeal
Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]