20230565 Ver 1_3736.4_Meadow Valley_PCN_4.18.23_20230418

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- 2018-02095 Begin Date (Date Received): 4.18.23
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Meadow Valley (Basswood Avenue)
2. Work Type: ✓❑Private ❑Institutional ❑Government ❑Commercial
3. Project Description/Purpose [PCN Form B3d and B3e]:
See PCN.
4. Property Owner/Applicant [PCN Form A3 or A41: See PCN
5. Agent/Consultant [PNC Form A5 —or ORM Consultant ID Number]:
Bradley S. Luckey, Pilot Environmental
6. Related Action ID Number(s) [PCN Form B5b]: Unknown
7. Project Location—Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
36.03950, -80.03150
8. Project Location—Tax Parcel ID [PCN Form B 1 a]: See PCN
9. Project Location—County [PCN Form A2b]: Guilford
10. Project Location—Nearest Municipality or Town [PCN Form A2c]: High Point
11. Project Information—Nearest Waterbody [PCN Form 132a]: West Fork Deep River
12. Watershed/ 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03030003
Authorization: Section 10 ❑ Section 404 ✓❑ Section 10 and 404 ❑
Regulatory Action Type:
❑ Standard Permit ❑Pre-Application Request
0 Nationwide Permit# ❑Unauthorized Activity
Regional General Permit# ❑Compliance
Jurisdictional Determination Request ❑No Permit Required
Revised 20150602

OF W A TF9
moo`' pG Office Use Only:
Corps action ID no.
o < DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s)of approval sought from the
Corps: ® Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit(NWP) number: NWP 29 or General Permit(GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes ® No
1d. Type(s)of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification—Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification—Express ❑ Riparian Buffer Authorization
1 e. 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: Basswood Avenue
2b. County: Guilford
2c. Nearest municipality/town: High Point
2d. Subdivision name: Meadow Valley
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s)on Recorded Deed: Clayton Properties Group, Inc.
3b. Deed Book and Page No. 183/66
3c. Responsible Party(for LLC if Mr. Will Derrickson
applicable):
3d. Street address: 221 Jonestown Road
3e. City, state, zip: Winston-Salem, North Carolina 27104
3f. Telephone no.: 336.231.6764
3g. Fax no.:
3h. Email address: [e-mail]
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PCN Form—Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Bradley S. Luckey
5b. Business name
(if applicable): Pilot Environmental, Inc.
5c. Street address: PO Box 128
5d. City, state, zip: Kernersville, NC 27285
5e. Telephone no.: 336.708.4997
5f. Fax no.:
5g. Email address: [e-mail]
Page 2 of 12
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): Subdivision: 6893558624&6893455692. Sewer ROW:
6893677613&6893655203
1 b. Site coordinates (in decimal degrees): Latitude: 36.03950 Longitude: -80.03150
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 62.7 acres
2. Surface Waters
2a. Name of nearest body of water(stream, river, etc.)to West Fork Deep River
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-IV, CA
2c. River basin: Cape Fear
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 contains wooded land. Residential, commercial and light industrial development are located within the vicinity of
the site.
3b. List the total estimated acreage of all existing wetlands on the property:
Wetlands=-3.14 Ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial)on the property:
Streams=-2,510 LF
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to provide the remainder of the Meadow Valley subdivision road access and
sanitary sewer service.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project consists of a single family residential development in the remainder of the Meadow Valley subdivision.
In order to provide access to the northern portion of the sub-division, it is necessary to construct a road crossing and to
provide and maintain sanitary sewer service to the site, it is necessary to install a sewer line crossing. To facilitate the
construction of the roads, sewer lines and development of the site, clearing and grading the site is necessary. Graders,
haulers, excavators and other heavy equipment will be used during grading and construction of the site.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property/
project(including all prior phases) in the past? ®Yes ® No ❑ Unknown
Comments:45 Acre Portion USACE/NCDWR Field Visit
7.10.18. 17.7 Acre Portion Not USACE Confirmed
4b. If the Corps made the jurisdictional determination, what type
of determination was made? El Preliminary Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Pilot Enviromental, Inc.
Name (if known): Michael Brame/David Brame Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
DWR Letter 7.28.18& USACE JD Letter Pending for 45 Acre Tract
Page 3 of 12
PCN Form—Version 1.3 December 10, 2008 Version

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.
Based on information from the USACE in December 20, 2019 e-mail, a NWP 29/12 Verification was processed on
September 9, 2007 for impacts to waters associated with previous phases of the Meadow Valley Subdivision. However,
based on USACE review of permitting plans, field visit in 2018 and review of recent aerial photography, the USACE has
determined that previously permitted impacts to WoUS have not occurred on the constructed phases of the Meadow
Valley sub-division.
The applicant receied NWP 29 Verification and assoicated 401 WQC dated 2.24.20 to authorize the permanent impact to
175 linear foot of stream channel, of which 145 linear foot was net loss and 30 linear feet was rip-rap dissipater, the
permanent impact to 0.241 acres of wetlands and temporary impact to 51 liner feet of stream channel for the stream
crossing to access the northern portion of the site, a sewer line maintenance access crossing and sewer line crossing.
The applicant satisfied mitigation requirements of the 2.24.20 NWP 29 Verification through the NCDMS compensatory
mitigation program.A copy of the mitigation transer responsibility form is included as an attachment.
Based on a field visit conducted to the site by Pilot personnel on March 20, 2023. The previously authorized sewer line
maintenance access crossing has been installed.Clearing and installation of sediment and erosion control devices have
been installed within wetlands for the stream crossing to access the northern portion of the site. Fill has not been placed
within the stream crossing to access the northern portion of the site and temporary impacts for sewer line installation have
not yet occurred. At the time of this application, the applicant is not working within waters on the site. Based on the field
vist conducted by Pilot personnel on March 20, 2023, the estimated average width of the proposed road crossing is no
more than 6.25 feet in width and the estimted average width of the previously installed stream crossing is no more than 3
feet in width. Photographs documenting the widths of the streams within the proposed stream crossing and the
previously installed stream crossing are included as attachments.
6. Future Project Plans
6a. Is this a phased project? ®Yes ❑ No
6b. If yes, explain.
Other phases of the subdivision have been constructed and there are no other future phases of the subdivision. Impacts
to streams/wetlands, outside of those proposed in this application, are not anticipated as a result of the proposed project.
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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 ® T Road Crossing PFO ® Yes ® Corps 0.173/0.02
❑ 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 0.173/0.03
2h. Comments: Crossing 1 will permanently impact 0.173 acres (7,546 SF)of wetlands by road and rip-rap fill and temporarily
impact 0.02 acres (940 SF)of wetlands associated with temporary construction access.
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)
Road Crossing
S1 ® P ® T Fill/Rip-rap/De- Unnamed ® PER ® Corps 6.24 89/15/34
Watering El INT [_1 DWQ
S2 ❑ P ® T Sewer Crossing & Unnamed ® PER ® Corps 6.20 34
De-Watering ❑ INT ❑ DWQ
S3 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacts 89/15/68
3i. Comments:
Crossing 1: The proposed road crossing will permanently impact 89 linear feet(556SF)of stream from culvert/sideslope fill, 15
linear feet 94SF with keyed-in rip-rap and temporarily impact 34 linear feet 204SF)of stream from dewatering with pump
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PCN Form—Version 1.3 December 10, 2008 Version

around.
Crossing 2: The proposed sewer line crossing will temporarily impact 34 linear feet of stream from excavation/backfill of the
sewer line and de-watering.
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. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number— (if applicable) Type of impact Waterbody type Area of impact(acres)
Permanent(P)or
Temporary T
01 ❑ P ❑ T
02 ❑ P ❑ T
03 ❑ P ❑ T
04 ❑ P ❑ T
4f.Total open water impacts
4g. Comments: Open water impacts are not proposed.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5L Total
5g. Comments: Pond or lake construction is not proposed.
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:
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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 El Tar-Pamlico El 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 T impact required?
131 ❑ P ❑ T ❑ Yes
❑ No
B2 ❑ P ❑ T ❑ Yes
❑ No
B3 ❑ P ❑ T ❑ Yes
❑ No
6h. Total buffer impacts
6i. Comments: The applicant will obtain a buffer authorization for the project from the local DWR delegated municipality prior
to impacts occuring.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The applicant has designed the proposed residential sub-division to avoid other impact to streams and wetlands, specifically
associated with lot/pad fill. Based upon the stream and wetland delineation, the applicant has updated their plans to remove
three lots from the development that would have resulted in an additional stream/wetland crossing.
The applicant has further demonstrated avoidance and minimization of stream impacts by proposing to construct culvert
head/end walls for Crossing 1. Rip-rap will be keyed-in to existing bed and banks at Crossing 1, thus avoiding net loss of
stream channel. The applicant has designed the stream crossings in relatively straight portions of the streams. The sewer
line crossing has been designed to avoid impact to wetlands.
The remaining 2,372 linear feet of stream and 2.90 acres of wetlands are being avoided.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The clearing limits will be staked and silt fence will be used. Temporary coffer dams will be installed upgradient of the
proposed culvert/utility line. During construction, water will be pumped around the construction footprint. Appropriate stream
bank protection will be provided in the channel during construction and all excess excavated material will be immediately
removed from the crossing areas and stock piled in upland locations. The excavated soils removed from streams during
construction will be utilized to backfill the top 12 inches within areas of temporary stream impacts. Upon completion of the
culvert/sewer line installations, the temporary sand bag coffer dams will be removed and flow will be diverted through the
culvert and over the sewer line. Following installation of the culvert, areas of temporary stream or wetland impact will be
restored to similar pre-construction grade. The stream banks will be matted with biodegradable materials and seeded/live
staked with native species. The wetland will be planted with a native herbaceous seed mix.
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
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PCN Form—Version 1.3 December 10, 2008 Version

3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
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: NA linear feet
4c. If using stream mitigation, stream temperature: ❑warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): NA square feet
4e. Riparian wetland mitigation requested: 0.24 acres
4f. Non-riparian wetland mitigation requested: NA acres
4g. Coastal (tidal)wetland mitigation requested: NA acres
4h. Comments: The applicant has preivously mitigated for the unavoidable net loss to 0.241 acres wetlands through purchase
of 0.482 acres of wetland mitigation credits from NCDMS on 2.25.22.A copy of the MTRF dated 2.25.22 is attached.
The applicant proposes to utilize 0.346 acres of the 0.482 acres of wetlands mitigation credits previously purchased on
2.25.22 to mitigate for the unavoidable net loss to 0.173 acres of wetlands at a 2:1 ratio. Mitigation is not proposed for
permanent/temporary stream impacts or temporary wetland impacts.
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 ❑ Yes ® No
buffer mitigation?
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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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:
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PCN Form—Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ® 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.
❑ Yes ® No
Comments: City of HP SWMP
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 41.3 %
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:
The proposed project will utilize an existing stormwater management plan and a new stormwater managmenet plan for
the northern portion of the site prior to impacts occuring.
® 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? High Point
® Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply(check all that apply): ❑ USMP
® 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
❑ 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
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
Page 9 of 12
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)?
1 c. If you answered "yes"to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes ® No
Comments: A NEPA or SEPA is not required as part of this project.
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.
We are not aware of additional development that will result which will impact nearby downstream water quality.
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.
Wastewater from the proposed subdivision will be discharged into the existing sanitary sewer system. Impacts outside of
those in this application are not anticipated as a result of providing sewer service to the site.
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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?
5c. If yes, indicate the USFWS Field Office you have contacted. ❑ Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS IPaC database is down for service the week of April 10, 2023. The USFWS and NC NHP database
identifies the following protected species in Guilford County: bald eagle, Cape Fear shiner(by river basin), Roanoke
logperch (by river basin), Schweinitz's sunflower and small whorled pogonia. There are no large waterbodies on the site
or on nearby properties that provide suitable habitat for bald eagle. The Cape Fear shiner and Roanoke logperch do not
occur within the proposed project's watershed. Based on our observations, the impact areas are heavily wooded and/or
already cleared and do not contain sutiable habitat for Schweinitz's sunflower and small whorled pogonia. Therefore, we
have made determinations of no effect for Cape Fear shiner, Roanoke logperch, Schweinitz's sunflower and small
whorled pogonia. Based on the limited size of the water bodies proposed for impact, we have also made the
determination that the proposed impacts will not disturb the bald eagle.
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?
Based on our knowledge of the site, the site is not located in or near an area designated as 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 ❑ 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?
We reviewed the SHPO Map (http://gis.ncdcr.gov/hpoweb/)to identify historic and/or archaeological resources of the site.
The map does not identify eligible for listing or listed properties on the site.A copy of the map is included as an
attachment.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s)did you use to make the floodplain determination? 3710689300K(Drawings 4, JD Requests)
Digitally signed by Bradley Luckey
Bradley
DN:cn=Bradley Luckey,o=Pilot
Enviromental,Inc.,ou, 4.18.23
Bradley S. Luckey Luckey email=[e-mail],
c=US
Date:2023.04.18 14:20:39-04'00' Date
Applicant/Agent's Printed Name Applicant/Agent's Signature
Page 11 of 12
PCN Form—Version 1.3 December 10, 2008 Version

Proposal for Environmental Services
Pilot Proposal 3736.4
March 21,2023
AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address: W ��
Applicant Information:
Name:
Address:
Telephone Number:
Fax Number:
E-mail Address:
Signature: Date: z-�, a ua
4

9rcjl NOTE
O O \ - POND "C 1. WETLANDS AND STREAM VERIFIED BY PILOT
ENVIRONMENTAL INC. WITH USACE AND NCDEQ—DWR ON
iix JULY 10, 2019. GREEN MOUNTIAN ENGINEERING, PLLC.
FIELD LOCATED THE VERIFIED WETLAND AND STREAM
FLAGS PLACED BY PILOT ENVIRONMENTAL INC.
2. THIS DEVELOPMENT HAS BEEN ACCEPTED BY THE CITY
OF HIGH POINT AS A HIGH DENSITY STORMWATER
PROJECT, WITH WET DETENTION PONDS AS STORMWATER
R ® ® MANAGEMENT DEVICES FOR RANDLEMAN LAKE BUFFER
RULES.
ROAD/CULVERT IMPACT �C ® d LIFT STATION FORCEMAIN
O gob CONNECTS TO EXISTING 3. STORMWATER PONDS "A" & "B" PERMITTED AND
SEWER IN BASSWOOD CONSTRUCTED IN 2007.
TEMPORARY SEWER m AVE AND FLOWS NORTH
CROSSING IMPACT (PREVIOUSLY INSTALLED)
(CONSTRUCTION & 9L
P
CLEARING �?
STARTED/PLACEMENT OF ® , j �+
FILL HAS NOT OCCURRED) ® ® ® o © -POND "B'
i •
� E
gg � O� R 1
® ® ® ® ® I
DEVELOPER:
CLAYTON PROPERTIES GROUP
® © ® ® ® 221 JONESTOWN RD.
WINSTON—SALEM, NC 27104
CONTACT: WILL DERRICKSON
PH: 336.765.9661
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IMPACT MAP ENGINEERING, PLLC
DEVELOPER:
CLAYTON PROPERTIES GROUP MEADOW VALLEY 1AWENDYCT
221 JONESTOWN RD. GREENSBORO, NC 27409
N AL 27104 C SUBDIVISION CONTACT:TACT: WILLL DERRICKSON Tel: [phone]
PH: 336.765.9661 CERTIFICATE#P-0826
(FIGURE 3) www.greenmountainengineers.com

NOTE PERENNIAL STREAM/ WETLAND IMPACT MAP
1. WETLANDS AND STREAM VERIFIED BY PILOT MEADOW VALLEY SUBDIVISION
ENVIRONMENTAL INC. WITH USACE AND NCDEQ—DWR ON
JULY 10, 2019. GREEN MOUNTIAN ENGINEERING, PLLC. CROSSING „C„
FIELD LOCATED THE VERIFIED WETLAND AND STREAM
FLAGS PLACED BY PILOT ENVIRONMENTAL INC. (FIGURE 4)
2. THIS DEVELOPMENT HAS BEEN ACCEPTED BY THE CITY IMPACT LINEAR STREAM LINEAR STREAM WETLAND IMPACT
OF HIGH POINT AS A HIGH DENSITY STORMWATER TYPE
PROJECT, WITH WET DETENTION PONDS AS STORMWATER LOCATION IMPACT IMPACT ZONE
MANAGEMENT DEVICES FOR RANDLEMAN LAKE BUFFER \ ID (FEET) (SQUARE FEET) (SQUARE FEET)
RULES. \ 1 SEWER CROSSING &
TEMP. PUMP AROUND 34 211 0
' I M PACT
�• X /
I CENTERLINE X `
0' 15' 30' 60' I ■ X STREAM
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SCALE: V = 30' C
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PRO 221 JONESTOWN RD. �`� 1A WENDY CT
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CONTACT: WILL DERRICKSON s�`'"'�mmmlilt +� Tel: [phone]
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SITE PHOTOGRAPHS
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Photograph 1 - View of proposed stream crossing.
Photograph 2 - View of proposed stream crossing.

SITE PHOTOGRAPHS
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Photograph 3 - View of measured stream width in the proposed stream
crossing.
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Photograph 4 - View of stream down-gradient of previously installed
culvert for sewer line maintenance activities.

SITE PHOTOGRAPHS
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Photograph 5 - View of stream up-gradient of previously installed culvert
for sewer line maintenance activities.
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Photograph 6 - View of measured stream width up-gradient of previously
installed culvert for sewer line maintenance activities.

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Site Boundary .
Drawing 1 j ,y USGS Topographic Map
Meadow Valley Subdivision
USGS Topographic Map
Kernersville, NC Quadrangle ` i Approximate 45 Acre Tract
Scale: 1" = 2 000' PILOT f� High Point, Guilford County, NC
PILOT ENV] RONMENTALINC , Pilot Project 3736

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Site Boundary
Drawing 2A Published Soil Map
USDA Soil Survey Meadow Valley Subdivision
of Guilford County, NC *X t Approximate 45 Acre Tract
Published 1977, Sheets 25 & 31 PILGT A � High Point, Guilford County, NC
Not to Scale �" PILOT ENVIRONMENTAL. INC Pilot Project3736

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FLAG NUMBERS/INFO
WETLAND FLAGS=
STREAM FLAGS=
Stream Flags=40 SA 1-5
Wetland Flags= 115
Total Flags= 155
ISA 1-5 WB 1-7
ESA 1-5 \
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WA 1-30
SC—Not
Flagged \
SE 1-15
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W B 1-62 /
WC 1-3 DP-1
WCA 1-4 DP
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SB 1-8 /
WBA 1-29
LEGEND
Site Boundary
■■■■■■ Intermittent Stream
SD 1-7 Perennial Stream
wD 1-7 Wetland
SA 1-5 Flag Number
DP-1 O Data Point
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY WERE VERIFIED BY MR. DAVID BAILEY
WITH THE USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ-DWR ON JULY 10, 2018.. THEY HAVE NOT BEEN SURVEYED OR
GEOLOCATED.
Drawing 5 Wetland Map
Aerial Imagery from ESRI
Meadow Valley Subdivision
and Pilot Field Notes _
Scale: 1" - 500' — Approximate 45 Acre Tract
Date: 5.2 50 PILOT � High Point, Guilford County, NC
PILOT ENVIR0NMENTAL.INC Pilot Project3736
Revised: 7.12.18

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USGS Topographic Map
Drawing 1 x
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USGS Topographic Map High Point, NC Quadrangle Approximate 17.7-Acre Tract
pf� 01� �, -
Scale: 1" = 2 000' High Point, Guilford County, NC
/ PILOT ENVIRONMENTAL INC Pilot Project3736.3

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Q Site Boundary
Drawing 2 Web Soil Map
USDA Web Soil Survey _ Meadow Valley Subdivision
Of Guilford County NC ,�, Approximate 17.7-Acre Tract
Scale: 1" = 500' pI��1 High Point, Guilford County, NC
P I LOT ENVI R O N M E N T A L.I N C
Pilot Project 3736.3

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Drawing 2A Published Soil Map
USDA Soil Survey Meadow Valley Subdivision
of Guilford County, NC Approximate 17.7-Acre Tract
Published 1977, Sheet 31 p���1� High Point, Guilford County, NC
Scale: 1" = 1000/ RiLOT ENVIRONMENTAL.INC Pilot Project3736.3

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Site Boundary
Freshwater Emergent
Freshwater Forested/Shrub
Estuarine and Marine Deepwater
Estuarine and Marine
Freshwater Pond
Lake
Riverine
Otherl
Drawing 3 f
NWI Map
USFWS NWIWetlands MapperMeadow Valley Subdivision
Approximate 17.7-Acre Tract
Scale: 1" = 500' 1f.01 High Point, Guilford County, NC
OT E N V I R O N M E N T A L I N C
Pilot Project 3736.3

LEGEND
Site Boundary
Special Flncictmay,
Drawing FEMAF|0M
National Flood Hazard Layer T Meadow Valley Subdivision
From FEMA\Neb Map Service ` Approximate 17.7-AcreTract
Scale:� 1" = 5OO' �,.`"` "°,I ""° °"°,^`..""T High Point, Guilford County, NC
Pilot Project 3736.3

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(393 LF)
LEGEND
1111- Site Boundary
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY.THEY HAVE NOT BEEN VERIFIED "'■■■ Intermittent Stream
BY THE USACE. THIS EXHIBIT INCLUDES GPS LOCATIONS OF DELINEATED FEATURES. DELINEATION SA 1-5 Flag Number/Feature ID
CONDUCTED BY PILOT PERSONNEL ON 01.24.22.
Drawing 5 Wetland Map
2019 Satellite Imagery g Y from ESRI !j` Meadow Valley Subdivision
and Pilot GPS Data Approximate 17.7-Acre Tract
Scale: 1" = 350' p���1' High Point, Guilford County, NC
Date: 01.25.22 PILOT ENV I RON M E N T A L.I N C
Pilot Project 3736.3

U.S. Army Corps of Engineers RegminementContr&Symboi
WETLAND DETERMINATION DATA SHEET—Eastern Mountains and Piedmont Region EXEMPT
(Authordy.AR 335-15,
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R paragraph 5-2a)
Project/Site: Meadow Valley subdivision City/County: High Point/Guilford Sampling Date: 01.24.2022
Applicant/Owner: State: NC Sampling Point: DP-1
Investigator(s): Pilot Environmental, Inc Section,Township, Range: N/A
Landform(hillside,terrace,etc.): upland Local relief(concave,convex,none): None Slope(%): 1
Subregion(LRR or MLRA): LRR P,MLRA 136 Lat: 36.041870 Long:-80.030997 Datum:
Soil Map Unit Name: Casville sandy loam(Cac) NWI classification: None
Are climatic/hydrologic conditions on the site typical for this time of year? Yes No (If no,explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are"Normal Circumstances"present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS-Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes No X Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) —Surface Soil Cracks(136)
—Surface Water(Al) —True Aquatic Plants(1314) _Sparsely Vegetated Concave Surface(138)
_High Water Table(A2) _Hydrogen Sulfide Odor(Cl) _Drainage Patterns(B10)
—Saturation(A3) —Oxidized Rhizospheres on Living Roots(C3) —Moss Trim Lines(B16)
—Water Marks(131) _Presence of Reduced Iron(C4) _Dry-Season Water Table(C2)
_Sediment Deposits(132) _Recent Iron Reduction in Tilled Soils(C6) _Crayfish Burrows(C8)
_Drift Deposits(133) —Thin Muck Surface(C7) —Saturation Visible on Aerial Imagery(C9)
—Algal Mat or Crust(B4) —Other(Explain in Remarks) —Stunted or Stressed Plants(D1)
_Iron Deposits(B5) —Geomorphic Position(D2)
_Inundation Visible on Aerial Imagery(137) —Shallow Aquitard(D3)
—Water-Stained Leaves(139) _Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes No X Depth(inches):
Water Table Present? Yes No X Depth(inches):
Saturation Present? Yes No X Depth(inches): Wetland Hydrology Present? Yes No X
(includes capillary fringe)
Describe Recorded Data(stream gauge, monitoring well,aerial photos, previous inspections),if available:
Remarks:
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP-1
Absolute Morninant indicator
Tree Stratum (Plot size: 30 ) %Cover Species? Status Dominance Test worksheet:
1. Pinas uirginiana 20 Yes UPL Number of Dominant Species
2. Fagusgrandifoiia 20 Yes FACU That Are OBL, FACW,or FAC: 3 (A)
3. Liquidambarstyracifiva 20 Yes FAC Total Number of Dominant
4. Species Across All Strata: 8 (B)
5. Percent of Dominant Species
6. That Are OBL, FACW,or FAC: 37.5% (A/B)
7. Prevalence Index worksheet:
60 =Total Cover Total%Cover of: Multiply by:
50%of total cover: 30 20%of total cover: 12 OBL species 0 x 1 = 0
Sapling/Shrub Stratum (Plot size: 15 ) FACW species 0 x 2= 0
1. Fagusgrandifoiia 10 Yes FACU FAC species 35 x 3= 105
2. Acerrubrum 5 Yes FAC FACU species 40 x 4= 160
3. ✓umperrrs uirginiana 5 Yes FACU UPL species 20 x 5= 100
4. Column Totals: 95 (A) 365 (B)
5. Prevalence Index =B/A= 3.84
6. Hydrophytic Vegetation Indicators:
7. _1 -Rapid Test for Hydrophytic Vegetation
8. 2-Dominance Test is>50%
9. _3-Prevalence Index is:53.0'
20 =Total Cover 4-Morphological Adaptations'(Provide supporting
50%of total cover: 10 20%of total cover: 4 data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5 ) _Problematic Hydrophytic Vegetation' (Explain)
1. Poiystichum acrostichoides 5 Yes FACU 'Indicators of hydric soil and wetland hydrology must
2. be present, unless disturbed or problematic.
3. Definitions of Four Vegetation Strata:
4• Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
5. more in diameter at breast height(DBH),regardless of
6 height.
7• Sapling/Shrub-Woody plants,excluding vines, less
8. than 3 in. DBH and greater than or equal to 3.28 ft
9 (1 m)tall.
10. Herb-All herbaceous(non-woody)plants, regardless
11 of size,and woody plants less than 3.28 ft tall.
5 =Total Cover Woody Vine-All woody vines greater than 3.28 ft in
50%of total cover: 3 20%of total cover: 1 height.
Woody Vine Stratum (Plot size: 30 )
1. Smilax rotundifoiia 10 Yes FAC
2.
3.
4.
5' Hydrophytic
10 =Total Cover Vegetation
50%of total cover: 5 20%of total cover: 2 Present? Yes No X
Remarks: (Include photo numbers here or on a separate sheet.)
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point: DP-1
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type Loc Texture Remarks
0-18 10YR 5/8 100 Loamy/Clayey
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix,MS=Masked Sand Grains. 2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators. Indicators for Problematic Hydric Soils3:
_Histosol(A1) _Polyvalue Below Surface(S8)(MLRA 147,148) _2 cm Muck(A10)(MLRA 147)
_Histic Epipedon(A2) —Thin Dark Surface(S9)(MLRA 147,148) —Coast Prairie Redox(A16)
_Black Histic(A3) —Loamy Mucky Mineral(F1)(MLRA 136) (MLRA 147,148)
_Hydrogen Sulfide(A4) _Loamy Gleyed Matrix(F2) _Piedmont Floodplain Soils(F19)
_Stratified Layers(A5) _Depleted Matrix(F3) (MLRA 136,147)
_2 cm Muck(A10)(LRR N) _Redox Dark Surface(F6) _Red Parent Material(F21)
_Depleted Below Dark Surface(A11) _Depleted Dark Surface(F7) (outside MLRA 127,147,148)
_Thick Dark Surface(Al2) _Redox Depressions(F8) —Very Shallow Dark Surface(F22)
—Sandy Mucky Mineral(S1) _Iron-Manganese Masses(F12)(LRR N, —Other(Explain in Remarks)
—Sandy Gleyed Matrix(S4) MLRA 136)
—Sandy Redox(S5) _Umbric Surface(F13)(MLRA 122,136) 3Indicators of hydrophytic vegetation and
—Stripped Matrix(S6) _Piedmont Floodplain Soils(F19)(MLRA 148) wetland hydrology must be present,
Dark Surface(S7) Red Parent Material(F21)(MLRA 127,147,148) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes No X
Remarks:
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont—Version 2.0

From: Heather LaGamba
To: 40lPreFile(c ncdenr.aov
Subject: Pre-File Notice-Meadow Valley Subdivision-Basswood Avenue(3736.4)
Date: Tuesday,March 21,2023 11:33:38 AM
We would like to submit a Pre-filing Notice for the following project:
Project Name: Meadow Valley Subdivision — Basswood Avenue (3736.4)
Project Owner: Clayton Properties Group
Project Owner's Address: 2221 Jonestown Road, Winston-Salem, North Carolina 27104
Project County: Guilford
Type of project/Approval Sought: 401 WQC, Pre-Application Request Meeting Declined
Thank you and have a wonderful day!
Sincerely,
Heather LaGamba
336.345.9536(c)
336.310.4527 (o)
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Kernersville, NC 27285
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