20052116 Ver 2_401 Application_20170126

WETLANDS
wi
a
T� WATERS
NC DWR, 401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Water Quality Certification
AID # SAW -2015-01697
Caleb's Creek
Nationwide Permit Verification
Kernersville, Forsyth County, NC
To whom it may concer
I
January 24`h, 2017
Attached please find four (4) copies of a permit verification that was mailed to the Army Corps of
Engineers, Raleigh Field Office, for the Caleb's Creek project located in Kernersville, NC. Included is a
check for $570.00 for the fee associated with this Water Quality Certification application. Please do not
hesitate to let me know if there are any questions regarding this submittal.
Best regards,
Perry Isner
Wetlands & Waters, Inc.
704.773.4239
[e-mail]
JAN 2 6 2017
CHRISTOPHER HUYSMAN WETLANDS & WATERS, INC. TAMP BANDY
1 70 DEW DROP ROAD 41 OB LB PROPST DRIVE
SPARTA, NC 28675 CONOVER, NC 2B61 3
336.406.0906 B2B.302.3437
CHRIS. [e-mail] [e-mail]

Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name Caleb's Creek
2. Name of Property Owner/Applicant: BOMA North Carolina, LLC
3. Name of Consultant/Agent: Wetlands & Waters, Inc. Attn: Perry Isner
*Agent authorization needs to be attached.
4. Related/Previous Action ID nurnber(s): SAW -2015-o1697
5. Site Address: 168o Pine Tree Drive
6. Subdivision Name: Caleb's Creek
7. City: Kernersville
8. County: Forsyth
9. Lat: 36.o62387 Long: -8°•091225 (Decimal Degrees Please)
10. Quadrangle Name:
11. Waterway: Abbotts Creek HUC 030401030202
12. Watershed: Lower Yadkin
13. Requested Action: N7
Nationwide Permit # ko l'J
General Permit #D
.IAN 2 6 2011
Jurisdictional Determination Request
DEQ TER R SOUR
Pre -Application Request 401 & BUFFER P R I ING
7I:;A
The following information will be completed by Corps office:
Prepare File Folder
AID:
Assign number in ORM
Authorization: Section 10
Project Description/ Nature of Activity/ Project Purpose:
Section 404
Site/Waters Name: Abbotts Creek HUC 030401030202
Keywords:
Begin Date

4wWETLANDS
a T& WATERS
January 23 d, 2017
Ms. Jean Gibby
US Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
RE: AID # SAW -2015-01697
Caleb's Creek
Nationwide Permit Verification
Kernersville, Forsyth County, NC
Ms. Gibby,
Attached please find a Pre -Construction Notification for a Nationwide Permit Verification for a mixed-
use development located in Kernersville, Forsyth County, NC. The impacts associated with this project
are broken down by corresponding Nationwide Permit numbers on the tables attached with this
notification.
Prosect History
The approximately 87S acre site consists of an abandoned golf course, three large ponds that require
dam rehabilitation efforts, and extensive floodplain along Abbott's Creek. When this project was first
contemplated, it was intended to be a residential subdivision centered around a modernized and
improved golf facility. After extensive financial and environmental analysis, it was determined that the
golf course was not feasible and the decision was made to move forward with a mixed-use
residential/commercial development that incorporates large areas of common open space and
greenway walking trails. This alternative was deemed to be the least environmentally damaging, with
impacts only necessary for road and utility crossings, as well as dam rehabilitation.
In August of 2015, your office issued a Preliminary Jurisdictional Determination with the Action ID
number referenced above. This determination serves as the basis for this permit verification.
Project Purpose
The purpose of the proposed project is to construct a mixed-use residential/commercial development in
order to meet the growing demands for housing and infrastructure in the region. The Town of
Kernersville will sign as a co -applicant for the impacts necessary for the completion of major public
thoroughfare right of ways through the project. These road improvements are part of the Kernersville
Thoroughfare and Street Plan, which is included with this submittal and would be completed
independent of the residential subdivision. All construction and permitting requirements will be the
obligation of the developer.
Project Need
Impacts to regulated features have been limited to road and utility crossings, as well as the impacts
necessary for the rehabilitation of the three dams currently on site. These dam improvements are
necessary to ensure the long term stability of the impounded waters. Impacts to the jurisdictional
ponds will consist of expanding and stabilizing the existing earthen dams, as well as burying large
CHRISTOPHER HUYSMAN
1 70 DEW DROP ROAD
SPARTA, NO 28675
336.406.0906
CHRIS. H UYSMAN@GMAIL. COM
WETLANDS & WATERS, INC.
TAMP BANDY
41 08 LB PROPST DRIVE
CONOVER, NO 2B613
B2B.302.3437
JTAM PBAN DY@GMAIL. COM

diameter riprap/boulders at both the inlets and outlets of the ponds. This large riprap will serve as an
energy dissipator directly below both the primary and emergency spillways. Riprap will be placed below
the surface of the water and submerged aquatic vegetation will be planted in order to increase stability
of riprap and provide habitat for aquatic wildlife. Extensive floodway analysis has been conducted to
confirm that these efforts are warranted and will provide the best method for protecting the
downstream watershed, while simultaneously minimizing impacts to the ponds themselves.
All impacts associated with roadway crossings are necessary for access to high ground, with the majority
of these impacts associated with the public thoroughfares mentioned above. Internal subdivision roads
have been carefully designed to access all necessary areas of high ground while avoiding impacts to
jurisdictional Waters of the US to the maximum extent practicable. This has been done by utilizing
existing infrastructure wherever possible. There are four existing culvert crossings, all failing and in
need of repair, that do not currently meet the standards for preservation of aquatic life passage. These
crossings will be removed and replaced with new lengths of pipe that will meet the current
specifications for preservation of aquatic life passage as well as downstream water quality. All work will
be done in the dry, with stream banks returned to existing grade and stabilized with appropriate bio-
engineering practices.
All impacts necessary for utility access will be temporary, open trench crossings that will be restored to
original contours following construction. The developer will make use of the extensive sanitary sewer
already present on site that runs along Abbotts Creek, with many crossings located in areas where sewer
is already located that previously served the existing golf course. Wherever possible, many of the new
crossings will be located just downstream of road crossings, below the riprap aprons, in order to limit
grading and disturbance to regulated channels.
Project Description
The project consists of mixed-use development, residential (low, medium and high density),
commercial/office areas, a large amenity center, and a public school. Approximately 185 acres will be
left in common, passive -use open space. Incorporated throughout the subdivision as well as the open
space will be approximately 30,000 linear feet (5.7 miles) of greenway walking trails and 18,000 linear
feet (3.4 miles) of greenway biking trails. Infrastructure will consist of public thoroughfare roads,
internal subdivision circulation roads, and appurtenant parking facilities. Transportation approvals
mandate the establishment of multilane ingress and egress for safety and they dictate that the
driveways be located within a certain range of locations.
Stormwater management will adhere to Phase II standards for development, with review by the Town of
Kernersville. As this is a phased project, individual stormwater plans for each phase will be approved
prior to commencement of construction activities. Although major thoroughfare right-of-ways will be
turned over to the Town of Kernersville following construction, stormwater approvals for this work will
also be approved at the time of construction. Following approval, the stormwater management plans
will also be provided to the Division of Water Resources.
Avoidance and Minimization
The site has been carefully designed to avoid impacts to regulated features wherever possible. Where
impacts cannot be completely avoided, extensive engineering analysis has been done in order to
minimize impacts. The proposed stream crossings are perpendicular to the existing natural channels
and impacts are as narrow as possible to minimize impacts while allowing suitably functioning
CHRISTOPHER HUYSMAN WETLANDS & WATERS, INC. TAMP BANDY
1 70 DEW DROP ROAD 41 OB LB PROPST DRIVE
SPARTA, NC 28675 CONOVER, NO 28613
336.406.0906 B2B.302.3437
CHRIS. [e-mail] [e-mail]

infrastructure. Proposed road locations are situated, to the maximum extent practicable, at locations
that have been previously impacted by existing roads or fairways. The proposed site development
eliminates the golf component of the prior project plans and replaces it with passive recreational uses
thereby reducing wetland impacts by over 4 acres. The applicant proposes that box culverts will be
sized with the consideration of natural stream design protocols and will be constructed with sills that
will maintain natural stream bed material that is a minimum of twelve (12) inches deep. The applicant
has designed a site plan that minimizes riparian habitat fragmentation through the establishment of
dispersal corridors along all remaining streams. Total impacts to open waters necessary for completion
of the dam rehabilitation totals 1.04 acres, approximately 5% of the total surface area of open waters
present on site. New impacts associated with internal subdivision roads have been limited to 135 linear
feet of stream and 0.009 acres of linear wetland or jurisdictional ditch. Road crossings will be designed
to utilize retaining walls and riprap dissipators in order to minimize impacts to regulated features.
Riprap will be pressed into the stream banks and will not be placed into the stream bed itself. Existing
utility and road crossings will be up -fitted and utilized wherever possible. Remaining jurisdictional
Waters of the US consist of approximately 30,000 linear feet of intermittent streams, 14,000 linear feet
of perennial streams, 18 acres of jurisdictional open waters, and 15 acres of jurisdictional wetlands.
Mitigation
The applicant is proposing to mitigate for all permanent impacts to jurisdictional features, including the
impacts associated with the public thoroughfare roads. With the amount of preservation that will be
provided through local buffers, the applicant is proposing to provide compensatory mitigation at a ratio
of 2:1 for loss of aquatic features. As no mitigation banks with the credit types needed are available in
the area, the applicant is proposing to provide this compensatory mitigation through the Division of
Mitigation Services. An acceptance letter from DMS for the necessary impacts is included with this
request.
Please do not hesitate to let me know if you have any questions or if further information is required to
process this request.
Best regards,
f,
Perry Isner
CHRISTOPHER HUYSMAN WETLANDS & WATERS, INC. TAMP BANDY
1 70 DEW DROP ROAD 41 OB LS PROPST DRIVE
SPARTA, NC 26675 CONOVER, NC 2B61 3
336.406.0906 828.302.3437
[e-mail] [e-mail]

0�yN A t�c
o�<
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:
Q Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
Q Yes ❑ No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes 0 No
For the record only for Corps Permit:
❑ Yes N No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
Q Yes ❑ No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
N Yes 0 No
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes Q No
2.
Project Information
2a.
Name of project:
Caleb's Creek
2b.
County:
Forsyth
2c.
Nearest municipality / town:
Kernersville
2d.
Subdivision name:
Caleb's Creek
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
BOMA North Carolina, LLC
3b.
Deed Book and Page No.
B. 2954 p. 2403
3c.
Responsible Party (for LLC if
applicable):
Kory Reimann
3d.
Street address:
1668 Ridge Point Dr.
3e.
City, state, zip:
Bountiful, UT 84010-1054
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ❑ Other, specify:
4b.
Name:
4c.
Business name
(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:
Perry Isner
5b.
Business name
(if applicable):
Wetlands & Waters, Inc.
5c.
Street address:
2712 Minden Rd.
5d.
City, state, zip:
Pleasant Garden, NC 27313
5e. Telephone no.:
704.773.4239
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
6874-65-5960.00, 6874-86-7026.00, 6874-82-3360.00
1 b. Site coordinates (in decimal degrees):
Latitude: 36.062387 Longitude: -80.091225
1 c. Property size:
875 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Abbotts Creek
2b. Water Quality Classification of nearest receiving water:
WS -III
2c. River basin:
Lower Yadkin
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 consists of a mixture of early and mid -succession forest and an abandoned golf course, as well as three large ponds. The land use
surrounding the site consists of agriculture and undeveloped land, along with some residential. 1-40 is directly north of the project.
3b. List the total estimated acreage of all existing wetlands on the property: 15.43
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 44,822
3d. Explain the purpose of the proposed project:
To construct a mix -used development to meet the growing housing demands of the region and meet the economic expectations of the owner.
3e. Describe the overall project in detail, including the type of equipment to be used:
(see attached narrative)
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
❑X Yes ❑ No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
Preliminary ❑X Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Chris Huysman, Perry Isner
Agency/Consultant Company: Wetlands & Waters, Inc.
Other: WNR Consultants
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
08/04/15; SAW -2015-01697
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
El Yes ❑X No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑X Yes ❑ No
6b. If yes, explain.
Due to the size of the project and in order to meet the economic pro forma the project will be phased out of necessity.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands ❑X Streams — tributaries ❑ Buffers ❑X Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1
Choose one
Choose one
Yes/No
W2
Choose one
Choose one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
2h. Comments:
see attached Impact Table for impacts to wetlands
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1
Choose one
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
3h. Total stream and tributary impacts
3i. Comments:
see attached Impact Table for impacts to streams
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then indivi ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f. Total open water impacts
4g. Comments: see attached Impact Table for impacts to open waters
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation. then vou MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
B1
Yes/No
B2
Yes/No
B3
Yes/No
B4
Yes/No
B5
Yes/No
B6
Yes/No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Original concepts for a golf -course have been eliminated, thereby greatly reducing impacts to jurisdictional features. The site plan has been
exhaustively designed to limit impacts to wetlands and streams wherever reasonably practicable. All impacts are necessary for internal circulation
and to connect existing ROW'S to comply with DOT requirements. Approximately 185 acres will be left in natural open -space for passive recreation.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The site will be constructed under an approved Erosion Control Plan. Site will be also be constructed in phases as to limit the number of areas
subject to impact at any one given time. Upon completion, all contours will be restored to previous conditions and fill slopes will be re -seeded with
appropriate bio -engineering practices and allowed to re -naturalize.
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?
❑X Yes No
2b. If yes, mitigation is required by (check all that apply):X❑
DWQ ❑X Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑X Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑X Yes
4b. Stream mitigation requested:
465 linear feet
4c. If using stream mitigation, stream temperature:
warm
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian 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:
Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes 0 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
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
2b. Does this project require a Stormwater Management Plan?
X❑ 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:
Project will adhere to Phase II standards under review by the Town of Kernersville. As this is a phased project, individual stormwater approvals will
be provided for separate phases prior to any construction.
2e. Who will be responsible for the review of the Stormwater Management Plan?
Kernersviile
3. Certified Local Government Stormwater Review
3a. In which localgovernment's jurisdiction is thisproject?
Kernersviile
0 Phase It
❑ NSW
3b. Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑X 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):
HSessionLaw 2006-246
❑Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ 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
❑ 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 28.0200)?
2b. Is this an after -the -fact permit application?
El Yes ❑X 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 ❑X No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge)
of wastewater generated from
the proposed project, or available capacity of the subject facility.
Site will utilize existing gravity -fed sanitary sewer line that is present on site and will upfit as necessary.
Page 9 of 10
PCN Form — Version 1.4 January 2009

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
El Yes No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Site occurs in the range of the Northern Long -Eared Bat. however there are no known hibemaculum locations in Forsyth County and therefore we are
deferring to Corps guidance for notification. Natural Heritage Report detailing no known occurrences of federally listed species is attached.
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?
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 10 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?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain? Q Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
8c. Whatsource(s) did you use to make the floodplain determination?
Forsyth County GIS
91tv / "� wtA IV nl
Applicant/Agenes Printed Name
Applicant/Agent's Signature
ate
(Agent's signature is valid only if an authorization
letter from the a licent isprovided.)
Page 10 of 10

C. Proposed Impacts Inventory
Table 1. Nationwide Permit 14 Impacts: Public Thoroughfare Road
Stream Impact
Type of
Stream Name Perennial or
Type of
Average
Pipe Length Rip Rap
Number-
Impact
Intermittent
Jurisdiction
Stream
Permanent Length -
Permanent or
Average
Width (feet)
(linear feet) Temporary
Temporary
Permanent
(linear feet)
R -2 -Permanent
Culvert
UT to Abbotts Perennial
Corps
6
105 50
Creek
R -4 -Permanent
Culvert
UT to Abbotts Intermittent
Corps
3
75 40
Name
Intermittent
Creek
Width
R -5 -Permanent
Culvert
UT to Abbotts Intermittent
Corps
3
75 40
(linear feet)
Creek
R-6 - Permanent
Culvert
Abbotts Creek Perennial
Corps
20
75 40
Total Stream Impacts
330 170
Wetland Impact
Type of
Type of
Forested
Type of
Area of
Abbotts
Number-
Impact
Wetland
75
Jurisdiction
Impact
Permanent or
(acres)
Temporary
UTto
R-3 - Permanent
Culvert
Bottomland
Hardwood Forest
Yes
Corps
0.046
60
40
Total Wetland
Impacts
1 0.046
Table 2. Nationwide Permit 29 Impacts: Subdivision Road
Pipe Length
Rip Rap
Stream Impact
Average
Permanent
Length -
Number -
Type of
Stream
Perennial or
Type of
Stream
(linear feet)
Temporary
Permanent or
Impact
Name
Intermittent
Jurisdiction
Width
(linear feet)
Temporary
(feet)
UTto
R -la - Permanent
Culvert
Abbotts
Perennial
Corps
6
75
50
Creek
UTto
R-7 - Permanent
Culvert
Abbott,
Intermittent
Corps
3
60
40
Creek
Total Stream Impacts
135
90
Wetland Impact
Area of
Number - Type of
Type of
Type of
Forested
Impact
Permanent or Impact
Wetland
Jurisdiction
(acres)
Temporary
- Permanent Culvert
Ditch
No
Corps 0.009
rjb
Total Wetland Impacts 0.009

Table 3. Nationwide Permit 3 Impacts: Subdivision Roads and Dams
Stream Impact
Type of
Stream Name
Perennial or
Type of
Average
Impact
Number -
Impact
Name
Intermittent
Jurisdiction
Stream
Length
Permanent or
Width
(linear feet)
Temporary
(feet)
feet)
E-1 - Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
Creek
E-2 - Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
Creek
E-3 - Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
Creek
E -4 -Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
Creek
S-1 - Permanent
Rip Rap
UT to Abbotts
Perennial
Corps
6
100
Creek
U-6 - Temporary
Sewer
UT to Abbotts
Intermittent
Total Stream Impacts
500
Open Water
Type of
Waterbody
Area of
Impact Number -
Impact
Type
Impact
Intermittent
Corps
3
Permanent or
(acres)
Temporary
U -8 -Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
P-1- Permanent Fill Pond 0.2
P-2 - Permanent Fill Pond 0.2
P-3 - Permanent Fill Pond 0.2
P -4a - Permanent Rip Rap Pond 0.1
P -4b - Permanent Rip Rap Pond 0.09
P -5a - Permanent Rip Rap Pond 0.18
P -5b - Permanent Rip Rap Pond 0.07
Total Open Water Impacts 1.04
Table 4. Nationwide Permit 12 Impacts: Subdivision Sanitary Sewer
Stream Impact
Type of
Stream
Perennial or
Type of
Average
Impact
Number -
Impact
Name
Intermittent
Jurisdiction
Stream
Length
Permanent or
Width
(linear
Temporary
(feet)
feet)
U -1 -Temporary
Sewer
UT to Abbotts
Perennial
Corps
6
40
Creek
U -2 -Temporary
Sewer
UT to Abbotts
Perennial
Corps
6
40
Creek
U-3 - Temporary
Sewer
UT to Abbotts
Perennial
Corps
6
40
Creek
U-4 - Temporary
Sewer
UT to Abbotts
Perennial
Corps
6
40
Creek
U -S - Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
U-6 - Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
U-7 - Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
U -8 -Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
U-10 - Temporary
Sewer
Abbotts Creek
Perennial
Corps
20
60
U-12 - Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
Total Temporary Stream Impacts
420
Wetland Impact
Type of
Type of
Forested
Type of
Area of
Number-
Impact
Wetland
Jurisdiction
impact
Permanent or
(acres)
Temporary
U-8 -Temporary
Sewer
Bottomland
yes
Corps
0.02
Hardwood Forest
U-9 - Temporary
Sewer
o
Yes
Corps
0.06
ror est
Hardwdwoodd Forest
U-11- Temporary
Sewer
Battomland
Yes
Corps
0.06
Hardwood Forest
Total
Temporary Wetland
Impacts
0.14

USACE AID#:
SAW -2015-0169'
Section 404/401 Jurisdictic
Seasonal RPW's 30,833 LF
(depicted with light blue fines)
Perennial RPW's 13,989 LF
(depicted with dark blue lines)
Open Waters (Ponds)
(depicted as dark blue polygons)
Jurisdictional Wetlands
(depicted with green polygons)
1N
*Wetland Sketch provided for illustrative purposes for preliminary planning use only. Not intended
to be relied upon for exact location, dimensions, or orientation. All findings and assessments made
by wetland consultants regarding limits of jurisdiction or permitting requirements are subject to
1,000 ft verification by the US Army Corps of Engineers, the NC DWR, and other appropriate local authorities.
4w—t
WETLANDS
a & WATERS
Project Name:
Owner / Developer:
City / County:
Tax PIN(s):
Caleb's Creek
BOMA NC, LLC
Kernersville, Forsyth
(see attached parcel information)
Figure 1: Approximate Depiction Coordinates: Scale:
of Waters and Wetlands Lat: 36.062387 Long: -80.091225
graphic
Date:
01/23/17

Forsyth County, NC
r
+a
x
flit!,
ryr't,,
F
Ef
J f.n
`,..
i
a s .
M
Ilk
a
IA
a
1:18,056
0 1,100 2,200 4,40o ft
,3r'
20
gym. m
0 330 660 1N
Project Name: Caleb's Creek
WETLANDS Owner / Developer: BOMA NC, LLC
& WATERS City/County:
Kernersville, Forsyth
Tax PIN(s): 6874-65-5960.00, 6874-86-7026.00, 6874-82-3360.00
Figure 2: County GIS Coordinates:Scale: Date:
Lat: 36.062387 Long: -80.091225 graphic 01/23/17

Project Name: Caleb's Creek
WETLANDS Owner / Developer: BOMA NC, LLC
Sc WATERS City/County:
Kernersville, Forsyth
Tax PIN(s): 6874-65-5960.00, 6874-86-7026.00, 6874-82-3360.00
Figure 3: USGS Topo Quad Coordinates: Scale: Date:
Lat: 36.062387 Long: -80.091225 nts 01/23/17
TN
, I
or
,
a
,
,
.a
A
,
Project Name: Caleb's Creek
WETLANDS Owner / Developer: BOMA NC, LLC
Sc WATERS City/County:
Kernersville, Forsyth
Tax PIN(s): 6874-65-5960.00, 6874-86-7026.00, 6874-82-3360.00
Figure 3: USGS Topo Quad Coordinates: Scale: Date:
Lat: 36.062387 Long: -80.091225 nts 01/23/17
TN

;,. WETLANDS
.�a, WATERS
Figure 4b: Soil Survey
Project Name:
Owner/ Developer:
City / County:
Tax PIN(s):
Caleb's Creek
BOMA NC, LLC
Kernersville, Forsyth
(see attached parcel information)
Coordinates: Scale:
Lat: 36.062387 Long: -80.091225
graphic
Date:
01/23/17

NC Surface Water Classification
Surface Water Classifications:
12-119-(l)
Abbotts Creek
From source to a point 0.5
mile upstream of Davidson
County SR 1810
WS-III
August 2, 1992
Yadkin Pee-Dee
More info
1:36,112
Surface Water Classifications
0 0.35 0.7 1.4 mi
TN
0 0.35 0.7 1.4 km
Project Name:
Caleb's Creek
WETLANDS
Owner / Developer:
BOMA NC, LLC
& WATERS
City/County:
Kernersville, Forsyth
Tax PIN(s):
6874-65-5960.00, 6874-86-7026.00, 6874-82-3360.00
Figure 6: Stream Classification
Coordinates:
Scale:
Date:
Lat: 36.062387 Long:
-80.091225
graphic
01/23/17

Forsyth County, NC Convert to PDF 5/5/2015
Parcel ID Property Address January 1 Property Owner
6874-65-5960.00 1680 Pine Tree Dr Boma North Carolina L1c
Summary Appraisal Report - Commercial Bldgs: 7
M
Disclaimer The values and information provided on this property record card are based upon the best available
information on 01/01/2013. This information is subject to change because of changes to the property, correction of
existing information, additional information, oras the result of an appeal of the property.
Parcel Information
Block/Lot Neighborhood
5631 117B 321
Last 2 Recordations Available
Sale Date Estate Stamps Sale Price Book/Page
1/17/2008 60000 $30,000,000 2807/975
Assessed Values All Cards
Total Land Value Total Buildings Value Total Misc Imp Value Total Assessed Value
$16,625,210 $65,452 $125,700 $16,816,400
Road/Topography/Utilities
Roads Topography Utilities
RoadP ubPa\,ed Desirable
Land Valuation
Type Zoning Acres SgFt Rate Ut Size LC RF TO SH AC EZ Value
CL MU -S 0 23,707,965 1.65 0.5 1 1 1 0.85 1 1 1 $16,625,210
Total SgFt Total Acres Total Value
23, 707, 965 0 $16.625,210
Building Detail
Forsyth County considers all standard approaches to value. The assessed value on this building was
determined based upon the Income and Expense Approach.
Commercial Summary Information
Company Name Primary Address Occupancy Total Gross SgFt Net Lease SgFt Units
Old Pine Tree Golf Course 1680 Pine Tree DR MISC 0 0 0
Current Owners
Owner 1
Boma North Carolina Llc
Owner 2
Marling Address
7206 146th Street CIR SW
City, State Zip
Palmetto Bay FL 33158-1600
Mobile
Maps and A-f.
Information
Disclaimer The values and information provided on this property record card are based upon the best available
information on 01/01/2013. This information is subject to change because of changes to the property, correction of
existing information, additional information, oras the result of an appeal of the property.
Parcel Information
Block/Lot Neighborhood
5631 117B 321
Last 2 Recordations Available
Sale Date Estate Stamps Sale Price Book/Page
1/17/2008 60000 $30,000,000 2807/975
Assessed Values All Cards
Total Land Value Total Buildings Value Total Misc Imp Value Total Assessed Value
$16,625,210 $65,452 $125,700 $16,816,400
Road/Topography/Utilities
Roads Topography Utilities
RoadP ubPa\,ed Desirable
Land Valuation
Type Zoning Acres SgFt Rate Ut Size LC RF TO SH AC EZ Value
CL MU -S 0 23,707,965 1.65 0.5 1 1 1 0.85 1 1 1 $16,625,210
Total SgFt Total Acres Total Value
23, 707, 965 0 $16.625,210
Building Detail
Forsyth County considers all standard approaches to value. The assessed value on this building was
determined based upon the Income and Expense Approach.
Commercial Summary Information
Company Name Primary Address Occupancy Total Gross SgFt Net Lease SgFt Units
Old Pine Tree Golf Course 1680 Pine Tree DR MISC 0 0 0

Commercial Buildings Summary
Bldg Building Name Physical Addr Story Year Built Construction Occupancy Value
1 0 Teague LN 1 1970 1 BR 1108-Clubho $65,452
Total Buildings Value $65,452
Miscellaneous Improvements
Type
Construction
Height
Area
Year Built
Value
Pavilion 2
FR
1
1,104
1996
$2,939
Shed 4
CB
0
3,200
1970
$8,560
Paving Asp 1
ASPHALT
0
45.000
1970
$5,512
G Course 3
0
18
1970
$83,475
G Course 3
Bldg Value
0
1
0
$4,638
Canopy 2
FR
0
1,120
0
$1,344
Walls
BRICK
0
180
0
$594
Paving Asp 2
ASPHALT
0
140,000
0
$14,000
Total Miscellaneous Value
$125,700
Taxing Jurisdictions
Jurisidiction Fire District
Kemersville 100% FD
Income Detail
Income information on this report reflects market research and not specific data from the property.
Cost Detail
Detail Appraisal Report - Commercial Bldg: 1 of 1
Total Value from Cost
Total Section Total Addition local
Replacement
physical Depr
Econ/Func Depr
Value
Value Multiplier
Cost
$614,265
$45,672 0.87
$574,145
43%
80%
$246,882.35
($197,506.00)
$614,265
$45,672 0.87
$574,145
43%
80%
$246,882-35
($197,506-00)
Depriciated Value
Misc Imp. Value Total
Bldg Value
Land Value
Total All Bldgs
$65.452
$513
$65,965
$16,625,210
$16,816,400
$65,452
$121,062
$186,514
$16,625,210
$16,816,400
Building Information
Company Name Building Physical Address Occupancy Year Built Year Remod Condition
Old Pine Tree Golf Course 0 Teague LN 1108-Clubho 1970 0
Old Pine Tree Golf Course 0 Teague LN 1108-Clubho 1970 0
Foundation Construction Total Story Roof Roof Cover Ext Wallslnsul Walls Insul Ceiling
1 BR 1 Mansard/Mansard
1 BR 1 Mansard/Mansard
Section Details

Occupancy
Sqft/
Base
Heat/
Heat/
Heat
Adj #
Story perimeter Cost Sqft Cost
$40
Units
Cost
AC 1
AC 2
Adj
Base Stories
Hgt
1156-
240
$40
No
STOOP2
Stoop
( 10
$15
C hsbsmt
2,997
$34.64
Heat
0%
$0
1
1
1,065 1.02 $40.23 $120,569
240
$52
$12,480
100%
Open Porches
240
$40
$9,600
1109-
FR
1,120
Heat
0 C
50%
1 1
2801
Ctryclub
2,997
$138.59
Pump
0%
$9.15
1 10 1 1
1.065 1.02 $164.73 $493,696
Wall
BRICK
180
100%
0
45%
90%
$594
Sketched Additions
Type
Description
Area
Rate
Value
PORCH4
Open Porches
153
$40
$6,120
BAUL1
Bal/Landing
168
$20.75
$3,486
PORCH4
Open Porches
240
$40
$9,600
STOOP2
Stoop
60
$15
$900
BAUL1
Bal/Landing
168
$20.75
$3,486
P/PORCH4
Porch/Porch
240
$52
$12,480
PORCH4
Open Porches
240
$40
$9,600
Miscellaneous Improvements for this Bldg
Type
Const
Area
Rate
YearBuilt Condition Grade
Phy
EF
Value
Pavilion
FR
1,104
$17.75
1996 C
25%
80%
$2,939
Golf Course
18
$132,500
1970
65%
90°/a
$83,475
Paving Asp & Base
ASPHALT
45,000
$1.75
1970
65%
80%
$5,512
Shed -Small
CB
3,200
$26.75
1970 C
50%
80%
$8,560
Canopy
FR
1,120
$12
0 C
50%
80%
$1,344
Paving Asp & Base
ASPHALT
140,000
$2
0
75%
80%
$14,000
Wall
BRICK
180
$60
0
45%
90%
$594
Golf Course
1
$132,500
0
65%
90%
$4,638
Taxing Jurisdictions
Jurisidiction Fire District
Kernersville 100% FD

Property Report
Forsyth County, NC-onyet' tt?_P 5/5/2015
Parcel ID Property Address January 1 Property Owner
6874-82-3360.00 Teague Ln Boyd J Brown
Detail Appraisal Report - Land
Owner 1
Owner 2
Mailing Address
City, State Zip
5/5/15, 2:36 PM
Current Owners
Boyd J Brown
Manuela H Brown
1500 San Remo AVE STE 125
CORAL GABLES FL 33146
Mobile14- 91
Maps and
Information
Disclaimer: The values and information provided on this property record card are based upon the best available
information on 01 /01 /2013. This information is subject to change because of changes to the property, correction of
existing information, additional information, or as the result of an appeal of the property.
Parcel Information
Block/Lot Neighborhood
5628 119E 321
Last 2 Recordations Available
Sale Date Estate Stamps Sale Price Book/Page
12/19/2012 12000 $6,000,000 3097/2010
Assessed Values All Cards
Total Land Value Total Buildings Value Total Misc Imp Value Total Assessed Value
$5,798,402 $0 $0 $5,798,400
Road/Topography/Utilities
Roads Topography Utilities
RoadPrvGravel
Land Valuation
Type Zoning Acres SgFt Rate Ut Size LC RF TO SH AC EZ Value
CL MU -S 199.2 8,676,995 1.65 0.5 1 1 1 0.9 0.9 1 1 $5,798,402
http://maps.co.forsyth.nc.us/Property_Report/DefauIt.aspx?pin_6... Des ktop=true&map/mage=__ags-05b7216f2e3349ae9adf7e9bc74a0f41.jpg Page 1 of 2

Property Report 5/5/15, 2:36 PM
Total SgFt Total Acres Total Value
8,676,995 199.20 $5,798,402
Building Detail
Forsyth County considers all standard approaches to value. The assessed value on this building was
determined based upon the Cost Approach.
Detail Appraisal Report - Land
Photo not availableSketch not available
Taxing Jurisdictions
Jurisidiction
Kemersville 100%
Fire District
FD
http://maps.co.forsyth.nc.us/Property_Report/Default.aspx?pin=6...Desktop=true&mapimage=_ags_05b7216f2e3349ae9adf7e9bc74aOf4l.jpg Page 2 of 2

Table 1. Nationwide Permit 14 Impacts: Public Thoroughfare Road
Stream Impact
Type of Stream Name
Perennial or
Type of
AveragePipe
Length
Rip Rap
Number-
Impact
Intermittent
Intermittent
Jurisdiction
Stream
Permanent
Length -
Permanent or
Stream
Perennial or
Type of
Stream
Width (feet)
(linear feet)
Temporary
Temporary
P-Sa - Permanent
(feet)
Pond
(linear feet) T
Permanent or
Impact
(linear feet)
R-2- Permanent
Culvert
UT to Abbotts
Perennial
Corps
6
105
50
(feet)
Creek
Culvert
UT to Abbotts
UTto
Corps
3
R-4 - Permanent
Culvert
UTtoMebtts
Intermittent
Corps
3
75
40
E -3 -Permanent
Culvert
UT to Abbotts
eek
Corps
3
100
40
R-5 - Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
75
40
UT to Abbotts
%,nbotts
Intermittent
3
100
40
Creek
R-6 - Permanent
Culvert
Abbotts Creek
Perennial
Corps
20
75
40
Corps
Total Stream Impacts
100
Wetland Impact
Total Stream Impacts
330
170
Wetland Impact
Type of
Type of
Forested
Type of
Area of
UT to Abbotts
Type of
Number-
Impact
Wetland
Jurisdiction
Impact
Permanent or
Permanent or
Impact
Wetland
UT to Abbotts
(acres)
Corps
3
Temporary
Creek
(acres)
',t
R-3 - Permanent
CulvertBon—land
UT to Abbotts
Yes
Corps 0.046
3
40
Hardwood Forest
Total Wetland Impacts
0.009
U-10 - Temporary
Sewer
Total Wetland
Impacts 0.046
Table 2. Nationwide Permit 29 Impacts: Subdivision Road
Table 3. Nationwide Permit 3 Impacts: Subdivision Road
Caleb's Creek
IMPACT LOCATION MAP
USACE AID#: SAW -2015-01697
HUC: 030401030202
Stream Impact
Type of
Stream Name Perennial or
Type of
Average
Impact
Pipe Length
Stream Impact
P-2 - Permanent
Intermittent
Jurisdiction
Stream
Average
Permanent or
Number-
Type of
Stream
Perennial or
Type of
Stream
Permanent
Rip Rap
Pond
0.09
P-Sa - Permanent
(feet)
Pond
(linear feet) T
Permanent or
Impact
Name
Intermittent
Jurisdiction
Width
40
Temporary
Creek
1.04
(feet)
(I
Culvert
UT to Abbotts
UTto
Corps
3
100
40
R -la - Permanent
Creek
nbbons
Perennial
E -3 -Permanent
Culvert
UT to Abbotts
eek
Corps
3
100
40
Creek
JTto
E -4 -Permanent
R-7 - Permanent
UT to Abbotts
%,nbotts
Intermittent
3
100
40
Creek
k
S-1 - Permanent
Rip Rap
UT to Abbotts
Perennial
Corps
Total Stream Impacts
100
Wetland Impact
Creek
Creek
rea of
Number -
Type of
Type of
UT to Abbotts
Type of
Impact
3
40
Forested
Permanent or
Impact
Wetland
UT to Abbotts
Jurisdiction
Corps
3
Temporary
Creek
(acres)
',t
Culvert
Ditch
UT to Abbotts
Intermittent
0.009
3
40
Total Wetland Impacts
0.009
Table 3. Nationwide Permit 3 Impacts: Subdivision Road
Caleb's Creek
IMPACT LOCATION MAP
USACE AID#: SAW -2015-01697
HUC: 030401030202
Stream Impact
Type of
Stream Name Perennial or
Type of
Average
Impact
Number -
Impact
P-2 - Permanent
Intermittent
Jurisdiction
Stream
Length
Permanent or
I
0.2
P -4a - Permanent
Rip Rap
Width
(linear feet)
Temporary
Rip Rap
Pond
0.09
P-Sa - Permanent
(feet)
Pond
E-1 - Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
40
Creek
1.04
E -2 -Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
40
Creek
Creek
E -3 -Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
40
Creek
Creek
E -4 -Permanent
Culvert
UT to Abbotts
Intermittent
Corps
3
100
40
Creek
Creek
S-1 - Permanent
Rip Rap
UT to Abbotts
Perennial
Corps
6
100
40
Creek
Creek
U -6 -Temporary
Sewer
UT to Abbotts
Total Stream Impacts
Soo
Open WaterType
Impact Number-
Permanent or
Temporary
of
Impact
Waterbody,
Type
Area of
Impact
(acres)
P-1 - Permanent
Fill
Pond
0.2
P-2 - Permanent
Fill
Pond
0.2
P-3 - Permanent
FIII
Pond
0.2
P -4a - Permanent
Rip Rap
Pond
0.1
P -4b - Permanent
Rip Rap
Pond
0.09
P-Sa - Permanent
Rip Rap
Pond
0.18
P -Sb - Permanent
Rip Rap
Pond
0.07
Corps
6
40
Total Open Water Impacts
1.04
Table 4. Nationwide Permit 12 Impacts: Subdivision Sanii
Stream Impact
Type of
Stream
Perennial or
Type of
Average
Impact
Number -
Impact
Name
Intermittent
Jurisdiction
Stream
Length
Permanent or
Width
(linear
Temporary
(feet)
feet)
U-1 -Temporary
Sewer
UT to Abbotts
Perennial
Corps
6
40
Creek
U -2 -Temporary
Sewer
UT toAbnottS
Perennial
Corps
6
40
Creek
U -3 -Temporary
Sewer
UTtoMbotts
Perennial
Corps
6
40
Creek
U-4 - Temporary
Sewer
UT to Abbotts
Perennial
Corps
6
40
Creek
U-5 - Temporary
Sewer
UT to Abbots
Intermittent
Corps
3
40
Creek
U -6 -Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
U -7 -Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
U-8 - Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
U-10 - Temporary
Sewer
Abbotts Creek
Perennial
Corps
20
60
U-12 - Temporary
Sewer
UT to Abbotts
Intermittent
Corps
3
40
Creek
Total Temporary Stream Impacts
420
Wetland Impact
Type of
Type of
Forested
Type of
Area of
Number -
Impact
Wetland
Jurisdiction
Impact
Permanent or
(acres)
Temporary
U -B - Temporary
Sewer
Bottomland
yes
Corps
0.02
Hardwood Forest
U -9 -Temporary
Sewer
Bottomland
Yes
Corps
0.06
Hardwood Forest
U -11 -Temporary
Sewer
Bottomland
Yes
Corps
MIS
HardwnoAForest
Total Temporary Wetland Impacts
0.14
m
P-3
a / P -4b
P-2
-5a / P -5b
1
f
��WETLANDS
�I N I� �I
.,1, �& WATERS 1 1,000ft

Table 1. Nationwide Permit 14 Impacts: Public Thoroughfare Road
Stream NnP— Type o, S. Name P—noi.l or
Type of
Arer4p
Pipe Letrgtb
Rip Rap
,,.,r.— Intermittent
IorNdictioo
Stream
PermaneM
Length
Permanmtor
WiAh (lee[)
(Rrtex/eel(
Temporary
Temporary
(Nrteir hell
R-] - Pemnanent Culvert Perennial
Corps
6
im
50
R -4 -Permanent Culvert *tvldbnt` Intermittent
Corps
3
15
40
R -S - Permanent Culvert Intermittent
-C—
Cprpz
3
75
40
R -6 -Permanent C.1— Perennial
Corps
ZO
TS
40
7 1Strcam Imports
330
]Jtl
Wet nd Impact
Type of
Typed
Torated
Type d
Area d
Number-
N.W
WdhM
lura notion
Impatt
Permanent or
laved
Tempo ary
Corps
0.046
R-3- Permanent
Culvert
Ves
Table 2. Nationwide Permit 29 Impacts: Subdivision Road
Table 3. Nationwide Permit 3 Impacts: Subdivision Roads and Dams R-2 --
U-3
Stream lmpatt Typed Stream Name Perennial or Typed Avenge Nnpatt
Number- lmpxt Imermittent lurisdktlon Stream Length
Permanent or WWM Ilatexhe) R -1a -
Temporary (teetf
E -1 -Permanent Culvert r corps 3 1]J
Caleb's Creek
IMPACT LOCATION MAP
USACE AID#: SAW -2015-01697
HUC: 030401030202
R-4 } ';<
Existing S.S.
eeeeea•.eee••ee.ee. Conceptual S.S.
............. Proposed S.S.
Table 4. Nationwide Permit 12 Impacts: Subdivision Sanitary
Sewer
❑
❑
❑
El
F]
Mixed Use
Residential -Low Density
Residential - Medium Density
Residential - High Density
Commercial I Office
Amenity
School
Stream lmpatt Typed 6tream Pemnnhl or Typed Average NnP—
Number- Impact Name IMermbtent lxlstll— Stream length
Pxmane— Width (Ynear
Ue Pl hen
-
- - - -
-..;n„.,r, ;:,,�.,- ..... ... •. ,,:.
rend umpPwry smeam anparN
Wetland Impact Type of Typed yorested Type of Arend
Number- Impact Wetlaod lurisdlction Impart
Perm—M or (xrasl
Tem n
Toful Temporary Wetbne briefs
WETLANDS
. Tr
e Y& WATERS
– U-8
R-3
— U-9
— P-3
P -4a / P -4b
� P-2
- P -5a / P -5b
P i
S-1
TN L1,000nJ

ProP. nershed lm ervioos CMO I Ions And Trxkin
SITE DATA:
ADDRESS; TEAGUE LANE
CURRENT OWNERS:
BOYO J. AND MANUELA H. SRO"
S0.00
007.4mLOCR662S11SE
20' ZONE 230' ZONE 1
RIETATIIE
rU
]0' ZONE 1
20' ZONE 2
I VES TIVE
SPIN:
D.S.3067 F0. MIC
BUFFER BUFFER��
(—UNI
QED
ER I—
MFA IN TEAWE RO RNl:0.12 ACRES
ew../buff-
master zoning Alar
$
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MEAINR 7. 3516ACRES
MDt[C.
AREA IN LOTS: 2134 ACRES
AREA IN 630 ACRES
SEE GUILFORD COUNTY
AREA OPENNEW
SP:
IN OPEN SPACE: 6.67 ACRES
DEVELOPMENT ORDINANCE FOR
AREA IN TEAGUE PARK: 1.M ACRES
BUFFER RESTRICTIONS.
NUMBER OF LOTS: B6
LINEAR FEET OF STREET, IEIOV
BUFFERS ME TO BE MEASURED
FROM TOP OF STREAM BANK.
ZONING
RIPARIAN
BUFFER
DETAIL
EXISTING ZONNO: MU!
NTS
MUNI DEVELOPMENT STANDARDS:
MINIMUM LOT SIZE: 8060 SOFT.
MINIMUM FRONTAGE: M
FRONT SETBACK S
SIDE SETBACK: D
REM SETBACK O
MAX WIUM H910KT: SS
AVO. LOT SIZE M RL -7 PROPOSED, 10AW OF
WATERSHED DATA
WATERSHED: LOWER ABS0TTS CREEK
DIST. TO FLOODWAY: 400
SOIL TYPES, TIn9, FM:, CoA, BID, FIF
AVO. SLOM: 7%
NOTES:
PROPERTY WLL BE SERVED BY PUBLIC WATER AND SANITARY
SEWER.
RESIDENTIAL STREETS WILL BE PUBLIC AND CONSTRUCTED TO TOWN OF KERNERSVILLE
STANDARDS,
ALL CONSTRUCTION 18 TO BE TO THE TOWN OF KERNERSVILLE STANDARDS AND SPECIFICATIONS.
FORSYTH COUNTY URLITY COMMISSION STANDARDS AND MODEM STANDARDS.
THIS PROPERTY IS LOCATED WITHIN ZONE X AS INDICATED ON THE FLOOD INSURANCE RATE AMP
(FIRM) MAP NUMBER 3710687400A EFFECTIVE DATE JANUARY 06, 2000,
NO N.C.G.S. MARKER WITHIN 20DO FEET Or PROPERTY.
THIS IMP DOES NOT MEET 0.8.47-30 AND M NOT FOR RECORDING OR CONVEYANCE.
THIS MAP IB OF EXISTING PARCELS OF LAND. PROPERTY LINE SHOWN IB BASED ON FIELD
LOCATIONS ONLY, NO BOUNDARY WAS PERFORMED AS PART OF THIS TOPOGRAPHIC SURVEY.
THIS MM IS SUBJECT TO ANY AND ALL EASEMENTS, RIGHT OF WAYS, AND AGREEMENTS NOT
VISIBLE OR APPARENT AT THE TIME OF THE SURVEY,
THE SURVEYOR HAS NOT PERFORMED A TITLE SEARCH, THEREFORE. THIS MAP 19 SUBJECT TO ANY
AND ALL FACTS AN ACCURATE TTILE SEARCH MAY DISCLOSE,
NO SUBSURFACE INVESTIGATION WAS PERFORMED BY FLEMING ENGINEERING. VISIBLE
APPURTENANCES SHOWN PER FIELD LOCATIONS.
SITE BENCH 1 IS NAIL SET WITH COORDINATES OF N.W2S6.20 E. 16"W.32, ELEVATION
810.11. SITE BENCHMARK 2 I NAIL BET WITH COORDINATES OF K 641264.64 E. 1670433.84,
ELEVATION 660.30
THIS SITE M PART OF APPROVED ORDINANCE 04116-01,
STREET LIGHTS ARE TO BE LED.
RETAINING WALL FOR SITE SHALL REQUIRE BUILDING PERMIT.
WITHIN ALL RESIOENTML AREAS STREETYAID TREES SMALL BE PLACED EITHER WITHIN 20 OF THE
RIGHT OF WAY OR EASEMENT, OR WITHIN THE RIGHT-OF-WAY OF A PUSUC SERVICES APPROVED
UTLITY CORRIDOR PVN. THE MINIMUM PLANTING INTERVALS SHALL BE ONE TREE PER LOT OR SO-
ON CENTER WHICHEVER 19 LESS.
ca�e�'s cree�C
Impact Area
RL -7
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master zoning Alar
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Buffer to be re -vegetated
following grading
TYPICAL OM6A. rE3CUL
MtA LM TO 8E 6LACX CORRE11— TO TOWN OF XERN6R4MLLE TYPfN.
TrolcM EMroPr TReF —11— Ivo BASLE oR NORTHERN REo oAX
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VICINITY MAP
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PI! 6874d63S80.00
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CAROLINA LIC
PIN: 6671.556060100
DA. 2064 fig, 3103
PRELIMINARY f�° Q
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�. Impact Area Buffer to be re -vegetated = �°`� Y..y� I : �•
RL -7 following grading >,
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' �'�'+•»• rEA«n 1wEAq q,aa ORAE
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I DENSITY CALCULATIONS:
WATERSHED SITE DATA: PRELIMINARY
"oaE""a w ql - ..
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master zoning Plan
,.,,�

Caleb's Creek Project - Kernersville, NC
(Conceptual sketch plans provided as an illustrative description of proposed activities. Final design to be determined by project engineer.)
Culvert buried 1 ft.
below existing
stream bed elevation
Culvert Cross -Section
Looking Up Stream
(not to scale)
=k�
Culvert Profile View
(not to scale)
Sill 1 ft. above existing
stream bed elevation
existing stream bed Sill 1 ft. above existing
t — — — — — — — — — — — — — — — — V
flow stream bed elevation
Inverts to be placed
1 foot below existing
stream bed elevation
fN

existing stream bed
Culvert Profile View
(not to scale)
WT MAX. R*W-OF-WAY
flow ---
Inverts to be placed
1 foot below existing
,tream bed elevation
existing stream bed
Sill placed at
flood -prone
bench elevation

Mitigation Services
ENVIRONMENTAL QUALITY
Kory Reimann
BOMA NC, LLC
1668 Ridge Point Drive
Bountiful, UT 84010
Project: Caleb's Creek
R01 COOPER
January 17, 2017
Expiration of Acceptance: July 17, 2017
County: Forsyth
The purpose of this letter is to notify you that the NCDEQ Division of Mitigation Services (DMS) is willing to accept
payment for compensatory mitigation for impacts associated with the above referenced project as indicated in the
table below. Please note that this decision does not assure that participation in the DMS in -lieu fee mitigation
program will be approved by the permit issuing agencies as mitigation for project impacts. It is the responsibility
of the applicant to contact permitting agencies to determine if payment to the DMS will be approved. You must
also comply with all other state, federal or local government permits, regulations or authorizations associated with
the proposed activity including G.S. § 143-214.11.
This acceptance is valid for six months from the date of this letter and is not transferable. If we have not
received a copy of the issued 404 Permit/401 Certification/CAMA permit within this time frame, this
acceptance will expire. It is the applicant's responsibility to send copies of the permits to DMS. Once DMS
receives a copy of the permit(s) an invoice will be issued based on the required mitigation in that permit and
payment must be made prior to conducting the authorized work. The amount of the in -lieu fee to be paid by an
applicant is calculated based upon the Fee Schedule and policies listed at http://portal.ncdenr.org/web/eep.
Based on the information supplied by you in your request to use the DMS, the impacts that may require
compensatory mitigation are summarized in the following table. The amount of mitigation required and assigned
to DMS for this impact is determined by permitting agencies and may exceed the impact amounts shown below.
Llmpact
River CU Location Stream (feet) +,. Wetlands (acres) Buffer I Buffer II
Basin (8 -digit HUC) (Sq. Ft.) (Sq. Ft.)
-r --
Cold TCool7-Warm Ri avian Non-Riparian�—.-_-i
---- -- _._ �__--Coastal Marsh _
Yadkin 03010403 0 I 0 465 0 0 -+ — 0 --( 0 0
I i _
Upon receipt of payment, DMS will take responsibility for providing the compensatory mitigation. The mitigation
will be performed in accordance with the In -Lieu Fee Program instrument dated July 28, 2010 and 15A NCAC
02B .0295 as applicable. Thank you for your interest in the DMS in -lieu fee mitigation program. If you have any
questions or need additional information, please contact Kelly Williams at [phone].
cc: Perry Isner, agent
Sincerely,
James./'`B Stanfill
AsseNnagement Supervisor
State of North Carolina Environmental Quality Mitigation Sen ices
1652 Mail Sen ice Center , Raleigh. NC 2 7699-1652 217 W_ Jones Street, Suite 300
919 7078976 T

PAT XleCRORY
SUSAN KLtTTZ
NCNHDE-2333
October 7, 2016
Perry Isner
Wetlands & Waters, Inc.
2712 Minden Rd.
Pleasant Garden, NC 27313
RE: Caleb's Creek
Dear Perry Isner:
The North Carolina Natural Heritage Program (NCNHP) appreciates the opportunity to provide information
about natural heritage resources for the project referenced above.
A query of the NCNHP database, based on the project area mapped with your request, indicates that there are
no records for rare species, important natural communities, natural areas, or conservation/managed areas
within the proposed project boundary. Please note that although there may be no documentation of natural
heritage elements within the project boundary, it does not imply or confirm their absence; the area may not have
been surveyed. The results of this query should not be substituted for field surveys where suitable habitat exists.
In the event that rare species are found within the project area, please contact the NCNHP so that we may
update our records.
The attached `Potential Occurrences' table summarizes rare species and natural communities that have been
documented within a one -mile radius of the property boundary. The proximity of these records suggests that
these natural heritage elements may potentially be present in the project area if suitable habitat exists and is
included for reference. Tables of natural areas and conservation/managed area within a one -mile radius of the
project area, if any, are also included in this report.
Please note that natural heritage element data are maintained for the purposes of conservation planning, project
review, and scientific research, and are not intended for use as the primary criteria for regulatory decisions.
Information provided by the NCNHP database may not be published without prior written notification to the
NCNHP, and the NCNHP must be credited as an information source in these publications. Maps of NCNHP
data may not be redistributed without permission.
The NC Natural Heritage Program may follow this letter with additional correspondence if a Dedicated Nature
Preserve (DNP), Registered Heritage Area (RHA), Clean Water Management Trust Fund (CWMTF) easement,
or Federally -listed species are documented near the project area.
If you have questions regarding the information provided in this letter or need additional assistance, please
contact Suzanne Mason at suzanne.mason(@ncdcr.gov or 919.707.8637.
Sincerely,
NC Natural Heritage Program
'Nothing Compares
��r

Natural Heritage Element Occurrences, Natural Areas, and Managed Areas Within a One -mile Radius of the Project Area
Caleb's Creek
October 7, 2016
NCNHDE-2333
No Element Occurrences are Documented Within a One -mile Radius of the Project Area
No Natural Areas are Documented Within a One -mile Radius of the Project Area
Managed Areas Documented Within a One -mile Radius of the Project Area
Managed Area Name Owner > Owner Type
Forsyth County Open Space Forsyth County: multiple local government Local Government
Definitions and an explanation of status designations and codes can be found at hftps;//ncnhde.natu[eserve.org/­­content/help. Data query generated on October 7, 2016; source: NCNHP, Q2 June 2016. Please resubmit your
information request if more than one year elapses before project initiation as new information is continually added to the NCNHP database.
Page 2 of 3

NCNHDE-2333: Caleb's Creek
Octubet 7, 20'6
1771 Project Boundary
Buffered Project Boundary
Managed Area (MAREA)
Page 3 of 3
1:48.067
04 06 1.6 mi
0 05 T km
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F40 NFS. NRCAN GeoBase, IGN. Kadxta N_. Ctdmnce Simey. Esr, Japan.
ME 11 2. Ch— 1�•Y w+^II — ,f Gw,n�•yb Me, C Cy 3—h`I.w
cor* bums. and tt» GIS Csm Command+

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2015-01697 County: Forsyth U.S.G.S. Quad: NC-KERNERSViLLE
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner: Boma North Carolina, LLC
Mark Brown
Address: 1668 Ridge Point Drive
Bountiful, UT, 84010
Telephone Number:
Size (acres) 875
Nearest Waterway Abbotts Creek
USGS HUC 03040103
:x =
Nearest Town Kernersville
River Basin Lower Yadkin
Coordinates Latitude: 36.062387
Longitude: -80.091225
Location description: Boma North Carolina, LLC property known as the proposed Caleb's Creek development located off of
the intersection of Teague Lane and Ogden School Road, adjacent to Abbotts Creek, south of Kernersville, in Forsyth County,
North Carolina.
Indicate Which of the Following Apply:
A. Preliminary Determination
_ Based on preliminary information, there may be waters of the U.S. including wetlands on the above described project area
We strongly suggest you have this property inspected to determine the extent of Department of the Army (DA)
jurisdiction. To be considered final, a jurisdictional determination must be verified by the Corps. This preliminary
determination is not an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33
CFR Part 331). 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.
B. Approved Determination
_ There are Navigable Waters of the United States within the above described project area subject to the permit requirements
of Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law
or our published regulations, this determination may be relied upon for a period not to exceed five years from the date of
this notification.
X There are waters of the U.S. including wetlands on the above described project area subject to the permit requirements of
Section 404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
_ We strongly suggest you have the waters of the U.S. including wetlands on your project area delineated. Due to the
size of your property and/or our present workload, the Corps may not be able to accomplish this wetland delineation in a
timely manner. For a more timely delineation, you may wish to obtain a consultant. To be considered final, any
delineation must be verified by the Corps.
X The waters of the U.S. including wetlands on your project area have been delineated and the delineation has been
verified by the Corps. We strongly suggest you have this delineation surveyed. Upon completion, this survey should be
reviewed and verified by the Corps. Once verified, this survey will provide an accurate depiction of all areas subject to
CWA jurisdiction on your property which, provided there is no change in the law or our published regulations, may be
relied upon for a period not to exceed five years.
Page 1 of 2

_ The waters of the U.S. including wetlands have been delineated and surveyed and are accurately depicted on the plat
signed by the Corps Regulatory Official identified below on Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
_ There are no waters of the U.S., to include wetlands, present on the above described project area which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
_ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act
(CAMA). You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to
determine their requirements.
Placement of dredged or fill material within waters of the US and/or wetlands without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). If you have any questions regarding this
determination and/or the Corps regulatory program, please contact John Thomas at 919-554-4884 x25 or
John.T.Thomas.JR(a),usace.army.mil.
C. Basis For Determination: Site inelndes tributaries ojAbbotts Creek which flows to the Yadkin River and on to
rhe Atlantic Ocean.
D. Remarks:
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the
particular site identified in this request. The del ineation/determination may not be valid for the wetland conservation
provisions of the Food Security Act of 1985. if you or your tenant are USDA Program participants, or anticipate participation
in USDA programs, you should request a certified wetland determination from the local office of the Natural Resources
Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in
B. above)
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room IOM 15
Atlanta, Georgia 30303-8801
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP.
Should you decide to submit an RFA orn, it must be received at the above address by 10104/2015.
**it is not necessary to submit an 'A form to the Wivision O tce if you do not object to the detennination in this
correspondence.** /
Corps Regulatory Official ---
Date: 8/04/2015

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NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
.REQUEST FOR APPEAL
Applicant: Mark Brown
Boma North Carolina LLC
File Number: SAW-2015-01697
Date: August -1, 201
Attached is:
See Section below
INITiA l., PROFFERED PERMIT (Standard Permit or Letter ofpermission)
A
PROFFERED PERMIT (Standard Permit or Letter of permission)
_ B
PERMIT DENIAL
C
APPROVED JURISDICTIONAL DETERMINATION
D
PRELIMINARY JURISDICTIONAL DETERMINATION
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at hitp•!!Nvww usace.arny.mi1 MissionsiCiviIWorks, ReggIatot3•ProgramandPermits.aspx or
Corps regulations at 33 CFR Part 331.
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 teens 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. 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.
• 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 11 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 1D 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.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
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.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
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
Attn: John Thomas
CESAD-PDO
U.S. Army Corps of Engineers, South Atlantic Division
60 Forsyth Street, Room I OM 15
Atlanta, Georgia 30303-8801
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 op ortunit to participate in all site investigations. _
Date: Telephone number:
Signature of appellant oragent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, John Thomas,
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]

TOWN OF KERNERSVILLE
P.O Box 728
Kernersville. NC 27285-0728
June 28, 2016
Mr. John Thomas
USACE Wilmington District
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Ste 105
Wake Forest, NC 27587
Re: Town of Kernersville Thoroughfare Roads
Calebs Creek Development
Dear Mr. Thomas,
Dawn H. !Horgan. Nla"or
Curtis L. Swisher. Town Nlanaeer
134 East Mountain Street
Telephone [phone]
Fax [phone]
The purpose of this letter is to express the Town of Kernersville's support of the construction of
thoroughfare and collector roads within the Calebs Creek Development. The roads are part of our
progressive transportation planning and are depicted on our 2011 adopted Thoroughfare and Street
Plan as attached. In this case, these corridors link Teague Lane with both Union Cross Road and
Highway 66 for access to Interstate 40. In addition to better access to Calebs Creek these public
roads ensure safe passage of vehicles detoured off of Interstate 40 in the event of an accident and or
construction.
The Town of Kernersville will act as a joint applicant for the processing of permits to impacts
streams for the construction of roads that are part of the Town's thoroughfare plan. The developer
will be responsible for all costs and permit compliance within the Calebs Creek project area.
Inter -agency cooperation is imperative when it comes to a project of this scope, and thus the Town
of Kernersville would ask the Corps to please advise us if there is any additional information that
we can provide in advance of the forthcoming application by the developer.
If you have any questions or concerns, please do not hesitate to contact me. 'Thank you for your
time on this matter.
Sincerely,
Jeffrey AICP
Community Development Director
ALDERMEN
Kenny Crews - Irving Neal - Joe L. Pinnix Jr. - Tracey H. Shitllette - Chris Thompson
NORTH CAROLINA'S
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ADUPIED: MAY I, 1979
AMENDED: IDLY 2,198!i
AMENDED: NIA 6, 1996
AHE\DED: 02/012000
KDP-2 / K.04-00
- AMENDED 02/02/2002
311
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KUP-3 / R-2002-11
tiY AMENDED 07/0512005
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•
AMENDED: 05/01/2907
WATIGNS FOR S•:Y::,S..
KDP-21 /
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tm.n of Kemers, i0e AMENDED: 12/0412007
C-1111"it, D—Ie pmen, Dep,. KDP-25 / R-200741
G 15736,992s4b0 AMENDED: 10/0612 9
KDP-30 / R-2009-32
Pain, Do,: 12/12/2012 AMENDED: 12/0612011
'y 311
KDP-34 / R-2011-20
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