20240840 Ver 1_10846_Burke Mill Rd_PCN App_06.18.24_20240619

NORTH CAROLINA
EnWronmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2024-01005 Date received: 6/18/2024
DWR project no. [Click enter.] Date received: 6/18/2024
Site Coordinates:
Latitude (DD.DDDDDD): 36.060898'
Longitude (DD.DDDDDD):-80.291724'
Form Version 4.3, 1210412023
Pre -Construction Notification (PCN) Form
(Ver. 4.2, 1210412023)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all
mandatory questions are answered.
The PCN help document may be found at this link:
https:Hedocs.deg. nc.gov/WaterResources/DocView.aspx?dbid=0&id=2196924&cr=1
Pagel of 20 PCN Form Version 4.3- December 4, 2023

A. Processing Information
County (counties) where project is located: *
Forsyth Additional (if needed).
Is this an ARPA project?
❑ Yes Z No
If yes, ARPA project number:
* The project number can be found on the "Letter of Intent to Fund"
(LOIF) or "Offer and Acceptance Letter". If you are unable to locate
Click or tap here to enter text.
your DWI ARPA Funding Project Number, please contact Corey
Basinger at core y.basinger[ ncdenr.gov for further assistance.
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
❑ Yes ❑x No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes Z No
or airport project)
Is this a NCDOT project?
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to enter.
X Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑ Yes Z No
Please provide the date of the previous submission. *
Clink to antar a riata
❑x Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
El Regional General Permit (RGP)
authorization?
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as attachments and
submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes ❑x No
NWP number(s) (list all numbers ):
29
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes ❑x No
If yes, please provide a statement concerning compliance with
the Coastal Zone Management Act
Click to enter text
1d. Type(s) of approval sought from DWR (check all that apply):
❑ 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
❑x Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes ❑x No
Page 2 of 20 PCN Form Version 4.3- December 4, 2023

1 e.
Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification:
❑ Yes
0 No
For the record only for Corps Permit:
❑ Yes
0 No
1f.
Is this an after -the -fact permit/certification application? *
❑ Yes
0 No
1g.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
❑ Yes
0 No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h.
Is the project located in any of NC's twenty coastal counties? *
❑ Yes
0 No
1 i.
Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑ Yes
0 No ❑ Unknown
1j.
Is the project located in a designated trout watershed? *
❑ Yes
0 No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.miI/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 20 PCN Form Version 4.3- December 4, 2023

B. Applicant Information
1a.
Who is the primary contact?
Alex Zendah (Anchor Properties of Raleigh, LLC)
1 b.
Primary Contact Email:
[e-mail]
1 c.
Primary Contact Phone: (###)###-####
[phone]
1 d.
Who is applying for the permit/certification? (check
all that apply)
® Owner ❑ Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed:
Anchor Properties of Raleigh, LLC
2b.
Deed Book and Page No.:
003804/02874
2c.
Contact Person (for corporations):
Alex Zendah
2d.
Address
Street Address:
503 Wrennstone Court
Address line 2:
Click to entei.
City:
Apex
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27539
Country:
US
2e.
Telephone Number: * (###)###-####
[phone]
2f.
Fax Number: (###)###-####
Click to entei.
2g.
Email Address:
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
Click to enter.
3b.
Business Name (if applicable):
Click to enter.
3c.
Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: * (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
3f.
Email Address:
Click to enter.
Page 4 of 20 PCN Form Version 4.3- December 4, 2023

4. Agent/ Consultant (if applicable)
4a. Name: *
Catherine L. Carston
4b. Business Name:
Pilot Environmental, Inc
4c. Address: *
Street Address:
743 Park Lawn Court
Address line 2:
Click to enter.
City:
Kernersville
State/ Province/ Region:
NC
Postal/ Zip Code:
27284
Country:
US
4d. Telephone Number: * (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to enter.
4f. Email Address: '
[e-mail]
Agent Authorization Letter:
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw. usace.army.mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 20 PCN Form Version 4.3- December 4, 2023

C. Project Information and Prior Project History
1. Project Information
la. Name of project: *
Anchor Acres Subdivision
1 b. Subdivision name (if appropriate):
Click to enter.
1 c. Nearest municipality/town: *
Winston-Salem, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
6814-83-3630
2b.
Property size (in acres):
4.49
2c.
Project Address:
Street Address:
1861 Burke Mill Road
Address line 2:
Click to enter
City:
Winston-Salem
State/ Province/ Region:
NC
Postal/ Zip Code:
27103
Country:
US
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point):
Latitude (DD.DDDDDD): 36.060898'
Longitude (-DD.DDDDDD):--80.291724°
3. Surface Waters
3a. Name of nearest body of water to proposed project:
Salem Creek
3b. Water Resources Classification of nearest receiving
Class C
water:
The Surface Water Classification map may be found at this link:
https:Hncdenr. maps.arcqis.com/apps/webappviewer/index. html?id=6el 25ad7628f494694e259c8Odd64265
Yadkin-PeeDee
3c. In what river basin(s) is your project located?`
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030401011305
located:
The Find Your HUC map may be found at this link:
https:Hncdenr.maps.arcqis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 20 PCN Form Version 4.3- December 4, 2023

4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application:
The site contains wooded land. A dilapidated agricultural structure is located on the central portion of the site.
The site is located in a residential area of Winston-Salem.
4b. Have Corps permits or DWR certifications been obtained for this
❑ Yes X No ❑ Unknown
project (including all prior phases) in the past?
If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
jClick to enter.]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete?
❑ Yes ❑x No
If yes, describe the completed work.
r lirlr to antar text.
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
Click to enter text.
4d. Attach an 8'/ x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'/ x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
0 acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
404 linear feet
and perennial) on the property:
4g1. List the total estimated acreage of all existing open waters on the
0 acres
property:
4h. Explain the purpose of the proposed project:
The purpose of the proposed project is to develop the site with Anchor Acres single family residential subdivision.
4i. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of Anchor Acres subdivision, a 13-lot single family residential
community. In order to access the site, it is necessary to impact a perennial stream with a road crossing. To
facilitate the development of the site, clearing and grading is necessary. Graders, haulers, excavators and other
heavy equipment will be used during grading and construction of the site.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters?
❑ Yes X No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
LACK to enter tex.
Page 7 of 20 PCN Form Version 4.3- December 4, 2023

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on
the property or in
0 Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
5b.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made? *
0 Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2024-01005
Name (if known): Brad Luckey/Catherine Carston
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental, Inc
areas?
Other: - 1inL- +„ nnfn-
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
PJD Requested, Not issued yet
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes Z No
6b. If yes, explain.
Click to enter.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to
authorize any part of the proposed project or related activity? This includes other separate and distant crossings
for linear projects that require Department of the Army authorization but don't require pre -construction
notification.
No other permits are intended to be used.
7. Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
Two property owners adjoin the waterbody, up -gradient of the impact as well as two property owners adjoin the
waterbody, down -gradient of the impact. See attached.
8. Scheduling of activity:
Prior to expiration of 404/401 authorizations
Page 8 of 20 PCN Form Version 4.3- December 4, 2023

D. Proposed Impacts Inventory
Impacts Summary
❑ Wetlands 0 Streams - tributaries
la. Where are the impacts associated with your project ❑ Buffers ❑ Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #
2a1.
Impact
Reason/Type
2b.
Impact
Duration*
2c.
Wetland Type
2d.
Wetland Name
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W2
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W3
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W5
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
0.hoose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
Click to enter. ac
2g3. Total wetland impacts
Click to enter. ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
Click to enter text.
Page 9 of 20 PCN Form Version 4.3- December 4, 2023

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
3a
3b.
3c.
3d.
3e.
3f.
3g.
3h.
Site #*
Impact
Impact
Impact Type*
Stream Name*
Stream
Jurisdiction
Stream Width
Impact length
Reason*
Duration*
Type"
Type*
(avg ft) *
(linear ft)
S1
Road Crossing
Permanent
Crossing/
Unnamed/SA
Perennial
Both
3.736932
147.68
Culvert
S2
Rip Rap
Permanent
Fill (Incl.
Unnamed/SA
Perennial
Both
4
20.66
Riprap)
S3
Coffer Dam
Temporary
Dewatering
Unnamed/SA
Perennial
Both
4
35.27
S4
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
0 linear ft
impact:
3i2. Total permanent stream
168.34 linear ft
impacts:
M. Total temporary stream
35.27 linear ft
impacts:
3i4. Total stream and ditch
203.61 linear ft
impacts:
3j. Comments:
The proposed culvert and road crossing fill will permanently impact 147.68 linear feet (0.012 acres) of perennial stream. The
proposed keyed in rip -rap dissipater will permanently impact 20.66 linear feet (0.001 acres) of perennial stream. The
proposed coffer dam and pump around will temporarily impact 35.27 linear feet (0.001 acres) of perennial stream. Areas of
temporary impact will be restored to similar pre -construction grades, seeded with native herbaceous vegetation and stabilized
with natural fiber matting as applicable. Mitigation is not required or proposed for net loss of stream.
Page 10 of 20 PCN Form Version 4.3- December 4, 2023

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., individually list all open water impacts in the table below.
4a.
Site #
4a1.
Impact Reason
4b.
Impact
Duration*
4c.
Waterbody Name
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
UICK to enter.
Temp/ Perm
UICK to enter.
Choose one
Choose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Open water impacts are not proposed.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete
the table
below. (*This
does NOT include offline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Click to enter.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter.
Page 11 of 20 PCN Form Version 4.3- December 4, 2023

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
(Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
131
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
132
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
133
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
134
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
135
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
136
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
137
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
138
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
139
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
1311
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Buffer impacts are not proposed.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 20 PCN Form Version 4.3- December 4, 2023

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The applicant has designed the remainder of the proposed development to avoid impacts to remaining streams. The
applicant has designed the proposed Lots 1,2, 11 and 12 to avoid net loss of additional waters from residential pads or
driveways. The applicant is utilizing a headwall and retaining walls to avoid additional net loss impacts to streams
from grading.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The clearing limits will be staked and silt fence or other BMPs will be used. Temporary coffer dams will be installed
around the construction footprint. 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
materials will be immediately removed from the crossing area and stockpiled in upland locations. Upon completion of
the culvert installation, the temporary sand bag coffer dams will be removed and flow will be diverted through the
culvert. Following installation of the culvert, areas of temporary stream impact will have stream beds and banks
restored to similar pre -construction grade. The stream banks will be matted with biodegradable materials and
seeded/live staked with native species.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? ❑ DWR ❑ Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? (check all that apply) ❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested:
Click to enter. linear feet
4c. If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https:Hribits.usace.army.miI/ribits apex/f?p=107:27:2734709611497::NO:RP:P27 BUTTON KEY:O
4d. Buffer mitigation requested (DWR only):
Click to enter. square feet
Page 13 of 20 PCN Form Version 4.3- December 4, 2023

4e. Riparian wetland mitigation requested:
Click to enter. acres
4f. Non -riparian wetland mitigation requested:
Click to enter. acres
4g. Coastal (tidal) wetland mitigation requested:
Click to enter. acres
4h. Comments:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
Click to CI ILCI
05b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffer
that requires buffer mitigation?
❑ Yes ❑x No
If yes, please complete this entire section — please contact DWR for more information.
6b.
If yes, identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required in the table below.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
'lick to enter.
Click to enter.
Choose one
:,lick to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or _F
NC Division of Mitigation Services proposed?
❑ Yes ❑ No
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Page 14 of 20 PCN Form Version 4.3- December 4, 2023

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
❑ Yes ❑x No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here.
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
❑ Yes ❑x No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?
0 Yes El No
To look up low density requirements, click here:
http://reports.oah.state.nc. us/ncac/title%2015a%20-%20environmental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑ Yes ❑x No
reviewed and approved under a state stormwater program or state -
approved local government stormwater program?
❑ n/a — project disturbs < 1 acre
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2d.
Which of the following stormwater management program(s) apply? _F
x❑ Local Government
(Check all that apply.)
El State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs
x❑ Phase II ❑ USMP
❑ NSW ❑ Water Supply
Page 15 of 20 PCN Form Version 4.3- December 4, 2023

Please identify which local government stormwater program you are using.
Winston-Salem/Forsyth County
State Stormwater Programs ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Click to enter.
Page 16 of 20 PCN Form Version 4.3- December 4, 2023

G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x No
funds or the 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 (North Carolina) Environmental
El Yes El No
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
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
A NEPA or SEPA is not required.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
❑ Yes ❑x No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
LACK to enter.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
❑ Yes Z No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
Additional development as a result of the proposed development is not anticipated.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdo
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? I ® Yes ❑ No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Additional impacts to streams or wetlands from sewer lines are not proposed.
Page 17 of 20 PCN Form Version 4.3- December 4, 2023

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected
❑ Yes 0 No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl)
5b. Have you checked with the USFWS concerning Endangered Species
❑ Yes 0 No
Act impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
;hoose one
5d. Is another federal agency involved?
❑ Yes 0 No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8?
❑ Yes 0 No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.?
®Yes El No
5g. Does this project involve bridge maintenance or removal?
❑ Yes 0 No
5g1. If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
❑ Yes ❑ No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http:Hsaw-reg.usace. army.mil/NLEB/1-30-17-signed NLEB-SLOPES&apps.pdf
If you answered yes to 5g1, did you discover any signs of bat use? *
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h. Does this project involve the construction/ installation of a wind
turbine(s)?
❑ Yes 0 No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdo
5i. Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes 0 No
mechanized pile drivers, etc.?
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdo
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat?
US Department of the Interior — Fish and Wildlife Service Official Species List from IPaC (Report attached)
Several listed species are identified on the IPaC report (attached). Tricolored bat (Proposed Endangered), Bog turtle
(Similarity of Appearance; Threatened), Monarch butterfly (Candidate) and Schweinitz's sunflower (Endangered).
The Bog turtle is listed due to similarity of appearance and is not afforded protection under Section 7. However, there
are not wetlands on the site, therefore the project would not be expected to effect the bog turtle. The Tricolored bat and
Monarch butterfly are not currently afforded protection under the ESA.
The project area consits of mature hardwoods with a densely vegetated mid and undertory that would not be consider
suitable habitat for Schweinitz's sunflower. Therefore, we have made a determination of no effect for Schweinitz's
sunflower.
Page 18 of 20 PCN Form Version 4.3- December 4, 2023

Attach consultation documentation. PaC report
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat?
El Yes x❑ No
Is there submerged aquatic vegetation (SAV) around
the project vicinity?
El Yes ❑x No El Unknown
Will this project affect submerged aquatic vegetation?
❑ Yes Z No ❑ Unknown
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper — NOAA Fisheries
7.
Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://qis.ncdcr.gov/hpoweb/
7a.
Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
El Yes x❑ No
properties significant in North Carolina history and archaeology)?
7b.
What data source(s) did you use to determine whether your site would impact historic or archeological
resources?
NC Historic Preservation Office's HPOWEB 2.0. Historic properties were not identified in the area of the impact or on
the site. Historic properties were not identified on properties within one mile of the site. A copy of the SHPO Map is
included as an attachment.
7c.
Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.ciov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes 0 No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
National Flood Hazard Layer from FEMA Web Map Service — Drawing 4 (Attached)
H. Miscellaneous
Comments:
Thank -you for your assistance.
Page 19 of 20 PCN Form Version 4.3- December 4, 2023

Attach pertinent documentation or attachments not previously requested
I. Signature *
X By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: Catherine L. Carston
Signature: * UI1cK to enter.
Date: 6/18/2024
Page 20 of 20 PCN Form Version 4.3- December 4, 2023

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Site Boundary
.J
-; USGS Topographic Map
Drawing 1 0
Burke Mill Road
USGS Topographic Map -
Approximate 4.48-Acre Tract
Winston-Salem West, NC Quadrangle -_
Winston-Salem, Forsyth County, NC
Scale: 1"=2,000' PILOT ENVIR0NMENTAE.INC Pilot Project10846

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of Forsyth County, NC PILOT
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Drawing 2A Published Soil Map
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of Forsyth County, NC -- a Approximate 4.48-Acre Tract
Published 1976DOo��� Winston-Salem, Forsyth County, NC
Scale: 1" = 600' ""°' `"v'"°""' E"'"`"` Pilot Project 10846

Drawing 3
USFWS NWI
Wetlands Mapper
Scale: 1" = 100'
LEGEND
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From FEMA Web Map Service
Scale: 1" = 600'
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Flag Number
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THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY THE USACE AND/OR THE NCDEQ
iovvn.THIS EXHIBIT INCLUDES GPSLOCATIONS OFDELINEATED FEATURES.
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and Pi|otGPS Data Approximate 4.48-AoreTract
Scale: 1"= 100' Winston-Salem, Forsyth County, NC

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: 1861 Burke Mill Road
Winston-Salem, NC 27103
Owner Information: Anchor Properties of Raleigh, LLC
Address: 503 Wrennstone Court
Telephone Number:
Fax Number:
E-mail Address:
ex, NC 27539
336-926-6395
[e-mail]
JURISDICTIONAL DETERMINATION REQUEST
D. PROPERTY ACCESS CERTIFICATION
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Alex Zendah
Print Name
Capacity: _ Owner X Authorized Agent
5/515/2024 /
Date
Signature'

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-----------------
6/11/2024, 1:51:02 PM 1:2,257
0 0.01 0.03 0.06 mi
O Address Points Parcels - Mailing Labels 0 0.03 0.05 0.1 km
------------
Forsyth County Boundary l___________I Legal Lot Lines
Streets Easement
FEMA, MapForsyth, Forsyth County Tax Administration
0 Parcels ITax Municipal Polygon
u Winston—Salem Forsyth County, NC
State of North Carolina DOT, Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS I See web site for license constraints. I FEMA, MapForsyth, Forsyth County Tax Administration I Forsyth County Tax

Forsyth County Property Record Card
Property Summary
Tax Year: 2024
REID 6814833630000 PIN
Location 1861 Burke Mill Property
Address RD Description
6814-83-3630 Property Owner
LO:008B Owner's Mailing
BL:3926 Address
Administrative Data
Transfer Information
Plat Book & Page
Deed Date
Old Map #
618842
Deed Book
Market Area
619843
Deed Page
Township
WINSTON-SALEM
Revenue Stamps
Planning
COUNTY WIDE
Package Sale Date
Jurisdiction
Package Sale Price
WINSTON-SALEM
City
CITY
Land Sale Date
Fire District
Land Sale Price
Spec District
Improvement Summary
Land Class
91.00-Vacant SF Res
Total Buildings
History REID 1
Total Units
History REID 2
Total Living Area
Acreage
4.48
Total Gross Leasable Area
Permit Date
Permit #
Photograph
Building Summary
Misc Improvements Summary
5/2/2024
003804
02874
$490
0
0
0
0
ANCHOR PROPERTIES OF
RALEIGH LLC
503 WRENNSTONE CT
APEX NC 27539
Property Value
Total Appraised Land Value
$59,100
Total Appraised Building Value
Total Appraised Misc
Improvements Value
Total Cost Value
$59,100
Total Appraised Value -valued By
$59,100
Cost
Other Exemptions
Exemption Desc
Use Value Deferred
Historic Value Deferred
Total Deferred Value
Total Taxable Value
$59,100
Card Unit Base Size Adj Eff Phys Depr Econ Depr Funct Depr Common Interest
# Quantity Measure Type Price Factor Year (% Bad) (% Bad) (% Bad) (% Good) Value
No Data
Total Misc Improvements Value Assessed:
Land Summary
Land Class: 91.00-Vacant SF Res Deeded Acres: 4.48
Zoning Soil Class Description Size
RS9 RES-ACREAGE 4.48 BY THE ACRE PRICE
Total Land Value Assessed: $59,100
Calculated Acres: 4.49
Rate Size Adj. Factor Land Adjustment Land Value
$16,500 TOPOGRAPHY-80.00 $59,100

Ownership History
Owner Name
Current
ANCHOR PROPERTIES OF RALEIGH LLC
1 Back
Palamaris, George
2 Back
Doby, Mary B Heirs
3 Back
Doby, Mary B Heirs
Notes Summary
Building Card
No Data
Deed Type % Ownership Stamps Sale Price Book Page Deed Date
DEED
100
490
$245,000 003804
02874
5/2/2024
DEED
100
280
$140,000 002503
03353
9/10/2004
DEED
100
0
000000
00000
12/3/1997
DEED
100
0
000000
00000
6/27/1997
Date
Line
Notes

Tax Parcel Viewer
WOODWORTH DR
i 686814 3-482.5.00'0 6814-83-5835. }
•1 65.000 14 3- 895. 00 -
i
------------
6814-84
94.22
------ 150.0
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6814-83-6771.000
6814-83-6673.000
6814- 3-65�74.000
6814-83-64�77.000
6/11 /2024, 4:46:13 PM 1:1,128
0 0.01 0.01 0.03 mi
O Address Points Parcels - Mailing Labels 0 0.01 0.02 0.04 km
------------
Forsyth County Boundary 1-----------J Legal Lot Lines
Streets Easement
FEMA, MapForsyth, Forsyth County Tax Administration
0 Parcels Tax Municipal Polygon
IWinston-Salem Forsyth County, NC
State of North Carolina DOT, Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS I See web site for license constraints. I FEMA, MapForsyth, Forsyth County Tax Administration I Forsyth County Tax

Forsyth County Property Record Card
Property Summary
Tax Year: 2024
6814832895000
6814-83-2895
MITROPOULOS, SERAFIM;GKOROGIA,
REID PIN
Property Owner
KALLIROI
Location 2940 Woodworth Property
LO:015
Owner's Mailing
2940 WOODWORTH DR
Address DR Description 131-:2925
Address
WINSTON SALEM NC 27103
Administrative Data
Transfer Information
Property Value
Plat Book & Page
Deed Date
9/14/2023
Total Appraised Land Value
$34,200
Old Map # 618842
Deed Book
003772
Total Appraised Building Value
$132,200
Market Area 619843
Deed Page
03935
Total Appraised Misc
$700
Improvements Value
Township WINSTON-SALEM
Revenue Stamps
$200
Total Cost Value
$167,100
Planning COUNTY WIDE
Package Sale Date
9/14/2023
Jurisdiction
Total Appraised Value -valued By
$167,100
Package Sale Price
$100,000
WINSTON-SALEM
Cost
City CITY
Land Sale Date
Other Exemptions
Fire District
Land Sale Price
Exemption Desc
Spec District
Use Value Deferred
Improvement Summary
Land Class 1.01-SFD Dwelling
Historic Value Deferred
Total Buildings
1
History REID 7
Total Deferred Value
Total Units
0
History REID 2
Total Taxable Value
$167,100
Total Living Area
1,568
Acreage 0.57
Total Gross Leasable Area 0
Permit Date
Permit #

Building Summary
Card 1 2940 Woodworth DR
Building Details
Bldg Type
RESIDENTIAL
Units
0
Living Area (SQFT)
1568
Number of Stories
1.00
Style
RANCH
Foundation
MASONRY
Frame
MASONRY
Exterior
BRICK
Const Type
Heating
Electric Bb/Clg
Air Cond
CENTRAL
Baths (Full)
2
Baths (Half)
0
Extra Fixtures
0
Total Plumbing
6
Fixtures
Bedrooms
3
CARPET -
Floor
HARDWOOD
Roof Cover
Asphalt Shingle
Roof Type
GABLE
Main Body (SQFT)
1568
Addition Summary
Story
1.00
1.00
1.00
1.00
Building Description
Year 1966
1990
Effective Year
Built
Additions 4
Remodeled 0
ADD FIREPLACE
AVERAGE (1.00)
Interior Adj
FIREPLACE AVERAGE
(2.00)
Other Features
Building Total & Improvement Details
C+10
Grade
110%
Percent Complete
100
Total Adjusted Replacement
$213,250
Cost New
Physical Depreciation (%
AVER
Bad)
38%
Depreciated Value
$132,215
Economic Depreciation (%
0
Bad)
Functional Depreciation (%
0
Bad)
Total Depreciated Value
$132,215
Market Area Factor
1
Building Value
$132,200
Misc Improvements Value
$700
Total Improvement Value
$132,900
Assessed Land Value
Assessed Total Value
Type
Code
Area
OPEN FRAME PORCH
OPEN
40
OPEN FRAME PORCH
OPEN
144
BASEMENT-UNFIN-CF
BASE
784
BASEMENT-FIN-LC-R
BASE
784
Building Sketch Photograph

W
Misc Improvements Summary
Card Unit Base
# Quantity Measure Type Price
1 22x20 DIMENSIONS CPA- $14.80
R
Total Misc Improvements Value Assessed: $700
`:. I
2925 015 01 04/04/2007
Size Adj Eff Phys Depr Econ Depr Funct Depr Common
Factor Year (% Bad) (% Bad) (% Bad) Interest (% Value
Good)
1966 90 0 0 $700
Land Summary
Land Class: 1.01-SFD Dwelling Deeded Acres: 0.57
Zoning Soil Class Description Size Rate
RS9 RES-LOT 1.00 BY THE UNIT PRICE $38,000
Total Land Value Assessed: $34,200
Ownership History
Calculated Acres: 0.57
Size Adj. Factor Land Adjustment Land Value
LOCATION-100.00 $34,200
EASEMENT-90.00
Owner Name
Deed Type
% Ownership
Stamps
Sale Price Book
Page
Deed Date
Current
MITROPOULOS, SERAFIM/ GKOROGIA, KALLIROI
DEED
100
200
$100,000 003772
03935
9/14/2023
1 Back
Poulos, John T/ Poulos, Helen P
DEED
50,50
0
003188
03866
7/24/2014
2 Back
Poulos, Helen P
DEED
100
0
000944
00014
6/23/2013
3 Back
Poulos, Theodore G
DEED
100
0
000944
00014
5/4/1967
Notes Summary
Building Card
No Data
Date
Line
Notes

Tax Parcel Viewer
m \ I
c
m
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WOODWORTH DR
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6/11 /2024, 4:48:45 PM 1:1,128
0 0.01 0.01 0.03 mi
O Address Points Parcels - Mailing Labels 0 0.01 0.02 0.04 km
------------
Forsyth County Boundary 1-----------I Legal Lot Lines
Streets Easement
FEMA, MapForsyth, Forsyth County Tax Administration
0 Parcels Tax Municipal Polygon
IWinston-Salem Forsyth County, NC
State of North Carolina DOT, Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS I See web site for license constraints. I FEMA, MapForsyth, Forsyth County Tax Administration I Forsyth County Tax

Forsyth County Property Record Card
Property Summary
Tax Year: 2024
6814831865000
6814-83-1865
Knight, Timothy D;Knight,
Amber
REID
PIN
Property Owner
G
Location
2990 Woodworth
Property LO:100
Owner's Mailing
2990 Woodworth Dr
Address
DR
Description 131-:2925
Address
Winston Salem NC 27103
Administrative Data
Transfer Information
Property Value
Plat Book & Page
Deed Date
4/27/2007
Total Appraised Land Value
$38,000
Old Map #
618842
Deed Book
002748
Total Appraised Building Value
$143,800
Market Area
619843
Deed Page
02452
Total Appraised Misc
Improvements Value
Township
WINSTON-SALEM
Revenue Stamps
$246
Total Cost Value
$181,800
Planning
COUNTY WIDE
Package Sale Date
4/27/2007
Jurisdiction
Total Appraised Value -valued By
$181,800
Package Sale Price
$123,000
WINSTON-SALEM
Cost
City
CITY
Land Sale Date
Other Exemptions
Fire District
Land Sale Price
Exemption Desc
Spec District
Use Value Deferred
Improvement Summary
Land Class
1.01-SFD Dwelling
Historic Value Deferred
Total Buildings
1
History REID 7
Total Deferred Value
Total Units
0
History REID 2
Total Taxable Value
$181,800
Total Living Area
1,676
Acreage
0.6
Total Gross Leasable Area
0
Permit Date
Permit #

Building Summary
Card 1 2990 Woodworth DR
Building Details
Bldg Type
RESIDENTIAL
Units
0
Living Area (SQFT)
1676
Number of Stories
1.00
Style
CONVENTIONAL
Foundation
MASONRY
Frame
FRAME
Exterior
STONE
Const Type
Heating
Heat Pump
Air Cond
HEAT PUMP
Baths (Full)
2
Baths (Half)
1
Extra Fixtures
0
Total Plumbing
8
Fixtures
Bedrooms
4
CARPET -
Floor
CONCRETE
Roof Cover
Asphalt Shingle
Roof Type
GABLE
Main Body (SQFT)
1676
Building Description
Year 1980 1990
Effective Year
Built
Additions 4 Remodeled 0
FIREPLACE AVERAGE
(2.00) ADD
Interior Adj FIREPLACE AVERAGE
(1.00)
Basement Car Storage
Other Features 1100.00
Building Total & Improvement Details
C+10
Grade
110%
Percent Complete
100
Total Adjusted Replacement
$230,891
Cost New
Physical Depreciation (%
AVER
Bad)
38%
Depreciated Value
$143,834
Economic Depreciation (%
0
Bad)
Functional Depreciation (%
0
Bad)
Total Depreciated Value
$143,834
Market Area Factor
1
Building Value
$143,800
Misc Improvements Value
Total Improvement Value
$143,800
Assessed Land Value
Assessed Total Value
Addition Summary
Story
Type
Code
Area
1.00
OPEN FRAME PORCH
OPEN
24
1.00
OPEN FRAME PORCH
OPEN
168
1.00
BASEMENT-FIN-AVG-R
BASE
838
1.00
BASEMENT-UNFIN-CF
BASE
838
Building Sketch
Photograph

Misc Improvements Summary
Card Unit Base
# Quantity Measure Type Price
No Data
Total Misc Improvements Value Assessed:
Land Summary
Land Class: 1.01-SFD Dwelling
Zoning Soil Class Description
RS9 RES-LOT
Total Land Value Assessed: $38,000
2925 100 01 04/04/2007
Size Adj Eff Phys Depr Econ Depr Funct Depr Common Interest Value
Factor Year (% Bad) (% Bad) (% Bad) (% Good)
Deeded Acres: 0.6
Size
1.00 BY THE UNIT PRICE
Calculated Acres: 0.6
Rate Size Adj. Factor Land Adjustment Land Value
$38,000 LOCATION-100.00 $38,000
Ownership History
Owner Name Deed Type % Ownership Stamps Sale Price Book Page Deed Date
Current Knight, Timothy D/ Knight, Amber G DEED 100 246 $123,000 002748 02452 4/27/2007
1 Back Poulos, George T DEED 100 0 001880 00444 11/30/1995
Notes Summary
Building Card
No Data
Date
Line
Notes

Tax Parcel Viewer
6814-83-0393.000
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2
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F
6814- 3-3154.000
4 o&D O
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6814- 3-5258.000
6/11 /2024, 4:52:11 PM 1:1,128
0 0.01 0.01 0.03 mi
O Address Points Parcels - Mailing Labels 0 0.01 0.02 0.04 km
------------
Forsyth County Boundary l___________I Legal Lot Lines
Streets Easement
FEMA, MapForsyth, Forsyth County Tax Administration
0 Parcels Tax Municipal Polygon
IWinston-Salem Forsyth County, NC
State of North Carolina DOT, Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS I See web site for license constraints. I FEMA, MapForsyth, Forsyth County Tax Administration I Forsyth County Tax

Forsyth County Property Record Card
Property Summary
Tax Year: 2024
REID 6814833209000 PIN 6814-83-3209 Property Owner HAWLEY, BUNNY MARIE
2136 Brighton CT LO:019 BL:2923 2136 Brighton Ct
Location Address Property Description Owner's Mailing Address Winston Salem NC 27103
Administrative Data
Plat Book & Page
Old Map #
Market Area
Township
Planning
Jurisdiction
City
Fire District
Spec District
Land Class
History REID 1
History REID 2
Acreage
Permit Date
Permit #
618842
619843
WINSTON-SALEM
COUNTY WIDE
WINSTON-SALEM
CITY
1.01-SFD Dwelling
0.8
Transfer Information
Deed Date
Deed Book
Deed Page
Revenue Stamps
Package Sale Date
Package Sale Price
Land Sale Date
Land Sale Price
Improvement Summary
Total Buildings
Total Units
Total Living Area
Total Gross Leasable Area
8/10/2018
003419
03746
8/10/2018
1
0
1,546
0
Property Value
Total Appraised Land Value
$38,000
Total Appraised Building Value
$117,200
Total Appraised Misc
Improvements Value
Total Cost Value
$155,200
Total Appraised Value -valued By
$155,200
Cost
Other Exemptions
Exemption Desc
Use Value Deferred
Historic Value Deferred
Total Deferred Value
Total Taxable Value
$155,200

Building Summary
Card 1 2136 Brighton CT
Building Details
Bldg Type
RESIDENTIAL
Units
0
Living Area (SQFT)
1546
Number of Stories
1.00
Style
RANCH
Foundation
MASONRY
Frame
MASONRY
Exterior
BRICK
Const Type
Heating
Heat Pump
Air Cond
HEAT PUMP
Baths (Full)
2
Baths (Half)
0
Extra Fixtures
0
Total Plumbing Fixtures
6
Bedrooms
3
Floor
CONCRETE
Roof Cover
Asphalt Shingle
Roof Type
GABLE
Main Body (SQFT)
1378
Building Description
Year Built 1963 Effective Year 1990
Additions 4 Remodeled 0
Interior Adj FIREPLACE LC (1.00)
Other Features
Building Total & Improvement Details
C+10
Grade
110%
Percent Complete
100
Total Adjusted Replacement
$189,026
Cost New
Physical Depreciation (%
AVER
Bad)
38%
Depreciated Value
$117,196
Economic Depreciation (%
0
Bad)
Functional Depreciation (%
0
Bad)
Total Depreciated Value
$117,196
Market Area Factor
1
Building Value
$117,200
Misc Improvements Value
Total Improvement Value
$117,200
Assessed Land Value
Assessed Total Value
Addition Summary
Story
Type
Code
Area
1.00
OPEN FRAME PORCH
OPEN
80
1.00
STOOP
STOO
16
1.00
FRAME ADDITION
FRAM
168
1.00
BASEMENT-UNFIN-CF
BASE
1378
Building Sketch
Photograph

14'
Misc Improvements Summary
Card Unit Base
# Quantity Measure Type Price
No Data
Total Misc Improvements Value Assessed:
Land Summary
Land Class: 1.01-SFD Dwelling
Zoning Soil Class Description
RS9 RES-LOT
Total Land Value Assessed: $38,000
Ownership History
Owner Name
Current
HAWLEY, BUNNY MARIE
1 Back
Sanford, Barbara P
2 Back
Newsom, Dorothy Mae
3 Back
Newsom, James G
Notes Summary
Building Card
No Data
Size Adj Eff Phys Depr Econ Depr Funct Depr Common Interest Value
Factor Year (% Bad) (% Bad) (% Bad) (% Good)
Deeded Acres: 0.8
Size
1.00 BY THE UNIT PRICE
Deed Type
EXECUTORS -DEED
DEED
DEED
DEED
Calculated Acres: 0.8
Rate Size Adj. Factor Land Adjustment Land Value
$38,000 LOCATION-100.00 $38,000
% Ownership
Stamps Sale Price
Book
Page
Deed Date
100
0
003419
03746
8/10/2018
100
0
002363
04955
6/17/2003
100
0
000872
00192
1/1/1999
100
0
000872
00192
10/15/1963
Date
Line
Notes

Tax Parcel Viewer
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O
Z
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6/11 /2024, 4:54:25 PM 1:1,128
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O Address Points Parcels - Mailing Labels 0 0.01 0.02 0.04 km
------------
Forsyth County Boundary 1-----------J Legal Lot Lines
Streets Easement
FEMA, MapForsyth, Forsyth County Tax Administration
0 Parcels Tax Municipal Polygon
IWinston-Salem Forsyth County, NC
State of North Carolina DOT, Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS I See web site for license constraints. I FEMA, MapForsyth, Forsyth County Tax Administration I Forsyth County Tax

Forsyth County Property Record Card
Property Summary
Tax Year: 2024
6814830393000
6814-83-0393
FONSECA, JESSICA JAQU ELIN E; FONSECA,
REID PIN
Property Owner
JORGE ADALBERTO
Location 1883 Burke Mill Property
LO:502B
Owner's Mailing
1883 BURKE MILL RD
Address RD Description
BL:3926
Address
WINSTON-SALEM NC 27103
Administrative Data
Transfer Information
Property Value
Plat Book & Page
Deed Date
8/23/2019
Total Appraised Land Value
$41,800
Old Map # 618842
Deed Book
003478
Total Appraised Building Value
$164,900
Market Area 619843
Deed Page
00576
Total Appraised Misc
Improvements Value
Township WINSTON-SALEM
Revenue Stamps
$366
Total Cost Value
$206,700
Planning COUNTY WIDE
Package Sale Date
8/23/2019
Jurisdiction
Total Appraised Value -valued By
$206,700
Package Sale Price
$183,000
WINSTON-SALEM
Cost
City CITY
Land Sale Date
Other Exemptions
Fire District
Land Sale Price
Exemption Desc
Spec District
Use Value Deferred
Improvement Summary
Land Class 1.01-SFD Dwelling
Historic Value Deferred
Total Buildings
1
History REID 7
Total Deferred Value
Total Units
0
History REID 2
Total Taxable Value
$206,700
Total Living Area
1,776
Acreage 0.61
Total Gross Leasable Area 0
Permit Date
Permit #

Building Summary
Card 1 1883 Burke Mill RD
Building Details
Bldg Type
RESIDENTIAL
Units
0
Living Area (SQFT)
1776
Number of Stories
1.00
Style
SPLIT-LEVEL
Foundation
MASONRY
Frame
FRAME
Exterior
VINYL
Const Type
Heating
Forced Warm Air
Air Cond
CENTRAL
Baths (Full)
2
Baths (Half)
1
Extra Fixtures
2
Total Plumbing
10
Fixtures
Bedrooms
3
CARPET -
Floor
PLYWOOD
Roof Cover
Asphalt Shingle
Roof Type
GABLE
Main Body (SQFT)
1776
Addition Summary
Story
1.00
1.00
1.00
1.00
Building Description
Year 1992 1999
Effective Year
Built
Additions 4 Remodeled 0
Interior Adj FIREPLACE LC (1.00)
Alarm 0.00 Garage
Other Features Doors Electric 250.00
Building Total & Improvement Details
Grade
B-5 116%
Percent Complete
100
Total Adjusted Replacement
$205,876
Cost New
Physical Depreciation (%
AVER
Bad)
20%
Depreciated Value
$164,901
Economic Depreciation (%
0
Bad)
Functional Depreciation (%
0
Bad)
Total Depreciated Value
$164,901
Market Area Factor
1
Building Value
$164,900
Misc Improvements Value
Total Improvement Value
$164,900
Assessed Land Value
Assessed Total Value
Type
Code
Area
STOOP
STOO
32
FRAME DECK LC
FRAM
336
PATIO LC
PATI
406
BASEMENT-UNFIN-CF
BASE
572
Building Sketch Photograph

3926 502B 61 04/65/2007
Misc Improvements Summary
Card Unit Base Size Adj Eff Phys Depr Econ Depr Funct Depr Common Interest
# Quantity Measure Type Price Factor Year (% Bad) (% Bad) (% Bad) (% Good) Value
No Data
Total Misc Improvements Value Assessed:
Land Summary
Land Class: 1.01-SFD Dwelling Deeded Acres: 0.61
Zoning Soil Class Description Size Rate
RS9 RES-LOT 1.00 BY THE UNIT PRICE $38,000
Total Land Value Assessed: $41,800
Ownership History
Owner Name Deed Type
Current FONSECA, JESSICAJAQUELINE/ FONSECA, DEED
JORGE ADALBERTO
1 Back NATIONAL ASSET ACQUISITION LLC TRUSTEES -
DEED
2 Back SMITH, MICHAEL C HEIRS DEED
3 Back Smith, Michael C DEED
4 Back Sarro, Anthony DEED
Notes Summary
Building Card Date
No Data
Calculated Acres: 0.61
Size Adj. Factor Land Adjustment Land Value
LOCATION-100.00 $41,800
SIZE ADJUSTMENT-110.00
RioSal
Ownership Stamps Pr Ce Book Page Date
100 366 $183,000 003478 00576 8/23/2019
100 270 $135,000 003469 02632 7/3/2019
100
0
002160
03594
9/14/2018
100
300
$150,000
002160
03594
3/15/2001
100
248
$124,000
002082
03841
8/23/1999
Line
Notes

6/14/24, 11:06 AM
EFH Report
EFH Data Notice
EFH Mapper Report
Essential Fish Habitat (EFH) is defined by textual descriptions contained in the fishery management plans developed by the regional fishery
management councils. In most cases mapping data can not fully represent the complexity of the habitats that make up EFH. This report should
be used for general interest queries only and should not be interpreted as a definitive evaluation of EFH at this location. A location -specific
evaluation of EFH for any official purposes must be performed by a regional expert. Please refer to the following links for the appropriate
regional resources.
Query Results
Degrees, Minutes, Seconds: Latitude = 36° 3' 40" N, Longitude = 8 V 42' 29" W
Decimal Degrees: Latitude = 36.061, Longitude =-80.292
The query location intersects with spatial data representing EFH and/or HAPCs for the following species/management units.
No additional Essential Fish Habitats (EFH) were identified at the report location.
Pacific Salmon EFH
No Pacific Salmon Essential Fish Habitat (EFH) were identified at the report location.
Atlantic Salmon
No Atlantic Salmon were identified at the report location.
HAPCs
No Habitat Areas of Particular Concern (HAPC) were identified at the report location.
EFH Areas Protected from Fisning
No EFH Areas Protected from Fishing (EFHA) were identified at the report location.
https://www.habitat.noaa.gov/apps/efhmapper/efhreport/ 1 /1

United States Department of the Interior
FISH AND WILDLIFE SERVICE
Asheville Ecological Services Field Office
160 Zillicoa Street, Suite B
Asheville, NC 28801-1082
Phone: [phone] Fax: [phone]
In Reply Refer To:
Project Code: 2024-0104101
Project Name: Burke Mill Rd
06/14/2024 14:59:16 UTC
Subject: List of threatened and endangered species that may occur in your proposed project
location or may be affected by your proposed project
To Whom It May Concern:
The enclosed species list identifies threatened, endangered, proposed and candidate species, as
well as proposed and designated critical habitat, that may occur within the boundary of your
proposed project and/or may be affected by your proposed project. The enclosed species list
fulfills the requirements of the U.S. Fish and Wildlife Service (Service) under section 7(c) of the
Endangered Species Act (Act) of 1973, as amended (16 U.S.C. 1531 et seq.).
Please note that new species information can change your official species list. Under 50 CFR
402.12(e) of the regulations implementing section 7 of the Act, the accuracy of this species list
should be verified after 90 days. The Service recommends you visit the ECOS-IPaC website at
regular intervals during project planning and implementation to ensure your species list is
accurate or obtain an updated species list.
The purpose of the Act is to provide a means whereby threatened and endangered species and the
ecosystems upon which they depend may be conserved. Under sections 7(a)(1) and 7(a)(2) of the
Act and its implementing regulations (50 CFR 402 et seq.), Federal agencies are required to
utilize their authorities to carry out programs for the conservation of threatened and endangered
species and to determine whether projects may affect threatened and endangered species and/or
designated critical habitat.
A biological assessment (BA) or biological evaluation (BE) should be completed for your
project. A BA is required for major construction activities (or other undertakings having similar
physical impacts) considered to be Federal actions significantly affecting the quality of the
human environment as defined in the National Environmental Policy Act (42 U.S.C. 4332(2) (c))
(NEPA). For projects other than major construction activities, the Service suggests that a BE be
prepared to determine effects of the action and whether those effects may affect listed species
and/or designated critical habitat. Effects of the action are all consequences to listed species or
critical habitat that are caused by the proposed action, including the consequences of other

Project code: 2024-0104101 06/14/2024 14:59:16 UTC
activities that are caused by the proposed action. A consequence is caused by the proposed action
if it is reasonably certain to occur and would not occur "but for" the proposed action..
Recommended contents of a BA/BE are described at 50 CFR 402.12. More information and
resources about project review and preparing a BA/BE can be found at the following web link:
https://www.fws. gov/office/asheville-ecological-services/asheville-field-office-online-review-
process-overview.
If a Federal agency determines listed species and/or designated critical habitat may be affected
by the proposed project, the agency is required to consult with the Service pursuant to 50 CFR
402. The Service is not required to concur with "no effect" determinations from Federal action
agencies. If consultation is required, the Service recommends that candidate species, proposed
species, proposed critical habitat, and at -risk species be addressed within the consultation. More
information on the regulations and procedures for section 7 consultation, including the role of
permit or licensed applicants, can be found in the "Endangered Species Consultation Handbook"
at the following web link: https://www.fws.gov/media/endangered-species-consultation-
handbook.
Migratory Birds: In addition to responsibilities to protect threatened and endangered species
under the Act, there are additional responsibilities under the Migratory Bird Treaty Act (MBTA)
and the Bald and Golden Eagle Protection Act (BGEPA) to protect native birds from project -
related impacts. Any activity, intentional or unintentional, resulting in take of migratory birds,
including eagles, is prohibited unless otherwise permitted by the Service (50 C.F.R. Sec. 10.12
and 16 U.S.C. Sec. 668(a)). More information about MBTA and BGEPA can be found at the
following web link: https://www.fws.gov/program/migratory-birds.
We appreciate your consideration of Federally listed species. The Service encourages Federal
agencies to include conservation of threatened and endangered species in their project planning
to further the purposes of the Act. Please contact our staff at 828-258-3939, if you have any
questions. In any future correspondence concerning this project, please reference the
Consultation Code which can be found in the header of this letter.
Attachment(s):
• Official Species List
• USFWS National Wildlife Refuges and Fish Hatcheries
• Bald & Golden Eagles
• Migratory Birds
• Wetlands
OFFICIAL SPECIES LIST
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
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any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Asheville Ecological Services Field Office
160 Zillicoa Street, Suite B
Asheville, NC 28801-1082
[phone]
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PROJECT SUMMARY
Project Code: 2024-0104101
Project Name: Burke Mill Rd
Project Type: Residential Construction
Project Description: Residential Development
Project Location:
The approximate location of the project can be viewed in Google Maps: https:
www. google.com/maps/(a)36.0610019,-80.29132081124672,14z
'h'no]wortr•pr bl';
pee Ln
c
.F
Counties: Forsyth County, North Carolina
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ENDANGERED SPECIES ACT SPECIES
There is a total of 4 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
Fisheriesi, as USFWS does not have the authority to speak on behalf of NOAA and the
Department of Commerce.
See the "Critical habitats" section below for those critical habitats that lie wholly or partially
within your project area under this office's jurisdiction. Please contact the designated FWS office
if you have questions.
NOAA Fisheries, also known as the National Marine Fisheries Service (NMFS), is an
office of the National Oceanic and Atmospheric Administration within the Department of
Commerce.
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MAMMALS
NAME STATUS
Tricolored Bat Perimyotis subflavus Proposed
No critical habitat has been designated for this species. Endangered
Species profile: https:Hecos.fws.gov/ecp/species/10515
REPTILES
NAME
STATUS
Bog Turtle Glyptemys muhlenbergii
Similarity of
Population: U.S.A. (GA, NC, SC, TN, VA)
Appearance
No critical habitat has been designated for this species.
(Threatened)
Species profile: https:Hecos.fws.gov/ecp/species/6962
INSECTS
NAME STATUS
Monarch Butterfly Danaus plexippus Candidate
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9743
FLOWERING PLANTS
NAME STATUS
Schweinitz's Sunflower Helianthus schweinitzii Endangered
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/3849
CRITICAL HABITATS
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.
YOU ARE STILL REQUIRED TO DETERMINE IF YOUR PROJECT(S) MAY HAVE EFFECTS ON ALL
ABOVE LISTED SPECIES.
USFWS NATIONAL WILDLIFE REFUGE LANDS
AND FISH HATCHERIES
Any activity proposed on lands managed by the National Wildlife Refuge system must undergo a
'Compatibility Determination' conducted by the Refuge. Please contact the individual Refuges to
discuss any questions or concerns.
THERE ARE NO REFUGE LANDS OR FISH HATCHERIES WITHIN YOUR PROJECT AREA.
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BALD & GOLDEN EAGLES
Bald and golden eagles are protected under the Bald and Golden Eagle Protection Actl and the
Migratory Bird Treaty Act2.
Any person or organization who plans or conducts activities that may result in impacts to bald or
golden eagles, or their habitats3, should follow appropriate regulations and consider
implementing appropriate conservation measures, as described in the links below. Specifically,
please review the "Supplemental Information on Migratory Birds and Eagles".
1. The Bald and Golden Eagle Protection Act of 1940.
2. The Migratory Birds Treaty Act of 1918.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
There are likely bald eagles present in your project area. For additional information on bald
eagles, refer to Bald Eagle Nesting and Sensitivity to Human Activity
For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, see the PROBABILITY OF PRESENCE
SUMMARY below to see when these birds are most likely to be present and breeding in your
project area.
1►/Juhl
BREEDING SEASON
Bald Eagle Haliaeetus leucocephalus Breeds Sep 1 to
This is not a Bird of Conservation Concern (BCC) in this area, but warrants attention Jul 31
because of the Eagle Act or for potential susceptibilities in offshore areas from certain
types of development or activities.
https:Hecos.fws.gov/ecp/species/1626
PROBABILITY OF PRESENCE SUMMARY
The graphs below provide our best understanding of when birds of concern are most likely to be
present in your project area. This information can be used to tailor and schedule your project
activities to avoid or minimize impacts to birds. Please make sure you read "Supplemental
Information on Migratory Birds and Eagles", specifically the FAQ section titled "Proper
Interpretation and Use of Your Migratory Bird Report" before using or attempting to interpret
this report.
Probability of Presence (■)
Green bars; the bird's relative probability of presence in the 10km grid cell(s) your project
overlaps during that week of the year.
Breeding Season( )
Yellow bars; liberal estimate of the timeframe inside which the bird breeds across its entire
range.
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Survey Effort (1)
Vertical black lines; the number of surveys performed for that species in the 10km grid cell(s)
your project area overlaps.
No Data (—)
A week is marked as having no data if there were no survey events for that week.
■ probability of presence breeding season I survey effort — no data
SPECIES JAN FEB MAR APR MAY
Bald Eagle Non -BCC ++++ I t W ++++ Wt t�-i
Vulnerable
JUN JUL AUG SEP OCT NOV DEC
Additional information can be found using the following links:
• Eagle Management https://www.fws.gov/program/eagle-management
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/library
collections/avoiding-and-minimizing-incidental-take-migratory-birds
• Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.pdf
• Supplemental Information for Migratory Birds and Eagles in IPaC https://www.fws.gov/
media/supplemental-information-migratory-birds-and-bald-and-golden-eagles-may-occur-
project-action
MIGRATORY BIRDS
Certain birds are protected under the Migratory Bird Treaty Acti and the Bald and Golden Eagle
Protection Act2.
Any person or organization who plans or conducts activities that may result in impacts to
migratory birds, eagles, and their habitats should follow appropriate regulations and consider
implementing appropriate conservation measures, as described in the links below. Specifically,
please review the "Supplemental Information on Migratory Birds and Eagles".
1. The Migratory Birds Treat. Act of 1918.
2. The Bald and Golden Eagle Protection Act of 1940.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
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For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, see the PROBABILITY OF PRESENCE
SUMMARY below to see when these birds are most likely to be present and breeding in your
project area.
BREEDING
NAME
SEASON
Bald Eagle Haliaeetus leucocephalus
Breeds Sep 1 to
This is not a Bird of Conservation Concern (BCC) in this area, but warrants attention
Jul 31
because of the Eagle Act or for potential susceptibilities in offshore areas from certain types
of development or activities.
https:Hecos.fws.gov/ecp/species/1626
Black -billed Cuckoo Coccyzus erythropthalmus
Breeds May 15
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
t0 Oct 10
and Alaska.
https:Hecos.fws.gov/ecp/species/9399
Cerulean Warbler Setophaga cerulea
Breeds Apr 28
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
t0 Jul 20
and Alaska.
https:Hecos.fws.gov/ecp/species/297
Chimney Swift Chaetura pelagica
Breeds Mar 15
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
t0 Aug 25
and Alaska.
https:Hecos.fws.gov/ecp/species/9406
Grasshopper Sparrow Ammodramus savannarum perpallidus
Breeds Jun 1 to
This is a Bird of Conservation Concern (BCC) only in particular Bird Conservation Regions
Aug 20
(BCRs) in the continental USA
https:Hecos.fws.gov/ecp/species/8329
Kentucky Warbler Geothlypis formosa
Breeds Apr 20
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
t0 Aug 20
and Alaska.
https:Hecos.fws.gov/ecp/species/9443
Prairie Warbler Setophaga discolor
Breeds May 1
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
to Jul 31
and Alaska.
https:Hecos.fws.gov/ecp/species/9513
Prothonotary Warbler Protonotaria citrea
Breeds Apr 1 to
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
Jul 31
and Alaska.
https:Hecos.fws.gov/ecp/species/9439
Red-headed Woodpecker Melanerpes erythrocephalus
Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
t0 Sep 10
and Alaska.
https:Hecos.fws.gov/ecp/species/9398
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NAME
BREEDING
SEASON
Rusty Blackbird Euphagus carolinus Breeds
This is a Bird of Conservation Concern (BCC) only in particular Bird Conservation Regions elsewhere
(BCRs) in the continental USA
https:Hecos.fws.gov/ecp/species/9478
Wood Thrush Hylocichla mustelina Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Aug 31
and Alaska.
https:Hecos.fws.gov/ecp/species/9431
PROBABILITY OF PRESENCE SUMMARY
The graphs below provide our best understanding of when birds of concern are most likely to be
present in your project area. This information can be used to tailor and schedule your project
activities to avoid or minimize impacts to birds. Please make sure you read "Supplemental
Information on Migratory Birds and Eagles", specifically the FAQ section titled "Proper
Interpretation and Use of Your Migratory Bird Report" before using or attempting to interpret
this report.
Probability of Presence (■)
Green bars; the bird's relative probability of presence in the 10km grid cell(s) your project
overlaps during that week of the year.
Breeding Season( )
Yellow bars; liberal estimate of the timeframe inside which the bird breeds across its entire
range.
Survey Effort (1)
Vertical black lines; the number of surveys performed for that species in the 10km grid cell(s)
your project area overlaps.
No Data (—)
A week is marked as having no data if there were no survey events for that week.
■ probability of presence breeding season I survey effort — no data
SPECIES JAN FEB MAR APR MAY JUINI I JIUILI I IA IUGI I SEPI I OCT
I I NOV DEC
Bald Eagle I I I I I TTTT TTTT ++ I I +TTT Non -BCC T
Vulnerable
Black -billed
Cuckoo +++ I I I I I I+++ ++ III I 1 1 [+ ++i I l l l l l l l fi++++ ++++ ++++
Cuckoo
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BCC Rangewide
(CON)
Cerulean ++++ ++++ ++++ +
BCC Rangewide
(CON)
-++ ++++ ++++ ++++ ++++ ++++ ++++
Chimney Swift +++ I I I I I I I I I i1'"'l"i''Jill
""""1* ++++ ++++
BCC Rangewide
(CON)
Grasshopper ++++
Sparrow ++++ ++++ ++++ ++++ �+ I I I I I-+ ++++ ++++ ++++ ++++
BCC -BCR
Kentucky Warbler
BCC Rangewide
441 IIII I +++ ++++ III
I 1 ++ J+i I I I I T +++ ++++ ++++ ++++
(CON)
Prairie Warbler
++++++++ +++ 11 I I I
L i
I I ++++ ++++
BCC Rangewide
I T+++
(CON)
Prothonotary
Warbler
II I
4-1 I I I I I 1 4+ I I I
L yy yy
I I I I r++++ +++T T+++ ++++ + I 1 1 1+
BCC Rangewide
(CON)
Red-headed Woodpecker
yy
BCC Rangewide
(CON)
Rusty Blackbird I I I I I I I I I+ •� I I I I I+++ ++++ ++++ ++++ ++++ ♦�++++�
BCC -BCR
Wood Thrush ++++ BCC Rangewide +4 4 ++++ [phone], All Jill 0A +0+0 *000 **++ ++++ ++++
(CON)
Additional information can be found using the following links:
• Eagle Management https://www.fws.gov/program/eagle-management
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/library
collections/avoiding-and-minimizing-incidental-take-migratory-birds
• Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.pdf
• Supplemental Information for Migratory Birds and Eagles in IPaC https://www.fws.gov/
media/SUDDlemental-information-mis7ratorv-birds-and-bald-and-p-olden-eas7les-mav-occur-
project-action
WETLANDS
Impacts to NWI wetlands and other aquatic habitats may be subject to regulation under Section
404 of the Clean Water Act, or other State/Federal statutes.
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For more information please contact the Regulatory Program of the local U.S. Army Corps of
Engineers District.
Please note that the NWI data being shown may be out of date. We are currently working to
update our NWI data set. We recommend you verify these results with a site visit to determine
the actual extent of wetlands on site.
RIVERINE
• R5UBH
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IPAC USER CONTACT INFORMATION
Agency: Pilot Environmental, Inc.
Name: Catherine Carston
Address: PO Box 128
City: Kernersville
State: NC
Zip: 27285
Email [e-mail]
Phone: [phone]
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