20070488 Ver 2_401 Application_20191204

a o1 q I Asa
Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW -
Prepare file folder ❑
Begin Date (Date Received):
Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Meadow Valley (Basswood Avenue)
2. Work Type: ✓❑Private ❑Institutional ❑Government ❑Commercial
4
3. Project Description / Purpose [PCN Form 133d and 133e]: '
See PCN.
a0sug DwR
RE pEC 0 4 Z019
4. Property Owner / Applicant [PCN Form A3 or A41: See PCN soorcat
Re
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:,;i�9
Bradley S. Luckey, Pilot Environmental
6. Related Action ID Number(s) [PCN Form 135b]: Unknown
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
36.03950,-80.03150
8. Project Location— Tax Parcel ID [PCN Form Bla]: See PCN
9. Project Location — County [PCN Form A2b]: Guilford
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: High Point
11. Project Information — Nearest Waterbody [PCN Form 132a]: West Fork Deep River
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03030003
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
Standard Permit
✓ Nationwide Permit #
Regional General Permit #
Jurisdictional Determination Request
Section 10 and 404 ❑
Pre -Application Request
Unauthorized Activity
Compliance
No Permit Required
Revised 20150602

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification C Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: NWP 29 or General Permit (GP) number.
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® 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.
® Yes
❑ No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
Basswood Avenue
2b. County:
Guilford
2c. Nearest municipality / town:
High Point
2d. Subdivision name:
Meadow Valley
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
Clayton Properties Group, Inc.
3b. Deed Book and Page No.
183/66
3c. Responsible Party (for LLC if
applicable):
Mr. Greg Garrett
3d. Street address:
221 Jonestown Road
3e. City, state, zip:
Winston-Salem, North Carolina 27104
3f. Telephone no.:
336.231.6764
3g. Fax no.:
3h. Email address:
[e-mail]
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Bradley S. Luckey
5b. Business name
(if applicable):
Pilot Environmental, Inc.
5c. Street address:
PO Box 128
5d. City, state, zip:
Kemersville, NC 27285
5e. Telephone no.:
336.708.4997
5f. Fax no.:
5g. Email address:
[e-mail]
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):
Subdivision: 6893558624. Sewer ROW: 6893677613 &
6893655203
1 b. Site coordinates (in decimal degrees):
Latitude: 36.03950 Longitude: - 80.03150
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
45 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
West Fork Deep River
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS-IV, CA
2c. River basin:
Cape Fear
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The site contains wooded land. Residential, commercial and light industrial development are located within the vicinity of
the site.
3b. List the total estimated acreage of all existing wetlands on the property:
Wetlands=-3.14 Ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Streams=-2,510 LF
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to provide the remainder of the Meadow Valley subdivision road access and
sanitary sewer service.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project consists of a single family residential development in the remainder of the Meadow Valley subdivision.
In order to provide access to the northern portion of the sub -division, it is necessary to construct a road crossing. In order
to provide and maintain sanitary sewer service, it is necessary to install a sewer line access road crossing and a utility
crossing. To facilitate the construction of the roads, sewer lines and development of the site, clearing and grading the site
is necessary. Graders, haulers, excavators and other heavy equipment will be used during grading and construction of
the site.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes ❑ No El Unknown
project (including all prior phases) in the past?
Comments: USACE/NCDWR Field Visit 7.10.18
4b. If the Corps made the jurisdictional determination, what type
Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: Pilot Enviromental, Inc.
Name (if known): Michael Brame/David Brame
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
DWR Letter 7.28.18. USACE JD Letter Pending.
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ❑ No ® Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ® Yes ❑ No
6b. If yes, explain.
The project is the remainder of a phased residential subdivision. Other phases of the subdivision have been constructed.
Impacts to streamstwetlands, outside of those proposed in this application, are not anticipated as a result of the proposed
project.
Page 4 of 12
PCN Form —Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non-404, other)
(acres)
Temporary T
W1 ®P ®T
Road Crossing
PFO
®❑ No
®❑ Corp
0.24/0.03
W2 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
2g. Total wetland impacts
0.24/0.03
2h. Comments: Crossing 1(A) will permanently impact 0.24 acres of wetlands by road fill and temporarily impact 0.03 acres of
wetlands associated with temporary construction access. Areas of temporary impact will be restored to pre -construction
conditions, seeded and allowed to regenerate woody vegetation.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ®T
Road Crossing
Fill/De-Watering
Unnamed
® PER
❑ INT
® Corps
❑ DWQ
8
108/29
S2 ®P ❑ T
Sewer Road
Crossing Fill/De-
Unnamed
® PER
❑ INT
® Corps
❑ DWQ
4
29/10
Watering
S3 ❑ P ®T
Sewer Crossing &
De -Watering
Unnamed
® PER
❑ INT
® Corps
❑ DWQ
6
29
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
137/68
3i. Comments:
Crossing 1 (A): The proposed road crossing will permanently impact 108 linear feet of stream from culvert/sideslo a fill and
Page 5 of 12
PCN Form — Version 1.3 December 10, 2008 Version

temporarily impact 29 linear feet of stream from dewatering with pump around.
Crossing 2 (B): The proposed sewer access road crossing will permanently impact 29 linear feet of stream from
culvert/sideslope fill and temporarily impact 10 linear feet of stream from de -watering.
Crossing 3 (C): The proposed sewer line crossing will temporarily impact 29 linear feet of stream from excavation/backfill of
the sewer line and de -watering.
Areas of temporary impact will be restored to similar pre -construction conditions.
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4L Total open water impacts
4g. Comments: Open water impacts are not proposed.
S. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
K Total
5g. Comments: Pond or lake construction is not proposed. Stormwater will be treated from existing stormwater treatement
devices located in previously constructed portions of the Meadow Valley subdivision.
5h. Is a dam high hazard permit required?
❑ Yes No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 6of12
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse ❑Tar -Pamlico El Other:
Project is in which protected basin?
❑ Catawba ® Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary
impact
re wired?
B1 ❑P❑T
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments: The applicant will obtain a buffer authorization for the project from the local DWR delegated municipality.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The applicant has designed the proposed residential sub -division to avoid other impact to streams and wetlands, specifically
associated with lot/pad fill. Based upon the stream and wetland delineation, the applicant has updated their plans to remove
three lots from the development that would have resulted in an additional stream/wetland crossing.
The applicant has further demonstrated avoidance and minimization of stream impacts by proposing to construct culvert
head/end walls for Crossing 1 (A). The applicant has designed the stream crossings in relatively straight portions of the
streams. The sewer line crossings have been designed to avoid impact to wetlands. The remaining 2,372 linear feet of
stream and 2.90 acres of wetlands are being avoided.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The clearing limits will be staked and silt fence will be used. Temporary coffer dams will be installed upgradient of the
proposed culverts/utility line. During construction, water will be pumped around the construction footprint. Appropriate stream
bank protection will be provided in the channel during construction and all excess excavated material will be immediately
removed from the crossing areas. The sewer line will be backfilled with native stream bed material to similar pre -construction
grade. Upon completion of the culvert/sewer line installations, the temporary sand bag coffer dams will be removed and flow
will be diverted through the culverts and over the sewer line. Following construction, disturbed banks will be restored to
similar pre -construction conditions, matted and seeded/live staked.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
® Yes ❑ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ® Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
®Payment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
Page 7 of 12
PCN Form —Version 1.3 December 10, 2008 Version

3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments: There are no private banks in site HUC.
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
® Yes
4b. Stream mitigation requested:
NA linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
NA square feet
4e. Riparian wetland mitigation requested:
0.24 acres
4f. Non -riparian wetland mitigation requested:
NA acres
4g. Coastal (tidal) wetland mitigation requested:
NA acres
4h. Comments: The applicant proposes mitigating for 0.24 acres of permanent wetland loss with purchase of 0.48 acres
wetlands credits from NCDMS. Mitigation is not proposed for permanent/temporary stream impacts or temporary wetland
impacts.
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 8 of 12
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: The proposed project will utilie an existing stormwater management
❑ Yes ® No
plan.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
41.3 %
2b. Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The proposed project will utilize an existing stormwater management plan.
® Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ Phase II
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a. Which of the following state -implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ 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 9of12
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ® No
letter.)
Comments: A NEPA or SEPA is not required as part of this project.
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑ Yes ® No
2c. If you answered 'yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered 'yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
We are not aware of additional development that will result which will impact nearby downstream water quality.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Wastewater from the proposed subdivision will be discharged into the existing sanitary sewer system. Impacts outside of
those presented in this application are not anticipated as a result of providing sewer service to the site.
Page 10 of 12
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS conceming Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS database identifies the following protected species in Guilford County: bald eagle, Cape Fear shiner (by
river basin), Roanoke logperch (by river basin), Schweinitz's sunflower and small whorled pogonia. There are no large
waterbodies on the site or on nearby properties that provide suitable habitat for bald eagle. The Cape Fear shiner and
Roanoke logperch do not occur within the proposed project's watershed. Based on our observations, the impact areas
are heavily wooded and do not contain sutiable habitat for Schweinitz's sunflower and small whorled pogonia. Therefore,
we have made determinations of no effect for Cape Fear shiner, Roanoke logperch, Schweinitz's sunflower and small
whorled pogonia. Based on the limited size of the water bodies proposed for impact, we have also made the
determination that the proposed impacts will not disturb the bald eagle.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
We reviewed the SHPO Map (http://gis.ncdcr.gov/hpoweb/) to identify historic and/or archaeological resources of the site.
The map does not identify eligible for listing or listed properties on the site. A copy of the map is included as an
attachment.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? 3710689300K (Drawing 4, JD Request)
Digitally signed by Bradley S. Luckey
DN: cn=Bradley S. Luckey, o=Pilot
Bradley S. Luckey
Enviromental, Inc, ou,
r` t email=[e-mail],
c=us
11.26.19
Date: 2019.112610:38:52 -05'00'
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
Page 11 of 12
PCN Form — Version 1.3 December 10, 2008 Version

Proposal for Wetland Permitting Services
Pilot Proposal3736.1
September 3, 2019
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: Meadow Valley
Applicant Information:
Name:
Address:
Telephone Number:
Fax Number:
E-mail Address:
Signature:
Clayton Properties Group, Inc.
221 Jonestown Road
Winston Salem, NC 27104
(336)-231-6764
[e-mail]
MIE
4

NOTE PERENNIAL STREAM/ WETLAND IMPACT MAP
1. WETLANDS AND STREAM VERIFIED BY PILOT MEADOW VALLEY SUBDIVISION
ENVIRONMENTAL INC. WITH USACE AND NCDEQ—DWR ON
FIELD LOCATED THE VERIFl DNTIAN NGWETLAND (AND (STREAM C� CROSSING 11A„
FLAGS PLACED BY PILOT ENVIRONMENTAL INC.
2. THIS DEVELOPMENT HAS BEEN ACCEPTED BY THE CITY
OF HIGH POINT AS A HIGH DENSITY STORMWATER
PROJECT, WITH WET DETENTION PONDS AS STORMWATER
MANAGEMENT DEVICES FOR RANDLEMAN LAKE BUFFER
RULES.
\ 7\ / /
IMPACT
LINEAR
LINEAR STREAM
WETLAND IMPACT
LOCATION
TYPE
ZONE
ID
(FEET)
(SQUARE FEET)
1
STORM/ROAD
CROSSING
108
10,665
2
TEMP. PUMP
34
1,140
AROUND IMPACT
+' �,` •
/�� `� . •
/ I EXISTING PERENNIAL ,
STREAM INVERT. 956.95
PIPE INVERT: 956.45
WETLANDS ......................
� mumn,u,,,,,
�. FARO
/ /f Q1C� iA=, GREEN MOUNTAIN
SCAM-1•-4°� _ ENGINEERING RLLC
TEMPORARY IMPACT = 29999 i_ 7A WENDY CT
34 LF STREAM COFFER DAM DEVELOPER:
SHUGART HOMES Q Z GREENSBORO, NC 27409
221 JONESTOWN RD. OsIni, GIN„E.��OJG'` Tel: [phone]
WINSTON—SALEM, NC 27104 FA CERTIFICATE N0. P SCAM- 1w=40, CONTACT- j���GARRETT
PH., '''''"'y,,,V,;,����o�````` www.greenmountainengineers.com

87(
WING—WAL
85;
1
STP-CHWTR-CULVERT
70
`o
t
WING—V
E
e
/60
i
55
+0 1 +00 1 +50
i
SCALE. iw—,v v PERRENIAL STREAM/ WETLAND
oEVELOPM IMPACT MAP
; OMES
22OFW• MEADOW VALLEY
WINSTON—SALEM, NC 27104
CONTACT: DREG GARRETT SUBDIVISION
FALL
wnNIG MTERhQTTa(NT
71W M INNER?
CAROB
Pzz-
�LA�F(
�`pN�nmVmmaa� , � ,•
GREEN MOUNTAIN
ENGINEERING. PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel:[phone]
CERTIFICATE NO. P-0826
www.greenmountainengineers.com

NOTE INTERMITTENT STREAM/ WETLAND IMPACT MAP
2.
t
WETLANDS AND STREAM VERIFIED BY PILOT MEADOW VALLEY SUBDIVISION
ENVIRONMENTAL INC. WITH USACE AND NCDEO—DWR ON
FIELD LOCATED THE VERIFl DNTIAN NGWETLAND (AND (STREAM C CROSSING "B"
FLAGS PLACED BY PILOT ENVIRONMENTAL INC.
THIS DEVELOPMENT HAS BEEN ACCEPTED BY THE CITY
OF HIGH POINT AS A HIGH DENSITY STORMWATER
PROJECT, NTH WET DETENTION PONDS AS STORMWATER
MANAGEMENT DEVICES FOR RANDLEMAN LAKE BUFFER
RULES. \
/ i/ Y \
ON MR
I h:70- 0
--qq�
Som Al
I � I �i,��l►�c / � l �P�
I ,woo
I
1 5 9 I I I
SCALE: 1 "-20'
a
IMPACT
LINEAR STREAM
WETLAND IMPACT
LOCATION
TYPE
IMPACT
ZONE
ID
(FEET)
(SQUARE FEET)
1
STORM CROSSING
29
0
2
TEMP. PUMP
10
0
AROUND IMPACT
A
�oX
IQom'/$�n�`s
'P/p�rc'gA/
29 LF ROADWAY IMPACT
10 LF TEMPORARY COFFER DAM
f IMPACT
SCALE. 1 "-20'
DEVELOPER:
SHUGART HOMES
221 JONESTONM RD.
NANSTON—SALEM, NC 27104
CONTACT: GREG GARRETT
PH: 336.7659661
I I I I I I II111„//
CAR
0�
c)
PPE AFIY=
o,tiff I N
II
9"Qmbhb..-
GREEN MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE NO. P-0826
www.greenmountainengineers.com

NOTE PERENNIAL STREAM/ WETLAND IMPACT MAP
1. WETLANDS AND STREAM VERIFIED BY PILOT MEADOW VALLEY SUBDIVISION
ENVIRONMENTAL INC. WITH USACE AND NCDEQ—DWR ON
FIELD LOCATED THE VERIFl DNTIAN WETLAND (AND (STREAM NGC� CROSSING licit
FLAGS PLACED BY PILOT ENVIRONMENTAL INC.
2. THIS DEVELOPMENT HAS BEEN ACCEPTED BY THE CITY
OF HIGH POINT AS A HIGH DENSITY STORMWATER
PROJECT, WITH WET DETENTION PONDS AS STORMWATER
MANAGEMENT DEVICES FOR RANDLEMAN LAKE BUFFER \ I I
RULES.
IMPACT
LINEAR STREAM
LINEAR
WETLAND IMPACT
LOCATION
TYPE
ZONE
ID
(FEET)
(SQUARE FEET)
3
SEWER CROSSING
20
0
3
TEMP. PUMP
34
0
AROUND IMPACT
I
4FMH-09 ( z I. SSMH-120
— LL1of
I.
COY) 0
I, LL �
� I � C�ER DAM 'IMPACT 7
fl
SSMH-11
o \ /
v TEMPORARYIMPACT —
> 34 LF STREAM COFFER DAM
N 1
CAR 0�
I 20I 0000' N I \ ,.�� ���,,ESS,,,,,,,,, i
SCALE: 1"-20' -4v, I
I 1 SCALE: 1's20' - =�a� -r-7 -
44AF
lDEVELOPER: Y
SHUGART HOMES
0 F, 221 JONESTOWN RD.
WINSTON—SALEM, NC 27104
CONTACT: GREG GARRETT
PH: 336.7659661
I
1\ t 1 js\oo
V
GREEN MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE NO. P-0826
www.greenmountainengineers.com

.u,
o�
5'
5'x
'
"-
M
ITI-SE
i
v C�T-ML20
Ir I
P
►�1J
p�
O 1�.16%
a
'x
x1'
. ao
—
a
0
ir
SCALE: 1"-40' H
1"=4' V
DEVELOPER:
SHUGART HOMES
221 JONESTOWN RD.
VANSTON—SALEM, NC 27104
CONTACT: GREG GARRETT
PH: 336.76&9681
3tuu
Otuu
PERRENIAL STREAM/ WETLAND
IMPACT MAP
MEADOW VALLEY
SUBDIVISION
►iZVINJ
.19
40
35
1111111111111111 //////
C A R
ESSI d, vim:
_PELIAFY
il
y1kINmn��Q G?
0
%,� �C•A �u�w�xuO, ���.
GREEN MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE NO. P-0826
www.greenmountainengineers.com

ROY COOPER
Gokww
NUCI AEL S. REGAN
seawwy
TIN BAUMGARTNER
orrectar
Greg Garrett
Clayton Properties Group, Inc.
221 Jonestown Road
Wlnston-Salem, NC 27104
sue*,
NORTH CAROUNA
En*wunwedQuaUty
November 25, 2019
Expiration of Acceptance: 5/25/2020
Project: Meadow Valley County: Guilford
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 govemment 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 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 on the DMS website.
Based on the information supplied by you in your request to use the DMS, the impacts for which you are
requesting compensatory mitigation credit 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. _
River Basin Impact Location Impact Type Impact Quantity
(8-digit HUC) -- :.
Cape Fear 03030003 Riparian Wetland 0.24
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.
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: Bradley Luckey, agent
D�EQr
Sincerely,
James. B Stanfill
asset Management Supervisor
Worth C"ama mpartaxnt of E wirorm W Quality I Division of W601M Services
W W.Jones Street I *52 service Cmm I Worth CW,*w 6"-W%
I.MI.M

(}U - � T; ''�'�� �' ,,, : � _ � `fir � � /;, r •
C
t
A_- k
41
14
IP
Ch
i
934 M M •( at
"—strip/
•
•
• i ;
,i
, \ YJ
r t •'
LEGEND
�a
dE
nc',c 1�n._ - - Site y
B oun a
,r • • tr Boundary
Drawing 1 USGS Topographic Map
.Y Meadow Valley Subdivision
USGS Topographic Map
Approximate 4S Acre Tract
Kernersville, NC Quadrangle . High Point, Guilford County, NC
Scale: 1"=2,000' .,,oT INVi0ONMINTAIL INC Pilot Project3736

Mor-
CkB
PoD s
2
SmE C a B E n D
C a.0
CkB PoD `�' EnC
J. ,+
NaC
I rB l.
i
lk
Vt.
'i► ,� 'fir+`
,, MhB2

ca t C CJ Cc P
C C
r � CA,
x ,
�'. F
\ CcB *�
C;rB
.>
•r5
i. - w is
mot
�; � �� { .�'/ a M�,t•� ° $fix,
E' Mr#
pC': IrH MWO
I GC ,
MhB k
M h Mr !r'
r. Iti< Lrt C"rFi
" r
n(: EnB
-
` EnE3wt) ` ` LEGEND
4
Site Boundary
Drawing 2A Published Soil Map
USDA Soil Survey "; Meadow Valley Subdivision
of Guilford County, NC Approximate 4S Acre Tract
Published 1977, Sheets 25 & 31 High Point, Guilford County, NC
PILOT�._�. -..
Not to Scale "`°' `""'"°""`"'"`"` Pilot Project3736

Drawing 4
FEMA FIRM Panels
3710689300K,
Effective 1.2.2009
Not to Scale
A t.
PILOT
P 1 L 0 1 I N V I A 0 N U i N / A I I N C
FEMA FIRM
Meadow Valley Subdivision
Approximate 45 Acre Tract
High Point, Guilford County, NC
Pilot Project 3736

FLAG NUMBERS/INFO
WETLAND FLAGS = I////////I
STREAM FLAGS =
Stream Flags = 40
Wetland Flags = 115
Total Flags = 155
SA 1-S
W
ISA 1-5 B 1-7
ESA 1-5 t �,,fi
WA 1-10
v*
4
SIC — Not
/'..
Flagged \
j
SE 1-15
WB 1-62 `
WC 1-3 DP-1
WCA 1-4 DP-2 0
O
SB 1-8 WBA 1-29 4
LEGEND
Site Boundary
■ • ■ ■ ■ ■ Intermittent Stream
Perennial Stream
SD 1-7
WD 1-7 Wetland
SA 1-5 Flag Number
DP-1 O Data Point
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY WERE VERIFIED BY MR. DAVID BAILEY
WITH THE USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ-DWR ON JULY 10, 2018.. THEY HAVE NOT BEEN SURVEYED OR
GEOLOCATED.
Drawing 5 Wetland Map
Aerial Imagery from ESRI
Meadow Valley Subdivision
and Pilot Field Notes
Approximate 45 Acre Tract
Scale: 1" = 500' PILGT High Point, Guilford County, NC
Date:5.23.18 PILOT ENVIRONMfNTAL.INC
Pilot Project 3736
Revised: 7.12.18

NORTH CAROLINA.
ROY COOPER Environmental Quality
Gen.cl my
MtIC14AEL S. RELAN
Secretory
LINDA CULPEPPER
!nren,m liltcctor
July 23, 2018
Mr. Michael Brame
Pilot Environmental Inc.
P.O. Box 128
Kernersville, NC 27285
Subject: On -Site Determination for Applicability to the Mitigation Rules (15A NCAC 2H .0500)
Subject Property: Meadow Valley Subdivision, High Point NC, Guilford County
Dear Mr. Brame:
On July 10, 2018, at your request, Sue Homewood conducted an on -site determination to review features
located on the subject project for stream determinations with regards to the above noted state regulations.
David Bailey with the US Army Corps of Engineers was also present during the site visit.
The Division acknowledges the areas and boundaries identified as jurisdictional wetlands by the USACE.
The attached sketch accurately depicts all stream determinations conducted during the site visit.
Please note that at the time of this letter, all perennial stream channels and jurisdictional wetlands found on
the property are subject to the mitigation rules cited above. In addition, the Randleman Lake Buffer Rules
may apply to some streams at this location, please be sure to contact the local government for further
information regarding the Randleman Lake Buffer Rules
The owner (or future owners) should notify the Division (and other relevant agencies) of this decision in
any future correspondences concerning this property. This on -site determination shall expire five (5) years
from the date of this letter.
D_EQ
North Carolina Department of Environmental Quality I Division of Water Resources
450 W. Hanes Mill Rd, Winston-Salem, NC 27107
336.776-9800

Page 2 of 2
Landowners or affected parties that dispute a determination made by the Division or Delegated Local
Authority that a surface water exists and that it is subject to the buffer rule may request a determination by
the Director. A request for a determination by the Director shall be referred to the Director in writing c/o
401 & Buffer Permitting Branch, 1650 Mail Service Center, Raleigh, NC 27699-1650. Individuals that
dispute a determination by the Division or Delegated Local Authority that "exempts" surface water from
the buffer rule may ask for an adjudicatory hearing. You must act within 60 days of the date that you
receive this letter. Applicants are hereby notified that the 60-day statutory appeal time does not start until
the affected party (including downstream and adjacent landowners) is notified of this decision. The
Division recommends that the applicant conduct this notification in order to be certain that third party
appeals are made in a timely manner. To ask for a hearing, send a written petition, which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, N.C. 27699-6714. This determination is final and binding unless you ask for a
hearing within 60 days.
This letter only addresses the applicability to the mitigation rules and the buffer rules and does not approve
any activity within Waters of the United States or Waters of the State or their associated buffers. If you
have any additional questions or require additional information, please contact me at 336-776-9693 or
sue. homewood(a,ncdenr. gov.
Sincerely,
Sue Homewood
Winston-Salem Regional Office
Enclosures: USGS Topo Map
Pilot Environmental Stream Map
Cc: Shugart Enterprises LLC ([e-mail])
David Bailey, USACE Raleigh Regulatory Field Office (via email)
DWR, Winston-Salem Regional Office

V•4=?v • - i
' • `aat i
�.,� ( N • - \yam.+-�� •� - x _ - • �e _I' _ f �.s r
IlkpIQ'
• w�f C • Q.f
1,17
-� J ( -a •�' Pat •
Ch
•e tanOlhQ! r � //J/ t:Y � F ` •� , �l y ~"���'t �-I.✓�„r`r C-6
4.877
• • "+ _- > .i - '� � kx�., ' /J. �• �r ,'ivy r -� . \��\.
*`1P��•9'8 ! �� Q . •P.' •[ �,/: ;• ' LEGEND
orne�tuwrr`_Imo. h - Site Boundary
.... ! ` % � - � f • .. „ _, �',_t� :-'�,' 1�:.- - . "f 1'�� ' I: �' � ,off" � '- -
Drawing 1 USGS Topographic Map
USGS Topographic Map ' Meadow Valley Subdivision
Approximate 45 Acre Tract
Kernersville, NC Quadrangle t' . r , High Point, Guilford County, NC
Scale: 1"=2,000' Ti_OT ENVigO NMFA T A L I h( j
Pilot Project 3736

FLAG NUMBERS/INFO
W ETLAN D FLAGS
STREAM FLAGS =
Stream Flags = 40
Wetland Flags = 115
Total Flags = 155
SA 1-5
ISA 1-5 -_
E
ESA 1-5 \
WA 1-10
SC — Not
Flagged \
SE 1-15
WB 1-/FDP-2
WC 1-3
WCA 1-4
i
9
SB 1-8
WBA 1-29
WS 1-7
LEGEND
Site Boundary
■ ■ ■ ■ ■ ■ Intermittent Stream
Perennial Stream
SOS-7
WD 1-7 Wetland
5A 1-5 Flag Number
DP-1 O Data Point
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY WERE VERIFIED BY MR. DAVID BAILEY
WITH THE USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ-DWR ON JULY 10, 2018.. THEY HAVE NOT BEEN SURVEYED OR
GEOLOCATED.
Drawing 5
Aerial Imagery from ESRI
and Pilot Field Notes
Scale: 1" = 500'
Date: 5.23.18
Revised: 7.12.18
PILOT ENV 1 RON MENTAL.INC_
Wetland Map
Meadow Valley Subdivision
Approximate 45 Acre Tract
High Point, Guilford County, NC
Pilot Project 3736