20201206 Ver 1_401 Application_20201103

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification PC.N) Form
A. Applicant Inforrnation
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. 14 or General Permit (GP) number.-
1 c.
Has the NWP or GP number been verified by the Corps? ® Yes
❑ No
1 d.
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
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Coldwater
2b.
County:
Forsyth / Guilford
2c.
Nearest municipality / town:
Stokesdale
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state
project no:
n/a
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Parrish Heirs Special Needs Trust
3b.
Deed Book and Page No.
3273-1847 (Forsyth); 7787-2290 (Guilford)
3c.
Responsible Party (for LLC if
applicable):
Stuart Wayne Parrish
3d.
Street address:
5409 Union Grove Road
3e.
City, state, zip:
Oak Ridge, NC 27310
3f.
Telephone no.:
336.643.9750
3g.
Fax no.:
n/a
3h.
Email address:
[e-mail]
RECEIVED
NOV 0 3 2020
Page 1 of 10
NCDEUDWRIMES PCN Form - Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: Buyer, under contract to purchase
4b. Name:
Paul Hoist
4c. Business name
(if applicable):
First Carolina Homes
4d. Street address:
5411 Tory Hill Drive
4e. City, state, zip:
Greensboro, NC 27410
4f. Telephone no.:
336.944.7919
4g. Fax no.:
n/a
4h. Email address:
[e-mail]
6. AgentlConsultant Information (if applicable)
5a. Name:
Perry Isner
5b. Business name
(if applicable):
Wetlands & Waters, Inc.
5c. Street address:
328 East Broad Street, Suite D
5d. City, state, zip:
Statesville, NC 28677
5e. Telephone no.:
704.773.4239
5f. Fax no.:
n/a
5g. Email address:
[e-mail]
Page 2 of 10
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identillication
1a. Property identification no. (tax PIN or parcel ID):
Forsyth: 6990-35-2534.00; Guilford: 229722, 165004
1b. Site coordinates (in decimal degrees):
Latitude: 36.23379 Longitude: --80.03715
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
+/- 100 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Belews Lake (East Belews Creek)
proposed project:
2b. Water Quality Classification of nearest receiving water:
B
2c. River basin:
Roanoke
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 property consists primarily of vacant, forested lands with an abanoned homesite. The general land use in the vicinity
of the project is primarily low density residential and agricultural.
3b. List the total estimated acreage of all existing wetlands on the property:
0.297
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1835
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to construct a road crossing in order to access high ground to be utilized for a
residential development.
3e. Describe the overall project in detail, including the type of equipment to be used:
Typical earth moving equipment will be utilized, including pan, excavator, dump truck, bulldozer, etc.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
® Yes [3 No El Unknown
project (including all prior phases) in the past.
Comments:
4b. If the Corps made the jurisdictional determination, what type
Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: Wetlands & Waters, Inc.
Name (if known): Perry Isner
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW-2020-00166, PJD pending
6. 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.
S. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 3 of 10
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
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments:
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
Culvert
LIT to Belew's
Lake
® PER
❑ INT
® Corps
❑ DWQ
5
35
S2 ❑ P ®T
Construction
access / pump-
LIT to Belew's
Lake
® PER
❑ INT
® Corps
❑ DWQ
5
10
around
S3 ❑ P ®T
Construction
access / pump-
LIT to Belew's
® PER
® Corps
5
10
around
Lake
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
55
3i. Comments:
Page 4 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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 []POT
02 ❑P[IT
03 []POT
04 ❑P[IT
4E Total open water impacts
4g. Comments:
6. 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
5E Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
S. 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 ❑Other:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
69.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary
impact
required?
B1 ❑P❑T
❑Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
B3 ❑ P [IT
❑ Yes
❑ No
6h. Total buffer impacts
61. Comments:
Page 5 of 10
PCN Form —Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Project has been designed such that impacts are only necessary for a single road crossing with all other potentially
jurisdictional features on site avoided. Concrete endwalls will be utilized in order to minimize impacts to the maximum extent
practicable. Temporary impacts for construction access and pump -around will be returned to original grade following
completion of construction.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Project will be designed and constructed under an approved sediment and erosion control plan such that materials incidental
to construction activities are not transported into downstream receiving waters.
2. Compensatory Mitigation for Impaots to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2h. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
0. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
A. Comments:
b. Complete If Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form —Version 1.3 December 10, 2008 Version

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 7 of 10
PCN Form —Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWG)
1. Diffuse Flow Plan
1a. 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.
El Yes [I No
Comments:
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project?
<24 %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Project meets low -density requirements
and will include vegetated swales along the roadway.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the 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?
Guilford / Forsyth counties
❑ Phase 11
3b. Which of the following locally -implemented stormwater management programs
El 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. DWG Stormwater Program Review
❑ Coastal counties
❑ HOW
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?
6. DWG 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 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.
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.
Project will utilize well and septic and does not include construction of sanitary sewer.
Page 9 of 10
PCN Form — Version 1.3 December 10, 2008 Version

6. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
® Yes ❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ 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?
NC Natural Heritage Program indicates no known occurences of federally protected species within one mile of the project
area.
G. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® 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?
NC HPOWEB service.
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: Project has been designed to be compliant with FEMA
requirements.
8c. What source(s) did you use to make the floodplain determination? FEMA National Flood Hazard Layer
PA uL,5
Applicant/Agent's Signature
Applicant/Agent's Printed Name
Date
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 10 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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T I M M O N S GROUP . • -. r��s,ox���TMxD�xD� ��
g a COLDWATER g$ m= g
P 9 GULL 0 AND FORSVTH COUNtt - NORh CAROUNA
N m COLD WATER TERRACE PLAN AND PROFILE '
�'-'
a

among Roy Cooper, Governor
•"'NN NC DEPARTMENT OF
■name NATURAL AND CULTURAL RESOURCES Susi Hamilton, Secretary
name Walter Clark, Director, Land and Water Stewardship
NCNHDE-12906
September 21, 2020
Meagan Jolly
Wetlands & Waters, Inc.
328 East Broad Street
Statesville, NC 28677
RE: Coldwater
Dear Meagan Jolly:
The North Carolina Natural Heritage Program (NCNHP) appreciates the opportunity to provide
information about natural heritage resources for the project referenced above.
Based on the project area mapped with your request, a query of the NCNHP database indicates that
there are no records for rare species, important natural communities, natural areas, and/or
conservation/managed areas within the proposed project boundary. Please note that although there
may be no documentation of natural heritage elements within the project boundary, it does not
imply or confirm their absence: the area may not have been surveyed. The results of this query
should not be substituted for field surveys where suitable habitat exists. In the event that rare
species are found within the project area, please contact the NCNHP so that we may update our
records.
The attached 'Potential Occurrences' table summarizes rare species and natural communities that
have been documented within a one -mile radius of the property boundary. The proximity of these
records suggests that these natural heritage elements may potentially be present in the project area
if suitable habitat exists. Tables of natural areas and conservation/managed areas within a one -mile
radius of the project area, if any, are also included in this report.
If a Federally -listed species is found within the project area or is indicated within a one -mile radius of
the project area, the NCNHP recommends contacting the US Fish and Wildlife Service (USFWS) for
guidance. Contact information for USFWS offices in North Carolina is found here:
httos://www.fws.aov/offices/Directory/ListOffices,cfm?statecode=37.
Please note that natural heritage element data are maintained for the purposes of conservation
planning, project review, and scientific research, and are not intended for use as the primary criteria
for regulatory decisions. Information provided by the NCNHP database may not be published
without prior written notification to the NCNHP, and the NCNHP must be credited as an information
source in these publications. Maps of NCNHP data may not be redistributed without permission.
The NC Natural Heritage Program may follow this letter with additional correspondence if a
Dedicated Nature Preserve, Registered Heritage Area, Clean Water Management Trust Fund
easement, or Federally -listed species are documented near the project area.
If you have questions regarding the information provided in this letter or need additional assistance,
please contact Rodney A. Butler at rodney.butler(d)ncdcr.gov or 919-707-8603.
Sincerely,
NC Natural Heritage Program

Natural Heritage Element Occurrences, Natural Areas, and Managed Areas Within a One -mile Radius of the Project Area
Coldwater
September 21, 2020
NCNHDE-12906
Element Occurrences
Documented Within a One -mile Radius of the Project Area
Taxonomic
EO ID Scientific Name Common Name
Last Element Accuracy
Federal State Global
Stati
Group
Observation Occurrence
Status Status Rank
Ranl
Date Rank
Natural
28460 Dry-Mesic ---
2010 C 3-Medium
--- --- G4G5
S4
Community
Oak --Hickory Forest
(Piedmont Subtype)
Vascular Plant
10455 Cyperus granitophilus Granite Flatsedge
1948-05-05 H 4-Low
--- Threatened G3G4
S2
Q
Natural Areas Documented Within a One -mile Radius of the Project Area
Site Name Representational Rating Collective Rating
Benefit Church Forests R5 (General) C5 (General)
No Managed Areas are Documented Within a One -mile Radius of the Project Area
Definitions and an explanation of status designations and codes can be found at httos://ncnhde.natureserve.or /� h In. Data query generated on September 2l, 2020; source: NCNHP, 03 July 2,
resubmit your information request if more than one year elapses before project initiation as new information is continually added to the NCNHP database.
Page 2 of 3

N
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s
September21, 2020
Project Boundary
Buffered Project Boundary
Q NHP Natural Area (NHNA)
NCNHDE-12906: Coldwater
f Rd
,.-H e?ewa Greek Re
vy
Page 3 of 3
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Potentially Jurisdictional
Water of the US
Tributary 5/5a Potentially Jurisdictional
-285 LF

fA
fs
ID#* 20201206 Version* 1
Regional Office * Winston-Salem Regional Office - [phone]
Reviewer List* Sue Homewood
Pre -Filing Meeting Request submitted 9/18/2020
Contact Name * Perry Isner
Contact Email Address* [e-mail]
Project Name * Coldwater
Project Owner* Andrew Quentin Parrish Special Needs Trust
Project County* Forsyth
Owner Address: Street Address
Address Line 2
City State / Ftovince / Fboon
Fbstal / Zip Code Country
Is this a transportation project? * r Yes r No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - I-"' 401 Water Quality Certification -
Regular Express
i Individual Permit r Modification
r Shoreline Stabilization
Does this project have an existing project ID#?
r Yes r No
Do you know the name of the staff member you would like to request a meeting with?
Sue Homewood
Please give a brief project description below.*
Proposed single family development.
Please give a couple of dates you are available for a meeting.
9/28/2020
9/29/2020
RECEIVED
NOV 0 3 2020
NCDEQ/DWR/NPDES

r�
Please attach the documentation you would like to have the meeting about.
(2020.08.28) - Overall Subdivision Plan.pdf 888.74KB
Pdf -b
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
/" lwk
Submittal Date 9/18/2020