20201529 Ver 1_ePCN Application_20201214

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
October 26, 2020 Ver 3.3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change only if needed.
BIMS # Assigned * Version#*
20201529 1
Is a payment required for this project?*
r No payment required
What amout is owed?*
r Fee received
IT $240.00
r Fee needed - send electronic notification
r $570.00
Reviewing Office *
Winston-Salem Regional Office - (336) 776-
Select Project Reviewer*
9800
Sue Homevmod:eads\slhomewood
Information for Initial Review
1a. Name of project:
Rich Fork Heights
1a. Who is the Primary Contact?*
Chuck Truby
1b. Primary Contact Email:*
1c. Primary Contact Phone:*
[e-mail]
[phone]
Date Submitted
12/14/2020
Nearest Body of Water
Rich Fork
Basin
Yadkin -Pee Dee
Water Classification
C
Site Coordinates
Latitude: Longitude:
36.018778-80.05547
Pre -Filing Meeting Information
ID# Version
20201529 1
Pre -fling Meeting or Request Date*
11/4/2020
Attach documentation of Pre -Filing Meeting Request here:*
DWR Pre -Filing Meeting Request Form.pdf 51.87KB
A. Processing Information v
County (or Counties) where the project is located:

Forsyth
Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
P Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
Ild. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
29 - Residential Developments
Ile. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification:
For the record onlyfor Corps Permit:
r 401 Water Quality Certification - E)press
W Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
HPT Investment Holdings, LLC
2b. Deed book and page no.:
DB 3511 PG 1504
2c. Responsible party:
Andy Dondero
2d.Address
r Yes r No
r Yes r No

Street Address
455 2nd Street S.E. 5th Floor
Address tine 2
city
State / Province / tegim
Charlotesville
Va
Postal / Zip Code
Country
22902
US
2e. Telephone Number:
2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History l^�
1. Project Information
1b. Subdivision name:
(d appropriate)
Rich Fork Heights
1c. Nearest municipality/ town:
Forsyth
F-
2. Project Identification
2a. Property Identification Number:
2b. Property size:
6882-77-3453
41.665
2c. Project Address
Street Address
4024 N Main ST
Address Line 2
city
State / Province / Pagion
High Point
NC
Postal / Zip Code
Country
Forsyth
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Rich Fork
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401030203
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:*
Wooded Land surrounded by interstate highway to the north.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
1612-19 USGS MAP.pdf
219.2KB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
SOILS MAP.pdf 1001.69KB
4f. List the total estimated acreage of all existing wetlands on the property:
3.23
4g. List the total estimated linear feet of all existing streams on the property:
2,826
4h. Explain the purpose of the proposed project:*
Residential Subdivision

41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The development of a 164 lot subdivision with streets, utilities, storm sewer and wet detention ponds. Equipment Used: Track Hoes, Bull Dozers , Pans, Dump Trucks
4j. Please upload project drawings for the proposed project.
PCN-4.pdf 1.31 MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
SAW-2018-01914
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Jay Lawson
Agency/Consultant Company: Progress Environmental Group
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
11/7/2018
5d1. Jurisdictional determination upload
SAW-2018-01914 (signed PJD).pdf 544.03KB
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
W Wetlands W Streams -tributaries
r Open Waters F Pond Construction
2. Wetland Impacts
r Buffers
2a1 Reason (?) 2b. Impact type * M 2c. Type of W.* 2d. W. name * 2e. Forested * 2f. Type of Impact
Jurisdicition*(?)]2g.
area
W1
Fill
P
Headwater Forest
W1
Yes
Corps
0.059
(acres)
W2
Sewer Line ��T
Headwater Forest
�W2
Yes
Corps
0.030
(acres)
2g. Total Temporary Wetland Impact
0.030
2g. Total Wetland Impact
0.089
2h. Comments:
3. Stream Impacts
2g. Total Permanent Wetland Impact
0.059
3a. Reason for impact (?) 3b.lmpact type" 3c. Type of impact" 3d. S. name" 3e. Stream Type" 3f. Type of 3g. S. width 3h. Impact
(?) Jurisdiction* i length*

S1
Sanitary Sewer
Temporary
Other
S1
Perennial
Corps
13
Average (feet)
28
(lir�rfeet)
S2
Coffer Dam
Tem orar
p y
Other
S2
Perennial
Corps
p
13
Average (feet)
10
(linearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
0
3i. Total stream and ditch impacts:
38
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
31. Total temporary stream impacts:
38
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The slopes are proposed to be 2:1 which is the steepest allowed. The pipe length is as short as possible to keep wetland impacts to the minimum
amount possible.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Silt Fence will be installed to prevent erosion from entering wetlands
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance (lower SMWT)
r Wetland Swale (higher SMWT)
9 Other SCM that removes minimum 30 % nitrogen
r Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater
program?
r Yes r No
r N/A - project disturbs < 1 acre
2d. Which of the following stormwater management program(s) apply:
W Local Government r State
Local Government Stormwater Programs
W Phase II W NSW r USMP W Water Supply
Please identify which local government stormwater program you are using.
Greensboro
Comments:
v

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes f• No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor WA
4b. 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.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?'
r Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS website with verification by USACE. https://ecos.fws.gov/ecp0/reports/species-by-current-range-county?fps-37081 and
https://ecos.fvvs.gov/ecp/
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
http://mm.fws.gov/raleigh/species/cntylist/county.html with verification by USACE. Site is not near salt marsh, oyster reef, or sea grass beds.
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 status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
State Historic Preservation Office
http://mm,hpo.dcr.state.nc.us/ with verification from the USACE
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
r Yes
r No
8b. If yes, explain how project meets FEMA requirements:
The sanitary sewer is underground and will have no impact on the flood elevation
8c. What source(s) did you use to make the floodplain determination?*
FEMA Map No. 371010688200K, Dated March 16, 2009
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
SAW-2020-01620 (signed NWP).pdf 1.87MB
Signature u
*
rJ By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
• 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.
• I have given true, accurate, and complete information on this form;
• I agree 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");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Andy Dondero
Signature
Date
12/14/2020

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KERNERWILLE, NG
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EN& I NEERI N& AND SURVEY I N S, INC
kz LAND DEVELOPMENT GON5ULTINCG
NGBEL5 FIRM LIGE*E NO, G-I315
4400 TYNIN& 5TREET
HIGH POINT, NORTH CAROLINA 2-7265
PHONE: (336) 8I2-8800 - FAX: (336) SI2-S180
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ID#* 20201529
Version* 1
Regional Office * Winston-Salem Regional Office - [phone]
Reviewer List* Sue Homewood
Pre -Filing Meeting Request submitted 10/20/2020
Contact Name* Chuck Truby
Contact Email Address* [e-mail]
Project Name* Rich Fork Heights
Project Owner* HPT Investment Holdings
Project County* Forsyth
Owner Address: Street Address
455 2nd St. SE 5th Floor
Address Line 2
aty
State / Province / Region
Charlottesville
VA
Postal / Zip axle
Country
22902
USA
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - F 401 Water Quality Certification
Regular Express
F- Individual Permit F- Modification
F Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- 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.*
Propose 0.059 acres of wetland impacts and temporay wetland impact of
0.03 acres for a sewer line and 38' of temporary stream impacts for a
sewer line crossing.
Please give a couple of dates you are available for a meeting.

10/28/2020
10/29/2020
11 /4/2020
Please attach the documentation you would like to have the meeting about.
PCN revised exhibits 9-22-20.pdf 329.39KB
PCN Submittal Package 9-14-2020.pdf 8.55MB
pdf only
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.
1 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
Submittal Date 10/20/2020