20201624 Ver 1_401 Application_20201228

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
r Yes r No
ID#*
20201624
Version* 1
Is this project a public transportation project?* r Yes
r No
Reviewer List:* Sue Homewood:eads\slhomewood
Select Reviewing Office:* Winston-Salem Regional Office - [phone]
Submittal Type:* 401 Application
Does this project require a request for payment to be sent?*
r
Yes
r
No
How much is r $240.00
owed?* r $570.00

Project Submittal Form
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Type: * r
For the Record Only (Courtesy Copy)
r
New Project
r
Modification/New Project with Existing ID
r
More Information Response
r
Other Agency Comments
r
Pre -Application Submittal
r
Re-Issuance\Renewal Request
r
Stream or Buffer Appeal
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not
be able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in
accordance with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project
proponent shall request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section
121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre -filing meeting request was
submitted to the certifying authority at least 30 days prior to submitting the certification request. Click here to read
more information on when this form is needed prior to application submission or here to view the form.
Attach documentation of Pre -Filing Meeting Request here:
Pre -Filing timeclock expired_11.27.20.pdf 51.38KB
Date for Meeting Request 10/27/2020
ID# 20201624 Version 1
Project Contact Information
Name: Michael Brame
who is subrritting the information?
Email Address: [e-mail]
Project Information
Project Name: Burlington Rd
Is this a public transportation project?
r Yes
r No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
County (ies)
Guilford
Please upload all files that need to be submited.

click the upload button or drag and drop files here to attach document
5740.1_6479 Burlington Road —Wet Ver & PCN
5.73MB
Application_12.24.20.pdf
Only pdf or krm files are accepted.
Describe the attachments
or comments:
401 WQC
Sign and Submit
V By checking the box and signing box below, I certify that:
■ I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to
the best of my knowledge and belief.
■ I, 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 agree that submission of this online 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 online form.
Signature:
Submittal Date: Is filled in autonatically.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 9: SAW- 2020
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Burlington Road
Begin Date (Date Received): 12.24.20
Assign Action ID Number in ORM ❑
2. Work Type: ❑✓ Private ❑Institutional ❑Government ❑ Commercial
3. Project Description / Purpose [PCN Form 133d and B3e]:
The site is proposed for residential development.
4. Property Owner / Applicant [PCN Form A3 or A4]: Brightwood Crossing, LLC
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Burlington Road
36.0685440/-79.5904020
8. Project Location —Tax Parcel ID [PCN Form B 1 a] : 8824546534
9. Project Location —County [PCN Form A2b]: Guilford
10. Project Location —Nearest Municipality or Town [PCN Form A2c]: Whitsett
11. Project Information — Nearest Waterbody [PCN Form 132a]: Rock Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03030002
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
❑ Standard Permit
✓ Nationwide Permit 9
Regional General Permit 9
✓ Jurisdictional Determination Request
Section 10 and 404 ❑
❑ Pre -Application Request
::]Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

urisdictional Determination Reauest
US Army Corps
of Engineers.
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.aimy.mil/Missions/Re ul�atoiyPermitProi4ram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: Burlington Road
City, State: Whitsett, NC
County: Guilford
Parcel Index Number(s) (PIN): 8824546534
B. REQUESTOR INFORMATION
Name: Michael Brame. Pilot Environmental.
Mailing Address: Post Office Box 128
Telephone Number:
Electronic Mail Address:
Select one:
Kernersville, NC 27285
336-708-4620
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultanti
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: Brightwood Crossing, LLC
Mailing Address: Post Office Box 16168
High Point, NC 27261
Telephone Number: 336-292-9010
Electronic Mail Address: [e-mail]
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION',4
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.
Amanda Williams
Print Name
Capacity: ❑✓ Owner ❑ Authorized Agents
10.28.20
Date
Attached
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑✓ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑ A Corps JD is required in order obtain my local/state authorization.
❑ I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑✓ Other: Client Requested
s For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
a If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
s Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERNIINATION (JD) TYPE (Select One)
0 I am requesting that the Corps provide a preliminM JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓❑ Size of Property or Review Area -20 acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude
36.0685440
Longitude:-79.5904020
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I Ix 17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. hM2://www.saw.usace.4rmy.mil/Missions/Regulatoly-Permit-
Pro gram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
F4Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDS• please complete an Approved Jurisdictional Determination Form'.
Vicinity Map
0 Aerial Photograph
F4 USGS Topographic Map
0 Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
❑ NC Division of Water Resources Stream Identification Forms
hJ Other Assessment Forms
' www.saw.usace.4rmy.mil/Portals/59/docs/regulatory/readocs/JD/RGL 08-02_App A Prelim _JD_Form fillable.pdf
8 Please see hM2://www.saw.usace.4M.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federaljurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Environmental Services Proposal
Pilot Proposal 5740.1
October 23, 2020
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: PTO
-��
Owner Information:
Address:
Vo v 3' ) �"l C/
�� ',1� V" �A �\J" a-� a�' I
Telephone Number:
Fax Number:
c
E-mail Address: 1 1��' -.t -- .5 .�J�-���tr� t,.7r— -'
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 dully authorized agent of the owner of record of the property.
Print Name
Capacity: V/ Owner —Authorized Agent
OA / R�
Date
Si
5

ICY191rf IN11
Property Report
Guilford County, NC - Property Report Convert to PDF 3/31/2020
Parcel ID Property Address Legal Description
106282 6479 Burlington Rd 20.06AC LOT 4B & .23AC & 6719-923
Mobile 0
i
Maps
Owner Information
Owner Name
Mailing Address
City, State Zip
BRIGHTERWOOD CROSSING LLC
3929 TINSLEY DR STE 104
HIGH POINT, NC 27265
Parcel Information
PIN
Zoning
Use
Tax District
8824546534-000
CU-PDR-Planned Development, Residential
RESIDENTIAL
0
Parcel Size
Appraisal Nbrhood
Plat/Condo Bk & Pg
20.29
8824A07
N/A
Recent Sales
Book & Page
Sale Date
Sale Price
Qualified?
Improved?
00807801363
$0
Yes
Yes
Appraisal Values
Land
Buildings
Extra Features
Total Value
$304,400
$0
$0
$304,400
Disclaimer. Map and parcel data are believed to be accurate, but accuracy is not guaranteed. This is not a legal document
and should not be substituted for a title search, appraisal, survey, or for zoning verification.
Disclaimer. Map and parcel data are believed to be accurate, but accuracy is not guaranteed. This is not a legal document
and should not be substituted for a title search, appraisal, survey, or for zoning verification.
gis.guilfordcountync.gov/PropertyCardjs/Default.aspx?pin=106282&maplmage=_ags_065ae1 cad 8764303bf78ffc0cee6651 b.jpg&isTinyScreen=false&i... 1 /1

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: December 24, 2020
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Michael Brame, Pilot Environmental, Inc.
Post Office Box 128, Kernersville, North Carolina 27285
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, Burlington Rd, SAW 2020-
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The site is located north of Burlington Road,
Whitsett, Guilford County, NC. The site contains wooded land and agricultural fields. The site is proposed for residential
development.
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: North Carolina County/parish/borough: Guilford County City: Whisett
Center coordinates of site (lat/long in degree decimal format): Lat.: 36.068544' Long.:-79.590402'
Universal Transverse Mercator: WGS 84
Name of nearest waterbody: Rock Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
Latitude (decimal
Longitude
Estimated amount of
Type of aquatic
Geographic authority to
Number
degrees)
(decimal degrees)
aquatic resources in
resources (i.e.,
which the aquatic resource
review area (acreage
wetland vs. non-
"may be" subject (i.e.,
and linear feet, if
wetland waters)
Section 404 or Section
applicable
10/404)
WA 1-3
36.0690390
-79.5923660
0.011-acres
Wetland
404
WA 4-6
36.0692380
-79.5918210
0.005-acres
Wetland
404
SA 1-33
36.0694180
-79.5913970
1,091-linear feet
Non -wetland
404
WA 7-10
36.0695780
-79.5905930
0.025-acres
Wetland
404
WA 11-29
36.0698940
-79.5898700
0.807-acres
Wetland
404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in the
review area, and the requestor of this PJD is hereby advised of his or her option to request
and obtain an approved JD (AJD) for that review area based on an informed decision after
having discussed the various types of JDs and their characteristics and circumstances when
they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a Nationwide
General Permit (NWP) or other general permit verification requiring "pre- construction
notification" (PCN), or requests verification for a non -reporting NWP or other general permit,
and the permit applicant has not requested an AJD for the activity, the permit applicant is
hereby made aware that: (1) the permit applicant has elected to seek a permit authorization
based on a PJD, which does not make an official determination of jurisdictional aquatic
resources; (2) the applicant has the option to request an AJD before accepting the terms and
conditions of the permit authorization, and that basing a permit authorization on an AJD could
possibly result in less compensatory mitigation being required or different special conditions;
(3) the applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can accept
a permit authorization and thereby agree to comply with all the terms and conditions of that
permit, including whatever mitigation requirements the Corps has determined to be necessary;
(5) undertaking any activity in reliance upon the subject permit authorization without
requesting an AJD constitutes the applicant's acceptance of the use of the PJD; (6) accepting a
permit authorization (e.g., signing a proffered individual permit) or undertaking any activity in
reliance on any form of Corps permit authorization based on a PJD constitutes agreement that
all aquatic resources in the review area affected in any way by that activity will be treated as
jurisdictional, and waives any challenge to such jurisdiction in any administrative or judicial
compliance or enforcement action, or in any administrative appeal or in any Federal court;
and (7) whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms and
conditions contained therein), or individual permit denial can be administratively appealed
pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it becomes appropriate to
make an official determination whether geographic jurisdiction exists over aquatic resources
in the review area, or to provide an official delineation of jurisdictional aquatic resources in
the review area, the Corps will provide an AJD to accomplish that result, as soon as is
practicable. This PJD finds that there "may be" waters of the U.S. and/or that there "may be"
navigable waters of the U.S. on the subject review area, and identifies all aquatic features in
the review area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources below where
indicated for all checked items:
❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:
® Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concurwith data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: Drawing 1
® Natural Resources Conservation Service Soil Survey. Citation: Drawings 2 & 2A
® National wetlands inventory map(s). Cite name: Drawing 3
❑ State/local wetland inventory map(s):
® FEMA/FIRM maps: Drawing 4
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
® Photographs: ®Aerial (Name & Date): Drawing 5
or ❑Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily been
verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of Regulatory
staff member completing PJD
�Wj 7 A**.— December 24, 2020
Signature and date of person
requesting PJD (REQUIRED,
unless obtaining the signature
is impracticable)'
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester does not respond within the
established time frame, the district may presume concurrence and no additional follow up is necessary prior to finalizing
an action.

Cl-
QN
9,7
Irk
LEGEND
13
Site Boundary
USGS Topographic Map
Drawing `
Burlington Road
USGSTopographic Map
� Approximate ZO-AcreTraot
Gibaonvi||e NC �
' VVhitaett,Guilford County, NC
Scale: 1"=2000' 0

Yw
7
f \1 dr... -- -" �: '•. ram` � i
5
aa
l 4
NOW }.
JIP
-fit � � � '�''� 4-� `'4�4 �' ,• s•
i.
+f f
-{ LEGEND
- .� $,• Site Boundary
Drawing 2 ` ' ° ` Web Soil Map
USDA Web Soil Survey - Burlington Road
Approximate 20-Acre Tract
of Guilford County, NC PIL137■ Whitsett/ Guilford County, NC
Scale: 1"=250' PILOT E N V I R 0 N M E N 7 A L. I NC
Pilot Project 5740.1

rE
CrB
Drawing 2A
USDA Soil Survey
of Guilford County, NC
Published 1977, Sheet 30
Not to Scale
Crc M
MhB2
eke
CrF3
yl
{
EnE
LEGEND
Site Bounc
= Published Soil Map
Burlington Road
Approximate 20-Acre Tract
PIL131 Whitsett, Guilford County, NC
PILOT ENVIR0NMEN7AL.INC Pilot Project5740.1

f r4 r y
r R
NP
• ' 1{ T • ter~+ y 4A�� +WY�}. ,
lY1 5 If
jar A Y _
1. ��� Y r � ,; ,u ' •y k'+. • - 1� . :lam ' i
,
Ayr
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tk
►� i . a~i
.. Ay it
► 4.
• l -5 T
j a
c � t
f wF4 , F
LEGEND.*"ap
{r Site Boundary
* , Freshwater Emergent
'+- • • Freshwater Forested/Shrub
i r � - . .� • + � . � � Estuarine and Marine Deepwater
Estuarine and Marine
1+ } f fVIP Freshwater Pond
r, F f, owl yt�► f ;,. Lake
ooL+ 's. �} '' Riverine
Other
NWI Map
Drawing 3"
USFWS NWI _ Burlington Road
Approximate 20-Acre Tract
Wetlands Mapper _ PILOT 'P, Whitsett' Guilford County, NC
Scale: 1" = 250'
• P f LOT EMVIRON M E N T A L I N C Pilot Project 5740.1

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16Site Boundary
Ab {, `+ :� 1 �'oAnnual Chance Flood Hazard
�* f Regulatory Flood,vay
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Area of Undetermined Flood Hazard
0.2%Annua1 Chance Flood Hazard
Opt } * h:Future Conditions 1'/¢Annual Chance Flood Hazard
► Area with R educed Risk Due to Levee
FEMA FIRM
Drawing 4
National Flood Hazard Layer -y Burlington Road
- _ w Approximate 20-Acre Tract
From FEMA Web Map Service p'�DT ,w,
Scale: 1" - 250' Whitsett, Guilford County, NC
PILOT ENYIRONMENTAL,INL Pilot Project5740.1

L-
_
Y
WA 11-29
,�#s y _.►w' (0.807 Ac) , L A• • , *#F
s '�
4
f"
VVH/-1V V-- - T t -
(1,091 U) (0.025 Ac) 0
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WA 4-6
(0.005 Ac)
WA 1-3� ,
dv
?matt 4�
Ilk
Z 1 .10
LEGEND
FLAG NUMBERS/INFO Site Boundary
Perennial Stream
WETLAND FLAGS =
STREAM FLAGS = Wetland
Stream Flags = 33
SA 1-5 Flag Number
Wetland Flags = 29
Total Flags = 62 DP-1 O Data Point
5
b THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY THE USACE AND/OR THE
NCDEQ-DWR. THIS EXHIBIT INCLUDES GPS LOCATIONS OF DELINEATED FEATURES.
7C� Y �"i—
Drawing 5 Wetland Map
Satellite Imagery from ESRI Burlington Road
and Pilot GPS Data - Approximate 20-Acre Tract
Scale: 1" = 250' PLOT � Whitsett, Guilford County, NC
Date:11.11.20 PILOT ENVIRONMENTAL,INC Pilot Project5740.1

U.S. Army Corps of Engineers OMB Con&oiA-07f0-xxxx,Exp.Pending
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region RequinementCOnbniSymbOiEA'EMPT
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R(AII&OnW..•AR335-15,pe-g-ph5-20)
Project/Site: 5740.1/Burlington Road City/County: Whitsett/Guilford Sampling Date: 11.10.20
Applicant/Owner: Brightwood Crossing, LLC State: NC Sampling Point: DP-1
Investigator(s): Pilot Section, Township, Range: NA
Landform (hillside, terrace, etc.): Drained Pond/Floodplain Local relief (concave, convex, none): Concave Slope (%): 0-1
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.069873 Long:-79.589605 Datum: wgs 84
Soil Map Unit Name: w - water NWI classification: None
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances' present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes X No within a Wetland? Yes X No
Wetland Hydrology Present? Yes X No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required: check all that apply)
X Surface Soil Cracks (136)
_ Surface Water (Al) —True
Aquatic Plants (1314)
—Sparsely Vegetated Concave Surface (138)
_ High Water Table (A2) _
Hydrogen Sulfide Odor (Cl)
X Drainage Patterns (1310)
X Saturation (A3) —Oxidized
Rhizospheres on Living Roots (C3)
_Moss Trim Lines (1316)
—Water Marks (131) _
Presence of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
—Sediment Deposits (132) _
Recent Iron Reduction in Tilled Soils (C6)
—Crayfish Burrows (C8)
_ Drift Deposits (133) —Thin
Muck Surface (C7)
X Saturation Visible on Aerial Imagery (C9)
—Algal Mat or Crust (134) _
Other (Explain in Remarks)
—Stunted or Stressed Plants (D1)
_ Iron Deposits (135)
_ Geomorphic Position (D2)
X Inundation Visible on Aerial Imagery (137)
—Shallow Aquitard (D3)
—Water-Stained Leaves (139)
_ Microtopographic Relief (D4)
Aquatic Fauna (1313)
X FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No
X Depth (inches):
Water Table Present? Yes No
X Depth (inches):
Saturation Present? Yes X No
Depth (inches): 2
Wetland
Hydrology Present? Yes X No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont —Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: DP-1
Absolute Uominant
Indicator
Tree Stratum (Plot size: 30 )
% Cover Species?
Status
Dominance Test worksheet:
1
Number of Dominant Species
2.
That Are OBL, FACW, or FAC: 2 (A)
3.
Total Number of Dominant
4.
Species Across All Strata: 3 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 66.7% (A/B)
7.
Prevalence Index worksheet:
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
20% of total cover:
OBL species 20 x 1 = 20
Sapling/Shrub Stratum (Plot size: 15
)
FACW species 20 x 2 = 40
1. Sa/ixnigra
20 Yes
OBL
FAC species 0 x 3 = 0
2.
FACU species 10 x 4 = 40
3.
UPL species 0 x 5 = 0
4.
Column Totals: 50 (A) 100 (B)
5.
Prevalence Index = B/A = 2.00
6.
Hydrophytic Vegetation Indicators:
7.
_ 1 - Rapid Test for Hydrophytic Vegetation
8.
X 2 - Dominance Test is >50%
9.
X 3 - Prevalence Index is <_3.01
20 =Total Cover
4 - Morphological Adaptations' (Provide supporting
50% of total cover:
10 20% of total cover:
4
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5 )
_ Problematic Hydrophytic Vegetation' (Explain)
1. C2/BX117&M&SCB/7S
20 Yes
FACW
Indicators of hydric soil and wetland hydrology must
2. Rubus befu/ifo/ius
10 Yes
FACU
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3.
4.
Tree- Woody plants, excluding vines, 3 in. (7.6 cm) or
5.
more in diameter at breast height (DBH), regardless of
6
height.
7.
Sapling/Shrub - Woody plants, excluding vines, less
8.
than 3 in. DBH and greater than or equal to 3.28 ft
9
(1 m) tall.
10.
Herb -All herbaceous (non -woody) plants, regardless
11.
of size, and woody plants less than 3.28 ft tall.
30 =Total Cover
Woody Vine -All woody vines greater than 3.28 ft in
50% of total cover:
15 20% of total cover:
6
height.
Woody Vine Stratum (Plot size: 30 )
1.
2.
3.
4.
5.
Hydrophytic
=Total Cover
Vegetation
50% of total cover:
20% of total cover:
Present? Yes X No
Remarks: (Include photo numbers here or on a separate sheet.)
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: DP-1
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type LOC2 Texture Remarks
0-3 10YR 4/4 100 Loamy/Clayey
3-18 2.5Y 4/1 95 7.5YR 4/6 5 C M Loamy/Clayey Prominent redox concentrations
Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (Al)
_ Histic Epipedon (A2)
_ Black Histic (A3)
_ Hydrogen Sulfide (A4)
_ Stratified Layers (A5)
_ 2 cm Muck (A10) (LRR N)
_ Depleted Below Dark Surface (A11)
—Thick Dark Surface (Al 2)
—Sandy Mucky Mineral (S1)
_ Sandy Gleyed Matrix (S4)
_ Sandy Redox (S5)
_ Stripped Matrix (S6)
Dark Surface (S7)
Restrictive Layer (if observed):
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix. MS=Masked Sand Grains.
Polyvalue Below Surface (S8) (MLRA 147, 148)
—Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Mucky Mineral (F1) (MLRA 136)
_ Loamy Gleyed Matrix (F2)
X Depleted Matrix (F3)
_ Redox Dark Surface (F6)
_ Depleted Dark Surface (F7)
_ Redox Depressions(F8)
_ Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
_ Umbric Surface (F13) (MLRA 122, 136)
_ Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 147, 148)
`Location: PL=Pore Lining, M=Matrix
Indicators for Problematic Hydric Soil:
2 cm Muck (A10) (MLRA 147)
—Coast Prairie Redox (A16)
(MLRA 147, 148)
_ Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
_ Red Parent Material (F21)
(outside MLRA 127, 147, 148)
—Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
3Indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes X No
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont —Version 2.0

U.S. Army Corps of Engineers OMB Con&oiA-07f0-xxxx,Exp.Pending
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region RequinementCOnbniSymbOiEA'EMPT
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R(AII&OnW..•AR335-15,pe-g-ph5-20)
Project/Site: 5740.1/Burlington Road City/County: Whitsett/Guilford Sampling Date: 11.10.20
Applicant/Owner: Brightwood Crossing, LLC State: NC Sampling Point: DP-2
Investigator(s): Pilot Section, Township, Range: NA
Landform (hillside, terrace, etc.): Side slope Local relief (concave, convex, none): Slope Slope (%): 1-2
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.069832 Long:-79.589401 Datum: wgs 84
Soil Map Unit Name: Coronaca clay loam (CrB) NWI classification: None
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances' present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required: check all that apply)
—Surface Soil Cracks (136)
_ Surface Water (Al) —True
Aquatic Plants (1314)
—Sparsely Vegetated Concave Surface (138)
_ High Water Table (A2) _
Hydrogen Sulfide Odor (Cl)
—Drainage Patterns (1310)
_ Saturation (A3) —Oxidized
Rhizospheres on Living Roots (C3)
_Moss Trim Lines (1316)
—Water Marks (131) _
Presence of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
—Sediment Deposits (132) _
Recent Iron Reduction in Tilled Soils (C6)
—Crayfish Burrows (C8)
_ Drift Deposits (133) —Thin
Muck Surface (C7)
—Saturation Visible on Aerial Imagery (C9)
—Algal Mat or Crust (134) _
Other (Explain in Remarks)
—Stunted or Stressed Plants (D1)
_ Iron Deposits (135)
_ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (137)
—Shallow Aquitard (D3)
—Water-Stained Leaves (139)
_ Microtopographic Relief (D4)
Aquatic Fauna (1313)
X FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No
X Depth (inches):
Water Table Present? Yes No
X Depth (inches):
Saturation Present? Yes No
X Depth (inches):
Wetland
Hydrology Present? Yes No X
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont —Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: DP-2
Absolute Uominant
Indicatc
Tree Stratum (Plot size: 30 )
% Cover Species?
Status
1.
2.
3.
4.
5.
6.
7.
=Total Cover
50% of total cover:
20% of total cover:
Sapling/Shrub Stratum (Plot size: 15
)
1. Sa/ix nigra
5 Yes
OBL
2.
3.
4.
5.
6.
7.
8.
9.
5 =Total Cover
50% of total cover:
3 20% of total cover:
1
Herb Stratum (Plot size: 5 )
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
=Total Cover
50% of total cover:
20% of total cover:
Woody Vine Stratum (Plot size: 30
)
1.
2.
3.
4.
5.
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 1 (A)
Total Number of Dominant
Species Across All Strata: 1 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: 100.0% (A/B)
Prevalence Index worksheet:
Total % Cover of:
Multiply by:
OBL species 5
x 1
= 5
FACW species 0
x 2
= 0
FAC species 0
x 3
= 0
FACU species 0
x 4
= 0
UPL species 0
x 5
= 0
Column Totals: 5
(A)
5 (B)
Prevalence Index
= B/A =
1.00
_ 1 - Rapid Test for Hydrophytic Vegetation
X 2 - Dominance Test is >50%
_ 3 - Prevalence Index is <_3.01
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree- Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft
(1 m) tall.
Herb -All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody Vine -All woody vines greater than 3.28 ft in
height.
Hydrophytic
=Total Cover Vegetation
50% of total cover: 20% of total cover: Present? Yes X No
Remarks: (Include photo numbers here or on a separate sheet.)
Black willow saplings are present but appear stressed from the loss of hydrology from the pond being drained.
ENG FORM 61164-SG, JUL 2018 Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: DP-2
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type LOC2 Texture Remarks
0-18 10YR 4/4 100 Loamy/Clayey
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric 801ls3:
_ Histosol (Al)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_ 2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
—Thin Dark Surface (S9) (MLRA 147, 148)
—Coast Prairie Redox (A16)
_ Black Histic (A3)
_ Loamy Mucky Mineral (F1) (MLRA 136)
(MLRA 147, 148)
_ Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Soils (F19)
_ Stratified Layers (A5)
_ Depleted Matrix (F3)
(MLRA 136, 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (F21)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
(outside MLRA 127, 147, 148)
—Thick Dark Surface (Al 2)
_ Redox Depressions (F8)
—Very Shallow Dark Surface (F22)
—Sandy Mucky Mineral (S1)
_ Iron -Manganese Masses (F12) (LRR N,
_ Other (Explain in Remarks)
Sandy Gleyed Matrix (S4)
MLRA 136)
_
_ Sandy Redox (S5)
_ Umbric Surface (F13) (MLRA 122, 136)
3Indicators of hydrophytic vegetation and
_ Stripped Matrix (S6)
_ Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present,
Dark Surface (S7)
Red Parent Material (F21) (MLRA 127, 147, 148)
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No X
Remarks:
ENG FORM 61164-SG, JUL 2018 Eastern Mountains and Piedmont —Version 2.0

S,AT;
� N
;3 y
NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. [Click to enter.] Date received: [Click to enter.]
DWR project no. [Click enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 36.068768'
Longitude (DD.DDDDDD):-79.590226'
Form Version 1.5, September 2020
Pre -Construction Notification (PCN) Form
(Ver. 1.5, September 2020)
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 online help file may be found at this link:
https:Hedocs.deg.nc.gov/WaterResources/0/edocl6247041PCN%2OHelp%2OFile%202018-1-30.pdf
The help document may be found at this link:
http://www.saw. usace.army. mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as DWR will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used to satisfy 40
C.F.R. Section 121.4(a) which states "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to the certifying authority
at least 30 days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) : 10/27/2020
DWR ID # 20201624 Version 1 (If applicable)
A. Processing Information
County (counties) where project is located:
Guilford Additional (if needed).
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes ❑x 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)
Pagel of 21 PCN Form - Version 1.5, September 2020

❑x Nationwide Permit (NWP)
1 b. Permit type(s)?
❑ Regional General Permit (RGP)
❑ 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 separate 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):
NWP 29
RGP number(s):
Click to enter.
1d. Type(s) of approval sought from the DWR (check all that apply):
❑x 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: *
❑ Yes ❑x No
For the record only for Corps Permit: *
❑ Yes ❑x No
1f. Is this an after -the -fact permit/certification application?
❑ Yes ❑x No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
❑ Yes ❑x 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 ❑x No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
❑ Yes ❑x No ❑ Unknown
1j. Is the project located in a designated trout watershed?
❑ Yes ❑x 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.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 2 of 21 PCN Form - Version 1.5, September 2020

B. Applicant Information
1 a.
Who is the primary contact?
Amanda Williams
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:
Brighterwood Crossing, LLC
2b.
Deed Book and Page No.:
00870801363
2c.
Responsible Party (for corporations):
Amanda Williams
2d.
Address
Street Address:
PO Box 16168
Address line 2:
Click to entei.
City:
High Point
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27265
Country:
U.S.
2e.
Telephone Number: - (###)###-####
[phone]
2f.
Fax Number: (###)###-####
Click to enter.
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.
Page 3 of 21 PCN Form - Version 1.5, September 2020

3f. Email Address: Click to enter.
4. Agent/ Consultant (if applicable)
4a. Name: *
Michael T. Brame
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:
U.S.
4d. Telephone Number: * (###)###-####
336.708.4620
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 4 of 21 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1. Project Information
la. Name of project:
Brighterwood @ Brightwood Farms
1 b. Subdivision name (if appropriate):
Brighterwood
1 c. Nearest municipality/town: *
Whitsett, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
8824546534-000
2b.
Property size (in acres):
20
2c.
Project Address:
Street Address:
Burlington Road
Address line 2:
Click to enter.
City:
Whitsett
State/ Province/ Region:
NC
Postal/ Zip Code:
27377
Country:
U.S.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): 36.068768'
Longitude (-DD.DDDDDD):--79.590226°
3. Surface Waters
3a. Name of nearest body of water to proposed project:
Rock Creek
3b. Water Resources Classification of nearest receiving
WS-IV;NSW;CA
water:
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
Cape Fear
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
030300020303
located:
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 5 of 21 PCN Form - Version 1.5, September 2020

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:
Partially cleared and graded and wooded land.
4b.
Have Corps permits or DWR certifications been obtained for this
❑ Yes ❑ No ❑x Unknown
project (including all prior phases) in the past?
4c.
If yes, please give the DWR Certification number and/or Corps
[Click to enter.]
Action ID (ex. SAW-0000-00000):
jClick to enter.]
Attach any pertinent project history documentation
4d.
Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.
Attach an 8'h 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
0.832 acres
property:
4g.
List the total estimated linear feet of all existing streams (intermittent
500 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 construct a residential subdivision.
4i.
Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of a multi -family residential subdivision. The subdivision includes the
construction of 107 residential units (including 5 apartment buildings), associated structures, paved and concrete
parking lots, driveways, a stormwater management device and maintained landscaped areas. In order to facilitate the
proposed development, it is necessary to fill 0.098 acres of wetland and to cross a stream to connect to sanitary sewer
service. To facilitate the 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.
4j.
Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on
the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
Delineated by Pilot Environmental November 2020.
Name (if known): David Brame/Michael Brame
5b.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental
areas?
Other: Click to enter
5c.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved ❑ Emailed Concurrence
what type of determination was made?
❑x Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
Click to enter.
Page 6 of 21 PCN Form - Version 1.5, September 2020

5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
'lick to PntP,r
5d1. Attach jurisdictional determinations.
Page 7 of 21 PCN Form - Version 1.5, September 2020

6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x No
6b. If yes, explain.
No additional phases are planned.
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 have been used or are intended to be used.
Page 8 of 21 PCN Form - Version 1.5, September 2020

D. Proposed Impacts Inventory
Impacts Summary
❑x Wetlands
1 a. Where are the impacts associated with your project ❑ Buffers
(check all that apply):
❑ Pond Construction
❑x Streams - tributaries
❑ Open Waters
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
2a1.
2b.
2c.
2d.
2e.
2f.
2g.
Site #
Impact
Impact
Wetland Name
Wetland Type*
Forested
Jurisdiction
Impact Area
Reason/Type
Duration
?*
Type*
(ac)
W1
Fill (Incl.
Permanent
WA
Unknown
No
Both
0.098
Riprap)
W2
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W3
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W4
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W5
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W6
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
2g1. Total temporary wetland impacts
0 ac
2g2. Total permanent wetland impacts
0.098 ac
2g3. Total wetland impacts
0.098 ac
2h. Comments:
The development will permanently impact 0.098 acres of wetland with fill to accommodate the proposed structures and
associated lawns.
Page 9 of 21 PCN Form - Version 1.5, September 2020

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
Site #
3a.
Impact Reason/
Type
3b.
Impact
Duration
3d.
Stream Name
3e.
Stream
Type
3f.
Jurisdiction
Type
3g.
Stream Width
(avg ft)
3h.
Impact length
(linear ft)
S1
Crossing/ Culvert
Temporary
Unnamed (SA)
Perennial
Both
3
15
S2
;hoose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch impact:
0 linear ft
3i2. Total permanent stream impacts:
0 linear ft
36. Total temporary stream impacts:
15 linear ft
3i4. Total stream and ditch impacts:
15 linear ft
3j. Comments:
In order to connect to existing sewer services, it is necessary to cross a stream. A temporary culvert, pump
around and 8 inch sewer line are being installed. Folowing construction, the stream channel will be restored to its
current condition.
Page 10 of 21 PCN Form - Version 1.5, September 2020

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.
4b.
4c.
4d.
4e.
4e1.
4f.
Site #
Impact Reason/
Impact
Waterbody Name
Waterbody
Jurisdiction
Impact area (ac)'
Type
Duration
Type*
Type
01
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
02
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
03
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
04
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
4g.
Total temporary open water impacts
0 ac
4g.
Total permanent open water impacts
0 ac
4g.
Total open water impacts
0 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 tL
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.
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:
Pond or lake construction is not proposed.
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 21 PCN Form - Version 1.5, September 2020

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
❑x 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)
B1
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B9
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.
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 required.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 21 PCN Form - Version 1.5, September 2020

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 proposed development to avoid other streams and wetlands on the site. The
remaining approximate 0.734 acres of wetlands are being avoided. With the exception of the 15 linear feet of
temporary stream impact, all the streams are being avoided. Stream buffers are also being avoided.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The clearing limits will be surveyed, staked and silt fencing and clearing limit fencing will be used. Disturbed areas will
be seeded and mulched to limit sediment from entering downgradient waters. Slope matting will be used on steep
slopes to avoid additional impacts to jurisdictional areas other than those specified in this application.
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 entei.
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://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO: RP: P27 BUTTON KEY:O
4d.
Buffer mitigation requested (DWR only):
Click to enter. square feet
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
Page 13 of 21 PCN Form - Version 1.5, September 2020

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 the amount of mitigation proposed.
Click to enter
5b. 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
❑ Yes ❑x No
that requires buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact (square
Multiplier
Required mitigation
feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
:,hoose one
Click to enter.
Zone 2
;lick to enter.
Click fo enter
" hnnca nna
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Buffer mitigation is not required or proposed.
Page 14 of 21 PCN Form - Version 1.5, September 2020

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 ❑ 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 forms of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse 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/energv-mineral-land-resources/energv-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
❑x 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?
El Yes ❑x No
2b. Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?
❑ Yes ❑x 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. IS the project over an acre?
❑x Yes ❑ No
2d. Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state-
❑x Yes ❑ No
approved local government stormwater program?
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.
2e. Which of the following stormwater management program(s) apply?
❑x Local Government
(Check all that apply)
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Page 15 of 21 PCN Form - Version 1.5, September 2020

❑ Phase II ❑ USMP
Local Government Stormwater Programs
❑ NSW ❑x Water Supply
Please identify which local government stormwater program you are using.
City Lake Basin GWA High Point. Quality and Quantity
❑ Phase II ❑ HQW or ORW
State Stormwater Programs
❑ Coastal Counties ❑ Other
Comments:
Guilford County SWMP review and approval is required prior to beginning any disturbance activities.
Page 16 of 21 PCN Form - Version 1.5, September 2020

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
❑ Yes ❑ No
requirements of the National or State (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
❑ 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),
DR Surface Water or Wetland Standards or Riparian Buffer Rules El Yes ❑x No
W
(15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
Click 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 ❑x 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 proposed and is not likely.
3c. If yes, attach a qualitative or quantitative cumulative impact analysis (.pdo in accordance with the most recent
DWR policy.
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.
Sewer impacts are discussed in the stream impact section and included on the attached exhibits.
Page 17 of 21 PCN Form - Version 1.5, September 2020

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected
® Yes ❑ No
species or habitat? (IPAC weblink: hftps://www.fws.gov/ipac/ Ifws.govl)
5b. Have you checked with the USFWS concerning Endangered Species
❑ Yes ❑x No
Act impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d. Is another federal agency involved?
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8?
❑ Yes ❑x No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.?
®Yes ElNo
5g. Does this project involve bridge maintenance or removal? "
❑ Yes ❑x No
Link to NLEB SLOPES document: http://saw-reg.usace. army. mil/NLEB/1-30-17-signed NLEB-
SLOPES&apps.pdf
5h. Does this project involve the construction/ installation of a wind
turbine(s)?
❑ Yes ❑x 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 ❑x 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
2 listed species are identified on the IPaC report. Habitat for Schweinitz's sunflower and the Small Whorled
Pagonia are not located on the site or within the proposed area of impact.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat?
❑ Yes
❑x No
Are there submerged aquatic vegetation (SAV) around
the project vicinity?
El Yes
❑x No El Unknown
Will this project affect submerged aquatic vegetation?
❑ Yes
❑x 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
Page 18 of 21 PCN Form - Version 1.5, September 2020

Page 19 of 21 PCN Form - Version 1.5, September 2020

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
hftp://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
❑ 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
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes ❑x No
8b. If yes, explain how the project meets FEMA requirements.
;lick to enter
8c. What source(s) did you use to make the floodplain determination?
National Flood Hazard Layer froom FEMA Web Map Service — FEMA Panel 3710882400J (Drawing 4)
Page 20 of 21 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
(`lirlr +n a -
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: Michael T. Brame
Michael ,9,Illr=g—erMkna1Br—
Signature:
Brame oa126„5°m.-=
12/24/2020
Page 21 of 21 PCN Form - Version 1.5, September 2020

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IPaC: Resources Page 1 of 10
IPaC Information for Planning and Consultation U.S. Fish & Wildlife Service
IPaC resource list
This report is an automatically generated list of species and other resources such as critical habitat
(collectively referred to as trustresources) under the U.S. Fish and Wildlife Service's (USFWS)
jurisdiction that are known or expected to be on or near the project area referenced below. The list
may also include trust resources that occur outside of the project area, but that could potentially be
directly or indirectly affected by activities in the project area. However, determining the likelihood and
extent of effects a project may have on trust resources typically requires gathering additional site -
specific (e.g., vegetation/species surveys) and project -specific (e.g., magnitude and timing of proposed
activities) information.
Below is a summary of the project information you provided and contact information for the USFWS
offices) with jurisdiction in the defined project area. Please read the introduction to each section that
follows (Endangered Species, Migratory Birds, USFWS Facilities, and NWI Wetlands) for additional
information applicable to the trust resources addressed in that section.
Project information
NAME
Brighterwood at Brightwood Farms
LOCATION
Guilford County, North Carolina
Lea
DESCRIPTION
Proposed
Residential Development
Local office
Raleigh Ecological Services Field Office
[phone]
J
0
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INC: Resources
Page 2 of 10
JEJ [phone]
MAILING ADDRESS
Post Office Box 33726
Raleigh, INC 27636-3726
PHYSICAL ADDRESS
551 Pylon Drive, Suite F
Raleigh, INC 27606-1487
�o�
Foy
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IPaC: Resources Page 3 of 10
Endangered species
This resource list is for informational purposes only and does not constitute an analysis of project
level impacts.
The primary information used to generate this list is the known or expected range of each species.
Additional areas of influence (AOI) for species are also considered. An AOI includes areas outside of the
species range if the species could be indirectly affected by activities in that area (e.g., placing a dam
upstream of a fish population, even if that fish does not occur at the dam site, may indirectly impact
the species by reducing or eliminating water flow downstream). Because species can move, and site
conditions can change, the species on this list are not guaranteed to be found on or near the project
area. To fully determine any potential effects to species, additional site -specific and project -specific
information is often required.
Section 7 of the Endangered Species Act requires Federal agencies to "request of the Secretary
information whether any species which is listed or proposed to be listed may be present in the area of
such proposed action" for any project that is conducted, permitted, funded, or licensed by any Federal
agency. A letter from the local office and a species list which fulfills this requirement can only be
obtained by requesting an official species list from either the Regulatory Review section in IPaC (see
directions below) or from the local field office directly.
For project evaluations that require USFWS concurrence/review, please return to the IPaC website and
request an official species list by doing the following:
1. Log in to IPaC.
2. Go to your My Projects list.
3. Click PROJECT HOME for this project.
4, Click REQUEST SPECIES LIST.
Listed species
1 and their critical habitats are managed by the Ecological Services Program of the U.S. Fish and Wildlife
Service (USFWS) and the fisheries division of the National Oceanic and Atmospheric Administration
(NOAA Fisheriesl).
Species and critical habitats under the sole responsibility of NOAA Fisheries are not shown on this list.
Please contact NOAA Fisheries for species under theirjurisdiction.
1. Species listed under the Endangered Species Act are threatened or endangered; IPaC also shows
species that are candidates, or proposed, for listing. See the listing status page for more
information.
2. 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.
The following species are potentially affected by activities in this location:
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INC: Resources
Page 4 of 10
Flowering Plants
NAME STATUS
Schweinitz's Sunflower Helianthus schweinitzii Endangered
No critical habitat has been designated for this species.
https://ecos.fws.gov/ecp/species/3849
Small Whorled Pogonia Isotria medeoloides Threatened
No critical habitat has been designated for this species.
https://ecos.fws.gov/ecp/species/1890
Critical habitats
Potential effects to critical habitats) in this location must be analyzed along with the endangered
species themselves.
THERE ARE NO CRITICAL HABITATS AT THIS LOCATION. O\
100
Migratory birds
Certain birds are protected under the Migratory Bird Treaty Act
1 and the Bald and Golden Eagle Protection Act?.
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 below.
1. The Migratory Birds Treaty Act of 1918.
2. The Bald and Golden Eagle Protection Act of 1940.
Additional information can be found using the following links:
Birds of Conservation Concern http://www.fws.gov/birds/management/managed-species/
birds-of-conservation-concern.php
Measures for avoiding and minimizing impacts to birds
htto://www.fws.Rov/birds/management/Droiect-assessment-tools-and-guidance/
conservation-measures.ph
• Nationwide conservation measures for birds
http://www.fws.gov/migratorybirds/pdf/management/nationwidestandardconservationmeasures.pdf
The birds listed below are birds of particular concern either because they occur on the USFWS Birds of
Conservation Concern (BCC) list or warrant special attention in your project location. To learn more
about the levels of concern for birds on your list and how this list is generated, see the FAQ below. This
is not a list of every bird you may find in this location, nor a guarantee that every bird on this list will be
found in your project area. To see exact locations of where birders and the general public have sighted
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INC: Resources
Page 5 of 10
birds in and around your project area, visit the E-bird data mapping tool (Tip: enter your location,
desired date range and a species on your list). For projects that occur off the Atlantic Coast, additional
maps and models detailing the relative occurrence and abundance of bird species on your list are
available. Links to additional information about Atlantic Coast birds, and other important information
about your migratory bird list, including how to properly interpret and use your migratory bird report,
can be found below.
For guidance on when to schedule activities or implement avoidance and minimization measures to
reduce impacts to migratory birds on your list, click on the PROBABILITY OF PRESENCE SUMMARY at
the top of your list to see when these birds are most likely to be present and breeding in your project
area.
NAME BREEDING SEASON (IFA BREEDING
SEASON IS INDICATED FOR A BIRD
.. ....- -.... ..... ....................... ..........
ON YOUR LIST, THE BIRD MAY
-------------------------------------------- ----- ---
BREED IN YOUR PROJE,
SOMETIME WITHIN THE
................................................................
TIMEFRAME SPECIFIED, WHICH IS A
.... ...... ...... ...... ...........................................................
VERY LIBERAL ESTIMATE OFTHE
............................................ ........
DATES INSIDEI-WHICH THE BIRD
.....................................................................................
BREEDS ACROSS ITS ENTIRE
.........................-.................. I.- .................... I—.
NGE. "BREEDS ELSEWHERE"
------------------------------ ------ ------ -----------------
INDICATES THAT THE BIRD DOES
........................................................................................
NOT LIKELY BREED IN YOUR
PROJECT AREA.)
•'ems
Bald Eagle Haliaeetus leucocephalus Breeds Sep 1 to Jul 31
This is not a Bird of Conservation Concern (BCC] in this area, but
warrants attention because of the Eagle Act or for potential
susceptibilities in offshore areas from certain types of development or
activities.
https://ecos.fws.2oWecp/species/ 1625
Red-headed Woodpecker Melanerpes erythrocephalus Breeds May 10 to Sep 10
This is a Bird of Conservation Concern (BCC} throughout its range in the
Lontinental USA and Alaska.
Wood Thrush Hylocichla mustelina Breeds May 10 to Aug 31
This is a Bird of Conservation Concern (BCC) throughout its range in the
continental USA and Alaska.
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 and understand the FAQ "Proper
Interpretation and Use of Your Migratory Bird Report" before using or attempting to interpret this
report.
Probability of Presence( )
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INC: Resources
Page 6 of 10
Each green bar represents the bird's relative probability of presence in the 10km grid cell(s) your
project overlaps during a particular week of the year. (A year is represented as 12 4-week months.) A
taller bar indicates a higher probability of species presence. The survey effort (see below) can be used
to establish a level of confidence in the presence score. One can have higher confidence in the
presence score if the corresponding survey effort is also high.
How is the probability of presence score calculated? The calculation is done in three steps:
1. The probability of presence for each week is calculated as the number of survey events in the week
where the species was detected divided by the total number of survey events for that week. For
example, if in week 12 there were 20 survey events and the Spotted Towhee was found in 5 of
them, the probability of presence of the Spotted Towhee in week 12 is 0.25.
2. To properly present the pattern of presence across the year, the relative probability of presence is
calculated. This is the probability of presence divided by the maximum probability of presence
across all weeks. For example, imagine the probability of presence in week 20 for the Spotted
Towhee is 0.05, and that the probability of presence at week 12 (0.25) is the maximum of any week
of the year. The relative probability of presence on week 12 is 0.25/0.25 = 1; at week 20 it is
0.05/0.25 = 0.2.
3. The relative probability of presence calculated in the previous step undergoes a statistical
conversion so that all possible values fall between 0 and 10, inclusive. This is the probability of
presence score.
To see a bar's probability of presence score, simply hover your mouse cursor over the bar.
Breeding Season (
Yellow bars denote a very liberal estimate of the time -frame inside which the bird breeds across its
entire range. If there are no yellow bars shown for a bird, it does not breed in your project area.
Survey Effort (1)
Vertical black lines superimposed on probability of presence bars indicate the number of surveys
performed for that species in the 10km grid cell(s) your project area overlaps. The number of surveys is
expressed as a range, for example, 33 to 64 surveys.
To see a bar's survey effort range, simply hover your mouse cursor over the bar.
No Data (—)
A week is marked as having n❑ data if there were In survey events for that week.
Survey Timeframe
Surveys from only the last 10 years are used in order to ensure delivery of currently relevant
information. The exception to this is areas off the Atlantic coast, where bird returns are based on all
years of available data, since data in these areas is currently much more sparse.
probability of presence breeding season I survey effort — no data
SPECIES JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
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INC: Resources
Page 7 of 10
Bald Eagle
Non -BCC Vulnerable
.........................................
(This is not a Bird of
Conservation Concern
..............................................
(BCC) in this area, but
............................................
warrants attention
......................................
because of the Eagle
..........................................
Act or for potential
susceptibilities in
...................................
offshore areas from
.........................................
certain types of
development or
.................................
activities.)
.....................
Red-headed
Woodpecker
BCC Rangewide (CON)
This is a Sird of
.................................
Conservation Concern
..............................................
(BCC] throughout its
..........................................
ran a in the
continental USA and
....................................
Alaska.)
Wood Thrush
SC Rangewide (CON)
(This is a Bird of
.............................
Conservation Concern
.. ..... ..... ..... ..... ..... .
(BCC) throughout its
range in the
continental USA and
.........................................
Alaska.)
--- ---- ­- ­- Al lill lill
-Mom Nil lill lul 11 -- ---- ----
Tell me more about conservation measures I can implement to avoid or minimize impacts to migratory birds.
Nationwide Conservation Measures describes measures that can help avoid and minimize impacts to all birds at any
location year round. Implementation of these measures is particularly important when birds are most likely to occur in
the project area. When birds may be breeding in the area, identifying the locations of any active nests and avoiding
their destruction is a very helpful impact minimization measure, To see when birds are most likely to occur and be
breeding in your protect area, view the Probability of Presence Summary. Additional measures and/or De rmits may be
advisable depending on the type of activity you are conducting and the type of infrastructure or bird species present
on your project site.
What does IPaC use to generate the migratory birds potentially occurring in my specified location?
The Migratory Bird Resource List is comprised of USFWS Birds of Conservation Concern (BCC] and other species that
may warrant special attention in your project location.
The migratory bird list generated for your project is derived from data provided by the Avian Knowledge Network
(AKN). The AKN data is based on a growing collection of survey, banding, and citizen science datasets and is queried
and filtered to return a list of those birds reported as occurring in the 10km grid cell(s) which your project intersects,
and that have been identified as warranting special attention because they are a BCC species in that area, an eagle
(Eagle Act requirements may apply), or a species that has a particular vulnerability to offshore activities or
development.
Again, the Migratory Bird Resource list includes only a subset of birds that may occur in your project area. It is not
representative of all birds that may occur in your project area. To get a list of all birds potentially present in your
project area, please visit the AKN Phenology Tool.
What does IPaC use to generate the probability of presence graphs for the migratory birds potentially occurring in
my specified location?
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INC: Resources
Page 8 of 10
The probability of presence graphs associated with your migratory bird list are based on data provided by the Avian
Knowledge Network (AKN). This data is derived from a growing collection of survey, banding, and citizen science
datasets .
Probability of presence data is continuously being updated as new and better information becomes available. To learn
more about how the probability of presence graphs are produced and how to interpret them, go the Probability of
Presence Summary and then click on the "Tell me about these graphs" link.
How do I know if a bird is breeding, wintering, migrating or present year-round in my project area?
To see what part of a particular bird's range your project area falls within (i.e. breeding, wintering, migrating or year-
round), you may refer to the following resources: The Cornell Lab of Ornithology All About Birds Bird Guide, or (if you
are unsuccessful in locating the bird of interest there), the Cornell Lab of Ornithology Neotropical Birds guide. If a bird
on your migratory bird species list has a breeding season associated with it, if that bird does occur in your project area,
there may be nests present at some point within the timeframe specified. If "Breeds elsewhere" is indicated, then the
bird likely does not breed in your project area.
What are the levels of concern for migratory birds?
Migratory birds delivered through IPaC fall into the following distinct categories of concern;
1. "BCC Rangewide" birds are Birds of Conservation Concern (BCC) that are of concern throughout their range
anywhere within the USA (including Hawaii, the Pacific Islands, Puerto Rico, and the Virgin islands);
2. "BCC - BCR" birds are BCCs that are of concern only in particular Bird Conservation Regions (BCRs) in the
continental USA; and
3. "Non -BCC - Vulnerable" birds are not BCC species in your project area, but appear on your list either because of
the Eagle Act requirements (for eagles) or (for non -eagles) potential susceptibilities in offshore areas from certain
types of development or activities (e.g. offshore energy development or Iongline fishing).
Although it is important to try to avoid and minimize impacts to all birds, efforts should be made, in particular, to avoic
and minimize impacts to the birds on this list, especially eagles and BCC species of rangewide concern. For more
information on conservation measures you can implement to help avoid and minimize migratory bird impacts and
requirements for eagles, please see the FAQs for these topics,
Details about birds that are potentially affected by offshore projects
For additional details about the relative occurrence and abundance of both individual bird species and groups of bird
species within your project area off the Atlantic Coast, please visit the Northeast Ocean Data Portal. The Portal also
offers data and information about other taxa besides birds that may be helpful to you in your project review.
Alternately, you may download the bird model results files underlying the portal maps through the NOAA NCCOS
Integrative Statistical Modeling and Predictive Mapping of Marine Bird Distributions and Abundance on the Atlantic
Outer Continental Shelf project webpage.
Bird tracking data can also provide additional details about occurrence and habitat use throughout the year, including
migration. Models relying on survey data may not include this information. For additional information on marine bird
tracking data, see the Diving Bird Study and the nanotag studies or contact Caleb Spiegel or Pam Loring.
What if I have eagles on my list?
If your project has the potential to disturb or kill eagles, you may need to obtain a permit to avoid violating the Eagle
Act should such impacts occur.
Proper Interpretation and Use of Your Migratory Bird Report
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INC: Resources
Page 9 of 10
The migratory bird list generated is not a list of all birds in your project area, only a subset of birds of priority concern.
To learn more about how your list is generated, and see options for identifying what other birds may be in your project
area, please see the FAQ "What does IPaC use to generate the migratory birds potentially occurring in my specified
location". Please be aware this report provides the "probability of presence" of birds within the 10 km grid cell(s) that
overlap your project; not your exact project footprint. On the graphs provided, please also look carefully at the survey
effort (indicated by the black vertical bar) and for the existence of the "no data" indicator (a red horizontal bar). A high
survey effort is the key component. If the survey effort is high, then the probability of presence score can be viewed as
more dependable. In contrast, a low survey effort bar or no data bar means a lack of data and, therefore, a lack of
certainty about presence of the species. This list is not perfect; it is simply a starting point for identifying what birds of
concern have the potential to be in your project area, when they might be there, and if they might be breeding (which
means nests might be present). The list helps you know what to look for to confirm presence, and helps guide you in
knowing when to implement conservation measures to avoid or minimize potential impacts from your project
activities, should presence be confirmed. To learn more about conservation measures, visit the FAQ "Tell me about
conservation measures i can implement to avoid or minimize impacts to migratory birds" at the bottom of your
migratory bird trust resources page.
Facilities
Wildlife refuges and fish hatcheries
%,vREFUGE AND FISH HATCHERY INFORMATION IS NOT AVAILABLE AT THIS TIMME
z !
Wetlands in the National Wetlands Inventory
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.
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 oul
NWI data set. We recommend you verify these results with a site visit to determine the actual extent of
wetlands on site.
This location overlaps the following wetlands:
FRESHWATER POND
PUBHh
RIVERINE
R4SBC
A full description for each wetland code can be found at the National Wetlands Inventory website
Data limitations
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IPaC: Resources
Page 10 of 10
The Service's objective of mapping wetlands and deepwater habitats is to produce reconnaissance level information
on the location, type and size of these resources. The maps are prepared from the analysis of high altitude imagery.
Wetlands are identified based on vegetation, visible hydrology and geography. A margin of error is inherent in the use
of imagery; thus, detailed on -the -ground inspection of any particular site may result in revision of the wetland
boundaries or classification established through image analysis.
The accuracy of image interpretation depends on the quality of the imagery, the experience of the image analysts, the
amount and quality of the collateral data and the amount of ground truth verification work conducted. Metadata
should be consulted to determine the date of the source imagery used and any mapping problems.
Wetlands or other mapped features may have changed since the date of the imagery or field work. There may be
occasional differences in polygon boundaries or classifications between the information depicted on the map and the
actual conditions on site.
Data exclusions
Certain wetland habitats are excluded from the National mapping program because of the limitations of aerial imagers
as the primary data source used to detect wetlands. These habitats include seagrasses or submerged aquatic
vegetation that are found in the intertidal and subtidal zones of estuaries and nearshore coastal waters. Some
deepwater reef communities (coral or tuberficid worm reefs) have also been excluded from the inventory. These
habitats, because of their depth, go undetected by aerial imagery.
Data precautions
Federal, state, and local regulatory agencies with jurisdiction over wetlands may define and describe wetlands in a
different manner than that used in this inventory. There is no attempt, in either the design or products of this
inventory, to define the limits of proprietary jurisdiction of any Federal, state, or local government or to establish the
geographical scope of the regulatory programs of government agencies. Persons intending to engage in activities
involving modifications within or adjacent to wetland areas should seek the advice of appropriate federal, state, or
local agencies concerning specified agency regulatory programs and prop rietaryjurisdictions that may affect such
activities.
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ID#* 20201624
Version* 1
Regional Office * Winston-Salem Regional Office - [phone]
Reviewer List* Sue Homewood
Pre -Filing Meeting Request submitted 10/27/2020
Contact Name*
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Bradley Luckey
[e-mail]
Burlington Rd
Brighterwood Crossing, LLC
Guilford
Street Address
3929 Tinsley Drive
Address Line 2
Suite 104
aty
High Point
Postal / Zip axle
27265
Is this a transportation project?* r Yes r No
State / Province / Pegion
NC
Country
USA
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
* 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.*
The applicant does not request a meeting. The applicant may submit a
request for 401 WQC.
Please give a couple of dates you are available for a meeting.

Please attach the documentation you would like to have the meeting about.
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
0. a6;6F.A,,
Submittal Date 10/27/2020