20110359 Ver 1_401 Application_20110411

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April 12, 2011
Ms. Cyndi Karoly ,~~
North Carolina Division of Water Quality, 401 Wetlands Unit ~'m°
2321 Crabtree Blvd. Suite 250
Raleigh, North Carolina 27604 0 ~ ~ t~ ~ l'1 l ~'i
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Subject: Pre-Construction Notification Application AFR ~ 3 2011
Request for Water Quality Certification ~NR-WATER QUALITY
Proposed Village Point Drive sANDSroRMwgr~H
Clemmons, Forsyth County, North Carolina
ECS Project 09-15128C
Dear Ms. Karoly:
Please find five copies of the Pre-Construction Notification Application for the above referenced
site. The site is located on Harper Road in Clemmons (Figure 1) and consists of an
approximate 124 acre tract that is being developed with a school and medical buildings that are
part of Village Point Community. The tract contains a school that is in the construction phase,
dilapidated residential structures, graded land, wooded land and fields. As part of the
development, the' Village of Clemmons is requiring Novant Health, the primary developer of the
124 acre tract, to construct Village Point Drive from Harper Road to the northern site boundary.
In order to construct the proposed road, it is necessary to cross two streams (289 linear feet)
and fill associated wetland pockets (0.0404 acres). Based on a meeting with Mr. John Thomas
with the U.S. Army Corps of Engineers and Ms. Sue Homewood with the NC Division of Water
Quality at the site on February 2, 2011, the project will be permitted as a linear transportation
project. Stream mitigation is required and is being proposed through payment to a private
mitigation bank.
On behalf of Novant Health, we request that a Water Quaiity Certification be issued to
authorize the impact to 123 linear feet of stream channel and 0.0193 acres of wetland at
crossing #1 and the impact to 166 linear feet of stream channel and 0.0211 acres of wetland at
crossing #2 (289 linear feet of stream channel and 0.0404 acres of wetland, total). There are
no other stream or wetland impacts associated with this project. In the future, if the property
north of the site is developed, the road will be extended to Peacehaven Road. ECS has not
evaluated the proposed alignment beyond the northern site boundary and this portion of the
road will be developed and constructed by others. Therefore, future impacts associated with
the road construction project are not known at this time.
4811 Koger Boulevard Greensboro, NC 27407 • T: 336-856-7150 • F: 336-856-7160 • www.ecslimited.com
ECS Caralinas, LLP • ECS Florida, LLC • ECS Mid-Atlantic, LLC • ECS Southeast, LLC • ECS Texas, LLP

Section 401 Permitting
Proposed Village Point Drive
ECS Project 09-15128C
Apri112; 2011
Please feel free to contact us at [phone] if you have any questions concerning this
request or if additional information is required. Thank you in advance for your timely
consideration of this matter.
Sincerely,
ECS Carolinas, LLP
.~
. ~ / ~~
Michael T. Brame, PWS
Senior Environmental Scientist
Attachment: Pre-Construction Notification Application
401 Water Quality Certification Fee -$570
Denise M. Poulos, LSS, PWS
Principal Scientist
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Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. A licant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: -=l~••...~.®~'i
®Section 404 Permit ^ Section 10i'ermit ~'~
1 b. Specify Nationwide Permit (NWP) number: NWP 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ^Yes ®No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification -Regular ^ Non-404 Jurisdictional General Permit
^ 401 Water Quality Certification -Express ^ Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
^ Yes ®No For the record only for Corps Permit:

^Yes ®No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ®Yes ^ No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ^Yes ®No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ^Yes ®No
2. Project Information
2a. Name of project: Village Point Drive
2b. County: Forsyth
2c. Nearest municipality /town: Clemmons p
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state
project no:
APR 1 3 2011
3. Owner Information (~ry~,y~~~~~n,
3a. Name(s) on Recorded Deed: Novant Health Inc BRMICH
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable): Mr. Nick Eller
3d. Street address: 1980 S. Hawthorne Street
3e. City, state, zip: Winston Salem, NC 27114
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: [e-mail]
Page 1 of 12
PCN Form -Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ^ Agent ^ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Mr. Michael Brame
5b. Business name
(if applicable): ECS Carolinas, LLP
5c. Street address: 4811 Kroger Boulevard
5d. City, state, zip: Greensboro, NC 27407
5e. Telephone no.: [phone]
5f. Fax no.: (336) 8567160
5g. Email address: [e-mail]
Page 2 of 12
PCN Form -Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
The project consists of the construction of the southern
section of Village Point Drive, a linear transportation
project. The road will cross multiple parcels that contain
approximately 124 acres. Two unnamed tributaries to
1 a. Property identification no. (tax PIN or parcel ID): Johnson Creek will be crossed during the construction of
the road. The tributaries are located near the eastern
boundary of PIN No. 5883-62-5755.00 and the southern
boundary of PIN No. 5883-84-4575.00. These parcels
are owned by Novant Health, Inc.
1 b. Site coordinates (in decimal degrees): Latitude: 36.03186 Longitude: - 80.39345
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: The road crosses multiple parcels that contain
approximately 124 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Johnson Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: WS IV
2c. River basin: Yadkin River
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The area where the road is being constructed contains wooded land, fields and areas that have been graded. The areas
where stream impacts will occur contain wooded land. The site is located iri a residental/commercial are of Clemmons,
North Carolina.
3b. List the total estimated acreage of all existing wetlands on the property:
ECS delineated wetlands on multiple parcels that the proposed road will cross (approximately 124 acres). We estimate
there are approximately two acres of wetlands on the 124 acre tract.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
ECS delineated streams on the approximate 124 acres. We estimate there are approximately 4,000 linear feet of stream
on the 124 acre tract.
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to construct Village Point Drive across the site. The Village of Clemmons is
requiring that the road be connected to Harper Road and extended to the northern boundary of several tracts that are
being developed (Village Point Community). The construction of Village Point Drive is a linear transportation project that
is being required by the Village of Clemmons as part of the development plan for Village Point Community. The road will
eventually connect to Peace Haven Road. However, this is not part of the proposed project. In order to construct the
southern section of Village Point Drive, two streams must be crossed.
3e. Describe the overall project in detail, including the type of equipment to be used:
The road will be consttructed using graders, haulers, and excavators. Stream Crossing #1 will impact 123 linear feet of
stream and 0.0193 acres of wetlands. Stream Crossing #2 will impact 166 linear feet of stream and 0.0211 acres of
wetlands. Reinforced concrete pipe (66") and rip rap energy dissipators will be used to cross the streams/wetlands.
Page 3 of 12
PCN Form -Version 1.3 December 10, 2008 Version

4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes ^ No ^ Unknown
project (including all prior phases) in the past?
Comments: John Thomas/Corps and Sue Homewood/DWQ
4b. If the Corps made the jurisdictional determination, what type
®Preliminary ^ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: ECS Carolinas, LLP
Name (if known): Brame and Poulos Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
February 2, 2011
5. Project History
5a. Have permits or certifications been requested or obtained for ^Yes ®No ^ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
This project is a linear transportation project for the construction of Village Point Drive. No permits have been issued for
this transportation project in the past.
6. Future Project Plans
6a. Is this a phased project? ®Yes ^ No
6b. If yes, explain.
This is the initial construction phase of Village Point Drive. The Village of Clemmons is requiring that Village Point Drive
be extended from Harper Road to the northern site boundary of Village Point Community. The extension of Village Point
Drive from the northern site boundary to Peacehaven Road will eventually be constructed, but not as part of this phase of
the project.
Page 4 of 12
PCN Form -Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
® Wetlands ®Streams -tributaries ^ Buffers
^ Open Waters ^ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ -non-404, other) (acres)
Tempora T

W1 ®P ^ T Rip Rap, Fill, Bottomland ®Yes ®Corps
0193
0
Culvert Hardwood ^ No ®DWQ .
W2 ®P ^ T Rip Rap, Fill, Bottomland ®Yes ®Corps 0
0211
Culvert Hardwood ^ No ®DWQ .
W3 ^ P ^ T ^Yes ^Corps
^ No ^DWQ
W4 ^ P ^ T ^Yes ^Corps
^ No ^DWQ
W5 ^ P ^ T ^Yes ^Corps
^ No ^DWQ
W6 ^ P ^ T ^Yes ^Corps
^ No ^DWQ
2g. Total wetland impacts 0.0404
2h. Comments:~The road will impact 0.0404 acres of wetlands.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - PER or
( )
(Corps - 404, 10
stream
length
Permanent (P) or intermittent DWQ -non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ®P ^ T Culvert/Rip Rap Unnamed ®PER
^ INT ®Corps
®DWQ 5 123
S2 ®P ^ T Culvert/Rip Rap Unnamed ®PER
^ INT ®Corps
®DWQ 5 166
S3 ^ P ^ T ^PER ^Corps
^ INT ^DWQ
S4 ^ P ^ T ^PER ^Corps
^ INT ^DWQ
S5 ^ P ^ T ^PER ^Corps
^ INT ^DWQ
S6 ^ P ^ T ^PER ^Corps
^ INT ^DWQ
3h. Total stream and tributary impacts 289
3i. Comments: The road will impact 289 linear feet of stream channel.
Page 5 of 12
PCN Form -Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tempora T
01 ^P^T
02 ^P^T
03 ^P^T
04 ^P^T
4f. Total open water impacts
4g. Comments: Open water impacts are not proposed.
5. Pond or Lake Construction
If and or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1 View SWM-1.0 and SWM-
1.1
P2
5f. Total
5g. Comments: The stormwater management plan consists of the construction of eight stormwater retention ponds on tracts
located within the Village Point Community. The drainage areas to the ponds range between 2.55 and 32.08 acres. The
ponds have been sized to treat runoff from each of the properties based on 70% impervious surfaces with the exception of the
tract that is being developed with a school, which is 35.1 % impervious. stormwater runoff from the proposed road will be
diverted into the eight stormwater ponds. For details pertaining to the drainage areas, sizes and locations of each of the
ponds, view exhibits SWM-1.0 and SWM-1.1, included as attachments.
5h. Is a dam high hazard permit required?
^ Yes ®No If yes, permit ID no:
5i. Expected pond surface area (acres): View exhibits SWM-1.0 and SWM-1.1
5j. Size of pond watershed (acres): View exhibits SWM-1.0 and SWM-1.1
The ponds are to be excavated and constructed in upland areas with the
exception of the pond that was constructed on the school site. It was in an
5k. Method of construction: unmitigable stream and the impacts were authorized by a Nationwide Permit
and an associated Water Quality Certification. Additional impacts associated
with the construction of the stormwater ponds are not anticipated or
proposed.
Page 6 of 12
PCN Form -Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require miti ation, then ou MUST fill out Section D of this form.
6a.
^ Neuse ^Tar-Pamlico ^ Other:
Project is in which protected basin? ^ Catawba ^ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem ora T im act re wired?
B1 ^P^T ^Yes
^ No
B2 ^ P ^ T ^Yes
^ No
63 ^P^T ^Yes
^ No
6h. Total buffer impacts
6i. Comments: The project is in the Yadkin River basin.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Road Crossing #1 has been designed to cross a stream in the location of an existing culvert. The existing culvert is 21 feet
long. The road crossing has been designed perpendicular to the stream. Wetlands are located upgradient and downgradient
of the proposed crossing. Headwalls and endwalls have been designed to further minimize the stream and wetland impacts.
Road Crossing #2 has been designed to cross a stream in the location immediately downgradient of the confluence of two
streams and immediately upgradient of existing wetlands. Headwalls and endwalls have been designed to further minimize
the stream and wetland impacts.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Water will be diverted around each of the areas of impact during the preparation and installation of the proposed culverts
through by-pass channels. Silt fence will be installed along the by-pass channel. Construction sequence exhibits providing
details are included as attachments. Upon completing construction of the road, slopes will be properly graded, stabilized,
matted and seeded to prevent sediment from washing into the streams. Best management practices will be used throughout
the road construction project to prevent sediment from entering the streams.
Z. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ®Yes ^ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ® DWQ ®Corps
® Mitigation bank
2c. If yes, which mitigation option will be used for this
project?
^ Payment to in-lieu fee program
^ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: Fisher River and Deep Creek
3b. Credits Purchased (attach receipt and letter) Type Stream Quantity 289
Page 7 of 12
PCN Form -Version 1.3 December 10, 2008 Version

3c. Comments: We have included as an attachment an "Agreement for Sale of Stream Mitigation (SMS) Credits." Novant
Health has paid a 10% non-refundable holding fee for the mitigation credits.
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ^ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ^ warm ^ cool ^cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) -required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ^ Yes ®No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier ~ 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments: Buffer mitigation is not required or proposed as part of this project.
Page 8 of 12
PCN Form -Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ^Yes ®No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
^ Yes ®No
Comments: Diffuse Flow is not required in this watershed.
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? up to 70
2b. Does this project require a Stormwater Management Plan? ®Yes ^ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The stormwater management plan consists of the construction of eight stormwater retention ponds on tracts located
within the Village Point Community. The drainage area to each of the ponds ranges between 2.55 and 32.08 acres. The
ponds have been sized to treat runoff from each of the properties based on a maximum of 70% impervious surfaces with
the exception of the tract that is being developed with a school which is 35.1 % impervious. Stormwater runoff from the
proposed road will be diverted into the eight stormwater ponds. For details pertaining to the drainage areas, sizes and
locations of each of the ponds, view exhibits SWM-1.0 and SWM-1.1, included as attachments.
®Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ^DWQ Stormwater Program
^ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? Village of Clemmons
® Phase II
3b. Which of the following locally-implemented stormwater management programs ^ NSW
^ USMP
apply (check all that apply): ^ Water Supply Watershed
^ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ^Yes ®No
attached?
4. DWQ Stormwater Pro ram Review
^ Coastal counties

4a. Which of the following state-implemented stormwater management programs apply ^ HQW
^ ORW
(check all that apply): ® Session Law 2006-246
^ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ^Yes ®No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ^Yes ^ No
Page 9 of 12
PCN Form -Version 1.3 December 10, 2008 Version

5b. Have all of the 401 Unit submittal requirements been met? ^ Yes ^ No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the Yes
^ ®No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ^ Yes ®No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter. )
^ Yes ®No
Comments: Based on our understanding, a SEPA or NEPA is not required for the
proposed project.
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ^ Yes ®No
or Riparian Buffer Rules (15A NCAC 26 .0200)?
2b. Is this an after-the-fact permit application? ^ Yes ®No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ®Yes ^ No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. ff you answered "no," provide a short narrative description.
The road is being ended at the northern site boundary as part of this project. At some date in the future, the road will be
extended north to Peacehaven Road. We do not know when the extension will occur or if additional impacts or permits
will be required. The schedule for the next phase of road construction is not known.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
The development will be provided with sanitary sewer services by the Winston-Salem/Forsyth County Utility Commission.
Page 10 of 12
PCN Form -Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
^ Yes
®No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
^ Yes
®No
impacts?

5c. If yes, indicate the USFWS Field Office you have contacted. ^ Raleigh
^ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
ECS consulted the Natural Heritage Program Website to determine if Federally Protected Endangered or Threatened
speices inhabit the Clemmons, NC Quadrangle (the quadrangle that includes the site) and the Winston-Salem West, NC
Quadrangle (the quadrangle that borders the site quadrangle to the east). The Bog Turtle (Glyptemys muhlenbergii) is
identified on the Winston-Salem West, NC Quadrangle as a federally protected threatened species due to similarity in
appearance. This vertebrate animal inhabits bogs, wet pastures and wet thickets. We did not observe this species or
suitable habitat for this species on the site.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ^ Yes ®No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
The NCDENR has classified the watershed that includes the site as WS-IV. The endangered species list does not identify
protected fish species that inhabit waterbodies nearby the site. Based on our knowledge of the site, the project does not
occur in or near an area designated as essential fish habitat.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ^ Yes ®No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology}?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
The site contains several dilapidated structures. To our knowledge, the structures have not been designated as having
historic or cultural preservation status. ECS has performed multiple site visits in conjunction with wetland delineation
services on the site. We have not observed arrowheads or other artifacts on the site during our visits.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in aFEMA-designated 100-year floodplain? ^ Yes ®No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA Map Panel 37105588300) (Attachment)
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Page 11 of 12
PCN Form -Version 1.3 December 10, 2008 Version

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SOURCE:
FIGURE 1
USGS TOPOGRAPHIC MAP
CLEMMONS, NC QUADRANGLE SITE LOCATION MAP
DATED 1968, REVISED 1994 APPROXIMATE 124 ACRE TRACT
WINSTON-SALEM WEST, NC QUADRANGLE UP VILLAGE POINT DRIVE
DATED 1950, REVISED 1994 CLEMMONS, NORTH CAROLINA
SCALE: I"=2,000' CAROLINAS ECS PROJECT NO. 09-15128C

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SOURCE: FIGURE 2
r a .:--.-:->..:: ----
USDA SOIL SURVEY OF SOIL MAP
FORSYTH COUNTY ~ APPROXIMATE 124 ACRE TRACT
SHEET NUMBER 43 VILLAGE POINT DRIVE
ISSUED MAY 1976 ~e CLEMMONS, NORTH CAROLINA
NOT TO SCALE ~ `w~ ECS PROJECT NO. 09-15128C

THE STREAM, POND AND WETLAND LOCATIONS SHOWN ON THIS MAP ARE APPROXIMATE. THEY HAVE BEEN DELINEATED BY
ECS. THEY HAVE NOT BEEN VERIFIED BY THE U.S. ARMY CORPS OF ENGINEERS. THEY HAVE NOT BEEN SURVEYED.
3 ,: -, -
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1 ,~ ~l ~ •~ ~ ,..
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3
~;~_~ .~;, ;~~ ~ _ 1 DP 1 O Approximate Location of Data Point
~- _.
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.d SOURCE: FIGURE 3
2005 AERIAL PHOTOGRAPH STREAM/WETLAND LOCATION MAP
FROM THE FORSYTH COUNTY GIS ~ APPROXIMATE 124 ACRE TRACT
WEBSITE AND FIELD NOTES PREPARED BY VILLAGE POINT DRIVE
ECS PERSONNEL CLEMMONS, NORTH CAROLINA
SCALE: 1" = 754' CAROLINAS ECS PROJECT NO. 09-15128C

DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Approximate 124 Acre Tract -Harper Road Project No: Date: October 22, 2007
Applicant/Owner: Novant Health County: Forsyth
Investigators: ECS Carolinas, LLP 09-15128C State: North Carolina
Plot ID: DP-1
Do Normal Circumstances exist on the site? Yes No Community ID: Wooded
Is the site significantly disturbed (Atypical Situation:)? ^Yes ®No Transect ID:
Is the area a potential Problem Area? ^Yes ®No Field Location: View figure 3
(If needed, explain on the reverse side)
VL'liL' 1A11V1V
Dominant Plant Species (Latin/Common) Stratum Indicator Plant Species (Latin/Common) Stratum Indicator
Eulalia viminea
Nepal microstegium Herb FAC+
Fraxinus pennsylvanica
Green ash Sap FACW
Acer rubrum
Red maple Sap FAC
Rosa palustris
Swamp rose Herb OBL

Percent of Dominant Species that are OBL, FACW or FAC: 100%
(excluding FAC-) FAC Neutral:
Numeric Index:
Remarks:
The dominant vegetation is hydrophytic.
HYDROLOGY
Recorded Data (Describe in Remarks):
^ Stream, Lake or Tide Gauge
^ Aerial Photographs
^ Other

® No Recorded Data

Field Observations

Depth of Surface Water: 0"

Depth to Free Water in Pit: >12"

Depth to Saturated Soil: 10" Wetland Hydrology Indicators
Primary Indicators
^ Inundated
®Saturated in Upper 12 Inches
^ Water Marks
^ Drift Lines
^ Sediment Deposits
^ Drainage Patterns in Wetlands
Secondary Indicators
®Oxidized Root Channels in Upper 12 Inches
^ Water-Stained Leaves
^ Local Soil Survey Data
^ FAC-Neutral Test
^ Other (Explain in Remarks)
Remarks:
Wetland hydrology indicators are present.
(Wetform) Page I of 2

DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Approximate 124 Acre Tract -Harper Road Project No: Date: October 22, 2007
Applicant/Owner: Novant Health County: Forsyth
Investigators: ECS Carolinas, LLP 09-15128C State: North Carolina
Plot ID: DP-1
Map Unit Name (Series and Phase): Chewacla loam
Map Symbol: Ch Mapped Hydric Inclusion? ®Yes ^ No
Drainage Class: Somewhat poorly drained Field Observations Confirm Mapped Type: ®Yes ^ No
Taxonomy (Subgroup): Fluvaquentic dystrochrepts
Profile Descri tion
Depth Matrix Color Mottle Color Mottle
(inches) Horizon (Munsell Moist) (Munsell Moist) Abundance/Contrast Texture, Concretions, Structure, etc.

0-6" lOYR 4/4 0% Loam
7-12" 2.SY 4/2 7.SYR 4/6 30% Loam

Hydric Soil Indicators:
^ Histosol ^ Concretions
^ Histic Epipedon ^ High Organic Content in Surface Layer in Sandy Soils
^ Sulfidic Odor ^ Organic Streaking in Sandy Soils
^ Aquic Moisture Regime ^ Listed on Local Hydric Soils List
^ Reducing Conditions ^ Listed on National Hydric Soils List
® Gleyed or Low Chroma Colors ^ Other (Explain in Remarks)
Remarks:
Hydric soil indicators are present.
tI/T T7 • AST TT TTT1~RiwT ~ Ti~~T
••L1Lt'!1\L LG1Tilllrlll\H 11V1\I
Hydrophytic Vegetation Present? Yes No Is the Sampling Point within the Wetland? Yes No
Wetland Hydrology Present? ®yes ^ No
Hydric Soils Present? ®yes ^ No
Remarks:
The three wetland criteria are present. The sampling point is located within a wetland
(Wetform) Page 2 of 2

DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Approximate 124 Acre Tract -Harper Road Project No: Date: October 22, 2007
Applicant/Owner: Novant Health County: Forsyth
Investigators: ECS Carolinas, LLP 09-15128C State: North Carolina
Plot ID: DP-2
Do Normal Circumstances exist on the site? Yes No Community ID: Wooded
Is the site significantly disturbed (Atypical Situation:)? ^Yes ®No Transect ID:
Is the area a potential Problem Area? ^Yes ®No Field Location: View Figure 3
(If needed, explain on the reverse side)
[1T /'PTT 1 TiA1T
•L'VL' 1Cf 11V1\
Dominant Plant Species (Latin/Common) Stratum Indicator Plant Species (Latin/Common) Stratum Indicator
Liquidambar styraciflua
Sweet gum Sap FAC+
Liriodendron tulipifera
Tulip tree Sap FAC
Acer rubrum
Red maple Sap FAC
Smilax rotundifolia
Common greenbrier Vine FAC .
Rubus betulifolius
Blackberry Herb FAC

Percent of Dominant Species that are OBL, FACW or FAC: 100%
(excluding FAC-) FAC Neutral:
Numeric Index:
Remarks:
The dominant vegetation is hydrophytic.
iit~7~ni'-r ~w
Recorded Data (Describe in Remarks):
^ Stream
Lake or Tide Gauge Wetland Hydrology Indicators
P
i
,
^ Aerial Photographs r
mary Indicators
^ Inundated
^ Other ^ Saturated in Upper 12 Inches
^ Water Marks
® No Recorded Data ^ Drift Lines
^ Sediment Deposits
Field Observations ^ Drainage Patterns in Wetlands
Secondary Indicators
Depth of Surface Water: 0" ^ Oxidized Root Channels in U
e
12 I
h
pp
r
nc
es
^ Water-Stained Leaves
Depth to Free Water in Pit: >12" ^ Local Soil Survey Data
^ FAC-Neutral Test
Depth to Saturated Soil: >12" ^ Other (Explain in Remarks)
Remarks:
Wetland hydrology indicators are not present.
(W ettorm) Page I of 2

DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Approximate 124 Acre Tract -Harper Road Project No: Date: October 22, 2007
Applicant/Owner: Novant Health County: Forsyth
Investigators: ECS Carolinas, LLP 09-15128C State: North Carolina
Plot ID: DP-2
Map Unit Name (Series and Phase): Chewacla loam
Map Symbol: Ch Mapped Hydric Inclusion? ®Yes ^ No
Drainage Class: Somewhat poorly drained
Taxonomy (Subgroup): Fluvaquentic dystrochrepts Field Observations Confirm Mapped Type: ^Yes ®No
Profile Descri tion
Depth Matrix Color Mottle Color Mottle
(inches) Horizon (Mansell Moist) (Mansell Moist) Abundance/Contrast Texture, Concretions, Structure, etc.

0-12" lOYR 4/6 0% Loam

Hydric Soil Indicators:
^ Histosol
^ Concretions
^ Histic Epipedon ^ High Organic Content in Surface Layer in Sandy Soils
^ Sulfidic Odor ^ Organic Streaking in Sandy Soils
^ Aquic Moisture Regime ^ Listed on Local Hydric Soils List
^ Reducing Conditions ^ Listed on National Hydric Soils List
^ Gleyed or Low Chroma Colors ^ Other (Explain in Remarks)
Remarks:
Hydric soil indicators are not present.
WETLAND DETERMIN
ATION
Hydrophytic Vegetation Present? Yes No Is the Sampling Point within the Wetland? Yes No
Wetland Hydrology Present? ^yes ®No
Hydric Soils Present? ^yes ~ No
Remarks:
Wetland hydrology and hydric soil indicators are not present. The sampling point is not located within a wetland.
(Wetform) Page 2 of 2

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD): April 5, 2011
B. DISTRICT OFFICE, FILE NAME, AND NUMBER: Raleigh, Approximate 124 Acre Tract, Proposed Village Point Drive, ECS
Project No. 09-15128C
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: NC County/parish/borough: Forsyth City: Clemmons
Center coordinates of site (lat/long in degree decimal format): Lat, 36.0297° N, Long. -80.39671 ° W.
Universal Transverse Mercator:
Name of nearest waterbody: Yadkin River
Name of nearest Traditional Navigable Water (TNW) Into which the aquatic resource flows: Yadkin River
Name of watershed or Hydrologic Unit Code (HUC): 03040101
Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
[] Office (Desk) Determination. Date:
Fietd Determination. Date(s): February 2, 2011
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are: no "navigable waters of the US."within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
[~ Waters subject to the ebb and flow of the tide.
Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There ire "waters of the U.S."within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [ReguiredJ
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): t
[] TNWs, including territorial seas
fl Wetlands adjacent to TNWs
Relatively permanent watersZ (RPWs) that flow directly or indirectly into TNWs
Non-RPWs that flow directly or indirectly into TNWs
Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
Impoundments of jurisdictional waters
Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non-wetland waters: 4,000 linear feet: 5 width (ft) and/or 0.46 acres.
Wetlands: ~3 acres.
c. Limits (boundaries) of jurisdiction based on: 1987'Delineation Manual
Elevation of established OHWM (ifknown): Unknown.
2. Non-regulated waters/wetlands (check if applicable):3
Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
~ Boxes checked below shall be supported by completing the appropriate sections in Section III below.
a For purposes of this form, an 1tPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
3 Supporting documentation is presented in Section III.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non-navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section IILD.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
if the waterbody° is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.C below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 278 acres
Drainage area: 278 acres
Average annual rainfall: 42.7 inches
Average annual snowfall: 8.6 inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
^ Tributary flows directly into TNW.
® Tributary flows through 7 tributaries before entering TNW.
Project waters are 2=5 river miles from TNW.
Project waters are I< (or less) river miles from RPW.
Project waters are ~ ~ aerial (straight) miles from TNW.
Project waters are 3!(or-less) aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNWS: Unnamed tributar\ies flow through several ponds and unnamed tributaries before entering
Johnson Creek. Johnson Creek flows into the Yadkin River.
° Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the arid
West.
s Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Tributary stream order, if known: First and second.
(b) General Tributary Characteristics (check all that applv)'
Tributary is: ®Natural
^ Artificial (man-made). Explain:
® Manipulated (man-altered). Explain: The tributaries have been manipulated in areas.
Tributary properties with respect to top of bank (estimate):
Average width: 5 feet
Average depth: 1-2 feet
Average side slopes: Vertical(1:1 or less).
Primary tributary substrate composition (check all that apply):
® Silts ®Sands ^ Concrete
® Cobbles ®Gravel ^ Muck
® Bedrock ®Vegetation. Type/% cover: Hardwoods and saplings 80%
^ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain: Eroded, sloughing banks.
Presence of run/riffle/pool complexes. Explain: Moderate amount of riffle-pool complexes.
Tributary geometry: Meandering
Tributary gradient (approximate average slope): 2.1
(c) Flow:
Tributary provides for: Seasonal flow
Estimate average number of flow events in review area/year: 20 (or greater)
Describe flow regime: Constant.
Other information on duration and volume:
Surface flow is: Discreteand confined. Characteristics:
Subsurface flow: Unlcnowa. Explain findings:
^ Dye (or other) test performed:
Tributary has (check all that apply):
® Bed and banks
® OHWM6 (check all indicators that apply):
® clear, natural line impressed on the bank
® changes in the character of soil ^
^ shelving
® vegetation matted down, bent, or absent
® leaf litter disturbed or washed away
® sediment deposition
® water staining ^
^ other (list):
the presence of litter and debris
destruction of terresMal vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
^ Discontinuous OHWM.~ Explain:
If factors other than the OHWM were used to determ
High Tide Line indicated by:
^ oil or scum line along shore objects
^ fine shell or debris deposits (foreshore)
^ physical markings/characteristics
^ tidal gauges
^ other (list):
ine lateral extent of CWA jurisdiction (check al] that apply):
Mean High Water Mark indicated by:
^ survey to available datum;
^ physical markings;
^ vegetation lines/changes in vegetation types.
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain: Water color is relatively clear.
Identify specific pollutants, if known: No sheens observed.
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average width): The area bordering the stream contains undeveloped wooded
land.
® Wetland fringe. Characteristics: Bottomland hardwood wetlands abut the streams. Some originate as wetland seeps.
® Habitat for:
^ Federally Listed species. Explain findings:
^ Fish/spawn areas. Explain findings:
^ Other environmentally-sensitive species. Explain findings:
® Aquatic/wildlife diversity. Explain findings: Minnows, crayfish, salamanders and frogs were observed.
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) Genera] Wetland Characteristics:
Properties:
Wetland size: 3 acres
Wetland type. Explain: Bottomland hardwood .
Wetland quality. Explain: Moderate.
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Intermittent low. Explain: Saturated to surface.
Surface flow is: Overland sheetflow
Characteristics: No surface flow.
Subsurface flow: Unknown. Explain findings:
^ Dye (or other) test performed:
(c) Wetland Adiacencv Determination with Non-TNW
® Directly abutting
^ Not directly abutting
Discrete wetland hydrologic connection. Explain: Immediately adjacent.
Ecological connection. Explain:
^ Separated by berm/barrier. Explain:
(d) Proximitv (Relationship) to TNW
. Project wetlands are?,=~ river miles from TNW.
Project waters are I~ aerial (straight) miles from TNW.
Flow is from: ~Netland to navigable waters.
Estimate approximate location of wetland as within the 2-,year-or less floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain: Water color is clear where present.
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
® Riparian buffer. Characteristics (type, average width): Bottomland hardwood.
® Vegetation type/percent cover. Explain: Trees/Saplings; 80% Cover.
^ Habitat for:
^ Federally Listed species. Explain findings:
^ Fish/spawn areas. Explain findings:
^ Other environmentally-sensitive species. Explain findings:
® Aquatic/wildlife diversity. Explain findings: Minnows, crayfish salamanders, macro-invertebrates and amphibians.
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: 8
Approximately (3) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/Nl Size (in acresl
Y .1
Y .25
1' .25
Y .8
Directly abuts? (Y/N) Size (in acresl
Y .1
1' .25
Y .25
Y 1
Summarize overall biological, chemical and physical functions being performed: The wetlands contain habitat for
crayfish and amphibians. The wetlands function to filter and dissipate stormwater runoff.
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with al] of its adjacent wetlands, then go to
Section IILD:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
^ TNWs: linear feet width (ft), Or, acres.
^ Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: Minnows, crayfish, salamanders, frogs, iron oxidizing bacteria, substrate sorting, riffle-pool complexes
and ordinary high water mark were observed.
^ Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally: .

Provide estimates for jurisdictional waters in the review area (check all that apply):
Tributary waters: 4,000 linear feet 5 width (ft).
^ Other non-wetland waters: acres.
Identify type(s) of waters:
3. Non-RPWss that flow directly or indirectly into TNWs.
^ Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
Tributary waters: linear feet width (fl).
Other non-wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW: Physically connected.
Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: 3 acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section III.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a T'NW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
Impoundments of jurisdictional waters v
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
Demonstrate that impoundment was created from "waters of the U.S.," or
Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED (INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
^ which are or could be used by interstate or foreign travelers for recreational or other purposes.
from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
^ which are or could be used for industrial purposes by industries in interstate commerce.
^ Interstate isolated waters. Explain:
^ Other factors. Explain:
BSee Footnote # 3.
v To complete the analysis refer to the key in Section IILD.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdicton Following Rapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
^ Tributary waters: linear feet width (ft).
Other non-wetland waters: acres.
Identify type(s) of waters:
^ Wetlands: acres.
F. NON-JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
^ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
^ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
^ Other: (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
Non-wetland waters (i.e., rivers, streams): linear feet width (ft).
^ Lakes/ponds: acres.
Other non-wetland waters: acres. List type of aquatic resource:
Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
^ Non-wetland waters (i.e., rivers, streams): linear feet, width (ft).
Lakes/ponds: acres.
Other non-wetland waters: acres. List type of aquatic resource:
Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply -checked items shall be included in case file and, where checked
and requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant:
Data sheets prepared/submitted by or on behalf of the applicant/consultant.
^ Office concurs with data sheets/delineation report.
^ Office does not concur with data sheets/delineation report.
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:2,000', Clemmons.
® USDA Natural Resources Conservation Service Soil Survey. Citation:Sheet Number 43.
National wetlands inventory map(s). Cite name:
~^ State/Local wetland inventory map(s):
FEMA/FIRM maps:
^ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
Photographs: ®Aerial (Name & Date): Stream Location Map 2005.
or ^ Other (Name & Date): .
Previous determination(s). File no. and date of response letter:February 2, 2011 Verification Meeting.
^ Applicable/supporting case law:
Applicable/supporting scientific literature:
Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD: The streams on the site are perennial with the exception of the upper reach of one
stream. Permits are required from the USACE and DWQ for impacts to the streams, pond and wetlands.

~~~~~~ _ ,., date: 311711 - job #: ~0-122
s„ re zoo
N,~Sto~ sa~~• . project: NOVANT - CLEMMONS PE-1.2 INFRASTRUCTURE
t.andscape Architecture "°'-29'5
Civil Engineering 7 scale: __~ "=500' sheet 1 Of 3
336 23 Q6'
Stimmel Associates, PA Land Planning s:?s -2 ~ •..e? description: OVERALL IMPACT LOCATION MAP
EXHIBIT -- --------~
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336 ?23 1067
St~mm~l Asti~~ i;,tc~s- 1',: land Planning ~ a3F ~aj,~6s description: STREAM CROSSING#1
EXHIBIT ---___.
__ _ _ --
--~ , , „ .
PRO('OSE[) RE1AINiNG~ PROPOSED '
HEADWALL TO MINIMI~ ~ `ROADWAY ` '
~~,
~~TREAM IMPAGIS __~ ! '
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Stimmel .~c, v i'aae scree; date: 3/17!11 ____ _jab #: t0-122
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N+nston Saie*~- ~,c project: Novant - Clemmons Ph 2 Infrastructure
Landscape Architecture 2''o'-2916 -- -- __
Civil Engineering o _ 5C81e.: _-_ t"=40' (PLAN) sheet 3 Of 3
33fi l23 1067
Stimmel Assoc;gates, PA Land Planning F 336 723 1065 description: STREAM CROSSING tF2
EXHIBIT _---__-_ ______..~_.
_ _. ______ _._ J~_~ -_ -
----- --
PROPOSED RETAININGi ~~~ ~ r l --
/ ~ / ~--.- ~ / PROPOSED
HEADWALL TO MINIMIZE -- / / ~ 0 PROPOSED ~ / RETAINING!
STREAM IMPACTS ~ / / ~ IDEWALK ~ / __ HEADWALL
EXISTING END IMPACT / ~ gyp' ~ -LQ MINIMIZ
WETLANDS _ / ~ ~~` ~ STRER1Vt -
(LIGHT ~ CIL STREAM / / __ ._ -~ ~ ~~ C/L STREAM IMPACTS
HATCH) / / ~ ~ - -
-
" - ~` 1 ' ~ ` ,-~ ~ ~ BEGIN IMPACT
~ ~~~ - 10' FROM
. ~- - ~ ~ FACE Of WAIL
- " _ _~~, - 101't PROP. ~ `
___ --- --- --- +x~,, r. 66" RCP
/ O
36' PROPOSED RIP RAP _ ~-~~~~i--~`~ ~ ~ ~ ^~ C/l STREAM
ENERGY DISS TER / ~ A ~ /
TOTAL STR • // ~ RpOjOO ~ ~E: ~ „ = 40+
IMPACT=166 L t ~ ~I'V~O ~ ~`„'''
PROPOSED q Y - _ 4~ ... 4~
TOTAL WETLA ~ SIDEWALK -
IMPACT=917 ~ ~ ~! °C
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~ This Map Is For Advisory Purposes Only
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fs Natarrl Raaarrf
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Corporertiou
AGREEMENT
fur
SALE Or S'fR1CAM MITIGATION (SMS) CIRI:UI'1'S
This Agreement is entered into the ~if". __ of ~1 _, 2011 between American
Wetlands & Natural Resources Exchange Corporation (American Wetlands), 2310
Ballycairne Court, Reston, VA 20191 and N py/>N i N~la"1'1 ~ ANC
American Wetlands agrees to obligate Stream Mitigatiot Credits from their Fishtr River
and Weep Creek Mitigation Banks located in Surry and Yadkin Coun ies, NC for purposes
of mitigating for impacts for the N4AAON s •--~_61.14~,~ Ij,/r' ~~ pra,,ject.
American Wetlands warrants that the credits have been released for sale by the Intetngency
Review Teatn (IRT).
The price for the sale of LlS"1
IMllars ($ 243.Oplcredit) for a total
1'hrcc
Dollars
As a condition of obligating the %•~'1 SMiI's for _ (V OVA N"t' M~j4LTN.,
~._ _Ja[!~~ --__- _ _ --- ---------' --~QI>i'~~~_._.~~~' ~!~l~ ~l(.. agCCeS t0 pay a
front-end fee often percent (l0a~o) of the total cost ($ _~~~,-~ to guaranty
that the stream mitigation is held for use at the tune the project is approved by the
regulatory agencies for construction. The subject fee is non-refundable, but will be credit
toward the total mitigation costs when full paytncnt is due. The balance of $ ~ tf
will be due at the time NOVANf (~~At~"N~ IN ~ receives the necessary rmits
liom U~c appropriate regulatory agencies authorizine subieta nroiect.
The undersigned individuals represent
n
~`~AVt!D G, A~--
("Amcxican Wetlands")
HY: ~ ~~~~
TITLE: V I~ SAL r&ST/~tT~ E TITLE: ~ie$S r ~ ~N ~
C ataS~'~,t)e.TtpN
DATE: 3 ° i`'~•' ~•~ (, DATE: .~ ~5 //~
^ 3~ o $allycairne Corrt Reston, Virginia a o i y i
~~~r lO.~i
telcpbone X03.8'6 fax yo 3.8 tio.oo.~(.~.

AMFRICAT3
f: Natural Resource
INVOICE Exchange
Corporation
Invoice: #75
Billing llate: March 25, 201 l
TO: Novani Health, Inc.
Project: Clemmon's -Village Point PH.2
Project Activity: Payment far Obligating 289 SMU's of Mitigation
Amount
Initial Payment for Holding 289 SMU's of Mitigation for Subject $ 7,022.70
Project (Non-Refundable). This amount will applied to the total
amount of mitigation costs of project at time permits are issued.
Total $ 7,022.70
Payment Due: Upon Execution of Agreement, Dated March 25, 20l 1
Check shoWd be made payable to American Wetlands

'' ~ ' `~'~~ :~'' s 3 ~ o Ball7cairnc (,'ourt Beaton, Virginia s o i 9 ~
~ ~.aO~
telep}~one 703. fax ~o3.S6o.oo~

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Landscape Architecture rtot~zsts
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pfOject: NOVANT - CLEMMONS PH 2 INFRASTRUCTURI
scale: ~'~=soo~ _ sheet ~ of 3
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STREAM CROSSING #1 --~
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Stimmel Associates, PA Land Planning = ~a~> >zs ~aF.: description: STREAM CROSSING #1
EXHIBIT ------
--
~ PROpOSEO RETAINING; PROPOSED
tit'ADINAL~ TO MINIMIZE. - _ ROAONIAY ~9
STREAM IMPACTS. _ ~"pp"~ , `. - p
~~~,. _ .. EXISTING ~ ~- _
i/VETLANDS
Z., O PROPOSED
-(J<I HT HATCH; PROPOSE6.13ETAIfViNG/
SIDEWALK ~-- HEAD~ALL TO Mtr11MIZ
97 lF PROP 66" RCP ~ ~'"~"~ `6,TREAM`1MPACTS
~~~ 1 11 I
23 l F FX 30" RCP -~ g GIN IMPACT
~,
C/L S M ENO - ~ , , ~ _ ~ 10' OM
--_ IMPACT --_ FACE -WALL
36' PROPOSED RIP RAP ~ - " C/t STREAM
ENERGY DISSIPATER
--..._
TAL STREAM ,. - --- - " SCA E: '~n ~.
IMPA~123L~ 701 R11N 780 0
-~ "~t36 _
TOTAL WETLANDS - ---~~ ~ PROPOSED ~
~°'~°~~F - SIDEWALK

~t~~~~l 5 ~ '•aaP~,~P.
Suate 2CC --date: nnv1~ job #: 1a1z 2
} ~ 'ninstorv sa ~ .: pfojeCt: Novant - Clem mons Ph 2 Infrastruct ure
Landscape Architecture
-.._ Civil Engineering ~''0'-29t`'

~'
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SC81e: 1"=40' (PLAN)
sheet 3
Of 3

Slimmel Assariates, PA Land Planning 335 723 !
JCi'
~ 33r• ~z~ ~~~~
d@SCflptl011: STREAM CROSSING #2
EXHIBIT --

- .--
PROPOSED RETAININGI c~
/
/
HEADWALL TO MINIMIZE j /
/ ,,,, PROPOSED ~ PROPOSE©-
STREAM IM~'~TS~.., +'
/ SIDEWALK / RETAINING/
y I
E~J$?aNG END IMP/jCT -
ETLANDS ~

/ ~,, ~
~ R
~' / _

~ _ HEADWALL
M IQ MINIMIZ
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(LIGHT C/L STREAM
. % ~~o CIL STREAM
" IMPACTS
~
HATCH) ~
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• ,
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-
`°', ,. '~ BEGIN IMPACT
_ _ ~ 10' FROM

-- :~~. •.`= -
,ol PROP ;
. FACE OF WAl t
__ __ ___ ___ -
36' PROPOSED RIP RAP ~ ~
~ 66"
/ RCP
/ / ~ti"

ENERGY DISSIPATER
_ /
*
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~/ TR

`
TOTAL STREAM - - ROO~OOS
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IMPACT=1661F
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~ " - ~.^_`~„~'.=. ""'~` _ 4~
~~ ~ PROPOSED _
TOTAL WETLA
"- SIDEWALK --
IMPACT=917 -

__..- _ -_--- - __~_.~_ _ ,IMP I
____ _ EXISTING _ ,.__ EXISTING - -
STREAM BED _ _ ---_.__ ~Ti'~EAIUT~ _.~__--- - .__.. - ----
_.._ .__
- - -- - _ _
--. _` _ ._
66" RCP
---
PROPO ED CULVERT
- - -.__- IfVVEi~'f SET ' 9ELb4V
_ ,..
- --_.. - --_- -__ ._. ..___... _._-_-_. - - _._..-EXISTiN STREAM BED- -
30' PROPO ED RIP R_A_P
- ~ ENERGY 15SIPATER
7 ~:

~~' i 1 1~ G~ ! N r`aoe Str7~
, ;e 200
.Yi^ston Salem. R:
Landscape Architecture zna,•?s~s
Civil Engineering
Stimmel Associates, PA Land Planning .- 336 ?73 106'
;,~ art ,o,;:
EXHIBIT
,;~
'"- ~ r
1 \ h ,'~~'.4. ~..~
I
CULVERT CONSTRUCTION SEQUENCE:
1. CLEAR ONLY ENOUGH TREES TO INSTALL THE SILT FENCE ALONG THE
STREAM BANK AND FOR THE BY-PASS CHANNEL.
2. INSTALL 8Y-PASS CHANNEL. AND DIVERT ALL STREAM FLOW THROUGH THE
BY-PASS CHANNEL TO ALLOW THE NORTHERN PORTION OF THE HEADWALL ANO
ALL OF THE CULVERT TO BE INSTALLED.
3. CONSTRUCT THE HEADWALLS, CULVERT AND RIPRAP DISSIPATORS. (SEE
SHEET 2 OF 3) P7k1
4. DIVERT FLOW INTO CONSTRUCTED CULVERT. ~
5. REMOVE THE BY-PASS CHANNEL ~ ~r•~•~
6. COMPLETE THE HEADWALL CONSTRUCTION. (SEE SHEET 3 OF 3) ' .. ~~
7. BACKFILL ROADWAY.
__ ~ -
C/L OF STREAM ~'~
~.
END OF STREAM /
IMPACT
-~ / ~ ~
i _
`\
TEMPORARY SILT
FENCE (TYP.)'
~~ ~
_ date:__ 4/11/11 _~Ob #: 10-122
project: VILLAGE POINT PHASE II INFRASTRUCTURE
scale: 1"=40' sheet 1 of 3
deSCrlptlOtl: CULVERT CONSTRUCTION SEQUENCE

-_ ~ \
TEMPORARY SILT ~_
FENCE PLACE
ALONG TOP OF '~~ ~ ,
EX. STREAM BANK ~~ . t-
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.~\
~. _____
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d ~\•
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~~~~
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TEMPORARY BYPASS CHANNEL J
TO DNERT STREAM AROUND CONSTRUCTION
WITHIN THE STREAM IMPACT LIMITS.

\ -~ END OF
TEMPORARY SILT \\\ STREAM
FENCE (TYP.) ~ IMPACT
\ ,,_
~,
,~
,• _

~~'~~~~ ~). ~; '~C1f P,., date. 4/11/11 __ )Ob #. t0-122
J' a 2~0
s• '~~nston Sae v'. pt'OjeCt: VILLAGE POINT PNASE II INFRASTRUCTURE
E_andscape Architecture i'~D7-2916
Civil Engineering scale: 1"=40' sheet 2 Ot 3
JJ6 72J 106%
Stimmel Associates, PA Land Planning ,sF ~;> >^F,e deSCflptlOfl' CULVERT CONSTRUCTION SEQUENCE
EXHIBIT - -
-~ CONSTRUCT HEADW~
C/L OF STREAM ~` ~^~'- _ OF TEMPORARY STR
~- - AND INSTALL 66" RCP PIPE ~
~ END OF STREAM / ~ _ ~. .~
IMPACT ~
\ ~'
CONSTRUCT HEADWALL \.
NORTH OF TEMPORARY
\ ~ \ STREAM BYPASS AND
\ ` INSTALL 66" RCP PIPE
~_ ~~
' ~\ ~~
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~\ \\ ~ ~ \ IMPACT
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~~~~ Stimmel ~ ~~ade~,•,..,. date: 4;~v~> job #: ~0-122
,E 200
ti-,5ta~ ~a project: VILLAGE POINT PHASE II INFRASTRUCTURE
Landscape Architect«re ?''0+-2e~
Civil Engineering _ SCale: 1"=40' sheet 3 Of 3
336 723 ±067
51immPl Asso- r,+t+ ~ t~C~ Land Planning ~ 33F »? +oe~ description: CULVERT CONSTRUCTION SEQUENCE
EXHIBIT _
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/ -- _
END OF STREAM ` fi RCP, SEE PLAN
IMPACT ANO PROFILES FOR /
\ ~ ~ PIPE DATA ~ /
~~ ~~ ~ ~
/ ~ ~` \~ ~
/.
TEMPORARY SILT \ '~ ~~
FENCE (TYP.) ''~ / ~~ C/L OF `
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CONSTRUCT REMAINDER ~~ ~~ ~
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~ ,' ~ \~ ~
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CONSTRUCT REMAINDER \ ~ ~~ END OF
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