20201906 Ver 1_401 Application_20210115

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
r Yes r No
ID#*
20201906
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 12/7/2020
ID# 20201906 Version 1
Project Contact Information
Name: Bradley Luckey
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Scott 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.

Oickthe upload button or drag and drop files here to attach document
5339.1—Scott Rd_PCN 01.15.21.pdf 8.36MB
Only pdf or Iv17 files are accepted.
Describe the attachments
or comments:
PCN for WQC
Sign and Submit
P 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');
■ 1 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:
i iKM,It 0 W__???Ir6r
Submittal Date: Is filled in automatically.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- Begin Date (Date Received):
Prepare file folder Assign Action ID Number in ORM
1. Project Name [PCN Form A2a]:
2. Work Type: Private Institutional Government Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
4. Property Owner / Applicant [PCN Form A3 or A4]:
5. Agent / Consultant [PNC Form A5 – or ORM Consultant ID Number]:
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location – Coordinates, Street Address, and/or Location Description [PCN Form B1b]:
8. Project Location – Tax Parcel ID [PCN Form B1a]:
9. Project Location – County [PCN Form A2b]:
10. Project Location – Nearest Municipality or Town [PCN Form A2c]:
11. Project Information – Nearest Waterbody [PCN Form B2a]:
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]:
Authorization: Section 10 Section 404 Section 10 and 404
Regulatory Action Type:
Standard Permit Pre-Application Request
Nationwide Permit # Unauthorized Activity
Regional General Permit # Compliance
Jurisdictional Determination Request No Permit Required
Revised 20150602

Page 1 of 11
PCN Form – Version 1.3 December 10, 2008 Version
Office Use Only:
Corps action ID no. _____________
DWQ project no. _______________
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the
Corps: Section 404 Permit Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: NWP 12 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? Yes No
1d. Type(s) of approval sought from the DWQ (check all that apply):
401 Water Quality Certification – Regular Non-404 Jurisdictional General Permit
401 Water Quality Certification – Express Riparian Buffer Authorization
1e. 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: Scott Road
2b. County: Guilford
2c. Nearest municipality / town: Greensboro
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: Mccuiston, Robert William Jr. & Shreve, Judy
3b. Deed Book and Page No. 004583/00865 & 004026/00340
3c. Responsible Party (for LLC if
applicable):
3d. Street address: PO Box 154 & 2136 Scott Road
3e. City, state, zip: Stokesdale, NC 27357 & Browns Summit, NC 27214
3f. Telephone no.: 336-392-5066
3g. Fax no.:
3h. Email address: [e-mail]

Page 2 of 11
PCN Form – Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: Agent Other, specify: Developer
4b. Name: Mr. Bob Dunston
4c. Business name
(if applicable): National Heritage Academies
4d. Street address: 3850 Broadmoor Avenue SE
4e. City, state, zip: Grand Rapids MI, 49512
4f. Telephone no.: 616.299.6611
4g. Fax no.: 616.770.1701
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Bradley S. Luckey
5b. Business name
(if applicable): Pilot Environmental Inc.
5c. Street address: PO Box 128
5d. City, state, zip: Kernersville, NC 27285
5e. Telephone no.: 336.708.4997
5f. Fax no.:
5g. Email address: [e-mail]

Page 3 of 11
PCN Form – Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 788160026 & 7887053534
1b. Site coordinates (in decimal degrees):
Latitude: 36.154223 Longitude: -
79.243032
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 47.6 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Lake Herman
2b. Water Quality Classification of nearest receiving water: WS-V, NSW
2c. River basin: Cape Fear
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The sewer line crossing contains undeveloped wooded land. Structures are not located on the site. The site is located in
a mixed use area of Greensboro, NC.
3b. List the total estimated acreage of all existing wetlands on the property:
~5.41ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
~4,350LF & 0.10 ac open water pond
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is provide sanitary sewer services to the site.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project consists of the construction of a charter school which includes buildings, parking areas and
recreational areas. The site will be provided sanitary sewer services from proposed connection to an existing inactive
public sewer line/easement immediately south of the site. The proposed sewer line will be permanently maintained by the
City of Greensboro following the construction of the proposed project.

Two stream crossings will be directional drilled beneath the stream, resulting in no impact. The proposed sewer line will
result in one wetland crossing with permanent and temporary proposed impact to wetlands. To facilitate installation of the
sewer line and sewer line crossing, clearing and stumping/grubbing will be necessary in the vicinity of the stream
crossing. The remainder of the line will not require clearing. Graders, haulers, excavators and other heavy equipment will
be used during sewer line installation.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments: SAW -2020-00128
Yes No Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? Preliminary Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Bradley Luckey/Michael Brame
Agency/Consultant Company: Pilot Enviromental, Inc.
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
USACE PJD dated 6.11.20 & NCDWR Site Letter dated 3.26.20

Page 4 of 11
PCN Form – Version 1.3 December 10, 2008 Version

5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? Yes No Unknown
5b. If yes, explain in detail according to “help file” instructions.

6. Future Project Plans
6a. Is this a phased project? Yes No
6b. If yes, explain.
The project is not part of a phased project. Impacts to streams/wetlands, outside of those proposed in this application,
are not anticipated as a result of the proposed project.

Page 5 of 11
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.
Wetland impact
number –
Permanent (P) or
Temporary (T)
2b.

Type of impact
2c.

Type of wetland
(if known)
2d.

Forested

2e.
Type of jurisdiction
(Corps - 404, 10
DWQ – non-404, other)
2f.

Area of impact
(acres)
W1 P T Fill/Conversion PFO Yes
No
Corps
DWQ 0.011/0.085
W2 P T Yes
No
Corps
DWQ
W3 P T Yes
No
Corps
DWQ
W4 P T Yes
No
Corps
DWQ
W5 P T Yes
No
Corps
DWQ
W6 P T Yes
No
Corps
DWQ
2g. Total wetland impacts 0.011/0.085
2h. Comments: Wetland Impact 1 consists of the permanent fill of 0.011 acres of wetlands to satisfy the City of Greensboro’s
sewer line maintenance slope requirements and the temporary impact to 0.085 acres of wetlands from the conversion of
forested to emergent. Mitigation is not proposed for impacts to 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.
Stream impact
number -
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial
(PER) or
intermittent
(INT)?
3e.
Type of jurisdiction
(Corps - 404, 10
DWQ – non-404,
other)
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P T PER
INT
Corps
DWQ
S2 P T PER
INT
Corps
DWQ
S3 P T PER
INT
Corps
DWQ
S4 P T PER
INT
Corps
DWQ
S5 P T PER
INT
Corps
DWQ
S6 P T PER
INT
Corps
DWQ
3h. Total stream and tributary impacts
3i. Comments: Stream impacts are not being proposed.

Page 6 of 11
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.
Open water
impact number –
Permanent (P) or
Temporary (T)
4b.
Name of waterbody
(if applicable)
4c.

Type of impact
4d.

Waterbody type
4e.

Area of impact (acres)
O1 P T
O2 P T
O3 P T
O4 P T
4f. Total open water impacts
4g. Comments: Open water impacts are not being proposed.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.

Pond ID
number
5b.

Proposed use or purpose
of pond

5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments: Stormwater ponds will be constructed on the site within uplands. Pond or lake construction in regulated
waters is not being proposed.
5h. Is a dam high hazard permit required?
Yes No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:

Page 7 of 11
PCN Form – Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
Project is in which protected basin?
Neuse Tar-Pamlico Other: Jordan
Catawba Randleman
6b.
Buffer impact
number –
Permanent (P) or
Temporary (T)
6c.

Reason
for
impact
6d.

Stream name
6e.

Buffer
mitigation
required?
6f.

Zone 1 impact
(square feet)
6g.

Zone 2 impact
(square feet)
B1 P T Yes
No
B2 P T Yes
No
B3 P T Yes
No
6h. Total buffer impacts
6i. Comments: A No Practical Alternatives Letter has been submitted to the City of Greensboro separate of this application.
We request conditional 401 approval pending receipt of buffer authorization from delegated municipality.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The sewer line crossing has been designed to cross the wetland as near to perpendicular and at the narrowest location of the
wetland possible. Impacts from the overall development of the site with a charter school have been designed to avoid impacts
to regulated waters. The sewer line's permanent maintenance easement has been minimized to the narrowest width possible
to still allow for safe maintenance of the sewer line.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The clearing/disturbance and impact limits will be staked, surveyed and silt fence or other sediment BMPs will be used.
During sewer line installation, soils will be temporary stockpiled within uplands. In areas of temporary wetland impact, grades
will be restored to similar pre-construction condition, seeded with native herbaceous mix and stabilized with bio-degradable
matting.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
Yes No

2b. If yes, mitigation is required by (check all that apply): DWQ Corps
2c. If yes, which mitigation option will be used for this
project?
Mitigation bank
Payment to in-lieu fee program
Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity

Page 8 of 11
PCN Form – Version 1.3 December 10, 2008 Version

3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: warm cool cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
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:

Page 9 of 11
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
within one of the NC Riparian Buffer Protection Rules? Yes No
1b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Diffuse flow plan approval from delgated municipality Yes No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? %
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:
Stormwater mangement plan approval being requested from delgated municpality.
2e. Who will be responsible for the review of the Stormwater Management Plan?
Certified Local Government
DWQ Stormwater Program
DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government’s jurisdiction is this project? City of Greensboro
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply):
Phase II
NSW
USMP
Water Supply Watershed
Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
Yes No
4. DWQ Stormwater Program Review
4a. Which of the following state-implemented stormwater management programs apply
(check all that apply):
Coastal counties
HQW
ORW
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
5b. Have all of the 401 Unit submittal requirements been met? Yes No

Page 10 of 11
PCN Form – Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
use of public (federal/state) land? Yes No
1b. 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
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
Yes No
1c. 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.)
Comments: We are not aware of a NEPA or SEPA being required as part of this
project.
Yes No
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,
or Riparian Buffer Rules (15A NCAC 2B .0200)?
Yes No
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
additional development, which could impact nearby downstream water quality? Yes No
3b. If you answered “yes” to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered “no,” provide a short narrative description.
We are not aware of additional development that will impact nearby downstream water quality.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Impacts to regulated waters outside of those within this application are not being proposed.

Page 11 of 11
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
habitat? Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts? Yes No
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?
Pilot reviewed the USFWS database of federally protected species within Guilford County. Based on our site
observations, the proposed project will not impact suitable habitat of federally protected species. Therefore, we have
made a determination of no effect to federally protected species.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? Yes No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat. Best
management practices and the use of temporary sediment and erosion control devices will prevent sediment from entering
down-gradient waterbodies which may contain fish.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
Pilot consulted the NCSHPO historic properties website to determine if protected cultural resources are located within the
proposed project area (attached). The map does not depict eligible for listing cultural recourse within 1,000 feet of the
project area.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? Yes No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA NFHL (Drawing 4, Verification Package)

Bradley S. Luckey

Applicant/Agent's Printed Name

_______________________________
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)

01.15.21

Date

Proposal for Environmental Services
Pilot Proposal 5339.1
December 8, 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: d %X ` I "i k K-U
Applicant Information:
Name:
Address:
Telephone Number:
E-mail Address:
f is 5 r'-I f
Date: ,L Z�
5

SITEOVERVIEWNOT FOR CONSTRUCTION
NOT FOR CONSTRUCTIONEXHIBIT1
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U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT

Action Id. SAW-2020-00128 County: Guilford U.S.G.S. Quad: NC- Browns Summit
NOTIFICATION OF JURISDICTIONAL DETERMINATION

Requestor: Pilot Environmental, Inc.
Attn: Michael Brame
Address: PO Box 128
Kernersville, NC 27285

Size (acres) ~47.6 Nearest Town Greensboro
Nearest Waterway UT to Unnamed Tributary at Camp Herman River Basin Cape Fear
USGS HUC 03030002 Coordinates 36.154231, -79.743032
Location description: The project area is located on the south side of Scott Road, approximately 0.55 mile west of its
intersection with Summit Avenue, in Greensboro, Guilford County, North Carolina. The project area is shown as the orange
outlined “Site Boundary” on the attached sketch entitled “Drawing 5.”
Indicate Which of the Following Apply:
A.PreliminaryDetermination
܈ There appear to be waters, including wetlands on the above described project area/property, that may be subject to
Section 404 of the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33
USC § 403). The waters, including wetlands have been delineated, and the delineation has been verified by the Corps to be
sufficiently accurate and reliable. The approximate boundaries of these waters are shown on the enclosed delineation map
dated 3/25/2020. Therefore this preliminary jurisdiction determination may be used in the permit evaluation process,
including determining compensatory mitigation. For purposes of computation of impacts, compensatory mitigation
requirements, and other resource protection measures, a permit decision made on the basis of a preliminary JD will treat
all waters and wetlands that would be affected in any way by the permitted activity on the site as if they are jurisdictional
waters of the U.S. This preliminary determination is not an appealable action under the Regulatory Program
Administrative Appeal Process (Reference 33 CFR Part 331). However, you may request an approved JD, which is an
appealable action, by contacting the Corps district for further instruction.
܆ There appear to be waters, including wetlands on the above described project area/property, that may be subject to Section 404 of
the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). However,
since the waters, including wetlands have not been properly delineated, this preliminary jurisdiction determination may not be
used in the permit evaluation process. Without a verified wetland delineation, this preliminary determination is merely an
effective presumption of CWA/RHA jurisdiction over all of the waters, including wetlands at the project area, which is not
sufficiently accurate and reliable to support an enforceable permit decision. We recommend that you have the waters, including
wetlands on your project area/property delineated. As the Corps may not be able to accomplish this wetland delineation in a
timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by the Corps.
B. Approved Determination

܆ There are Navigable Waters of the United States within the above described project area/property subject to the permit
requirements of Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act
(CWA)(33 USC § 1344). Unless there is a change in law or our published regulations, this determination may be relied upon for
a period not to exceed five years from the date of this notification.
܆ There are waters, including wetlandson the above described project area/property subject to the permit requirements of Section
404 of the Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
܆We recommend you have the waters, including wetlands on your project area/property delineated. As the Corps may not be
able to accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that
can be verified by the Corps.
܆The waters, including wetlands on your project area/property have been delineated and the delineation has been verified by the
Corps. The approximate boundaries of these waters are shown on the enclosed delineation map dated . We strongly suggest you
have this delineation surveyed. Upon completion, this survey should be reviewed and verified by the Corps. Once verified, this
survey will provide an accurate depiction of all areas subject to CWA jurisdiction on your property which, provided there is no
change in the law or our published regulations, may be relied upon for a period not to exceed five years.
SAW-2020-00128
܆The waters, including wetlands have been delineated and surveyed and are accurately depicted on the plat signed by the Corps
Regulatory Official identified below on . Unless there is a change in the law or our published regulations, this determination may
be relied upon for a period not to exceed five years from the date of this notification.
܆ There are no waters of the U.S., to include wetlands, present on the above described project area/property which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
܆ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (CAMA).
You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to determine their
requirements.

Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material, construction or
placement of structures, or work within navigable waters of the United States without a Department of the Army permit may
constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If you have any questions
regarding this determination and/or the Corps regulatory program, please contact David E. Bailey at [phone] X 30 or
[e-mail].
C. Basis For Determination: See the preliminary jurisdictional determination form dated 06/11/2020.
D. Remarks: None.
E. Attention USDA Program Participants

This delineation/determination has been conducted to identify the limits of Corps’ Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination 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 request
a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B.
above)

This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this determination you
must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Phillip Shannin, Review Officer
60 Forsyth Street SW, Room 10M15
Atlanta, Georgia 30303-8801
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by Not applicable.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**

Corps Regulatory Official: ______________________________________________________

Date of JD: 06/11/2020 Expiration Date of JD: Not applicable

The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so,
please complete the Customer Satisfaction Survey located at http://corpsmapu.usace.army.mil/cm_apex/f?p=136:4:0.

Copy furnished:
Sue Homewood, NCDEQ-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston-Salem, NC 27105
Date: 2020.06.11 14:58:29
-04'00'
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SAW-2020-00128
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Pilot Environmental, Inc. (Attn: Michael Brame) File Number: SAW-2020-00128 Date: 06/11/2020
Attached is: See Section below
܆ INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission) A
܆ PROFFERED PERMIT (Standard Permit or Letter of permission) B
܆ PERMIT DENIAL C
܆ APPROVED JURISDICTIONAL DETERMINATION D
܈ PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx
or the Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
x ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
x OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
x ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
x APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice. D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
x ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
x APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
SAW-2020-00128
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.

SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)

ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
appeal process you may contact:
District Engineer, Wilmington Regulatory Division
Attn: David E. Bailey
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587

If you only have questions regarding the appeal process you may
also contact:
Mr. Phillip Shannin, Administrative Appeal Review Officer
CESAD-PDO
U.S. Army Corps of Engineers, South Atlantic Division
60 Forsyth Street, Room 10M15
Atlanta, Georgia 30303-8801
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportunity to participate in all site investigations.

________________________________________
Signature of appellant or agent.
Date: Telephone number:

For appeals on Initial Proffered Permits send this form to:

District Engineer, Wilmington Regulatory Division, Attn: David E. Bailey, 69 Darlington Avenue, Wilmington, North Carolina
28403

For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:

Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Phillip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

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Date: 2020.06.11
14:29:57 -04'00'

March 26, 2020

Mr. Spencer Burnett
Pilot Environmental Inc.
P.O. Box 128
Kernersville, NC 27285

Subject: On-Site Determination for Applicability to the Mitigation Rules (15A NCAC 2B .0500)
Subject Property: 2126 and 2146 Scott Rd, Browns Summit, NC Guilford County

Dear Mr. Burnett:

On March 25, 2020, at your request, Kelli Park conducted an on-site determination with you to review
features located on the subject project for stream determinations with regards to the above noted state
regulations.

The Division of Water Resources (Division) acknowledges the areas and boundaries identified as
jurisdictional wetlands by the USACE. The attached initialed and dated sketch accurately depicts all
Division stream determinations conducted during the site visit.

At the time of this letter, all perennial stream channels and jurisdictional wetlands found on the
property are subject to the mitigation rules cited above. In addition, the Jordan Lake Buffer Rules may
apply to some streams at this location, please be sure to contact the local government for further
information regarding the Jordan Lake Buffer Rules. Please note that these regulations may be subject
to change in the future.

The owner (or future owners) should notify the Division (and other relevant agencies) of this decision in
any future correspondences concerning this property. This on-site determination shall expire five (5)
years from the date of this letter.

Landowners or affected parties that dispute a determination made by the Division or Delegated Local
Authority that a surface water exists and that it is subject to the buffer rule may request a determination
by the Director. A request for a determination by the Director shall be referred to the Director in writing
c/o 401 & Buffer Permitting Branch, 1650 Mail Service Center, Raleigh, NC 27699-1650. Individuals that
dispute a determination by the Division or Delegated Local Authority that “exempts” surface water from
the buffer rule may ask for an adjudicatory hearing. You must act within 60 days of the date that you
receive this letter. Applicants are hereby notified that the 60-day statutory appeal time does not start
until the affected party (including downstream and adjacent landowners) is notified of this decision. The
Division recommends that the applicant conduct this notification in order to be certain that third party
appeals are made in a timely manner. To ask for a hearing, send a written petition, which conforms to

Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, N.C. 27699-6714. This determination is final and binding unless you ask for a
hearing within 60 days.

This letter only addresses the applicability to the buffer rules and does not approve any activity within
Waters of the United States or Waters of the State or their associated buffers. If you have any additional
questions or require additional information, please contact me at 336-776-9689 or [e-mail].

Sincerely,

Sue Homewood
Winston-Salem Regional Office

Enclosures: USGS Topo Map
Pilot Environmental Wetland Map - initialed and dated

Cc: Robert McCuiston ([e-mail])
David Bailey, USACE Raleigh Regulatory Field Office (via email)
DWR, Winston-Salem Regional Office
USGS Topographic Map
Scott Road
Approximate 47.6-Acre Tract
Greensboro, Guilford County, NC
Pilot Project 5339
Drawing 1
USGS Topographic Map
Lake Brandt and Browns Summit,
NC Quadrangles
Scale: 1” = 2,000’
LEGEND
Site Boundary
Web Soil Map
Scott Road
Approximate 47.6-Acre Tract
Greensboro, Guilford County, NC
Pilot Project 5339
Drawing 2
USDA Web Soil Survey
of Guilford County, NC
Scale: 1” = 300’
LEGEND
Site Boundary
Published Soil Map
Scott Road
Approximate 47.6-Acre Tract
Greensboro, Guilford County, NC
Pilot Project 5339
Drawing 2A
USDA Soil Survey
Of Guilford County, NC
Published 1977, Sheet 16
Not To Scale
LEGEND
Site Boundary
NWI Map
Scott Road
Approximate 47.6-Acre Tract
Greensboro, Guilford County, NC
Pilot Project 5339
Drawing 3
USFWS NWI
Wetlands Mapper
Scale: 1” = 400’
LEGEND
Site Boundary
FEMA FIRM
Scott Road
Approximate 47.6-Acre Tract
Greensboro, Guilford County, NC
Pilot Project 5339
Drawing 4
National Flood Hazard Layer
From FEMA Web Map Service
Scale: 1” = 400’
MWA 1-52
(1.43 ac)
FLAG NUMBERS/INFO
WETLAND FLAGS =
STREAM FLAGS =
Stream Flags = Limits
Wetland Flags = 148
Total Flags = 148
Wetland Map
Scott Road
Approximate 47.6-Acre Tract
Greensboro, Guilford County, NC
Pilot Project 5339
Drawing 5
Satellite Imagery from ESRI
and Pilot GPS Data
Scale: 1” = 300’
Date: 3.25.2020
DP-1
DP-2
DP-3DP-4
MSB
(870 LF)
MSA
(1,790 LF)
SA
(480 LF)
MSC
(1,060 LF)
SC
(150 LF)
PA
(0.10 ac)
WAA 1-52
(1.51 ac)
MWC 10-16
(0.09 ac)
MWC 1-9
(0.31 ac)
MWB 1-13
(0.32 ac)
WB 5-18
(0.09 ac)
WAB 1-2
(0.001 ac)
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP WERE VERIFIED BY MR.DAVID BAILEY WITH THE USACE BASED ON A DESKTOP REVIEW
AND MS.KELLI PARK WITH THE NCDEQ-DWR BASED ON A FIELD VISIT CONDUCTED ON 3.25.2020.THIS EXHIBIT INCLUDES GPS LOCATIONS
OF JURISDICTIONAL FEATURES.DELINEATION CONDUCTED BY PILOT PERSONNEL ON 1.10.2020.
LEGEND
Site Boundary
Perennial Stream
Wetland
Pond
50’ Jordan Lake Buffer
Culvert
Flag Number
Data Point
WA 1-5
DP-1
DWR Pre-Fil ing Meeting Req u est Form
ID#*Ve rsion *
Re gional Office *
Re v ie we r List *
Contact Name *
Contact Email Addre ss *
Proje ct Name *
Proje ct Owne r *
Proje ct County *
Owne r Addre ss:
Is this a transportation proje ct?*
Type (s) of approv al sought from the DWR:
Doe s this proje ct hav e an e xisting proje ct ID#?*
Do you know the name of the staff me mbe r you would like to re que st a me e ting with?
Ple ase giv e a brie f proje ct de scription be low.*
Please give a couple of dates you are available for a meeting.
20201906 1
Winston-Salem Regional Office - [phone]
Sue Homewood
Pre-Filing Me eting Reque st submitte d 12/7/2020
Heather LaGamba
[e-mail]
Scott Rd
multiple
Guilford
City
Stokesdale
State / Province / Region
NC
Postal / Zip Code
27357
Country
USA
Street Address
Post Office Box 154
Address Line 2
Yes No
401 Water Quality Certification -
Regular
401 Water Quality Certification -
Express
Individual Permit Modification
Shoreline Stabilization
Yes No
Sue Homewood
The applicant does not request a meeting. The applicant may submit
a
request for 401 WQC.
Ple ase attach the docume ntation you would like to hav e the me e ting about.
Signature
Submittal Date
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.
· I understand by signing this form that I cannot submit my application until 30 calendar days after this pre-filing
meeting request.
· I 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.
12/7/2020
DWR Pre-Fil ing Meeting Req u est Form
ID#*Ve rsion *
Re gional Office *
Re v ie we r List *
Contact Name *
Contact Email Addre ss *
Proje ct Name *
Proje ct Owne r *
Proje ct County *
Owne r Addre ss:
Is this a transportation proje ct?*
Type (s) of approv al sought from the DWR:
Doe s this proje ct hav e an e xisting proje ct ID#?*
Do you know the name of the staff me mbe r you would like to re que st a me e ting with?
Ple ase giv e a brie f proje ct de scription be low.*
Please give a couple of dates you are available for a meeting.
20201624 1
Winston-Salem Regional Office - [phone]
Sue Homewood
Pre-Filing Me eting Reque st submitte d 10/27/2020
Bradley Luckey
[e-mail]
Burlington Rd
Brighterwood Crossing, LLC
Guilford
City
High Point
State / Province / Region
NC
Postal / Zip Code
27265
Country
USA
Street Address
3929 Tinsley Drive
Address Line 2
Suite 104
Yes No
401 Water Quality Certification -
Regular
401 Water Quality Certification -
Express
Individual Permit Modification
Shoreline Stabilization
Yes No
Sue Homewood
The applicant does not request a meeting. The applicant may submit a
request for 401 WQC.
Ple ase attach the docume ntation you would like to hav e the me e ting about.
Signature
Submittal Date
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.
· I understand by signing this form that I cannot submit my application until 30 calendar days after this pre-filing
meeting request.
· I 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.
10/27/2020