20201836 Ver 1_More Info Received_20210503

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- 2020-01836
Prepare file folder ❑
Begin Date (Date Received): April 15, 2021
Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Stanfield Valley Subdivision
2. Work Type: ❑✓ Private ❑ Institutional ❑ Government ❑ Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
The purpose of the project is to develop the site with a single family residential subdivision.
4. Property Owner / Applicant [PCN Form A3 or A4]: Trust River Road -Reece Gibson
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
35.2226760/-80.456591 °, Renee Ford Road
8. Project Location— Tax Parcel ID [PCN Form Bla]: 556301488696, 556301498092, 556302592553, 556
9. Project Location — County [PCN Form A2b]: Stanly
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Stanfield
11. Project Information — Nearest Waterbody [PCN Form 132a]: Rock Hole Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03040105
Authorization: Section 10 ❑ Section 404 ❑✓
Regulatory Action Type:
❑ Standard Permit
✓ Nationwide Permit #
Regional General Permit #
Jurisdictional Determination Request
Section 10 and 404 ❑
❑ Pre -Application Request
❑ Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

Proposal for Environmental Services
Pilot Proposal 6137.1
April 1, 2021
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: Southeast of the intersection of
Renee Ford Rd and River Rd
Applicant Information:
Name:
Address:
Telephone Number:
Fax Number:
E-mail Address:
Reece Gibson
4512 River Rd
Stanfield, NC 28163
704-888-8376
704-888-1361
Signature: //( /L Date:
- /— 2L
5

9/25/2020 ConnectGIS Feature Report
�I II Stanly
Printed September 25, 2020
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9/25/2020 ConnectGIS Feature Report
OBJECTID Tax Record Owner Name
30907 137444 TRUST RIVER ROAD
Owner Name 2 Mailing Address Mailing Address 2
4512 RIVER RD
City State Zip
STANFIELD NC 28163
PIN Deed Acres Lots
556301488696 8.96 0
Physical Address District Code District Desc
RENEE FORD RD 110 WEST STANLY FD
Township Code Township Desc Description1
126 FURR #2 TWP VACANT
Year Built Finished Area DateSold
0 6/8/2015 12:00:00 AM
SaleAmount Deed Book Deed Page
0 1527 475
Plat Book Plat Page Landuse Record
23 90 Yes
This map is prepared for the inventory of Real Property found within this jurisdiction, and is compiled from recorded deeds, plats and other public records and data.
Users of the map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on
his map. The Stanly County Geographic Information Systems Division of the Office of Information Technology assumes no legal responsibility for the information
contained on this map. Also, when the deeds and or plats are viewed for a parcel, the Stanly County Register of Deeds Office makes no guarantees regarding the
collection, accuracy, authenticity, or use of these records. The web site is for informational use and convenience only. The Register of Deeds shall in no way be held
responsible for errors or omissions in these records nor for any actions resulting from their use. The official records are kept in the Stanly County Register of Deeds
Office. To view deeds on this site you must install the AlternaTIFF viewer. To install, please visit http://www.alternatiff.com/install-ie/ Warning: City of Norwood: Within
he city limits of Norwood any improvements such as boathouses or piers that have been built on land owned by Duke Energy are considered to be located on leased
land and therefore will not be found using this program. These improvements are also not considered to be located within the city limits of Norwood and are taxed
accordingly. These leased land records can be identified by going to StanlyTax.com. If a property is located on Lake Tillery in Norwood has a parcel number of 1234 then
he tax bill for the waterfront improvements located on Duke Energy property could be found by placing an LL01 after the parcel number. On StanlyTax.com search b
Parcel / Record number and enter 1234LL01 for this example.
https://stanly.connectgis.com/DownloadFile.ashx?i=_ags_map8763e00c01 ec446aac5e3d708dea4b5bx.htm&t=printid 2/2

9/25/2020 ConnectGIS Feature Report
tanly
jg,r, NEE T I , 2020
Printed September 25, 2020
WEB H05TING b
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❑ Richfield
Stanfield
Lease Land Records
Surroundira Courties
https:Hstanly.connectgis.com/DownloadFile.ashx?i=_ags_map806df7422dcc401 b84469f8f446ac23dx.htm&t=printid 1 /2

9/25/2020 ConnectGIS Feature Report
OBJECTID Tax Record Owner Name
30908 137443 TRUST RIVER ROAD
Owner Name 2 Mailing Address Mailing Address 2
4512 RIVER RD
City State Zip
STANFIELD NC 28163
PIN Deed Acres Lots
556301498092 8.76 0
Physical Address District Code District Desc
RENEE FORD RD 110 WEST STANLY FD
Township Code Township Desc Description1
126 FURR #2 TWP VACANT
Year Built Finished Area DateSold
0 6/8/2015 12:00:00 AM
SaleAmount Deed Book Deed Page
0 1527 475
Plat Book Plat Page Landuse Record
23 90 Yes
This map is prepared for the inventory of Real Property found within this jurisdiction, and is compiled from recorded deeds, plats and other public records and data.
Users of the map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on
his map. The Stanly County Geographic Information Systems Division of the Office of Information Technology assumes no legal responsibility for the information
contained on this map. Also, when the deeds and or plats are viewed for a parcel, the Stanly County Register of Deeds Office makes no guarantees regarding the
collection, accuracy, authenticity, or use of these records. The web site is for informational use and convenience only. The Register of Deeds shall in no way be held
responsible for errors or omissions in these records nor for any actions resulting from their use. The official records are kept in the Stanly County Register of Deeds
Office. To view deeds on this site you must install the AlternaTIFF viewer. To install, please visit http://www.alternatiff.com/install-ie/ Warning: City of Norwood: Within
he city limits of Norwood any improvements such as boathouses or piers that have been built on land owned by Duke Energy are considered to be located on leased
land and therefore will not be found using this program. These improvements are also not considered to be located within the city limits of Norwood and are taxed
accordingly. These leased land records can be identified by going to StanlyTax.com. If a property is located on Lake Tillery in Norwood has a parcel number of 1234 then
he tax bill for the waterfront improvements located on Duke Energy property could be found by placing an LL01 after the parcel number. On StanlyTax.com search b
Parcel / Record number and enter 1234LL01 for this example.
https://stanly.connectgis.com/DownloadFile.ashx?i=_ags_map806df7422dcc4Ol b84469f8f446ac23dx.htm&t=printid 2/2

9/25/2020 ConnectGIS Feature Report
Stanly
AWCONNECTGIS Printed September 25, 2020
WEB H05TING L Ill See Below for Disclaimer
k
S
l}17 RAI Road-s
Roads
Parcels
El
City Limit's
Albemarle
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New London
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❑ Richfield
Stanfield
Leasci Land Records
Surrourdira Courties
V
1 : 135 Feet �.
https://stanly.con nectgis.corn/Download File. ashx?i=_ags_rnapc57b560950c14a059677760f1 e539a14x.htm&t=printid 1/2

9/25/2020 ConnectGIS Feature Report
OBJECTID Tax Record Owner Name
30898 137436 TRUST RIVER ROAD
Owner Name 2 Mailing Address Mailing Address 2
4512 RIVER RD
City State Zip
STANFIELD NC 28163
PIN Deed Acres Lots
556302592553 8 0
Physical Address District Code District Desc
RIVER RD 110 WEST STANLY FD
Township Code Township Desc Description1
126 FURR #2 TWP VACANT
Year Built Finished Area DateSold
0 6/8/2015 12:00:00 AM
SaleAmount Deed Book Deed Page
0 1527 475
Plat Book Plat Page Landuse Record
23 90 Yes
This map is prepared for the inventory of Real Property found within this jurisdiction, and is compiled from recorded deeds, plats and other public records and data.
Users of the map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on
his map. The Stanly County Geographic Information Systems Division of the Office of Information Technology assumes no legal responsibility for the information
contained on this map. Also, when the deeds and or plats are viewed for a parcel, the Stanly County Register of Deeds Office makes no guarantees regarding the
collection, accuracy, authenticity, or use of these records. The web site is for informational use and convenience only. The Register of Deeds shall in no way be held
responsible for errors or omissions in these records nor for any actions resulting from their use. The official records are kept in the Stanly County Register of Deeds
Office. To view deeds on this site you must install the AlternaTIFF viewer. To install, please visit http://www.alternatiff.com/install-ie/ Warning: City of Norwood: Within
he city limits of Norwood any improvements such as boathouses or piers that have been built on land owned by Duke Energy are considered to be located on leased
land and therefore will not be found using this program. These improvements are also not considered to be located within the city limits of Norwood and are taxed
accordingly. These leased land records can be identified by going to StanlyTax.com. If a property is located on Lake Tillery in Norwood has a parcel number of 1234 then
he tax bill for the waterfront improvements located on Duke Energy property could be found by placing an LL01 after the parcel number. On StanlyTax.com search b
Parcel / Record number and enter 1234LL01 for this example.
https://stanly.connectgis.com/DownloadFile.ashx?i=_ags_mapc57b560950c14aO59677760f1 e539a14x.htm&t=printid 2/2

9/25/2020 ConnectGIS Feature Report
Stanly
NECTGIS Printed September 25, 2020
WEB H05TING i- IY I See Below for Disclaimer
Rrll Roads
— r t
Roads
F
Parcels
LU
j CitV LiMi-S
e
I. _:'=J `Il3arrarle
Badin
Misenheimer
New London
Norwood
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Oakboro
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Richfield
fi Stanfield
Lease Land Records
Surrourdira Courties
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,. 1 : 14d Feet
S
https://stanly.con nectgis.corn/Download File. ashx?i=_ags_rnapecdc7218e4fc438e91 fc417455337379x.htm&t=printid 1 /2

9/25/2020 ConnectGIS Feature Report
OBJECTID Tax Record Owner Name
30897 36666 TRUST RIVER ROAD
Owner Name 2 Mailing Address Mailing Address 2
4512 RIVER RD
City State Zip
STANFIELD NC 28163
PIN Deed Acres Lots
556302682581 12.27 0
Physical Address District Code District Desc
RIVER RD 110 WEST STANLY FD
Township Code Township Desc Description1
126 FURR #2 TWP VACANT
Year Built Finished Area DateSold
0 6/8/2015 12:00:00 AM
SaleAmount Deed Book Deed Page
0 1527 475
Plat Book Plat Page Landuse Record
23 90 Yes
This map is prepared for the inventory of Real Property found within this jurisdiction, and is compiled from recorded deeds, plats and other public records and data.
Users of the map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on
his map. The Stanly County Geographic Information Systems Division of the Office of Information Technology assumes no legal responsibility for the information
contained on this map. Also, when the deeds and or plats are viewed for a parcel, the Stanly County Register of Deeds Office makes no guarantees regarding the
collection, accuracy, authenticity, or use of these records. The web site is for informational use and convenience only. The Register of Deeds shall in no way be held
responsible for errors or omissions in these records nor for any actions resulting from their use. The official records are kept in the Stanly County Register of Deeds
Office. To view deeds on this site you must install the AlternaTIFF viewer. To install, please visit http://www.alternatiff.com/install-ie/ Warning: City of Norwood: Within
he city limits of Norwood any improvements such as boathouses or piers that have been built on land owned by Duke Energy are considered to be located on leased
land and therefore will not be found using this program. These improvements are also not considered to be located within the city limits of Norwood and are taxed
accordingly. These leased land records can be identified by going to StanlyTax.com. If a property is located on Lake Tillery in Norwood has a parcel number of 1234 then
he tax bill for the waterfront improvements located on Duke Energy property could be found by placing an LL01 after the parcel number. On StanlyTax.com search b
Parcel / Record number and enter 1234LL01 for this example.
https://stanly.con nectgis. com/Download Fi le.ashx?i=_ags_mapecdc7218e4fc438e9l fc4l 7455337379x.htm&t=printid 2/2

dsF SKATE q.
NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW— 2020-01836 Date received: 4/15/2021
DWR project no. [Click enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.222676'
Longitude (DD.DDDDDD):-80.456591'
Form Version 1.5, September 2020
Pre -Construction Notification (PCN) Form
(Ver. 1.5, September 2020)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk * are required. The form is not considered complete until all mandatory
questions are answered.
The online help file may be found at this link:
https://edocs.deg. nc.qov/WaterResources/O/edoc/624704/PCN%2OHelp%2OFile`/`202018-1-30.pdf
The help document may be found at this link:
http://www.saw. usace.army. m i I/M issions/ReguIatory-Perm it -Prop ram/Perm its/201 7-Nationwide- Perm its/Pre-
construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as DWR will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used to satisfy 40
C.F.R. Section 121.4(a) which states "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to the certifying authority
at least 30 days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) *: 10/16/2020
DWR ID # 20201484 Version 1 (If applicable)
A. Processing Information
County (counties) where project is located: *
Stanly Additional (if needed).
Is this a public transportation project? *
(Publicly funded municipal, state, or federal road, rail,
❑ Yes 0 No
or airport project)
Is this a NCDOT project? *
❑ Yes 0 No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number: *
Click to enter
0 Section 404 Permit (wetlands, streams, waters,
la. Type(s) of approval sought from the Corps:*
Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Page 1 of 21 PCN Form - Version 1.5, September 2020

❑x Nationwide Permit (NWP)
1 b. Permit type(s)? *
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as separate attachments
and submitted with this form.
1c. Has the NWP or GP number been verified by the Corps?*
❑ Yes ❑x No
NWP number(s):
NWP 29
RGP number(s):
Click to enter.
1d. Type(s) of approval sought from the DWR (check all that apply):
❑x 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
1 e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: *
❑ Yes ❑x No
For the record only for Corps Permit: *
❑ Yes ❑x No
1f. Is this an after -the -fact permit/certification application? *
❑ Yes ❑x No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
❑ Yes ❑x No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h. Is the project located in any of NC's twenty coastal counties? *
❑ Yes ❑x No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑ Yes ❑x No ❑ Unknown
1j. Is the project located in a designated trout watershed? *
❑ Yes ❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.miI/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 2 of 21 PCN Form - Version 1.5, September 2020

B. Applicant Information
1 a.
Who is the primary contact? *
Reece Gibson
1 b.
Primary Contact Email: *
Click to enter.
1 c.
Primary Contact Phone: * (###)###-####
[phone]
1 d.
Who is applying for the permit/certification? * (check
all that apply)
® Owner 0 Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?*
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed: *
Trust River Road
2b.
Deed Book and Page No.:
1527/475
2c.
Responsible Party (for corporations):
Reece Gibson
2d.
Address *
Street Address:
4512 River Road
Address line 2:
Click to enter.
City:
Stanfield
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
28163
Country:
U.S.
2e.
Telephone Number: * (###)###-####
[phone]
2f.
Fax Number: (###)###-####
[phone]
2g.
Email Address: *
Click to enter.
3.
Applicant Information (if different from owner)
3a.
Name:
Click to enter.
3b.
Business Name (if applicable):
Click to enter.
3c.
Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: * (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
Page 3 of 21 PCN Form - Version 1.5, September 2020

3f. Email Address: * Click to enter.
4.
Agent/ Consultant (if applicable)
4a.
Name: *
Michael T. Brame
4b.
Business Name:
Pilot Environmental, Inc.
4c.
Address: *
Street Address:
743 Park Lawn Court
Address line 2:
Click to enter.
City:
Kernersville
State/ Province/ Region:
NC
Postal/ Zip Code:
27284
Country:
U.S.
4d.
Telephone Number: * (###)###-####
336.708.4620
4e
Fax Number: (###)###-####
Click to enter.
4f.
Email Address: *
[e-mail]
Agent Authorization Letter:*
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw. usace.army. mil/Missions/Regulatory-Permit- Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 4 of 21 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1. Project Information
1a. Name of project: *
Stanfield Valley Subdivision
1 b. Subdivision name (if appropriate):
Stanfield Valley Subdivision
1c. Nearest municipality/town: *
Stanfield, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
556301488696, 556301498092, 556302592553,
556302682581
2b.
Property size (in acres):
34.5
2c.
Project Address:
Street Address:
Renee Ford Road and River Road
Address line 2:
Click to enter.
City:
Stanfield
State/ Province/ Region:
NC
Postal/ Zip Code:
28163
Country:
U.S.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.222676*
Longitude (-DD.DDDDDD): *--80.456591 °
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Rock Hole Creek
3b. Water Resources Classification of nearest receiving
Class C Waters
water: *
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6el25ad7628f494694e259c8Odd64265
Yadkin-PeeDee
3c. In what river basin(s) is your project located? *
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030401050704
located: *
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/PublicInformation/index.htmI?appid=ad3a85aOc6d644aOb97cd069db238ac3
Page 5 of 21 PCN Form - Version 1.5, September 2020

4.
Project Description and History
4a.
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application: *
The site contains fields and wooded land.
4b.
Have Corps permits or DWR certifications been obtained for this
❑ Yes M No ❑ Unknown
project (including all prior phases) in the past? *
4c.
If yes, please give the DWR Certification number and/or Corps
SAW — 2020-01836
Action ID (ex. SAW-0000-00000):
[Author]
Attach any pertinent project history documentation
4d.
Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.
Attach an 8'h x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f.
List the total estimated acreage of all existing wetlands on the
0.096 acres
property:
4g.
List the total estimated linear feet of all existing streams (intermittent
2,460 linear feet
and perennial) on the property:
4g1.
List the total estimated acreage of all existing open waters on the
0 acres
property:
4h.
Explain the purpose of the proposed project:
The purpose of the proposed project is to construct a 49-lot single family residential subdivision.
4i.
Describe the overall project in detail, including the type of equipment to be used: *
The overall project includes the construction of a residential subdivision. Construction of the subdivision includes
constructing access roads and installing utilities. In order to facilitate the proposed development, it is necessary to
install a road crossing that will impact 124 linear feet (0.0148 acres) of stream channel with a culvert, 10 linear feet
(0.0012 acres) of stream channel with rip rap that is to be keyed in and 40 linear feet (0.0048 acres) of stream channel
associated with a pump around. To facilitate the development of the site, clearing and grading the site is necessary.
Graders, haulers, excavators and other heavy equipment will be used during grading and construction of the site.
4j.
Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on
the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
Delineated by Pilot Environmental June 2018 and
verified by USACE August 8, 2018.
Name (if known): David Brame/Michael Brame
5b. If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental
areas?
Other: Click to enter.
5c. If the Corps made a jurisdictional determination,
❑x Preliminary ❑ Approved ❑ Emailed Concurrence
what type of determination was made? *
❑ Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
SAW — 2020-01836
Page 6 of 21 PCN Form - Version 1.5, September 2020

5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
10/22/2020
5d1. Attach jurisdictional determinations.
Page 7 of 21 PCN Form - Version 1.5, September 2020

6. Future Project Plans
6a. Is this a phased project?
N Yes ❑ No
6b. If yes, explain.
This is a proposed 49-lot single family residential subdivision. A road is stubbed onto adjoining property east of
the site. There are no immediate plans to extend the subdivision to the east. The developer is aware that
impacts from future phases are considered cumulative.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to authorize
any part of the proposed project or related activity? This includes other separate and distant crossings for linear
projects that require Department of the Army authorization but don't require pre -construction notification.
No other permits have been used or are intended to be used.
Page 8 of 21 PCN Form - Version 1.5, September 2020

D. Proposed Impacts Inventory
1. Impacts Summary
❑ Wetlands ❑x Streams - tributaries
la. Where are the impacts associated with your project ❑ Buffers ❑ Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
2a1.
2b.
2c.
2d.
2e.
2f.
2g.
Site #*
Impact
Impact
Wetland Name*
Wetland Type*
Forested
Jurisdiction
Impact Area
Reason/Type*
Duration*
?*
Type*
(ac)*
W1
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W2
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W3
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W4
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W5
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W6
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
Click to enter. ac
2g3. Total wetland impacts
Click to enter. ac
2h. Comments:
Wetland impacts are not proposed.
Page 9 of 21 PCN Form - Version 1.5, September 2020

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #*
3a.
Impact Reason/
Type*
3b.
Impact
Duration*
3d.
Stream Name*
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft) *
S1
Crossing/ Culvert
Temp/ Perm
Unnamed
Perennial
Both
5.2
40/124/10
S2
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch impact:
Click to enter. linear ft
3i2. Total permanent stream impacts:
134 linear ft
36. Total temporary stream impacts:
40 linear ft
3i4. Total stream and ditch impacts:
174 linear ft
3j. Comments:
In order to access two lots within the subdivision and in order to provide access to an adjoining tract owned by the
same applicant, it is necessary to install a road crossing that will impact 124 linear feet (0.0148 acres) of stream
channel with a culvert, 10 linear feet (0.0012 acres) of stream channel with rip rap that is to be keyed in and 40 linear
feet (0.0048 acres) of stream channel associated with a pump around.
Page 10 of 21 PCN Form - Version 1.5, September 2020

4.
Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries,
sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
4b.
4c.
4d.
4e.
4e1.
4f.
Site #*
Impact Reason/
Impact
Waterbody Name*
Waterbody
Jurisdiction
Impact area (ac)*
Type*
Duration*
Type*
Type*
01
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
02
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
03
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
04
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Open water impacts are not proposed.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete
the table
below. (*This
does NOT include offline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts (ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Pond or lake construction is not proposed.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter.
Page 11 of 21 PCN Form - Version 1.5, September 2020

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
* (Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
131
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
The site is located in the Yadkin River Basin.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 21 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The applicant has designed the remaining roads, utility lines and lots/pads to avoid additional impacts to streams and
wetlands. The remaining approximate 2,286 linear feet of stream and 0.096 acres of wetlands are being avoided.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The clearing limits will be surveyed, staked and silt fencing and clearing limit fencing will be used. Disturbed areas will
be seeded and mulched to limit sediment from entering downgradient waters. Slope matting will be used on steep
slopes.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? ❑ DWR ❑ Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? (check all that apply) ❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Mitigation is not required or proposed.
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
Click to enter. linear feet
4c.
If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO: RP:P27 BUTTON KEY:O
4d.
Buffer mitigation requested (DWR only):
Click to enter. square feet
4e.
Riparian wetland mitigation requested:
Click to enter. acres
4f.
Non -riparian wetland mitigation requested:
Click to enter. acres
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter. acres
Page 13 of 21 PCN Form - Version 1.5, September 2020

4h. Comments:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including the amount of mitigation proposed.
Click to enter.
5b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffe�E[-]
Yes ❑x No
that requires buffer mitigation?
If yes, please complete this entire section — please contact DWR for more information.
6b.
If yes, identify the square feet of impact to each zone of the riparian buffer that requires
mitigation. Calculate the
amount of mitigation required in the table below.
6c.
6d.
6e.
Zone
Reason for impact
Total impact (square
Multiplier
Required mitigation
feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Buffer mitigation is not required or proposed.
Page 14 of 21 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
❑ Yes ❑x No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other forms of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-Permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here:
Attach diffuse flow documentation.
2. Stormwater Management Plan
2a. Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250? *
❑ Yes ❑x No
2b. Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
0 Yes El No
To look up low density requirements, click here:
http://reports.oah. state. nc.us/ncac/title%2015a%20-%20environmental %20guaIity/chapter%2002%20-
%20environmental %20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c. IS the project over an acre?
❑x Yes ❑ No
2d. Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state-
❑ Yes ❑x No
approved local government stormwater program? *
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2e. Which of the following stormwater management program(s) apply?
❑ Local Government
(Check all that apply) *
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Page 15 of 21 PCN Form - Version 1.5, September 2020

Local Government Stormwater Programs *
❑ Phase II
❑ USMP
❑ NSW
❑ Water Supply
Please identify which local government stormwater program
you are using.*
No state or local stormwater program
State Stormwater Programs *
❑ Phase II
❑ HQW or ORW
❑ Coastal Counties
❑ Other
Comments:
The total impervious surfaces are calculated to be 16.82%.
No stormwater plan is required. To be confirmed by
Stanly County.
Page 16 of 21 PCN Form - Version 1.5, September 2020

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x No
funds or the use of public (federal/state) land? *
1 b. If you answered "yes" to the above, does the project require
preparation of an environmental document pursuant to the
❑Yes ❑ No
requirements of the National or State (North Carolina) Environmental
Policy Act (NEPA/SEPA)? *
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
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
A NEPA or SEPA is not required.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
DWR Surface Water or Wetland Standards or Riparian Buffer Rules El Yes ❑x No
(15A NCAC 2B .0200)? *
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
Click to enter.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
❑ Yes ❑x No
downstream water quality? *
3b. If you answered "no", provide a short narrative description:
Additional development as a result of the proposed development is not anticipated at this time.
3c. If yes, attach a qualitative or quantitative cumulative impact analysis (.pdf) in accordance with the most recent
DWR policy.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? * ❑ Yes ❑x No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Wastewater generated at the residences when constructed will be treated in individual septic systems. Impacts for
sewer infrastruture will not be required.
Page 17 of 21 PCN Form - Version 1.5, September 2020

5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will this project occur in or near an area with federally protected
® Yes ❑ No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl) *
5b.
Have you checked with the USFWS concerning Endangered Species
❑ Yes 0 No
Act impacts? *
5c.
If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d.
Is another federal agency involved? *
❑ Yes 0 No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e.
Is this a DOT project located within Divisions 1-8? *
❑ Yes N No
5f.
Will you cut any trees in order to conduct the work in waters of the
U.S.? *
0 Yes ❑ No
5g.
Does this project involve bridge maintenance or removal? *
❑ Yes N No
Link to NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed NLEB-
SLOPES&apps.pdf
5h.
Does this project involve the construction/ installation of a wind
turbine(s)? *
El Yes 0 No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i.
Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑Yes ❑x No
mechanized pile drivers, etc.? *
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j.
What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
USFWS Endangered and Threatened Species List — Stanly County
3 federally listed species are identified in Stanly County. Habitat for the Bald Eagle and Schweinitz's sunflower are not
located on the site or within the proposed area of impact. The site contains potential summer roosting habitat for the NLEB.
However, based on a review of the Asheville Field Office website's June_1_2016_NLEB_HUC12 NLEB shapefiles, the 12-
digit HUC with the nearest confirmed hibernation and/or maternity sites is located more than 80 miles from the site. Incidental
take that occurs beyond one quarter mile of a known hibernation site or 150 feet of a known occupied maternity roost during
the pup season (June 1-July 31) is exempt from ESA requirements under the final 4(d) rule. The project is not likely to
adversely affect these species.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat? *
El Yes 0 No
Are there submerged aquatic vegetation (SAV) around
the project vicinity? *
El Yes ❑x No El Unknown
Page 18 of 21 PCN Form - Version 1.5, September 2020

Will this project affect submerged aquatic vegetation?
❑ Yes ❑x No ❑ Unknown
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper — NOAA Fisheries
Page 19 of 21 PCN Form - Version 1.5, September 2020

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://qis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
❑ Yes ❑x No
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
NC Historic Preservation Office's HPOWEB 2.0
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes ❑x No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
National Flood Hazard Layer froom FEMA Web Map Service — FEMA Panel 3710556200K
Page 20 of 21 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested
I. Signature *
❑x By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * Michael T. Brame
Digitally signed by Michael Brame
* DN: cn=Michael Brame, -PilotBnvironmental,
Signature: Michael Brame
mail=mbrame@pilo m`rO.com. c=US
Date: 2021.04.15 11:11:1 ]-04'00'
4/15/2021
Page 21 of 21 PCN Form - Version 1.5, September 2020

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2.94 ACRES /i/ /(1 J, (1 ( ) 1 ) \ \ \ \ \ \ ` \ c \ 1 t l ( 1
RIVER ROAD TRU'T
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/ z I I. nl� J/ ✓>///�//%r \f �_sSt/ /if ,I e2\�,J \ >\ (/I� \\\t� o \ I \ \ )I \ \ LEGEND
Mar9terlineFpanvement ' I `1 I
I I LOT 1J l 1 /� / I 0;'
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I I LOT 2 I I LOT 3 ) //// 1} I %/LOOT I I -� 7 I I \ \ O \ \ \ \\ \ \\Sg \�-�
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Existin Wetland
P' I/ /0, 48 AC,R 7S/ CRES I ! 0.48 ACRES /j, 0�48�ES I I 10.48 ACRES 10.4 C \\ A ES �` �OIf 101 I \ \ t �J� \\ \ �21 12 \\ \ J / 1 \ ` \ \ I ( \
/ I I J / 1 r I I /�/ �� �I �4� R g 4 A�d� \f\\ \ \ ,� TRU��
r/ /i/ i/ J i i ,�/ / I I I `� �I> \� ( l> ll>�' 1I o_- 4`� ^%-) I 1 1
y �/ �.� f / I // /� , /1.1r� l�I '// / // I ~I� h \\ \ ��� ^ 1 1 ( () II �r \I(1 IIII J// ��\\ y ? `� J Temporary Stream Impact
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dr I I L - f ✓! , j� 1 / //Y J / / �J - I 1 \I \ \\ I J ) ( / �\ \� 1 �. \\ \ _ Permanent Stream Impact
/�-�� -- - �� r�r��� L1� (� I� 1 I) �l//�I (c� �(� \ \ 1/ // p
Point can Ina \ \ \ \ \ / / 1 r / �- \> I 1 tlu" y� gra,nti C \\\ \ \ \ / / ) ( J� \/ /
pavement / / " �'�'� t 'J ^_ = \ \ \ \- -� \ \\
�(r J� \ \ \ \ \ \
\��II / \\N \ � �i
1/2' ltebor Found L�J J / /' / f / / J I / \ \- \ \ 1 i 1 \ (\ ` ; ✓�\l I \ \\\\\\\
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R�A \\
L' N r / / \ ` \ \\ \ \ \ \ \\ \ \ \ \ \ ( \ l IN: -5630
�RRY D. GIBBON \ r 1 �" r / / \ \ \ \ \ \ \ \ \ \ I \\ 1) % 77
MELISSA . IBSON I/ 'AR Y D. GIBBON \ ` \ �\ } \ \ \ \\ \� \ \ \1 L(AR �D. GIBSO I \ \ l\\�� B:
F / �', il PIN: 01 ,S6 0 )�� I \ \ \
/ \ I. 1 J� \ a J r -/ , MELIS A H. GIBBON \ \ \ \ \ \ \ \ \\ \\ \ \M �I S Ii. GIBSO
PG; 38 1�. ! �J i
N\' �cUZ) 8430PIN: 5 0 80239 I l/_ I(/ I / J �I
80' 160'
/DB:119\UB G: 38 /fr
\ 1 ) IIII l
\ SCALE 1 80' HCR
_
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2 3 4 5
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Point centerline
pova lent
Mng Noll Found
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centerline pent
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centerline povanent
1 f I
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centerline pavement
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Centerline povanent
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REECE GIBSON
STANFIELD, NC
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SHEET NUMBER
1

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! 0100
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HW 5--
__— I N V: 567.00
APRON A-4. 10 LF OF 12" THICK
COUNTERSUNK RIP —RAP TO BE
INSTALLED FLUSH WITH EXISTING
STREAMBED, REF. DETAIL
0.0024 ACRE TEMPORARY STREAM IMPACT. ±20 !
LF @ 5.2 FT AVERAGE WIDTH. SLOPE MATTING
! TO BE INSTALLED ALONG STREAM BANKS IN
TEMPORARY IMPACT AREAS AS REQ'D
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595
590-
585-
580-
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570-
565-
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93.17' of 48" RCP ® 2.15% ---- —_ _ __-----------�
ago ado HW 5.1------------- /
00
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0.0024 ACRE TEMPORARY STREAM IMPACT. ±20
LF ® 5.2 FT AVERAGE WIDTH. SLOPE MATTING
TO BE INSTALLED ALONG STREAM BANKS IN O_J
TEMPORARY IMPACT AREAS AS REQ'D o /
I /
0.0148 ACRE PERMANENT STREAM IMPACT. /
±124 LF ® 5.2 FT AVERAGE WIDTH /
I /
/
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— -- — — — — — — — -- — J /
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STREAM IMPACTS
PERMANENT TEMPORARY
_A--v
0.0148 ACRES 0.0048 ACRES
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1 +50
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EXISTING
GRADE
RCIP
@2.15%
7' of 48"
48 "CULVERT SHALL
BE INSTALLED
1.0' BELOW EXISTING
STREAMBED
590
585
580
575
570
565
560
LEGEND
Existing Wetland
Temporary Stream Impact
Permanent Stream Impact
I
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0 40' 0 4' 8'
SCALE 1 " = 2 0' HOP, SCALE 1 " = 4' VERT.
555 555
—0+50 0+00 0+50 1 +00 1 +50
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STANFIELD, NC
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SHEET NUMBER
2

3
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5
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L 48"" CULVERT SHALL BE INSTALLED
APRON A-7. 10 LF OF 12" THICK 1.0' BELOW EXISTING STREAMBED
COUNTERSUNK RIP -RAP ALONG THE WIDTH OF EXISTING STREAMBED
STREAMBED. TO BE INSTALLED SHALL BE MAINTAINED
FLUSH WITH EXISTING STREAMBED.
APRON A-5 CROSS SECTION VIEW
NO SCALE
COIR FIBER MAT
LIVE STAKES
NORMAL WATER
ELEVATION
STREAMBED
ON -SITE, ALLUMUM
RIP RAP STREAM RESTORATION NOTES
1. Planting of Tier I and Tier II buffers is to be per detail.
2. no trees to be planted within 3 feet of center of pipe
through stream bank.
3. Contractor is responsible for ensuring 80% survival of all
plantings after 12 months from completion of construction.
4. New 12 month warranty begins after replanting.
STREAM RESTORATION DETAIL
NO SCALE
PUNTING DETAILS
LIVE STAKES PLANTING DETAIL
LIVE STAKE
50 Lff NT
BM FAW FI
LN WM
err-rowErf"
2-3Post
RUE W I W
UM SIASR. WON WITH UYE STIKiS
WM
LNE Enna SR0.L E{ SP 0 MNKW MT 4 MT
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LNE ES BEn1h IEIIL MT�NYTnT ]/
6 �
WE gTAKE LE 6 RinM fA0110
BAREROOT PLANTING DETAIL
DIRHI.B PLANTING METHOD
USING THE RBC PLAN77NG MR
PLANI`ING NOTES:
RANTM RW
EBtliM1f a,n . ,a"
BBC FLU"M MR
WIN 114L1 R f�}�IIGP
h. 12 eR7pe, ,ed ,h,H
�"
1 �h dd de
t�c�n{S �La11Le fa1IM
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V 5wfwv WA A,
-MN,
PLANTING DET�
NO SCALE
EXISTING/ PROPOSED
GROUND
RIP RAP TO BE BURIED
BELOW NATURAL CHANNEL
ELEVATION AND BACKFIELD
WITH ON -SITE ALLUMUM
❑ TYPE I STREA11IBANK REFORESTATION SHALL BE PLANTED 3 FT. TO 5 FT.
ON CENTER, RANDOM SPACING, AVERAGING 4 F.C. ON CENTER,
APPROXIMATELY 2724 PLANTS PER ACRE.
❑ TYPE 2 STRFAULM REFORESTATION SHALL BE PLANTED 6 FT. TO 10 Fr.
ON CENTER, WINDOM SPACING, AVERAGING S FIT ON CEN A
APPRONUdATELY 6W PLANTS PER ACRE.
❑ NOT& TYPE I AND TYPE 2 STREI REFORESTATION SHALL BE
PAW FOR AS "STREAMBANK REFORESTATION"
Sl?"D M REFORESTATION rRICAI
TYPE H
(TYPE I
R �r.
�4•I
STREAM" RI TOY"rATION
�O
DEWATERING DEVICE -'
NOTES:
1. ENERGY DISSIPATOR TO BE RIP RAP.
2. IMPERVIOUS DIKE TO BE SANDBAG
NOTE
ENSURE TO ANCHOR ALL
PUMPSAND PIPES SECURELY.
%MffU %rA%=�, AM RXIMH Mkkl Cali TO TM FOfIOVI
TYPE 1
50% SAILIX NIGRA
BLACK WnMW
2 it - 3 ft LIVE STAKES
50% CORNUS AMOMUM
SUM DOGWOOD
2 It-3 d,LA% STAKES
TYPE 2
2596 LIRLODENDRON TUIIPIFEBA
TULIP POPLAR
12 in - IS in BR
25% PIATANUS OCMENTAIA
SYCAMORE
12 in -18 in BR
25% PRUNUS SEROTINA
BLACK CHERRY
12 in -IS in BR
25% BF'TUTA NIGRA
RIVER BIRCH
12 in 18 in BR
❑ SEE PLAN MEETS FOR AREAS TO BE WANTED
►ILS
*-FLOWS
IMPERVIOUS DIKE
VPROJECT
INSTALLATION REQUIREMENTS:
1. INSTALL EROSION CONTROL MEASURES INCLUDING RIP RAP ENERGY
DISSIPATER.
2. EXCAVATE THE DIVERSION CHANNEL WITHOUT DISTURBING THE
EXISTING CHANNEL.
3. PLACE POLY -FABRIC LINER IN DIVERSION CHANNEL WITH A MINIMUM
OF 4 FEET OF MATERIAL OVERLAPPING THE CHANNEL BANKS.
FABAIC. OVERLAPPING BANK SECURE THE OVERLAPPED MATERIAL USING AT LEAST 1 FOOT OF
FILL MATERIAL.
AND SECURED 4. CONNECT THE DOWNSTREAM DIVERSION CHANNEL INTO THE
DOWNSTREAM EXISTING CHANNEL AND SECURE THE POLY -FABRIC
LINER AT THE CONNECTION.
L- FABRIC!LINED 5. CONNECT THE UPSTREAM DIVERSION CHANNEL INTO THE UPSTREAM
b1VERsb4 CHANNEL EXISTING CHANNEL AND SECURE THE POLY -FABRIC LINER AT THE
CONNECTION.
6.
CONSTRUCT AN IMPERVIOUS DIKE IN THE EXISTING CHANNEL AT THE
UPSTREAM SIDE TO DIVERT THE FLOW INTO THE DIVERSION
CHANNEL.
7.
CONSTRUCT AN IMPERVIOUS DIKE IN THE EXISTING CHANNEL AT THE
DOWNSTREAM SIDE TO ISOLATE THE WORK AREA.
8.
UPON COMPLETION OF THE CULVERT CONSTRUCTION, REMOVE THE
IMPERVIOUS DIKES AND DIVERT THE CHANNEL BACK INTO THE
CULVERT.
9.
REMOVE THE POLY -FABRIC LINER AND FILL IN THE DIVERSION
CHANNEL.
10.
ESTABLISH VEGETATION ON FILL SECTION AND ALL OTHER BARE
VO`II
AREAS.
MAINTENANCE
REQUIREMENTS:
1.
CHECK THE POLY -FABRIC LINER FOR STABILITY DURING NORMAL
TOP OFBANK
FLOW.
2.
CHECK THE LINER FOR STABILITY AFTER EACH RAINFALL EVENT.
IMPERVIOUS -DIKE
SANDBAG
INSTALLATION NOTES:
1.
REMOVE BRANCHES AND LARGE ROCKS FROM AREA WHERE THE
SAND BAGS WILL BE PLACED.
2.
LAY OUT THE IMPERVIOUS POLY -FABRIC LINER WITH THE CENTER
OF THE LINER LOCATED OVER THE CENTER OF THE SAND BAG DIKE.
3.
PLACE THE SANDBAGS TO THE DESIRED HEIGHT. THE DIKES SHALL
HAVE A WIDTH SUITABLE TO SUPPORT THE HEIGHT. EACH ROW
SHALL BE OFFSET SO THE JOINTS ARE STAGGERED PACK
UVORKAREA SANDBAGS TIGHTLY TOGETHER.
4. WRAP IMPERVIOUS POLY -FABRIC AROUND SANDBAG DIKE AND
SECURE WITH FINAL LAYER OF SANDBAGS.
SANDBAG MAINTENANCE NOTES:
1. PERIODICALLY INSPECT SANDBAG DIKE FOR DAMAGE AND LEAKS.
2. REMOVE IMPOUNDED TRASH AND SEDIMENT.
FIBER LINED DIVERSION CHANNEL
NO SCALE
PLAN VIEW
approved
dewatering device
stream
diversion pumps
discharge hoses
P intake
dewatering pump hose
P
i r
flow
---- 4� intake hose flow
sediment dike clean water dike sum" ole
.. .. .. po
(12" to 18" deep
work area 2' dia.)
pumps should discharge length not to exceed
onto a stable velocity that which can be
dissipater made of rip rap completed in one day
or sandbags
SECTION A -A
impervious sheeting
base flow + 1 foot
work area (2 foot minimum)
crass section of sandbag dike
PUMP AROUND DETAIL
NO SCALE
SURFACE FLOW DIVERSION
UNDISTURBED BANK
MATTING ANCHOR TRENCH
IN TRENCH ON 1' CENTERS
ANCHOR OVERLAP
ON 1' CENTERS
-------------- ---�
��i�i�i�i�i�i�i�i�i�i'�i�i�i�i�i���i �i'�i*i�i�i''i�i�i�i'i�i�i�i�i'i�i�< , •
►i�i�i�i�i�i�i�i�i�i�i�i�i�i�i�i�iJ i���i�i�i�i���i�i���a�i�i�i�i�i�i�i ,
$" OVERLAY(MIN)
ANCHORS ON
1' CENTERS PLAN VIEW
{IS, FLOOOPLAIN(
COIR FIBER EXISTING
MATTING BACKFILL GROUND
ANCHORS ON
3' CENTERS
EXTEND MATTIN
TO NWSEL 6" MIN
)ANCHORS ON
1' CENTERS
IN TRENCH
.... ..............-T.-..---.._..-----... MATTING SHALL BE
PLACED IN TRENCH
AND BACKFILLED
ANCHORS ON
STREAM BED 1' CENTERS
TYPICAL CROSS SECTION
COIR FIBER MATTING DETAIL
NO SCALE
PLAN VIEW
- straw bale d1ICe of helm `
- - -.
- _- 1.5 f;
G-ft (I.B-m)
T (G.45 rn)
minimum
i
6-t (r-r11) _
minl m
f.
A
9 re
A
51111" Outflelt
sfft cture
SEMON
A -A
1.5•ft'
(0.45 m1
L.
.. 12.1
(H:V}'
flow
er fabric '
4 to , 6•4n
15 cm) ripap ,
sEcr ort :
B-B '
2 to 3-ft (0.6.1* 0.9-m),.'
rebar Or !bites for
minimum delAh
DEWATERING BASIN DETAIL
NO SCALE
SURFACE FLOW DIVERSION
letation to
thin
Ile drawing.
wn mvuir �� rirw�
TO CARRY STREAM BASE FLOW 3. Remove temporary equipment crossing at conclusion
of project and install live stake/ streambank
restoration per this detail sheet.
TEMPORARY CULVERT EQUIPMENT CROSSING
NO SCALE
2" z 2" (nominal)
WOODEN STAKE
1 !T
1-2
12-24"
#10 STEEL
REINFORCEMENT BAR
. rr
4
24"
1" (nominal)
STAPLE
FI1"
12"
ANCHOR OPTIONS
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STANFIELD, NC
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U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2020-01836 County: Stanly U.S.G.S. Quad: NC- Stanfield
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Requestor:
River Road Trust
Reece Gibson
Address:
4512 River Road
Stanfield, NC 28163
Telephone Number:
704-533-2461
E-mail:
not provided
Size (acres) 34.5 Nearest Town Stanfield
Nearest Waterway Rock Hole Creek River Basin Upper Pee Dee
USGS HUC 03040105 Coordinates Latitude: 35.222676
Longitude:-80.456591
Location description: The review area is located at the southeastern corner of the intersection of Renee Ford Road and River
Road. PINS: 556302682581, 556302592553, 556301498092, and 556301488696. Reference review area description shown in
Jurisdictional Determination Request package entitled "Drawing 1, USGS Topographic Mad'.
Indicate Which of the Following Apply:
A. Preliminary Determination
® 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 10/1/2020. 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 DATE. We strongly

SAW-2020-01836
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.
❑ The waters, including wetlands have been delineated and surveyed and are accurately depicted on the plat signed by the
Corps Regulatory Official identified below onDATE. 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 (LAMA).
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 Bryan Roden -Reynolds at 704-510-1440 or
bryan.roden-reynolds(a,usace.army.mil.
C. Basis For Determination: Basis For Determination: See the preliminary jurisdictional determination
form dated 10/22/2020.
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 1OM15
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.**
RODEN Digitally signed by RODEN
REYNOLDS.BRYAN.KENNETH.1263385574
Corps Regulatory Official: REYNOLDS.BRYAN.KENNETH.1263385574 Date: 2020.10.22 08:56:45 -04'00'
Date of JD: 10/22/2020 Expiration Date of JD: Not applicable

SAW-2020-01836
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/Pp=l 36:4:0
Copy furnished:
Agent:
Pilot Environmental, Inc.
David Brame
Address:
P.O. Box 128
Kernersville, NC 27285
Telephone Number:
336-310-4527
E-mail:
dbrameAyilotenviro.com

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
is= REQUEST FOR APPEAL
Applicant: River Road Trust, Reece Gibson File Number: SAW-2020-01836 Date: 10/22/2020
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
❑X
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.g.M.mil/Missions/CivilWorks/Re ugulatoryProgramandPennits.aspx
or the Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• 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.
• 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
• 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.
• 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.
• 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.
• 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.

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
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division
Mr. Phillip Shannin, Administrative Appeal Review Officer
Attn: Bryan Roden -Reynolds
CESAD-PDO
Charlotte Regulatory Office
U.S. Army Corps of Engineers, South Atlantic Division
U.S Army Corps of Engineers
60 Forsyth Street, Room 1OM15
8430 University Executive Park Drive, Suite 615
Atlanta, Georgia 30303-8801
Charlotte, North Carolina 28262
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 opportuni to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: Bryan Roden -Reynolds, 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 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 10/22/2020
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: River Road Trust, Reece Gibson, 4512 River
Road, Stanfield, NC 28163
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District, Renee Ford Road, SAW-
2020-01836
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The review area is located at the
southeastern corner of the intersection of Renee Ford Road and River Road. PINS: 556302682581,
556302592553, 556301498092, and 556301488696. Reference review area description shown in
Jurisdictional Determination Request package entitled "Drawing 1, USGS Topographic Map".
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES
AND/OR AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County: Stanly City: Stanfield
Center coordinates of site (lat/long in degree decimal format): Latitude: 35.222676 Longitude:-80.456591
Universal Transverse Mercator:
Name of nearest waterbody: Rock Hole Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
® Office (Desk) Determination. Date: 10/22/2020
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO
REGULATORY JURISDICTION
Feature
Latitude
Longitude
Estimated amount
Type of
Geographic authority to
(decimal
(decimal
of aquatic
aquatic
which the aquatic
degrees)
degrees)
resources in
resources (i.e.,
resource "may be"
review area
wetland vs.
subject (i.e., Section 404
(acreage and
non -wetland
or Section 10/404)
linear feet, if
waters)
applicable
Wetland WA
35.22301100
-80.45649200
0.026 acre
Wetland
404
Wetland WB
35.22325300
-80.45622900
0.056 acre
Wetland
404
Wetland WC
35.22333500
-80.45544800
0.014 acre
Wetland
404
Stream SA
35.22383600
-80.45710600
1340 linear feet
Non -wetland
404
Stream SB
35.22302100
-80.45662900
50 linear feet
Non -wetland
404
Stream SC
35.22304100
-80.45632700
90 linear feet
Non -wetland
404
Stream SD
35.22306000
-80.45599700
230 linear feet
Non -wetland
404
Stream SE
35.22397100
-80.45529500
660 linear feet
Non -wetland
404
1. The Corps of Engineers believes that there may be jurisdictional aquatic resources in the
review area, and the requestor of this PJD is hereby advised of his or her option to request
and obtain an approved JD (AJD) for that review area based on an informed decision after
having discussed the various types of JDs and their characteristics and circumstances when
they may be appropriate.
2. In any circumstance where a permit applicant obtains an individual permit, or a Nationwide
General Permit (NWP) or other general permit verification requiring "pre- construction

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

SUPPORTING DATA. Data reviewed for PJD (check all that apply) Checked items are included in the administrative
record and are appropriately cited:
0 Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: Drawings 1-5
0 Data sheets prepared/submitted by or on behalf of the PJD requestor. Datasheets:
0 Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑Corps navigable waters' study:
❑U.S. Geological Survey Hydrologic Atlas:
❑USGS NHD data:
❑USGS 8 and 12 digit HUC maps:
0 U.S. Geological Survey map(s). Cite scale & quad name: Drawing 1, USGS Topographic Map (7.5-minute
Ouadrangle Stanfield, NC)
ONatural Resources Conservation Service Soil Survey. Citation: Drawing 2, Web Soil Map (Web Soil Survey of
Stanly County) and Drawing 2A, Published Soil Map (Soil Survey of Stanly County Sheet 8 Dated 1989)
ONational wetlands inventorymap(s). Cite name: Drawing 3, NWI Map (USFWS NWI Mapper)
❑ State/local wetland inventory map(s):
0 FEMA/FIRM maps: Drawing 4, FEMA FIRM (National Flood Hazard Laver)
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
0 Photographs: 0 Aerial (Name & Date): Drawing 5, Wetland Map (Dated 10/01/2020)
or ❑ Other (Name & Date):
❑Previous determination(s). File no. and date of response letter:
❑Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily been verified by the Corps
and should not be relied upon for later jurisdictional determinations.
RODEN Digitally signed by RODEN
REYNOLDS.BRYAN.KENNETH.12633855 REYNOLDS.BRYAN.KENNETH.1263385574
74 Date: 2020.10.22 08:56:19-04'00'
Signature and date of Regulatory
staff member completing PJD
10/22/2020
Signature and date of person requesting PJD
(REQUIRED, unless obtaining the signature is
impracticable)1
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester does not respond within the established
time frame, the district may presume concurrence and no additional follow up is necessary prior to finalizing an action.

3.
SA J l
1,430 LF +'
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10 NrN
FLAG NUMBERS/INFORMATION
SE
660 LF
SD 11
230 LF
/ WC 1-3
V�0.014Ac.
I n
SC
90 LF
WETLAND FLAGS = V/////>I THE LOCATIONS OF FEATURES SHOWN ON THIS MAP
STREAM FLAGS = zz ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY
Wetland Flags = 19 THE USACE OR NCDEQ-DWR. THIS EXHIBIT INCLUDES
Stream Flags = Flagged at origins GPS LOCATIONS OF DELINEATED FEATURES.
and intersections; surveyor locate DELINEATION CONDUCTED BY PILOT ON 9.30.20.
Drawing 5
2019 Satellite Imagery from ESRI
and Pilot GPS Data
Scale: 1" = 200'
Date: 10.1.20
PILO
PILOT f N V I R❑ 4 M E N T AL. I N C
Site Boundary
Perennial Stream
Wetland
DP-1 O Data Point
WA 1-2 Flag Number/Feature ID
Wetland Map
Renee Ford Road & River Road
Approximate 34.5-Acre Tract
Stanfield, Stanly County, NC
Pilot Project 6137

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USGS Topographic Map F r Renee Ford Road & River Road
Stanfield, NC Quadrangle- Approximate 34.5-Acre Tract
Scale: 1" - 2,000' PILOT® A% Stanfield, Stanly County, NC
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Site Boundary
Drawing 2A Published Soil Map
USDA Soil Survey y` r Renee Ford Road & River Road
of Stanly County, NC ' Approximate 34.5-Acre Tract
Published 1989, Sheet 8 PILOT . -- Stanfield, Stanly County, NC
Not to Scale PIL0r ENVIR0NMENTAL,INC Pilot Project6137

U
LEGEND
Site Boundary
Freshwater Emergent
Freshwater Forested/Shrub
Estuarine and Marine Deepwater
Estuarine and Marine
Freshwater Pond
La ke
Riverine
Other
Drawing 3
USFWS NWI
Wetlands Mapper
Scale: 1" = 300'
ail .
NWI Map
Renee Ford Road & River Road
Approximate 34.5-Acre Tract
Stanfield, Stanly County, NC
Pilot Project 6137

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LEGEND
Site Boundary
1%Annual Chance Flood Hazard
Regulatory Floodway
Special Floodway
Area of Undetermined Flood Hazard
0.2%Annual Chance Flood Hazard
,• 7 f�, I .'
Future Conditions 1% Annual Chance Flood Hazard
Area with Reduced Risk Due to Levee
Drawing 4
National Flood Hazard Layer
From FEMA Web Map Service
Scale: 1" = 300'
FEMA FIRM
Renee Ford Road & River Road
Approximate 34.5-Acre Tract
Stanfield, Stanly County, NC
Pilot Project 6137

WB 1-10
0.056 Ac.
DP-2 O
DP-1 O
SC
90 LF
9
SE
660 LF
SD
230 LF
/ WC 1-3
)0.014 Ac.
or
SA
1,430 LF
I�F �
SB
50 LF
WA 1-6
'T� # 0.026 Ac.
4 V� �
FLAG NUMBERS/INFORMATION
WETLAND FLAGS = THE LOCATIONS OF FEATURES SHOWN ON THIS MAP
STREAM FLAGS = - ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY
Wetland Flags = 19 THE USACE OR NCDEQ-DWR. THIS EXHIBIT INCLUDES
Stream Flags = Flagged at origins GPS LOCATIONS OF DELINEATED FEATURES.
and intersections; surveyor locate DELINEATION CONDUCTED BY PILOT ON 9.30.20.
Drawing 5
2019 Satellite Imagery from ESRI
and Pilot GPS Data
Scale: 1" = 200'
Date: 10.1.20
PILOT
T I t 0 T E N V I R O N M E N 7 A L I N C
3
Site Boundary
Perennial Stream
Wetland
DP-1 O Data Point
WA 1-2 Flag Number/Feature ID
Wetland Map
Renee Ford Road & River Road
Approximate 34.5-Acre Tract
Stanfield, Stanly County, NC
Pilot Project 6137

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