20201695 Ver 1_Previous USACE Permit File_20211004

Roden Reynolds, Bryan K CIV (US)
From: Roden Reynolds, Bryan K CIV (US)
Sent: Tuesday, October 2, 2018 2:06 PM
To: [e-mail]'
Cc: 'Phil May'
Subject: Nationwide Permit 29 Verification Letter (SAW-2018-01547)
Attachments: SAW-2018-01547 (signed NWP-PJD).pdf; 2017NWP29.pdf
Mr. Mendenhall,
Please see the attached Nationwide Permit 29 verification letter and jurisdictional determination. I have also attached a
copy of Nationwide Permit 29 and the associated general and regional conditions.
PLEASE NOTE:
- Page 4 of this verification is a compliance certification. You are required by general condition 30 to return a signed copy
of this form to our office within 30 days of completion of the authorized activity or the implementation of any required
compensatory mitigation, whichever occurs later. We recommend that you retain your environmental consultant to
conduct a post construction site inspection to confirm you are in compliance with your permit. Failure to return this
form constitutes permit non-compliance and can result in the initiation of class I administrative penalties.
No hardcopies will be mailed. Please let me know if you have any questions.
Thanks,
Bryan Roden -Reynolds
Regulatory Project Manager
U.S. Army Corps of Engineers
Charlotte Regulatory Office
8430 University Executive Park Drive
Charlotte, NC 28262
Office: [phone]
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
1

SAW-2018-01547
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2018-01547 County: Forsyth U.S.G.S. Quad: NC -Winston-Salem West
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: 806 Gibb Street, LLC
Justin Mendenhall
Address: 11 Brookstown Avenue
Winston-Salem, NC 27101
Telephone Number: 336-659-9503
E-mail. iustin(d,theardengroup.com
Size (acres) 19.37 Nearest Town Winston-Salem
Nearest Waterway Muddy Creek River Basin Upper Pee Dee
USGS HUC 03040101 Coordinates Latitude: 36.119240
Longitude: -80.334008
Location description: The review area is located on the southeast side of Robinhood Road; approximately 0.5 miles east of the
intersection of Robinhood Road and Millhaven Road. PINs: 6806-55-5433, 6806-55-5323, 6806-54-4996, 6806-64-0893, 6806-
55-7293, 6806-55-9337, and 6806-55-8602. Reference review area description shown in Pre -Construction Notification package
entitled "Figure 1, USGS Map" and Printed Date of August 2018.
Description of projects area and activity: This verification authorizes the permanent impacts to 106 linear feet of perennial
stream and temporary impacts to 42 linear feet of perennial stream to facilitate the development of a single-family residential
sub -division. Permanent stream impacts are associated with culvert placement whereas temporary stream impacts are
associated with bank stabilization activities and dewaterin2 activities (i.e., coffer dam installation and pump -around) during
construction.
Applicable Law(s): ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: NWP 29. Residential Developments
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the enclosed
Conditions, your application signed and dated 8/2/2018, and the enclosed plans Impact Drawings 1-4 dated 7/24/2018. Any
violation of the attached conditions or deviation from your submitted plans may subject the permittee to a stop work order, a
restoration order, a Class I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified, suspended
or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or modified, this
verification will remain valid until the expiration date identified below, provided it complies with all requirements of the modified
nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the activity would
no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are under construction)
or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the activity is completed
within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless discretionary authority has
been exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA), prior
to beginning work you must contact the N.C. Division of Coastal Management Morehead City, NC, at [phone].
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits.

SAW-2018-01547
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory program,
please contact Bryan Roden -Reynolds at 704-510-1440 or bryan.roden-revnolds*usace.army.mil.
Digilallysigned RODEN REYNOLOS.BRYAN ENNETH.12.3855,.
RODEN REYNOLDS.BRYAN.KENNETH.1 263385574 w% .a -
Corps Regulatory Official: Date201810021•a13700
00
Date: 10/2/2018
Expiration Date of Verification: 03/18/2022
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
htip ://corpsmapu.usace .army.mil/cm_apex/f?p=136:4:0
Copy furnished:
Agent: Carolina Ecosystems. Inc.
Philip May
Address: P.O. Box 41
Lewisville, NC 27023
Telephone Number: 919-606-1065
E-mail. phil.may(d,carolinaeco.com

SAW-2018-01547
SPECIAL CONDITIONS
a. Please be advised that if additional impacts to waters of the U.S., either on this property or on/adjacent
to this property and associated with this project/activity, are proposed at a later date, those impacts will
be combined with the current impacts to waters of the U.S. and will be reviewed cumulatively.
Generally, compensatory mitigation will be required if individual or cumulative (i.e., past and present)
losses or degradation of waters of the U.S., are greater than 150 linear feet of perennial or intermittent
stream channel and/or 0.1 acre of wetland. Additionally, cumulative impacts that result in the loss or
degradation of greater than 300 linear feet of perennial or intermittent stream channel and/or 0.5 acre of
wetland, will be processed under an Individual Permit. This verification of the use of the Nationwide
Permit Program for this project does not imply that this office will necessarily approve any future
proposal to impact waters of the U.S. on this property and/or associated with this project/activity.

Action ID Number: SAW-2018-01547 County: Forsyth
Permittee: 806 Gibb Street, LLC, Justin Mendenhall
Project Name: Pheasant Ridge Subdivision
Date Verification Issued: 10/2/2018
Project Manager: Bryan Roden -Reynolds
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: Bryan Roden -Reynolds
Charlotte Regulatory Office
U.S Army Corps of Engineers
8430 University Executive Park Drive, Suite 615
Charlotte, North Carolina 28262
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee Date

MEMORANDUM FOR RECORD
SUBJECT: Department of the Army Memorandum Documenting General Permit Verification
1.0 Introduction and overview: Information about the proposal subject to one or more of the
Corps regulatory authorities is provided in Section 1, detailed evaluation of the activity is found
in Sections 2 through 4 and findings are documented in Section 5 of this memorandum.
Further, summary information about the activity including administrative history of actions
taken during project evaluation is attached (ORM2 summary).
1.1 Applicant name: 806 Gibb Street, LLC, Justin Mendenhall
1.2 Activity location: Latitude: 36.119240 Longitude: -80.334008 Location description: The review
area is located on the southeast side of Robinhood Road; approximately 0.5 miles east
of the intersection of Robinhood Road and Millhaven Road. PINs: 6806-55-5433, 6806-
55-5323, 6806-54-4996, 6806-64-0893, 6806-55-7293, 6806-55-9337, and 6806-55-8602.
Reference review area description shown in Pre -Construction Notification package
entitled "Figure 1, USGS Map" and Printed Date of August 2018.
1.3 Description of activity requiring verification: This verification would authorize the permanent
impacts to 106 linear feet of perennial stream and temporary impacts to 42 linear feet of
perennial stream to facilitate the development of a single-family residential sub -division.
Permanent stream impacts are associated with culvert placement whereas temporary
stream impacts are associated with bank stabilization activities and dewatering
activities (i.e., coffer dam installation and pump -around) during construction.
1.4 Permit authority: Section 404 of the Clean Water Act (33 USC 1344)
1.5 Applicable Permit: NWP 29. Residential Developments
1.6 Activity requires written waiver? No. A waiver is not required for the applicant to begin
work because the project did not exceed any established thresholds that require a
waiver.
2.0 Evaluation of the Pre -Construction Notification
2.1 Direct and indirect effects caused by the GP activity: The direct effects of the proposed
activity in waters would include the loss of jurisdictional waters (as specified in Section
1.3) and their associated aquatic resource functions. The proposed activity also has the
potential to result in indirect effects to waters including excess sedimentation in
downstream waters, disruption and/or killing of aquatic life in the direct vicinity of the
project area, increase of downstream flows, and blocking/restricting aquatic life
passage transiting in and through the project area. These indirect effects are expected
to be minimal due to design criteria and Best Management Practices (BMPs) required by
Nationwide Permit General and Regional Conditions. Additionally, indirect effects would
be further reduced through the implementation of BMPs required by state, local, and
Federal ordinances and regulations.
2.2 Site specific factors: The project area is part of a 0.23 square -mile watershed that
consists of approximately nine percent impervious surfaces. Given the largely

residential nature of the watershed, the waters within the project area provide important
aquatic resource functions to downstream waters. The loss of functions associated with
this specific project are expected to be minimal due to the applicant's efforts to avoid
and minimize impacts to jurisdictional waters.
2.3 Coordination
2.3.1 Was the PCN coordinated with other agencies? No.
Agency coordination with the USFWS is required for the Northern Long Eared Bat.
However, the Corps is not required to wait for a response from the USFWS Asheville
Office in accordance with local procedures.
2.3.2 Was the PCN coordinated with other Corps offices? No.
2.4 Mitigation
2.4.1 Provide brief description of how the activity has been designed on -site to avoid and minimize
adverse effects, both temporary and permanent, to waters of the United States to the
maximum extent practicable at the project site: The applicant provided the following
information regarding their effort to avoid and minimize impacts to waters of the United
States: A small stream beginning near the eastern side of the property has been
avoided by realigning the road to the north and using a retaining wall at the cost of
several potential lots. The only proposed stream crossing has been minimized as much
as practicable while maintaining required slope on the roadway, and has also been
shifted away from a distinct "s" curve in the channel to avoid additional stream impact
and the only wetland onsite. Utilities will be located within proposed roads including at
the stream crossing.
2.4.2 Is compensatory mitigation required for unavoidable impacts to jurisdictional aquatic resources
to reduce the individual and cumulative adverse environmental effects to a minimal level?
No.
Provide rationale: Compensatory mitigation is not required because project impacts do
not exceed national and regional impact thresholds that normally trigger a
compensatory mitigation requirement. There are no project specific circumstances that
would warrant requiring compensatory mitigation in this case.
3.0 Compliance with Other Laws, Policies and Requirements
3.1 Section 7(a)(2) of the Endangered Species Act (ESA)
3.1.1 ESA action area: The action area includes the waters of the United States that will be
directly affected by the proposed work or structures and uplands directly affected as a
result of authorizing the work or structures.
3.1.2 Has another federal agency taken steps to document compliance with Section 7 of the ESA
and completed consultation(s) as required? No.
3.1.3 Known species/critical habitat present? No. The Corps has determined that it has fulfilled
its responsibilities under Section 7(a)(2) of the ESA.

Listed Species in Forsyth County:
Northern Long-eared Bat (Myotis septentrionalis) - Threatened
Small-anthered Bittercress (Cardamine micranthera) - Endangered
Effect determination(s), including no effect, for all known species/habitat, and basis for
determination(s):
On August 7, 2018, the North Carolina Natural Heritage Program database dated
January 2018 was consulted for the presence/absence of federally listed threatened or
endangered species. There are no federally threatened or endangered species listed in
the Natural Heritage database within the action and/or project area.
The USACE reviewed this project in accordance with (IAW) the NLEB Standard Local
Operating Procedures for Endangered Species (SLOPES) between the USACE,
Wilmington District, and the Asheville and Raleigh U.S. Fish and Wildlife Service
(Service) Offices, and determined that the action area for this project is located outside
of the highlighted areas/red 12-digit HUCs and activities in the action area do not
require prohibited incidental take; as such, this project meets the criteria for the 4(d)
rule and any associated take is exempted/excepted. IAW the NLEB SLOPES, the USACE
sent a Situation 1 email to the Service on August 7, 2018, informing them about this
project.
Service Concurrence: as established in the NLEB SLOPES, this project does not require
prohibited intentional take of the NLEB and it meets the criteria for the 4(d) rule;
therefore any associated take is exempt and it is not necessary for the USACE to wait
30 days for the Service to object or concur.
Based upon the Natural Heritage Program database, the Corps believes the project
would have no effect on listed species.
3.1.4 Consultation with either the National Marine Fisheries Service and/or the U.S. Fish and Wildlife
Service was initiated and completed as required, for any determinations other than "no effect"
(see the attached "Summary" sheet for begin date, end date and closure method of the
consultation). Based on a review of the information above, the Corps has determined that it
has fulfilled its responsibilities under Section 7(a)(2) of the ESA.
3.2 Magnuson -Stevens Fishery Conservation and Management Act, Essential Fish Habitat
(EFH) N/A, there is no essential fish habitat in this district's area of responsibility.
3.2.1 Has another federal agency taken steps to comply with EFH provisions of Magnuson -Stevens
Act? No.
3.2.2 Did the proposed project require review under the Magnuson -Stevens Act? No.
3.3 Section 106 of the National Historic Preservation Act (Section 106)
3.3.1 Section 106 permit area: The permit area includes only those areas comprising waters of the
United States that will be directly affected by the proposed work or structures. Activities
outside of waters of the U.S. are not included because all three tests identified in 33 CFR 325,
Appendix C(g)(1) have not been met.

Final description of the permit area: The permit area for this project includes the waters of
the United States directly impacted and the uplands that would be impacted to
accomplish the work within waters of the United States
3.3.2 Has another federal agency taken steps to comply with Section 106 of the National Historic
Preservation Act and completed consultation(s) as required? No.
3.3.3 Known cultural resource sites present and/or survey or other additional information needed?
No. On August 7, 2018, the most recent version (SHPO ArcGIS Mapservice) of the North
Carolina State Historic Preservation Office database was consulted for the presence or
absence of historic properties within the permit area. No properties are listed within the
boundaries of the Corps permit area as described in Section 3.3.1.
Basis for effect determination(s) for all known site(s) and/or site(s) identified by a survey: The
Corps has determined the proposed action has no potential or little likelihood to cause
effect to any historic property listed, or eligible for listing, in the National Register of
Historic Places because there are no known historic properties within or in close
proximity to the Corps permit area.
3.3.4 Consultation was initiated and completed as required with the appropriate agencies, tribes
and/or other parties for any determinations other than "no potential to cause effects" (see the
attached "Summary" sheet for consultation type, begin date, end date and closure method of
the consultation). The Corps has determined that it has fulfilled its responsibilities under
Section 106 of the NHPA.
3.4 Tribal Trust Responsibilities
3.4.1 Was government -to -government consultation conducted with Federally -recognized Tribe(s)?
No. There are no known tribal interests in the project area.
Provide a description of any consultation(s) conducted including results and how concerns
about significant effects to protected tribal resources, tribal rights and/or Indian lands were
addressed. The Corps has determined that it has fulfilled its tribal trust responsibilities.
3.5 Section 401 of the Clean Water Act — Water Quality Certification (WQC)
3.5.1 Is a Section 401 WQC required, and if so, has the certification been issued or waived? An
individual water quality certification is required, and has not been issued or waived to
date. A provisional general permit will be verified for this activity.
3.6 Coastal Zone Management Act (CZMA)
3.6.1 Is a CZMA consistency concurrence required, and if so, has the concurrence been issued,
waived or presumed? N/A, a CZMA consistency concurrence is not required.
3.7 Wild and Scenic Rivers Act
3.7.1 Is the project located in a component of the National Wild and Scenic River System, or in a
river officially designated by Congress as a "study river" for possible inclusion in the system?
No. According to http://www.rivers.gov, the proposed project area is not within a
designated or study river.

3.8 Effects on Corps Civil Works Projects (33 USC 408)
3.8.1 Does the applicant also require permission under Section 14 of the Rivers and Harbors Act (33
USC 408) because the activity, in whole or in part, would alter, occupy, or use a Corps Civil
Works project? No, there are no Corps Civil Works project(s) in or near the vicinity of the
proposal.
4.0 Special Conditions
4.1 Are special conditions required to ensure minimal effects, protect the public interest and/or
ensure compliance of the activity with any of the laws above? Yes.
If no, provide rationale: N/A
4.2 Required special condition(s)
Special condition:
a. Please be advised that if additional impacts to waters of the U.S., either on this
property or on/adjacent to this property and associated with this project/activity, are
proposed at a later date, those impacts will be combined with the current impacts to
waters of the U.S. and will be reviewed cumulatively. Generally, compensatory
mitigation will be required if individual or cumulative (i.e., past and present) losses or
degradation of waters of the U.S., are greater than 150 linear feet of perennial or
intermittent stream channel and/or 0.1 acre of wetland. Additionally, cumulative impacts
that result in the loss or degradation of greater than 300 linear feet of perennial or
intermittent stream channel and/or 0.5 acre of wetland, will be processed under an
Individual Permit. This verification of the use of the Nationwide Permit Program for this
project does not imply that this office will necessarily approve any future proposal to
impact waters of the U.S. on this property and/or associated with this project/activity.
5.0 Determination
5.1 Waiver request conclusion, if required or select N/A: N/A.
5.2 The activity will result in no more than minimal individual and cumulative adverse effects on the
aquatic environment and will not be contrary to the public interest.
5.3 This activity, as described, complies with all terms and conditions of the permit identified in
Section 1.5.
PREPARED BY:
RO D E N Digitally signed by RODEN
REYNOLDS.BRYAN.KENNETH.1263385574
REYNOLDS.BRYAN.KENNETH.126 DN:e=US,n=US.Government, nu=DoD,ou=PH,nu=USA,
cn=RODEN REYNOLDS.BRYAN.KENNETH.1263385574
3385574 Date: 2018.10.0214:02:12 -04'00'
Bryan Roden -Reynolds
Date: 10/2/2018

SAW-2018-01547
Determination of Jurisdiction:
A. ® There are waters including wetlands, on the above described project area 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). 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. Please note, if work is authorized by either a general or nationwide permit, and you wish to request an appeal of an
approved JD, the appeal must be received by the Corps and the appeal process concluded prior to the commencement of any work
in waters of the United States and prior to any work that could alter the hydrology of waters of the United States.
B. ❑ There are Navigable Waters of the United States within the above described project area 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 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.
C. ❑ There are waters including wetlands, within the above described project area that are 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.
D. ❑ The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued DATE. Action ID: FILE NUMBER.
Basis For Determination: See the preliminary jurisdictional determination form dated 08/24/2018.
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 jurisdiction determinations as indicated in B and C
above).
This correspondence constitutes an approved jurisdiction 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: Jason Steele, Review Officer
60 Forsyth Street SW, Room 10M15
Atlanta, Georgia 30303-8801
Phone: [phone]
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. * *
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mente�DSDRYANNE, NETH.1 czNODEN NEYNOLDS.BNYFN.KENNElN.12633855I6
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Bryan Roden -Reynolds
Date of JD: 08/24/2018
Expiration Date of JD: Not applicable

PROCESS AND
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND
REQUEST FOR APPEAL
Applicant: 806 Gibb Street, LLC, Justin Mendenhall File Number: SAW-2018-01547 Date: 10/2/2018
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
Additional information may be found at or
http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx or
appeal of the above decision.
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:
new
•
•
APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal
information.
ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure
of the date of this notice, means that you accept the approved JD in its entirety, and
approved JD.
APPEAL: If you disagree with the approved JD, you may appeal the approved JD
Administrative Appeal Process by completing Section II of this form and sending the
the approved JD or provide
to notify the Corps within 60 days
waive all rights to appeal the
under the Corps of Engineers
form to the district engineer.
notice.
This form must be received by the division engineer within 60 days of the date of this
E:
the
appealed),
consideration
PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request
respond to the Corps regarding
an approved JD (which may be
new information for further
by contacting the Corps district for further instruction. Also you may provide
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
initial proffered permit in clear concise statements. You
your reasons or objections are addressed in the administrative
your reasons for appealing the decision or your objections to an
may attach additional information to this form to clarify where
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: Bryan Roden -Reynolds
Charlotte Regulatory Office
U.S Army Corps of Engineers
8430 University Executive Park Drive, Suite 615
Charlotte, North Carolina 28262
If you only have questions regarding the appeal process you
may also contact:
Mr. Jason Steele, 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.
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. Jason Steele, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 10/2/2018
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: 806 Gibb Street, LLC, Justin Mendenhall, 11
Brookstown Avenue, Winston-Salem, NC 27101
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District, Pheasant Ridge Subdivision, SAW-
2018-01547
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The review area is located on the southeast
side of Robinhood Road; approximately 0.5 miles east of the intersection of Robinhood Road and Millhaven Road.
PINs: 6806-55-5433, 6806-55-5323, 6806-54-4996, 6806-64-0893, 6806-55-7293, 6806-55-9337, and 6806-55-8602.
Reference review area description shown in Pre -Construction Notification package entitled "Figure 1, USGS Map" and
Printed Date of August 2018.
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County: Forsyth City: Winston-Salem
Center coordinates of site (lat/long in degree decimal format): Latitude: 36.119240 Longitude: -80.334008
Universal Transverse Mercator:
Name of nearest waterbody: Muddy Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
® Field Determination. Date(s): 05/02/2018
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site Number
Latitude (decimal
degrees)
Longitude (decimal
degrees)
Estimated amount of
aquatic resources in
reviewresources
area (acreage
and linear feet, if
applicable
Type of aquatic
(i.e.,
wetland vs. non
wetland waters)
Geographic authority to
which the aquatic resource
"may be" subject (i.e.,
Section 404 or Section
10/404)
Stream SA
36.118945
-80.334169
356 linear feet
Non -wetland
404
Stream SB
36.119498
-80.334147
441 linear feet
Non -wetland
404
Wetland
WA
36.119128
-80.334089
0.006 acres
Wetland
404
Wetland
WB
36.119259
-80.334077
0.033
Wetland
404
1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in the review
area, and the requestor of this PJD is hereby advised of his or her option to request and obtain an
approved JD (AJD) for that review area based on an informed decision after having discussed the
various types of JDs and their characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a Nationwide General
Permit (NWP) or other general permit verification requiring "pre- construction notification" (PCN), or
requests verification for a non -reporting NWP or other general permit, and the permit applicant has

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

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources below where
indicated for all checked items:
® Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: Impact Drawings 1-4 (Dated 07/24/2018)
® Data sheets prepared/submitted by or on behalf of the PJD requestor.
® 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.
® U.S. Geological Survey map(s). Cite scale & quad name: Figure 1, USGS Map (1:24,000 Rural Hall and Winston-
Salem West Dated 2013)
® Natural Resources Conservation Service Soil Survey. Citation: Figure 2, NRCS Map (Soil Survey of Forsyth County,
Sheets 22 and 29)
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMAIFIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
❑ Photographs: ❑Aerial (Name & Date):
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.
RO D E N Digitally signed by RODEN
REYNOLDS.BRYAN.KEN NETH.1263385574
REYNOLDS.BRYAN.KE ou=PKI,ou=USA,cnVGoRODENt,ou=DoD,
N N ETH.1263385574 REYNOLDS.BRYAN.KENNETH.1263385574
Date: 2018.10.02 14:02:52 -04'00'
Signature and date of Regulatory
staff member completing PJD Signature and date of person requesting PJD
08/24/2018 (REQUIRED, unless obtaining the signature is
impracticable)'
I 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.

DRAWING NAME: P: 201808Q9\Civil\180009_Lineback Culvert
9/18/2018 3:35 P \8\\
II
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1
ma.
va
\
PROPOSED UNDERGROUND
DETENTION STRUCTURE
IMPACT S11E
DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
6415 OLD PLANK RD, HIGH POINT, NC 27265
[phone] I WWW.DMP-INC.COM I LICENSE: F-0245
Crossing. — IERAL EX
\,
STREAM "A"
if
100
-�J
GRAPHIC SCALE
50 0 100
200
1" = 100 FEET
PHEASANT RIDGE SUBDIVISION
LINEBACK AVENUE OVERALL CREEK CROSSING
IMPACT MAP
WINSTON TOWNSHIP, FORSYTH COUNTY
WINSTON SALEM, NORTH CAROLINA

Roden Reynolds, Bryan K CIV (US)
From: Phil May <[e-mail]>
Sent: Wednesday, September 19, 2018 8:28 AM
To: Roden Reynolds, Bryan K CIV (US)
Cc: Homewood, Sue
Subject: [Non-DoD Source] Pheasant Ridge Development - Winston Salem NC
Attachments: PheasantRidge_PJDTable_Revised091818.pdf; PheasantRidge_SiteFeatures_091 81 8.pdf
Bryan
Hope you are doing well and weathered the storm.
Following up on our site visit from 8/23/18, attached are a revised features map for the Pheasant Ridge site and a
revised PJD table. In flagging out the additional wetland along the property line, I found a break in the soils between WA
(previously delineated) and WB (added from our discussion). Therefore we had it surveyed as a separate polygon. It is
one continuous wetland that runs along the boundary, but as discussed we clipped it at the property line, so there are
several polygons. SB was adjusted as well to reflect the portion only within the property, and SA was revised due to an
actual lower amount than originally estimated.
Let me know if you need anything else or have any questions.
Thanks
Phil
Phil May
Senior Scientist
CAROLINA ECOSYSTEMS INC.
3040 NC Hwy 42 West
P.O. Box 41
Cell [phone]
1

Clayton NC 27520
Lewisville, NC 27023
Office [phone] xt 102
Blockedwww.carolinaeco.com <Blockedhttp://www.carolinaeco.com/>
2

Pheasant Ridge Development
Forsyth County NC
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY JURISDICTION
9/18/2018
Site Name
Latitude
Longitude
Estimated Amount of
Aquatic Resources
Type of Aquatic
Resource
Geographic Authority to which the
aquatic resource "may be" subject
WA
36.119128
-80.334089
0.006
Wetland
Section 404
WB
36.119259
-80.334077
0.033
Wetland
Section 404
SA
36.118945
-80.334169
356
Non -wetland waters
Section 404
SB
36.119498
-80.334147
441
Non -wetland waters
Section 404

DRAWING NAME: P: 2018\ 80a09\Civil\180009_Lineback Culvert
9018/2018 3:35 P \ +
\
PROPOSED UNDERGROUND
DETENTION STRUCTURE
IMPACT SIZE
Crossing. — Q IERAL EX
\
\\
STREAM 'B';
180± LF
111' \�
Ilk
STREAM 'B
253± LF
if
MILANO "B"
0.001 t ACRES
100
\
\
GRAPHIC SCALE
50 0 100
200
1" = 100 FEET
DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
6415 OLD PLANK RD, HIGH POINT, NC 27265
[phone] I WWW.DMP-INC.COM I LICENSE: F-0245
PHEASANT RIDGE SUBDIVISION
LINEBACK AVENUE OVERALL CREEK CROSSING
IMPACT MAP
WINSTON TOWNSHIP, FORSYTH COUNTY
WINSTON SALEM, NORTH CAROLINA

N.
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Roden Reynolds, Bryan K CIV (US)
From: Roden Reynolds, Bryan K CIV (US)
Sent: Tuesday, August 7, 2018 8:57 AM
To: 'Hamstead, Byron'
Subject: NLEB Excepted/Exempted from Take Prohibitions (Situation 1), Forsyth County,
SAW-2018-01547
This email serves as the USACE notification for the NLEB (Situation 1), Action ID No. SAW-2018-01547.
1) Brief project description (note percussive activities if applicable): The review area is located on the southeast side of
Robinhood Road; approximately 0.5 miles east of the intersection of Robinhood Road and Millhaven Road. PINs: 6806-
55-5433, 6806-55-5323, 6806-54-4996, 6806-64-0893, 6806-55-7293, 6806-55-9337, and 6806-55-8602. : This
verification authorizes the permanent impacts to 106 linear feet of perennial stream and temporary impacts to 42 linear
feet of perennial stream to facilitate the development of a single-family residential sub -division. Permanent stream
impacts are associated with culvert placement whereas temporary stream impacts are associated with bank stabilization
activities and dewatering activities (i.e., coffer dam installation and pump -around) during construction.
2) Project latitude and longitude in decimal degrees: 36.119240, -80.334008
3) Estimate of tree clearing in the USACE action area in either acreage or number of trees cleared: —1-13 acres
Species: Northern long-eared bat (NLEB) (Myotis septentrionalis)
This project qualifies for Situation 1-
- i.e., the action area is located outside of a red HUC and there is no pile driving, blasting, or other percussive activities.
USACE Rationale and Determination: The USACE conducted a review of the project and surrounding areas and also
reviewed the most current maps of confirmed/known hibernation and maternity (tree) sites for the NLEB available on
sciencebase.gov and has determined that the action area for this project is located outside of the highlighted areas/red
12-digit HUCs and activities in the action area do not require prohibited incidental take; as such, this project meets the
criteria for the 4(d) rule and any associated take is exempted/excepted.
U.S. Fish and Wildlife Service (Service) Concurrence: This notice is being sent to the Service in accordance with the
surrogate consultation procedure/SLOPES that was established between the Service's Asheville and Raleigh Ecological
Offices and the USACE, Wilmington District, for the NLEB. This project does not require prohibited intentional take of the
NLEB and meets the criteria for the 4(d) rule; therefore any associated take is exempt and it is not necessary for the
USACE to wait 30 days for the Service to object or concur.
Also, based on the information presented in the PCN and from geospatial date sources, the USACE is not aware of any
other issues concerning listed species and/or critical habitat and has determined that the project would have no effect
on any other species and/or critical habitat.
Thanks,
Bryan Roden -Reynolds
Regulatory Project Manager
U.S. Army Corps of Engineers
Charlotte Regulatory Office
1

8430 University Executive Park Drive
Charlotte, NC 28262
Office: [phone]
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
2

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APPLICATION
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APPLICATION
ORM ID NUMBER: SAW-2018-01547
From Date: To Date:
Combined with: SAW-
02 Aug 2018
Converted From: SAW -
Related to: SAW -
Remarks:

1 1
t'MI1
DWRs
D1Wflon of water Regpprcbg
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
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.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Forsyth
Is this project a public transportation project? *
0 Yes 0 No
This is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
la. Type(s) of approval sought from the Corps:*
m Section 404 Permit (wetlands, streams and waters, Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
121 Nationwide Permit (NWP)
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E-PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number:
NWP Number Other:
29 - Residential Developments
List all NAN nurrbers you are applying for not on the drop down list.
lc. Type(s) of approval sought from the DWR:*
check all that apply
• 401 Water Quality Certification - Regular
✓ Non-404 Jurisdictional General Permit
✓ Individual Permit
✓ 401 Water Quality Certification - Express
✓ Riparian Buffer Authorization
*
Id. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: € Yes 0 No

For the record only for Corps Permit: C Yes t' No
le. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in -lieu fee program
O Yes C No
1f. Is the project located in any of NC's twenty coastal counties?*
O Yes C No
1h. Is the project located in a designated trout watershed?*
0 Yes t No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
la. Who is the Primary Contact?*
Philip May
1 b. Primary Contact Email:*
[e-mail]
lc. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
❑ Owner ❑ Applicant (other than owner) 17 Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
806 GIBE STREET LLC
2b. Deed book and page no.:
DB 003395, Deed Pages 03020,25,30,35,40,45,48
2c. Responsible party:
(for Corporations)
Justin Mendenhall
2d. Address
Street Address
11 Brookstown Avenue
Address Line 2
CIty State / Province / Region
Winston Salem NC
Postal / Zip Code Country
27101 USA
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]

4. Agent/Consultant (if applicable)
4a. Name:
Philip May
4b. Business Name:
(if applicable)
Carolina Ecosystems, Inc.
4c. Address
Street Address
P.O. Box 41
Address Line 2
City State / Province / Region
Lewisville NC
Fbstal / Zip Code Country
27023 USA
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
PheasantRidge-AgAuth.pdf
FILE TYFE M..ST BE RT
571.72KB
C. Project Information and Prior Project History
1. Project Information
la. Name of project:*
Pheasant Ridge
1b. Subdivision name:
(if appropriate)
Pheasant Ridge
1c. Nearest municipality/ town:*
Winston Salem
Id. Driving directions*
If ft is a new project and can rot easily be found in a GPS napping system Rease provide directions.
From downtown Winston Salem, take Reynolda Road northwest, turn left onto Robinhood Road. Approximately a quarter mile after passing
Shattalon Drive, take a left onto Gibb Street.
2. Project Identification
2a. Property Identification Number:
(tax FIN or parcel ID)
6806-55-5433.00, 6806-55-5323.00, 6806-54-4996.00, 6806-64-0893.00,
6806-55-7293.00, 6806-55-9337.00, 6806-55-8602.00

2b. Property size:
(in acres)
19.37
2c. Project Address
Street Address
800 Gibb Street
Address Line 2
City
Winston Salem
Postal / Zip Code
27106
State / Province / Region
NC
Country
USA
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as
appropriate, based on how the location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:*
36.119240
ex: 34.208504
3. Surface Waters
Longitude:*
-80.334008
-77.796371
3a. Name of the nearest body of water to proposed project:*
UT to Muddy Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
River Basin Lookup
4. Project Description
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:*
Existing site conditions include pasture, forest areas, and light residential development. The project vicinity is
generally residential and forest.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
nick the upload button or drag and drop files here to attach docurrent
PheasantRidge_Fig 1 _USGS. pdf
Fle type mist be pdf
1.85MB
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
nick the upload button or drag and drop files here to attach docurrent
PheasantRidge_Fig2_NRCS.pdf
Fle type mist be pdf
5.24MB
4d. List the total estimated acreage of all existing wetlands on the property:

<0.01 - one small wetland adjacent to existing sewer line
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
895 - Streams SA (320' per) and SB (575 int & per)
4f. Explain the purpose of the proposed project:*
To provide single family residential housing in close proximity to major commercial and transportation routes within
the Winston Salem city limits.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Standard construction equipment will be used to clear and grade the portions of the site to be developed. Erosion
and sediment control measures will be installed. The proposed culvert will be built in the dry using temporary coffer
dams and a bypass pipe to maintain downstream flows.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
Pheasant Ridge Plans.pdf
File type mist be pdf
5. Jurisdictional Determinations
1.54MB
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
0 Yes
Comments:
Prelim JD Request attached to this application
0 No r Unknown
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
0 Preliminary 0 Approved 0 Unknown
Corps AID Number:
Exanple: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Philip May
Carolina Ecosystems, Inc.
(= N/A
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
Pheasant Ridge PJD Form.pdf
PhesantRidge_Forms.pdf
Pheasant Ridge Creek Crossing Overall Exhibit_PJD Labels.pdf
File type mist be FCFi
6. Project History
112.91KB
5.04MB
786.27KB
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes ( No r Unknown
7. Future Project Plans
7a. Is this a phased project?*

0 Yes
l3No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre -construction notification.
No other permits are used or intended to be used for this project.
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
❑ Wetlands
❑ Open Waters
m Streams -tributaries
❑ Pond Construction
❑ Buffers
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. Reason for impact*3b.Impact
type*
S1 Road Crossing P
Map label (e.g. R ad Crossing Fbrrranent (F) or
1) Terrporary (T)
3c. Type of impact*3d. Stream name*
Culvert
S2 Road Crossing T Bank
Map label (e.g. R ad Crossing
1)
Perrranent (F) or Stabilization
Terrporary (T)
SA (UT M uddy Cr)
SA (UT M uddy Cr)
3e. Stream
Type *
3f. Type of 3g. Stream 3h. Impact
Jurisdiction* width* length*
Perennial Both 5 106
F2rennial (FER) or
interrrittent (IM)
Perennial Both
F2rennial (FER) or
interrrittent (IM)
**All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
106
3i. Total temporary stream impacts:
42
3i. Total stream and tributary impacts:
148
3j. Comments:
Perpendicular crossing of stream SA avoiding "s" curve. Temporary impacts include stabilization after construction
and coffer dam dewatering during construction.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
A small tributary stream (intermittent and perennial) beginning near the eastern side of the property has been
avoided by realigning the road to the north and using a retaining wall at the cost of several potential lots. The only
proposed stream crossing has been minimized as much as practicable while maintaining required slope on the
roadway, and has also been shifted away from a distinct "s" curve in the channel to avoid additional stream impact
and the only wetland on site. Utilities will be located within proposed roads including at the stream crossing.
Average (linear feet)
(feet)
5 42
Average (linear feet)
(feet)
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*

Erosion control measures in compliance with North Carolina regulations will be installed and maintained on the site
during construction. The stream crossing will be built using coffer dams and a bypass pipe as shown in the
attached plans.
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?
C Yes C No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Stream impacts are under 150 linear feet. Owner has made expenditures (including retaining wall and loss of lot potential with road
realignment) to avoid stream SB channel.
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
***Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
O Yes G No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Yadkin River basin does not have riparian buffer rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOTs Individual NPDES permit NCS000250? *
O Yes t No
2b. Does this project meet the requirements for low density projects as defined in 15ANCAC 02H .1003(2)?*
fs Yes
( No
To look up low density requirement click here 15A NCAC 02H .1003(2).
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -
approved local government stormwater program?*
d Yes
O No
Hnt: projects that have vested rights, exerrptions, or grandfathering from state or locally irrplerrented storrrwater prograrrs or projects that satisfy state or locally-irrplerrented storrrwater prograrrs
through use of corrrunity in -lieu prograrrs should answer no to this question.
2d. Which of the following stormwater management program(s) apply (check all that apply):*
12 Local Government
❑ State
Local Government Stormwater Programs*
12 Phase II
El NSW
❑ USMP
❑ Water Supply
Please identify which local government stormwater program you are using.*
Winston Salem

G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
✓ Yes C3No
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), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?*
O Yes C No
2b. Is this an after -the -fact permit application?*
O Yes O No
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 downstream water quality? *
C'Yes ONo
3b. If you answered "no," provide a short narrative description.
The surrounding area is already relatively built out with residential and commercial development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
d Yes C No r N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
Sewage will be transported through an existing sewer line on site to the Winston-Salem Muddy Creek Plant.
Adequate capacity has been confirmed with the City.
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?*
O Yes C No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
O Yes
0 No C' Unknown
5e. Is this a DOT project located within Division's 1-8? *
O Yes t' No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?*
C• Yes r No
5g. Does this project involve bridge maintenance or removal?*
C Yes C5 No

Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEBSLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?**
C Yes 0 No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?*
✓ Yes t' No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Current Natural Heritage Program Element Occurrence data, review of site habitats, and review of USFWS
Asheville office guidance and GIS data on location of known northern long-eared bat.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
( Yes C No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA EFH Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.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 properties significant in North Carolina history and archaeology)?*
C` Yes 0 No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCHPO HPOWeb Mapping Program.
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach docurrent
PheasantRidge_HPOWeb_080118. pdf
Fle mist be FDF
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 0 No
8c. What source(s) did you use to make the floodplain determination?*
NC Flood Mapping Program
Miscellaneous
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach docurrent
Fle mist be FDF or IMQ
Signature
360.52KB
*

m By checking the box and signing below, I certify that:
■ I have given true, accurate, and complete information on this form;
■ I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act");
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act");
■ I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
■ I intend to electronically sign and submit the PCN form.
Full Name:*
Philip May
Signature
Date
8/2/2018

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD:
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Philip May, Carolina Ecosystems, PO Box 41, Lewisville NC 27023
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Forsyth City: Winston Salem
Center coordinates of site (lat/long in degree decimal format):
Lat.: 36.119240
Long.: -80.334008
Universal Transverse Mercator:
Name of nearest waterbody: UT to Muddy Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non -wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (i.e., Section
404 or Section 10/404)
WA
36.119128
-80.334089
0.01
wetland
Section 404
SA
36.118945
-80.334169
320
non -wetland waters
Section 404
SB
36.119498
-80.334147
575
non -wetland waters
Section 404

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

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
■❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: Pheasant Ridge Overall Plan (attached design layout)
O Data sheets prepared/submitted by or on behalf of the PJD requestor.
n Office concurs with data sheets/delineation report.
n 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:
n USGS NHD data.
n USGS 8 and 12 digit HUC maps.
■❑ U.S. Geological Survey map(s). Cite scale & quad name: 1:24000 Rural Hall & Winston Salem West, 2013
. Natural Natural Resources Conservation Service Soil Survey. Citation: Forsyth Co Sheets 22 & 29
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
n Previous determination(s). File no. and date of response letter:
n Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
1 Districts may establish timeframes for requestor to return signed PJD forms. If the requestor 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.

DRAWING NAME: P:
7/24/2018 9:13 A
2018\ 80•Q9\Civil\180009_Lineback Culvert Crossin
\ \ \
\
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IMPACT SITE
DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
6415 OLD PLANK RD, HIGH POINT, NC 27265
[phone] I WWW.DMP-INC.COM I LICENSE: F-0245
Strea S
PROPOSED UNDERGROUND
DETENTION STRUCTURE
100
L_
GRAPHIC SCALE
50 0 100
1" = 100 FEET
PHEASANT RIDGE SUBDIVISION
LINEBACK AVENUE OVERALL CREEK CROSSING
IMPACT MAP
WINSTON TOWNSHIP, FORSYTH COUNTY
WINSTON SALEM, NORTH CAROLINA
200

DRAWING NAME: P:
7/24/2018 9:13 A
2018\ 80•Q9\Civil\180009_Lineback Culvert Crossin
\ \ \
\\ \
IMPACT SITE
DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
6415 OLD PLANK RD, HIGH POINT, NC 27265
[phone] I WWW.DMP-INC.COM I LICENSE: F-0245
PROPOSED UNDERGROUND
DETENTION STRUCTURE
1171)
_
100
GRAPHIC SCALE
50 0 100
200
1" = 100 FEET
PHEASANT RIDGE SUBDIVISION
LINEBACK AVENUE OVERALL CREEK CROSSING
IMPACT MAP
WINSTON TOWNSHIP, FORSYTH COUNTY
WINSTON SALEM, NORTH CAROLINA

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ENGINEERS & SURVEYORS
6415 OLD PLANK RD, HIGH POINT, NC 27265
[phone] WWW.DMP-INC.COM LICENSE: F-0245
PHEASANT RIDGE SUBDIVISION
LINEBACK AVENUE CREEK CROSSING
TEMPORARY & PERMANENT IMPACTS
WINSTON TOWNSHIP, FORSYTH COUNTY
WINSTON SALEM, NORTH CAROLINA
PRELIMINARY
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NOT FOR CONSTRUCTION
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NOTES:
1. ALL PUBLIC UTILITIES ARE TO BE
LOCATED IN THE ROAD CORRIDOR.
DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
6415 OLD PLANK RD, HIGH POINT, NC 27265
[phone] WWW.DMP-INC.COM LICENSE: F-0245
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WINSTON SALEM, NORTH CAROLINA
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CAROLINA
ECOSYSTEMS
August 2018
Feet
0 500 1,000
Study Area
Rural Hall and Winston Salem West (2013)
USGS 1:24K Quadrangle Map
Pheasant Ridge
Forsyth Countyy, NC
Figure 1: USGS Map

CAROLINA
ECOSYSTEMS
August 2018
Feet
0 200 400
Study Area
Forsyth County NRCS Soil Survey
Maps 22 and 29
Pheasant Ridge
Forsyth County, NC
Figure 2: NRCS Map

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CAROLINA
ECOSYSTEMS, INC.
PO Box 41; Lewisville, NC 27023
P:919-606-1065 —F:919-585-5570
PROPERTY ACCESS AND AGENT AUTHORIZATION FORM
Property Information
Property Address
and/or Description
Gibb Street — Pheasant Ridge development
Parcel Identification
Number(s) (PIN) 6806640893000, 6806544996000, 6806555323000, 6806555433000, 6806558602000,
6806559337000
City: Winston Salem State: NC County: Forsyth Property Size (Acres): 19.4
Property Owner Information
Owner: ® Authorized Agent*: ❑
Name: 806 Gibb Street LLC — NAME
Title:
TITLE
Street Address:
Mafia Jinc mtmD2r
11 Brookstown Avenue
City: Winston Salem
State: NC Zip Code:27101
*Written proof of authorization from owner required.
Authorization
1, the undersigned, a duly authorized owner of record of the property/properties identified herein, do authorize
representatives of the Wihnington District, U.S. Army Corps of Engineers (Corps) to enter upon the property herein
described for the purpose of conducting on -site investigations and issuing a determination associated with Waters of the
U.S. subject to Federal jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors
Act of 1899.
Additionally, I hereby grant Carolina Ecosystems, Inc. (CEI) staff, their designated contractors and representatives, as
well as other Federal, State or local authorities access to the above referenced property when necessary for the purposes of
conducting on -site environmental consulting services. I also grant CEI the authority to act as authorized agent on behalf of
the owner of the above listed property for the communication, submission, and/or application to relevant govenunent
entities, including local, state, and federal authorities, for the review, acceptance, concurrence, and/or approval of
environmental information, documents, and/or permit requests concerning the above listed property. These services may
include regulatory determinations of environmental features on my property such as issuing a determination associated
with streams and wetlands. I certify that I am the legal owner or authorized agent of the legal owner of the above property
and have authority to grant such access. I have made CEI aware of, and supplied all available records related to, previous
environmental investigations on the subject property of which I have knowledge.
Owner/AgentDa
(signature) to to 1 —

CAROLINA
ECOSYSTEMS, INC.
PO Box 41; Lewisville, NC 27023
P:919-606-1065 — F:919-585-5570

a
II__ WETLAND DETERMINATION DATA FORT - Eastern Mountains and Piedmont Region
Q
Project/Site: I YI eAl q^fi A: pig t Cit','..ounty: Sampling Date: Cj1// fr
Applicant/Owner:M 9 0 State: /V C- Sampling Point: 4/4 - 0 f
p
Investigator(s): fin I ill 4 7 / Se Jn, Township, Range:
Landform (hillslope, terrace, etc.): n7 (04d pi.: ^ Lczal i ief (conca.e, convex, none): C 0 c q ' Slope (%): Q` a
Subregion (LRR or MLORA):13 6 9 Lat:['3 (, 1( 1 0 S 4 Long: CCO , ci 311 t' 0 7 Datum: L 6 S A
Soil Map Unit Name: j k r 9 A� 0 t t 're, 5. n'° 04 L Off A ", NWI classification: «e�'1
Are climatic / hydrologic conditions on the site typical for this time of year? Yes __ ✓ No (If no, explain in Remarks.)
Are Vegetation Soil , or Hydrology significantly disturbed? /"0 Are "Normal Circumstances" present? Yes No
Are Vegetation , Soil , or Hydrology naturally problematic? /"0 (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes V. No
Hydric Soil Present? Yes ✓ No
Wetland Hydrology Present? Yes '� No
Is the Sampled Area
within a Wetland?
Yes ✓" No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Primary Indicators (minimum of one is required; check all that apply)
Secondary Indicators (minimum of two required)
Surface Soil Cracks
(B6)
Concave Surface (B8)
(B10)
(B16)
Table (C2)
(C8)
on Aerial Imagery (C9)
Plants (D1)
(D2)
(D3)
Relief (D4)
(D5)
Surface Water (A1) _ True Aquatic Plants (B14) _ Sparsely Vegetated
_ High Water Table (A2) Hydrogen Sulfide Odor (C1) _ Drainage Patterns
Y. Saturation (A3) X Oxidized Rhizospheres on Living Roots (C3) _ Moss Trim Lines
Water Marks (B1) _ Presence of Reduced,lron,(C4) _ Dry -Season Water
_ Sediment Deposits (B2) _ Recent Iron Reduction in Tilled Soils (C6) _ Crayfish Burrows
Drift Deposits (B3) _ Thin Muck Surface (C7) _ Saturation Visible
Algal Mat or Crust (B4) _ Other (Explain in Remarks) _ Stunted or Stressed
Iron Deposits (B5) Geomorphic Position
Inundation Visible on Aerial Imagery (B7) _ Shallow Aquitard
Water -Stained Leaves (B9) _ Microtopographic
Aquatic Fauna (B13) iX FAC-Neutral Test
Field Observations: 1�
Surface Water Present? Yes No X Depth (inches):
Wetland Hydrology Present?
, /
Yes`"
No
Water Table Present? Yes No X Depth (inches):
Saturation Present? Yes %� No Depth (inches): a
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers
Eastern Mountains and Piedmont - Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point:
Absolute Dominant Indicator
Tree Stratum (Plot size: ) % Cover Species? Status
1. 2
2.
3. / \�
4.
5.
6.
7.
= Total Cover
50% of total cover: 20% of total cover:
Sapling/Shrub Stratum (Plot size: )
1.
2.
3.
4.
5. ,..
6.
7.
8.
9.
= Total Cover
50% of total cover: 20% of total cover:
Herb Stratum (Plot size: )
1. COr'cx (-Vri It, �a r0p(31.
2. j 't e i[ `
c S P, 9 ✓ VA-61
3.
4.
5.
6.
7.
8.
9.
10.
11.
= Total Cover
50% of total cover: 0 20% of total cover:
Woody Vine Stratum Plot size: )
1.
2.
3.
4.
5.
= Total Cover
50% of total cover: 20% of total cover:
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 6' (A)
Total Number of Dominant
Species Across All Strata: (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: f I) (NB)
Prevalence Index worksheet:
Total % Cover of: Multiply by:
OBL species _ x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
1 - Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%
_ 3 - Prevalence Index is <_3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft (1
m) tall.
Herb - All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines greater than 3.28 ft in
height.
Hydrophytic
Vegetation
Present?
Yes No
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers
Eastern Mountains and Piedmont - Version 2.0

SOI L
Sampling Point:
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loc2 Remarks
0— IOY 5- /a 70 lank '41/6 30 L A
(Of! C-7J- '(0 7 5 Yik \'IAc a. A e ( (t'- 9) 4 c b 61 C r4 ✓e
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
Hydric Soil Indicators:
Histosol (Al)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
Stripped Matrix (S6)
Restrictive Layer (if observed):
Type:
Depth (inches):
Texture
Si
2Location: PL=Pore Lining, M=Matrix.
Dark Surface (S7)
Polyvalue Below Surface (S8) (MLRA 147, 148)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
7, Depleted Matrix (F3)
_ Redox Dark Surface (F6)
Depleted Dark Surface (F7)
_ Redox Depressions (F8)
_ Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
Umbric Surface (F13) (MLRA 136, 122)
_ Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 147)
Indicators for Problematic Hydric Soils3:
2 cm Muck (A10) (MLRA 147)
Coast Prairie Redox (A16)
(MLRA 147, 148)
Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
Very Shallow Dark Surface (TF12)
Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? YesNo
Remarks:
US Army Corps of Engineers
Eastern Mountains and Piedmont — Version 2.0

Applicant/Owner: y �'1 P
WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Region
Project/Site: ? Ilt. AS V` f E; A t. City/County: 10 ($ k Sampling Date:
State: � ii Sampling Point: VA-0 i
5-/01-// S1
Section, Township, Range:
Landform (hillslope, terrace, etc.): k ((i (4 e Local relief (concave, convex, none): n n k Slope (%): r%
Subregion (LRR or MLRA): L ' ) Lat: 1 - I I 9 n Long: e)-.3 i ‘-i Datum: 15 ✓k `
1(JA'
Investigator(s): P ` ! /II A +?
Soil Map Unit Name: '� I' I'qu 0 f F 7
NWI classification:
Are climatic / hydrologic conditions on the site typical for this time of year? Yes V No (If no, explain in Remarks.)
Are Vegetation , Soil , or Hydrology
Are Vegetation Soil , or Hydrology
significantly disturbed? /' j? Are "Normal Circumstances" present? Yes (O No
naturally problematic? NV0 (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes No
Hydric Soil Present? Yes No
Wetland Hydrology Present? Yes No X
Is the Sampled Area
within a Wetland? Yes No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Primary Indicators (minimum of one is required; check all that apply)
Secondary Indicators (minimum of two required)
Surface Soil Cracks
(B6)
Concave Surface (B8)
(B10)
(B16)
Table (C2)
(C8)
on Aerial Imagery (C9)
Plants (D1)
(D2)
(D3)
Relief (D4)
(D5)
_ Surface Water (A1) _ True Aquatic Plants (B14) _ Sparsely Vegetated
High Water Table (A2) " _ Hydrogen Sulfide Odor (C1) _ Drainage Patterns
Saturation (A3) _ Oxidized Rhizospher n Living Roots (C3) _ Moss Trim Lines
Water Marks (B1) _ resence of ced Iron (C4) _ Dry -Season Water
Sediment Deposits (82) _ Rece Reduction in Tilled Soils (C6) _ Crayfish Burrows
Drift Deposits (B3) _ T ' uck rface (C7) _ Saturation Visible
_ Algal Mat or Crust (B4) Other (Explain i emarks) _ Stunted or Stressed
Iron Deposits (B5) ".„ • _ Geomorphic Position
Inundation Visible on Aerial Imagery,-('7) _Shallow Aquitard
_ Water -Stained Leaves (B9) ! Microtopographic
Aquatic Fauna (B13) 4FAC-Neutral Test
Field Observations:
Surface Water Present? Yes No Depth (inches):
Wetland Hydrology Present?
Yes
No /
Water Table Present? Yes No Depth (inches):
Saturation Present? Yes No Depth (inches):
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers
Eastern Mountains and Piedmont — Version 2.0

Lc A-
VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point:
Tree Stratum (Plot size: n )
1.)ten; per,4,�.r.,:g
2. Lrp-r i nA
3.
4.
5.
6.
7.
Absolute Dominant Indicator
% Cover Species? Status
5 0 \-4(
f) `-. eA-cti
-'2= Total Cover Li
50% of total cover: ' -1)' 20% of total cover: I
Sapling/Shrub Stratum (Plot size: ()
1. :,,,,,,4 rvi-, 5:.,P ft 0,0 ✓ r-Au.,.
2.
3.
4.
5.
6.
7.
8.
9.
6-(1 = Total Cover
50% of total cover:
Herb Stratum (Plot size: 1
2. )T f in5c5
3. ri : AY._ rni ti
5
dal;
4.
5.
6.
7.
8.
9.
10.
11.
20% of total cover:
,J0 ✓ FA
l0 ✓ �w
(4 ✓ (%%1-
9 = Total Cover
50% of total cover: o 20% of total cover:
Woody Vine Stratum (Plot size:
1.
2.
3.
4.
5.
50% of total cover:
= Total Cover
20% of total cover:
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: (A)
Total Number of Dominant
Species Across All Strata: (B)
Percent of Dominant Species n
That Are OBL, FACW, or FAC: % (A/B)
Prevalence Index worksheet:
Total % Cover of: Multiply by:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals:
(A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
1 - Rapid Test for Hydrophytic Vegetation
_ 2 - Dominance Test is >50%
_ 3 - Prevalence Index is 53.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft (1
m) tall.
Herb - All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines greater than 3.28 ft in
height.
Hydrophytic
Vegetation
Present?
Yes No
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers
Eastern Mountains and Piedmont - Version 2.0

SOI L
Sampling Point:
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Lac' Texture Remarks
0 ' W. I 0 (41 cry (Q 9
'Type: C=Concentration, D=Depletion,
RM=Reduced Matrix, MS=Masked Sand Grains. Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
Stripped Matrix (S6)
Indicators for Problematic Hydric Soils3:
Dark Surface (S7) _ 2 cm Muck (A10) (MLRA 147)
Polyvalue Below Surface (S8) (MLRA 147, 148) _ Coast Prairie Redox (A16)
_ ark Surface (S9) (MLRA 147, 148) ----.(MLRA 147, 148)
Loamy GlPyd Matrix (F2)
_ Depleted Matrix
Redox Dark
_ Deple : lark Surface (F
ox Depressions (F8)
Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
_ Umbric Surface (F13) (MLRA 136, 122) 3lndicators of hydrophytic vegetation and
_ Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present,
_ Red Parent Material (F21) (MLRA 127, 147) unless disturbed or problematic.
Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
_ Very Shallow Dark Surface (TF12)
Other (Explain in Remarks)
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No
Remarks:
US Army Corps of Engineers
Eastern Mountains and Piedmont — Version 2.0