20211456 Ver 1_ePCN Application_20211004

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
Change only if needed.
BIMS # Assigned
20211456
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
1a. Name of project:
Champion Industries Site Road Realignment
1a. Who is the Primary Contact?
Robert Turnbull
1b. Primary Contact Email:*
[e-mail]
Date Submitted
10/4/2021
Nearest Body of Water
Leak Fork
Basin
Yadkin -Pee Dee
Water Classification
C
Site Coordinates
Version#*
1
What amout is owed?*
IT $240.00
r $570.00
Select Project Reviewer*
Sue Homewood:eads\slhomewood
1c. Primary Contact Phone:*
[phone]
Latitude:
Longitude:
36.147957
-80.241347
FA, Processing Information
County (or Counties) where the project is located:
Forsyth
Is this a NCDMS Project
r Yes IT No
Is this project a public transportation project?*
r Yes r No
Pre -Filing Meeting Information
Is this a courtesy copy notification?*

r Yes r No
ID#
Version
Pre -fling Meeting or Request Date
7/23/2021
Attach documentation of Pre -Filing Meeting Request here:
Qick the upload button or drag and drop files here to attach document
DWR Pre -Filing Meeting Request Form.pdf
File type must be FCF
1a. Type(s) of approval sought from the Corps:
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number: 13 - Bank Stabilization
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual 401 Water Quality Certification
le. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification:
For the record onlyfor Corps Permit:
49.3KB
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Champion Industries
2b. Deed book and page no.:
r Yes r No
r Yes r No
2c.Contact Person:

Roddy Sugg
2d.Address
Street Address
3765 Champion Boulevard
Address tine 2
City
State / Province / legion
Winston-Salem
NC
Postal / Zip Code
Country
27105
USA
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Robert Turnbull
4b. Business Name:
Terracon Consultants, Inc.
4c.Address
Street Address
2401 Brentwood Road, Suite 107
Address tine 2
city
Slate / Province / Region
Raleigh
NC
Postal / Zip (ode
Cbuntry
27604
USA
4d. Telephone Number:
4e. Fax Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Winston-Salem
2. Project Identification
2a. Property Identification Number:
2b. Property size:
6837-35-8103
13.38
2c. Project Address
Street Address
3765 Champion Boulevard
Address tine 2
city
Slate / Province / Region
Winston-Salem
NC
Postal / Zip Code
Country
27604
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Leak Fork
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
C^U

3d. Please provide the 12-digit HUC in which the project is located.
0304010113
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 project study area and vicinity consist of eAsting commercial, industrial, and residential areas near US Highway 52. The proposed project is immediately adjacent to the Champion
Industries manufacturing facility and next to the US Highway 52 Right-of-way.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
510
4h. Explain the purpose of the proposed project:*
The asphalt drive on the southwest side of the Champion Industries building is at the top of the slope along Leak Fork. Leak Fork has been eroding the bank near the asphalt drive
over time. The purpose of this project is to prevent further erosion of the bank that could result in the collapse of the asphalt drive. The asphalt drive is essential to the operation of the
Champion Industries facility.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The proposed project will reinforce the bank of Leak Fork to prevent further erosion. The project will move the asphalt drive closer to the Champion Industries building and repave the
drive. The slope below the relocated drive will be reinforced with excelsior matting and rip -rap down to and within the stream. Road construction equipment and excavators will be used.
Equipment will be stored in upland areas.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved (' Not Verified r Unknown r N/A
Corps AID Number:
SAW-2019-01629
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Michael Brame
Agency/Consultant Company: Pilot Environmental, Inc.
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made bythe Corps or DWR
Corps Determination - 11/20/2019
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
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?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries F Buffers
r Open Waters r Pond Construction
3. Stream Impacts
3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type * �3f. Type of 3g. S. width * �3h. Impact
(?) Jurisdiction* length*
Bank stabilization Permanent Bank Stabilization �ffFor
k Perennial Corps �;;]
(lir�rfeet)
31. Total jurisdictional ditch impact in square feet:

31. Total permanent stream impacts:
80
31. Total stream and ditch impacts:
80
3j. Comments:
Rip -rap on stream bank.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
31. Total temporary stream impacts:
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The extent of the bank stabilization area is the minimum needed to prevent further erosion on the slope. The remainder of Leak Fork within the
property will be avoided.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All applicable erosion and sediment control measures will be put in place and maintained according to current regulations. Cleared areas will be
immediately revegetated as required by regulations. Any spoil material will be placed in upland areas and excess material will be removed from the
site. All in -stream work will occur in the dry.
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?
r Yes
r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Stream impacts are less than 150 linear feet. No impacts to wetlands or other waters are proposed.
F. Stormwater Management and Diffuse Flow Plan (required by DWR) u
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes
r No
If no, explain why:
Project is located in the Yadkin -Pee Dee Basin. No riparian buffer rules apply in this basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
Disturbed area is less than 10,000 SF.
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
u
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)? *
r Yes
r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes
r No
31b. If you answered "no," provide a short narrative description.
The proposed project will result in no additional future impacts or development and will not result in any downstream impacts or growth -stimulating
effects. The existing use of Leak Fork (C) should not change as a result of this project.

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR forth is project?*
r Yes r Nor WA
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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
r Unknown
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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPAC review and NC Natural Heritage Program Data.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
hftp://mw.habitat.noaa.gov/protection/efhmapper/
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Online SHPO GIS mapping
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-yearfloodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
https://fris.nc.gov
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one
file when possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button a drag and drop files here to attach docunent
Champion Site_PCN Attachments.pdf 12.47MB
File rrust be FTF or I M
Comments
Signature
*
W By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.

• I 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:
Robert Turnbull
Signature
uL��L��/<6fdtGfCl�
Date
10/4/2021

�r
lrerracon
October 4, 2021
U.S. Army Corps of Engineers
Charlotte Regulatory Field Office
Champion Industries Site
Pre -Construction Notification
Forsyth County, North Carolina
Terracon Project No. 75195244
Please see attachments to the Pre -Construction Notification (PCN) for the Champion Industries
Site in Forsyth County, NC.
• USGS Figure
• NRCS Figure
• Permit Drawing
• PJD Tearsheet
• USFWS Species List
• NCNHP Records review
If you have any questions regarding the content of this submittal, please contact me at (919) 617-
9153 or via email at [e-mail].
Sincerely,
Terracon Consultants, Inc.
/fir-�,�-- ✓ -�
Robert Turnbull
Department Manager, Natural Resources
Terracon Consultants Inc. 2401 Brentwood Road, Suite 107, Raleigh, NC 28208-3608
Environmental Facilities
Geotechnical Materials

9/15/21, 2:11 PM
ACME Mapper 2.2 - 3.5 mi N of Winston-Salem NC
Leaflet I Tiles U Esri — Esri, DeLorme, NAVTEQ, TomTom, Intermap, iPG, USGS, and the GIS User Community
1/1
mapper.acme.com

USACE/NCDWR Agent Authorization Form
Property/Site: Champion Industries Site
Address of Site: 3765 Champion Boulevard
Winston-Salem, NC 27105
Parcel Identification Number (PIN): 6837-35-8103
Owner Information:
Name: Champion Industries c/o Roddy Sugq
Address: 3765 Champion Boulevard
Winston-Salem, NC 27105
Telephone Number: 336-661-1556
E-mail Address: rsugg(a�championindustries.com
Property Owner Certification:
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
and/ or the North Carolina Division of Water Resources (NCDWR) 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 (WOTUS) subject to Federal/State jurisdiction under Section
404 and 401 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899.
Terracon, as designated by the current property owner, is the authorized consultant to coordinate,
schedule, and provide supplemental infoation to both agencies in support of this verification
and/or permit application.
Property Owner Signature:
Date:
Terracon Consultants Inc. 7327-G West Friendly Avenue Greensboro, NC 27410
P: 336-904-7277 F: 336-365-7020 terracon.com

CD
--------- 0EX.SS
----_ %-CLEANOUZ
890 _ BEGIN 2' STAI
� C - - BM: #5 REBAR SET
/ WITH CAP - -
/ N: 875,225.64
-900- 7-
/ E:1,633,554.95
EL:886.74
EX. EP
hQ /
/
EX. 10" VCP \ - EX. SSMH
SANITARY SEWER TOP 884.70 MONITORING
INV IN(NNW)'87070- - - _ WELL
INV4N(E):873.50 - - - - -
ENV OU�'(SW):870.60 - - - - - - -
EX. ASPHALT
DRIVE
EX. EP
TAIL I
FROM PROP
CURB TO EX. I
Uf
-
\ I i
880
i

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2019-01629 County:Forsyth U.S.G.S.Quad:NC-Walkertown
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Requestor: Champion Industries
Will Means
Address: 3765 Champion Boulevard
Winston-Salem,NC 27105
Telephone Number: 336-661-1556
E-mail: [e-mail]
Size(acres) 1.25 Nearest Town Winston-Salem
Nearest Waterway Leak Fork River Basin Upper Pee Dee
USGS HUC 03040101 Coordinates Latitude: 36.147908
Longitude:-80.241078
Location description: The review area is located on the south end of Champion Boulevard: approximately 0.2 miles south of the
intersection of Champion Boulevard and Kapp Street.PIN: 6837-35-8103.Reference review area description shown in
Jurisdictional Determination Request package entitled"Drawing 1,USGS Topographic Map".
Indicate Which of the Following Apply:
A. Preliminary Determination
® There appear to be waters 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 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 5/28/2019.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 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
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 at the project area,which is not sufficiently accurate and reliable to support an enforceable
permit decision.We recommend that you have the waters 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 waterson 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 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.

SAW-2019-01629
❑ The waters 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 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 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(CAMA).
You should contact the Division of Coastal Management in Morehead City,NC,at(252)808-2808 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
[e-mail].
C. Basis For Determination: Basis For Determination: See the preliminary jurisdictional determination
form dated 11/20/2019.
D. Remarks: None.
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination may not be valid for the wetland conservation provisions of the Food Security
Act of 1985. If you or your tenant are USDA Program participants,or anticipate participation in USDA programs,you should request
a certified wetland determination from the local office of the Natural Resources Conservation Service,prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B.
above)
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination,you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process(NAP)fact sheet and request for appeal(RFA)form. If you request to appeal this determination you
must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Phillip Shannin,Review Officer
60 Forsyth Street SW,Room 10M15
Atlanta,Georgia 30303-8801
In order for an RFA to be accepted by the Corps,the Corps must determine that it is complete,that it meets the criteria for appeal
under 33 CFR part 331.5,and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form,it must be received at the above address by Not applicable.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
RODEN Digitally Signed by RODEN REYNOLDS.BRYAN.KENNETH.1263385574
Corps Regulatory Official: REYNOLDS.BRYAN.KENNETH.1263385574 Date:2019.11.2016:38:45-05'00'
Date of JD: 11/20/2019 Expiration Date of JD:Not applicable

SAW-2019-01629
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/cmapex/f?p=136:4:0
Copy furnished:
Agent: Pilot Environmental,Inc.
Michael Brame
Address: P.O.Box 128
Kernersville,NC 27285
Telephone Number: 336-310-4527
E-mail: mbramena,pilotenviro.com

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Champion Industries,Will Means File Number: SAW-2019-01629-= Date: 11/20/2019
Attached is: See Section below
❑ INITIAL PROFFERED PERMIT(Standard Permit or Letter of permission) A
❑ PROFFERED PERMIT(Standard Permit or Letter of permission) B
❑ PERMIT DENIAL C
❑ APPROVED JURISDICTIONAL DETERMINATION D
PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I- The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx
or the Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• 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.
IC: 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.
I 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 PERMI11111
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 10M15
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 opportunity 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 10M15,Atlanta,Georgia 30303-8801
Phone: [phone]

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 11/20/2019
B.NAME AND ADDRESS OF PERSON REQUESTING PJD: Champion Industries,Will Means, 3765
Champion Boulevard,Winston-Salem,NC 27105
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District, Champion Industries, SAW-2019-
01629
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The review area is located on the south end
of Champion Boulevard; approximately 0.2 miles south of the intersection of Champion Boulevard and Kapp Street.
PIN: 6837-35-8103. 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: Forsyth City: Winston-Salem
Center coordinates of site (lat/long in degree decimal format):Latitude: 36.147908 Longitude: -80.241078
Universal Transverse Mercator:
Name of nearest waterbody: Leak Fork
E. REVIEW PERFORMED FOR SITE EVALUATION(CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
® Field Determination. Date(s): 11/20/2019
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH"MAY BE"SUBJECT TO REGULATORY
JURISDICTION.
Estimated amount of Geographic authority to
Type of aquatic
aquatic resources in which the aquatic resource
Latitude(decimal Longitude(decimal resources(i.e., „
Site Number review area (acreage may be subject(i.e.,
degrees) degrees) and linear feet, if wetland vs. non Section 404 or Section
wetland waters)
applicable 10/404)
Stream A 36.148046 -80.241127 510 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 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:Drawings 1-5
® 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: Drawing 1,USGS Topographic Map (1:24,000 Rural
Hall,NC and 1:24,000 Walkertown,NC)
®Natural Resources Conservation Service Soil Survey. Citation: Drawing 2,Webs Soil Map (Web Soil Survey of
Forsyth County)and Drawing 2A,Published Soil Map(Soil Survey of Forsyth County,Sheet 23 Dated 1976)
®National wetlands inventory map(s). Cite name: Drawing 3,NWI Map (USFWS NWI Mapper)
❑State/local wetland inventory map(s):
®FEMA/FIRM maps: Drawing 4, FEMA FIRM (FEMA FIRM Panel No.3710683700J Dated 01/02/2009)
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
®Photographs: ®Aerial(Name & Date):Drawing 5,Wetland Map(05/28/2019)
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.1
REYNOLDS.BRYAN.KE 263385574
NNETH.1263385574 D05ate:200'019.11.20 16:38:16
Signature and date of Regulatory
staff member completing PJD Signature and date of person requesting PJD
11/20/2019 (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.

SA 30-37
SA 1-5
DP-1 o J
LEGEND
Site Boundary
Perennial Stream
Flag Number
Data Point
FLAG NUMBERS/INFO
WETLAND FLAGS =
STREAM FLAGS =
Stream Flags = 66
Wetland Flags = 0
Total Flags = 66
SA 1-29
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY HAVE NOT BEEN VERIFIED BY THE USACE
AND/OR THE NCDEQ-DWR. THEY HAVE NOT BEEN SURVEYED OR GEOLOCATED.
Drawing 5
2019 Aerial Imagery from Google Earth
and Pilot Field Notes
Scale: 1" = 75'
Date: 5.28.19
PILOT "" ry
PILOT E N 4 1 R❑ \ M E N, A L, i N C
Wetland Map
Champion Industries
Industrial Avenue
Winston-Salem, Forsyth County, NC
Pilot Project 4750

IPaC U.S. Fish &Wildlife Service
IPaC resource list
This report is an automatically generated list of species and other resources such as critical habitat
(collectively referred to as trust resources) under the U.S. Fish and Wildlife Service's (USFWS)
jurisdiction that are known or expected to be on or near the project area referenced below. The list
may also include trust resources that occur outside of the project area, but that could potentially be
directly or indirectly affected by activities in the project area. However, determining the likelihood
and extent of effects a project may have on trust resources typically requires gathering additional
site-specific (e.g., vegetation/species surveys) and project-specific (e.g., magnitude and timing of
proposed activities) information.
Below is a summary of the project information you provided and contact information for the USFWS
office(s)with jurisdiction in the defined project area. Please read the introduction to each section
that follows (Endangered Species, Migratory Birds, USFWS Facilities, and NWI Wetlands) for
additional information applicable to the trust resources addressed in that section.
Location
V. � 2
Forsyth County, North Carolina ,, ,‘IkS
= , 00\44114
rilliR141..
*14.4111 .
Ale.A C4
ifigi‘.4
V
13
Local office
Asheville Ecological Services Field Office
t. [phone]
fi [phone]
160 Zillicoa Street
Asheville, NC 28801-1082
http://www.fws.gov/nc-es/es/countyfr.html

Endangered species
This resource list is for informational purposes only and does not constitute an analysis of
project level impacts.
The primary information used to generate this list is the known or expected range of each species.
Additional areas of influence (AOI)for species are also considered. An AOI includes areas outside of
the species range if the species could be indirectly affected by activities in that area (e.g., placing a
dam upstream of a fish population even if that fish does not occur at the dam site, may indirectly
impact the species by reducing or eliminating water flow downstream). Because species can move,
and site conditions can change, the species on this list are not guaranteed to be found on or near
the project area. To fully determine any potential effects to species, additional site-specific and
project-specific information is often required.
Section 7 of the Endangered Species Act requires Federal agencies to "request of the Secretary
information whether any species which is listed or proposed to be listed may be present in the area
of such proposed action" for any project that is conducted, permitted, funded, or licensed by any
Federal agency. A letter from the local office and a species list which fulfills this requirement can
only be obtained by requesting an official species list from either the Regulatory Review section in
IPaC (see directions below) or from the local field office directly.
For project evaluations that require USFWS concurrence/review, please return to the IPaC website
and request an official species list by doing the following:
1. Draw the project location and click CONTINUE.
2. Click DEFINE PROJECT.
3. Log in (if directed to do so). ,
111/4
4. Provide a name and description for your project.
5. Click REQUEST SPECIES LIST.
Listed species1 and their critical habitats are managed by the Ecological Services Program of the U.S.
Fish and Wildlife Service (USFWS) and the fisheries division of the National Oceanic and Atmospheric
Administration (NOAA Fisheries).
Species and critical habitats under the sole responsibility of NOAA Fisheries are not shown on this
list. Please contact NOAA Fisheries for species under their jurisdiction.
1. Species listed under the Endangered Species Act are threatened or endangered; IPaC also shows
species that are candidates, or proposed, for listing. See the listing status page for more
information. IPaC only shows species that are regulated by USFWS (see FAQ).
2. NOAA Fisheries, also known as the National Marine Fisheries Service (NMFS), is an office of the
National Oceanic and Atmospheric Administration within the Department of Commerce.
The following species are potentially affected by activities in this location:
Mammals
NAME STATUS

Northern Long-eared Bat Myotis septentrionalis Threatened
Wherever found
No critical habitat has been designated for this species.
http://ecos.fws.gov/ecp/species/9045
Reptiles
NAME STATUS
Bog Turtle Clemmys muhlenbergii SAT
No critical habitat has been designated for this species.
http://ecos.fws.gov/ecp/species/6962
Insects
NAME STATUS
Monarch Butterfly Danaus plexippus Candidate Alci\O
Wherever found
No critical habitat has been designated for this species.
http://ecos.fws.gov/ecp/species/9743
Flowering Plants
NAME STATUS
Schweinitz's Sunflower Helianthus schweinitzii Endangered
Wherever found
No critical habitat has been designated for this species.
http://ecos.fws.gov/ecp/species/3849
Ar Si( *kr,
Critical habitats
Potential effects to critical habitat(s) in this location must be analyzed along with the endangered
species themselves.
THERE ARE NO CRITICAL HABITATS AT THIS LOCATION.
Migratory birds
Certain birds are protected under the Migratory Bird Treaty Act.'a and the Bald and Golden Eagle
Protection Acts.
Any person or organization who plans or conducts activities that may result in impacts to migratory
birds, eagles, and their habitats should follow appropriate regulations and consider implementing
appropriate conservation measures, as described below.

1.The Migratory Birds Treaty Act of 1918.
2.The Bald and Golden Eagle Protection Act of 1940.
Additional information can be found using the following links:
• Birds of Conservation Concern http://www.fws.gov/birds/management/managed-species/
birds-of-conservation-concern.php
• Measures for avoiding and minimizing impacts to birds
http://www.fws.gov/birds/management/project-assessment-tools-and-guidance/
conservation-measures.php
• Nationwide conservation measures for birds
http://www.fws.gov/migratorybirds/pdf/management/nationwidestandardconservationmeasures.pdf
The birds listed below are birds of particular concern either because they occur on the USFWS Birds
of Conservation Concern (BCC) list or warrant special attention in your project location. To learn
more about the levels of concern for birds on your list and how this list is generated, see the FAQ
below. This is not a list of every bird you may find in this location, nor a guarantee that every bird on
this list will be found in your project area. To see exact locations of where birders and the general
public have sighted birds in and around your project area, visit the E-bird data mapping tool (Tip:
enter your location, desired date range and a species on your list). For projects that occur off the
Atlantic Coast, additional maps and models detailing the relative occurrence and abundance of bird
species on your list are available. Links to additional information about Atlantic Coast birds, and
other important information about your migratory bird list, including how to properly interpret and
use your migratory bird report, can be found below.
For guidance on when to schedule activities or implement avoidance and minimization measures to
reduce impacts to migratory birds on your list, click on the PROBABILITY OF PRESENCE SUMMARY at
the top of your list to see when these birds are most likely to be present and breeding in your
project area.
NAME 1)
BREEDING SEASON (IFA
BREEDING SEASON IS INDICATED
FOR A BIRD ON YOUR LIST,THE
.141° BIRD MAY BREED IN YOUR
PROJECT AREA SOMETIME WITHIN
THE TIMEFRAME SPECIFIED,
WHICH IS A VERY LIBERAL
ESTIMATE OF THE DATES INSIDE
WHICH THE BIRD BREEDS
ACROSS ITS ENTIRE RANGE.
"BREEDS ELSEWHERE" INDICATES
THAT THE BIRD DOES NOT LIKELY
BREED IN YOUR PROJECT AREA.)

Bald Eagle Haliaeetus leucocephalus Breeds Sep 1 to Jul 31
This is not a Bird of Conservation Concern (BCC)in this area, but
warrants attention because of the Eagle Act or for potential
susceptibilities in offshore areas from certain types of development
or activities.
http://ecos.fws.gov/ecp/species/1626
Black-billed Cuckoo Coccyzus erythropthalmus Breeds May 15 to Oct 10
This is a Bird of Conservation Concern (BCC)throughout its range in
the continental USA and Alaska.
http://ecos.fws.gov/ecptspecies/9399
Cerulean Warbler Dendroica cerulea Breeds Apr 28 to Jul 20
This is a Bird of Conservation Concern (BCC)throughout its range in
the continental USA and Alaska.
http://ecos.fws.gov/ecp/species/2974
\01\141\
Kentucky Warbler Oporornis formosus Breeds Apr 20 to Aug 20
This is a Bird of Conservation Concern (BCC)throughout its range in r
the continental USA and Alaska.
Prairie Warbler Dendroica discolor qt. atk11113 Breeds May 1 to Jul 31
This is a Bird of Conservation Concern (BCC)throughout its range in
the continental USA and Alaska.
Prothonotary Warbler Protonotaria citrea ) Breeds Apr 1 to Jul 31
This is a Bird of Conservation Concern (BCC)throughout its range in
the continental USA and Alaska.
Red-headed Woodpecker Melanerpes erythrocephalus Breeds May 10 to Sep 10
This is a Bird of Conservation Concern (BCC)throughout its range in
the continental USA and Alaska.
Rusty Blackbird Euphagus carolinus Breeds elsewhere
This is a Bird of Conservation Concern (BCC) only in particular Bird
Conservation Regions(BCRs) in the continental USA
Wood Thrush Hylocichla mustelina Breeds May 10 to Aug 31
This is a Bird of Conservation Concern (BCC)throughout its range in
the continental USA and Alaska.
Probability of Presence Summary
The graphs below provide our best understanding of when birds of concern are most likely to be
present in your project area.This information can be used to tailor and schedule your project
activities to avoid or minimize impacts to birds. Please make sure you read and understand the FAQ

"Proper Interpretation and Use of Your Migratory Bird Report" before using or attempting to
interpret this report.
Probability of Presence (-)
Each green bar represents the bird's relative probability of presence in the 10km grid cell(s)your
project overlaps during a particular week of the year. (A year is represented as 12 4-week months.)
A taller bar indicates a higher probability of species presence. The survey effort (see below) can be
used to establish a level of confidence in the presence score. One can have higher confidence in the
presence score if the corresponding survey effort is also high.
How is the probability of presence score calculated?The calculation is done in three steps:
1.The probability of presence for each week is calculated as the number of survey events in the
week where the species was detected divided by the total number of survey events for that
week. For example, if in week 12 there were 20 survey events and the Spotted Towhee was
found in 5 of them, the probability of presence of the Spotted Towhee in week 12 is 0.25.
2. To properly present the pattern of presence across the year, the relative probability of presence
is calculated. This is the probability of presence divided by the maximum probability of presence
across all weeks. For example, imagine the probability of presence in week 20 for the Spotted
Towhee is 0.05, and that the probability of presence at week 12 (0.25) is the maximum of any
week of the year. The relative probability of presence on week 12 is 0.25/0.25 = 1; at week 20 it is
0.05/0.25 = 0.2. .1 lier
3. The relative probability of presence calculated in the previous step undergoes a statistical
conversion so that all possible values fall between 0 and 10, inclusive. This is the probability of
presence score.
To see a bar's probability of presence score, simply hover your mouse cursor over the bar.
Breeding Season ( )
Yellow bars denote a very liberal estimate of the time-frame inside which the bird breeds across its
entire range. If there are no yellow bars shown for a bird, it does not breed in your project area.
Survey Effort (I)
Vertical black lines superimposed on probability of presence bars indicate the number of surveys
performed for that species in the 10km grid cell(s) your project area overlaps. The number of
surveys is expressed as a range, for example, 33 to 64 surveys.
To see a bar's survey effort range, simply hover your mouse cursor over the bar.
No Data (—)
A week is marked as having no data if there were no survey events for that week.
Survey Timeframe
Surveys from only the last 10 years are used in order to ensure delivery of currently relevant
information. The exception to this is areas off the Atlantic coast, where bird returns are based on all
years of available data, since data in these areas is currently much more sparse.
probability of presence breeding season I survey effort —no data
SPECIES JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Bald Eagle
Noon BCC till TI Ili ++++
liii liii liii liii liii
I ++++
Vulnerable(This is
not a Bird of
Conservation
Concern(BCC)in
this area,but
warrants attention
because of the
Eagle Act or for
potential
susceptibilities in
offshore areas
from certain types
of development or
activities.)Black-billed ++++ ++++ T T T+ +T T T ++++ 1 1 1 - ++++ ++++ 04+ yy
+++ ++++
Cuckoo
BCC Rangewide
(CON)(This is a \40
Bird of
Conservation
Concern(BCC) st# ‘1)1 ‘
throughout its
range in the
continental USA
and Alaska.) 143\°I.
Cerulean Warbler ++++ ++++ ++++ +++ 4 yy++ ++++ ++++ ++++
BCC Rangewide " �I` ` f° �,i"+ +++� +T
(CON)(This is a
Bird of
Conservation
Concern(BCC)
throughout its
range in the
continental USA
and Alaska.) forir
Kentucky Warbler 4++ ++++ 1 1 1 1 I I I I 1 1 1 1 I I 1 I 11 I I III + +11+ ++I+ ++++ ++++
BCC Rangewide
(CON)(This is a
Bird of
Conservation
Concern(BCC)
throughout its
range in the
continental USA
and Alaska.)Prairie Warbler ++++ ++++ ++++ ++y+ 1111 fill 1,+] +++0 liii •+++ ++++ ++++
BCC Rangewide
(CON)(This is a
Bird of
Conservation
Concern(BCC)
throughout its
range in the
continental USA
and Alaska.)

Prothonotary ++++ ++++ ++++ III! ++++ +++I liii +++T +T++ ++++ ++++ ++++
Warbler .. �..
BCC Rangewide
(CON)(This is a
Bird of
Conservation
Concern(BCC)
throughout its
range in the
continental USA
and Alaska.) yy Red-headed ++++ ++++ ++++ ++++ +I++ lid' ++11 +I11 T+++ ++++ TTTT
Woodpecker
BCC Rangewide
(CON)(This is a
Bird of
Conservation
Concern(BCC)
throughout its014
range in the
continental USA
and Alaska.) yy Rusty Blackbird ++++ 1+11 101 11+T ++++ ++++ ++++ + + + TTTTC 11I+ 1+1+
BCC-BCR(This is a
Bird of
Conservation
Concern(BCC)only
in particular Bird
Conservation
10\4441‘
Regions(BCRs)in
the continental
USA) .4101k ICIP)
Wood Thrush WI 11 H - IlTl H 1 H H 1 1 1 1 1 1 1 1 1 1 1 I III 11111 1+i+ ++++ ++++
BCC Rangewide
(CON)(This is a ISIC. *kr,
Bird of
Conservation
Concern(BCC)
throughout its I'
range in the
continental USA
and Alaska.)
Tell me more about conservation measures I can implement to avoid or minimize impacts to migratory birds.
Nationwide Conservation Measures describes measures that can help avoid and minimize impacts to all birds at
any location year round. Implementation of these measures is particularly important when birds are most likely to
occur in the project area. When birds may be breeding in the area, identifying the locations of any active nests and
avoiding their destruction is a very helpful impact minimization measure.To see when birds are most likely to
occur and be breeding in your project area,view the Probability of Presence Summary.Additional measures or
permits may be advisable depending on the type of activity you are conducting and the type of infrastructure or
bird species present on your project site.
What does IPaC use to generate the migratory birds potentially occurring in my specified location?
The Migratory Bird Resource List is comprised of USFWS Birds of Conservation Concern (BCC)and other species
that may warrant special attention in your project location.

The migratory bird list generated for your project is derived from data provided by the Avian Knowledge Network
(AKN).The AKN data is based on a growing collection of survey, banding, and citizen science datasets and is
queried and filtered to return a list of those birds reported as occurring in the 10km grid cell(s)which your project
intersects, and that have been identified as warranting special attention because they are a BCC species in that
area, an eagle(Eagle Act requirements may apply), or a species that has a particular vulnerability to offshore
activities or development.
Again, the Migratory Bird Resource list includes only a subset of birds that may occur in your project area. It is not
representative of all birds that may occur in your project area.To get a list of all birds potentially present in your
project area, please visit the AKN Phenology Tool.
What does IPaC use to generate the probability of presence graphs for the migratory birds potentially
occurring in my specified location?
The probability of presence graphs associated with your migratory bird list are based on data provided by the
Avian Knowledge Network(AKN)..This data is derived from a growing collection of survey, banding, and citizen
science datasets .
"oink k
Probability of presence data is continuously being updated as new and better information becomes available.To
learn more about how the probability of presence graphs are produced and how to interpret them,go the
Probability of Presence Summary and then click on the "Tell me about these graphs" link. s.
e- ilk 11P11411"‘
How do I know if a bird is breeding,wintering, migrating or present year-round in my project area?
To see what part of a particular bird's range your project area falls within (i.e. breeding,wintering, migrating or
year-round),you may refer to the following resources:The Cornell Lab of Ornithology All About Birds Bird Guide, or
(if you are unsuccessful in locating the bird of interest there),the Cornell Lab of Ornithology Neotropical Birds
guide. If a bird on your migratory bird species list has a breeding season associated with it, if that bird does occur
in your project area,there may be nests present at some point within the timeframe specified. If"Breeds
elsewhere" is indicated,then the bird likely does not breed in your project area.
What are the levels of concern for migratory birds?
Migratory birds delivered through IPaC fall into the following distinct categories of concern:
1. "BCC Rangewide" birds are Birds of Conservation Concern (BCC)that are of concern throughout their range
anywhere within the USA(including Hawaii,the Pacific Islands, Puerto Rico, and the Virgin Islands);
2. "BCC- BCR" birds are BCCs that are of concern only in particular Bird Conservation Regions(BCRs) in the
continental USA; and
3. "Non-BCC-Vulnerable" birds are not BCC species in your project area, but appear on your list either because
of the Eagle Act requirements(for eagles) or(for non-eagles) potential susceptibilities in offshore areas from
certain types of development or activities(e.g. offshore energy development or longline fishing).
Although it is important to try to avoid and minimize impacts to all birds, efforts should be made, in particular,to
avoid and minimize impacts to the birds on this list, especially eagles and BCC species of rangewide concern. For
more information on conservation measures you can implement to help avoid and minimize migratory bird
impacts and requirements for eagles, please see the FAQs for these topics.
Details about birds that are potentially affected by offshore projects
For additional details about the relative occurrence and abundance of both individual bird species and groups of
bird species within your project area off the Atlantic Coast, please visit the Northeast Ocean Data Portal.The Portal
also offers data and information about other taxa besides birds that may be helpful to you in your project review.
Alternately,you may download the bird model results files underlying the portal maps through the NOAA NCCOS
Integrative Statistical Modeling and Predictive Mapping of Marine Bird Distributions and Abundance on the Atlantic
Outer Continental Shelf project webpage.

Bird tracking data can also provide additional details about occurrence and habitat use throughout the year,
including migration. Models relying on survey data may not include this information. For additional information on
marine bird tracking data, see the Diving Bird Study and the nanotag studies or contact Caleb Spiegel or Pam
Loring.
What if I have eagles on my list?
If your project has the potential to disturb or kill eagles,you may need to obtain a permit to avoid violating the
Eagle Act should such impacts occur.
Proper Interpretation and Use of Your Migratory Bird Report
The migratory bird list generated is not a list of all birds in your project area, only a subset of birds of priority
concern.To learn more about how your list is generated, and see options for identifying what other birds may be
in your project area, please see the FAQ "What does IPaC use to generate the migratory birds potentially occurring
in my specified location". Please be aware this report provides the "probability of presence" of birds within the 10
km grid cell(s)that overlap your project; not your exact project footprint. On the graphs provided, please also look
carefully at the survey effort(indicated by the black vertical bar)and for the existence of the "no data" indicator(a
red horizontal bar).A high survey effort is the key component. If the survey effort is high, then the probability of
presence score can be viewed as more dependable. In contrast, a low survey effort bar or no data bar means a lack
of data and, therefore, a lack of certainty about presence of the species.This list is not perfect; it is simply a
starting point for identifying what birds of concern have the potential to be in your project area, when they might
be there, and if they might be breeding(which means nests might be present).The list helps you know what to
look for to confirm presence, and helps guide you in knowing when to implement conservation measures to avoid
or minimize potential impacts from your project activities, should presence be confirmed.To learn more about
conservation measures,visit the FAQ "Tell me about conservation measures I can implement to avoid or minimize
impacts to migratory birds" at the bottom of your migratory bird trust resources page.
Facilities1;?`''
National Wildlife Refuge lands
Any activity proposed on lands managed by the National Wildlife Refuge system must undergo a
'Compatibility Determination' conducted by the Refuge. Please contact the individual Refuges to
discuss any questions or concerns.
THERE ARE NO REFUGE LANDS AT THIS LOCATION.
Fish hatcheries
THERE ARE NO FISH HATCHERIES AT THIS LOCATION.

Wetlands in the National Wetlands Inventory
Impacts to NWI wetlands and other aquatic habitats may be subject to regulation under Section 404
of the Clean Water Act, or other State/Federal statutes.
For more information please contact the Regulatory Program of the local U.S. Army Corps of
Engineers District.
Please note that the NWI data being shown may be out of date. We are currently working to update
our NWI data set. We recommend you verify these results with a site visit to determine the actual
extent of wetlands on site.
This location overlaps the following wetlands:
RIVERINE
R5UBH
% riOkk
A full description for each wetland code can be found at the National Wetlands Inventorywebsite
Data limitations
The Service's objective of mapping wetlands and deepwater habitats is to produce reconnaissance level
information on the location, type and size of these resources.The maps are prepared from the analysis of high
altitude imagery.Wetlands are identified based on vegetation,visible hydrology and geography.A margin of error
is inherent in the use of imagery;thus, detailed on-the-ground inspection of any particular site may result in
revision of the wetland boundaries or classification established through image analysis.
The accuracy of image interpretation depends on the quality of the imagery,the experience of the image analysts,
the amount and quality of the collateral data and the amount of ground truth verification work conducted.
Metadata should be consulted to determine the date of the source imagery used and any mapping problems.
Wetlands or other mapped features may have changed since the date of the imagery or field work.There may be
occasional differences in polygon boundaries or classifications between the information depicted on the map and
the actual conditions on site.
Data exclusions
Certain wetland habitats are excluded from the National mapping program because of the limitations of aerial
imagery as the primary data source used to detect wetlands.These habitats include seagrasses or submerged
aquatic vegetation that are found in the intertidal and subtidal zones of estuaries and nearshore coastal waters.
Some deepwater reef communities(coral or tuberficid worm reefs) have also been excluded from the inventory.
These habitats, because of their depth, go undetected by aerial imagery.
Data precautions
Federal, state, and local regulatory agencies with jurisdiction over wetlands may define and describe wetlands in a
different manner than that used in this inventory.There is no attempt, in either the design or products of this
inventory,to define the limits of proprietary jurisdiction of any Federal, state, or local government or to establish
the geographical scope of the regulatory programs of government agencies. Persons intending to engage in
activities involving modifications within or adjacent to wetland areas should seek the advice of appropriate federal,
state, or local agencies concerning specified agency regulatory programs and proprietary jurisdictions that may
affect such activities.

Roy Cooper,Governor
••flU NC DEPARTMENT OF Secretary
ME
Ji D.Reid Wilson,
■i■■■ NATURAL AND CULTURAL RESOURCES Walter Clark
■■■■i
Director,Division of Land and Water Stewardship
NCNHDE-15766
September 17, 2021
Katie Talavera
Terracon Inc.
2401 Brentwood Road, Suite 107
Raleigh, NC 27603
RE: Champion Industries Site; 75195244
Dear Katie Talavera:
The North Carolina Natural Heritage Program (NCNHP) appreciates the opportunity to provide
information about natural heritage resources for the project referenced above.
Based on the project area mapped with your request, a query of the NCNHP database indicates that
there are no records for rare species, important natural communities, natural areas, and/or
conservation/managed areas within the proposed project boundary. Please note that although there
may be no documentation of natural heritage elements within the project boundary, it does not
imply or confirm their absence; the area may not have been surveyed. The results of this query
should not be substituted for field surveys where suitable habitat exists. In the event that rare
species are found within the project area, please contact the NCNHP so that we may update our
records.
The attached `Potential Occurrences' table summarizes rare species and natural communities that
have been documented within a one-mile radius of the property boundary. The proximity of these
records suggests that these natural heritage elements may potentially be present in the project area
if suitable habitat exists. Tables of natural areas and conservation/managed areas within a one-mile
radius of the project area, if any, are also included in this report.
If a Federally-listed species is found within the project area or is indicated within a one-mile radius of
the project area, the NCNHP recommends contacting the US Fish and Wildlife Service (USFWS) for
guidance. Contact information for USFWS offices in North Carolina is found here:
https://www.fwsaov/offices/Directory/I istOffices.cfm?statecode=37.
Please note that natural heritage element data are maintained for the purposes of conservation
planning, project review, and scientific research, and are not intended for use as the primary criteria
for regulatory decisions. Information provided by the NCNHP database may not be published
without prior written notification to the NCNHP, and the NCNHP must be credited as an information
source in these publications. Maps of NCNHP data may not be redistributed without permission.
The NC Natural Heritage Program may follow this letter with additional correspondence if a
Dedicated Nature Preserve, Registered Heritage Area, Land and Water Fund easement, or Federally-
listed species are documented near the project area.
If you have questions regarding the information provided in this letter or need additional assistance,
please contact Rodney A. Butler at rodney.butlerncdcr aov or 919-707-8603.
Sincerely,
NC Natural Heritage Program
DEPARTMENT OF NATURAL AND CULTURAL RESOURCES

Natural Heritage Element Occurrences, Natural Areas, and Managed Areas Within a One-mile Rac
Champion Industries Site
Project No. 75195244
September 17, 2021
NCNHDE-15766
No Element Occurrences are Documented Within a One-mile Radius of the Project Area
No Natural Areas are Documented Within a One-mile Radius of the Project Area
Managed Areas Documented Within a One-mile Radius of the Project Area
Managed Area Name Owner Owner Type
City of Winston-Salem Open Space - Hanes Hosiery City of Winston-Salem Local Government
City of Winston-Salem Open Space - Jerry King City of Winston-Salem Local Government
Park
Definitions and an explanation of status designations and codes can be found at httos://ncnhde.natuireserve.org/heln. Data query generated on Sep
resubmit your information request if more than one year elapses before project initiation as new information is continually added to the NCNHP dat
Page 2 of 3

NCNHDE-15766: Champion Industries Site
�°n Abyfall Ur
0
Piney
Grove
Perk
eN Ave
ellowslone Ln
Tobacco Rd
Pa
\ 9 Longo, 1r
`rSLC
Fop Rd
Cussed ▪ St
Aseen 1M1'ay Howell St
O`
A Shame! St
tyro C�
BurnImm Dr
Crescent Rd
F�c
by
1004 ft
Dawson St
Motor Rd
Hudson SI
Kapp St
ona
Voss SI NF
r3 a
Newl°n
Leak Fork
Alspaugh _ \\ - ontarlo SI
a LL 51 McCreary SI
Forest Hills h o
1 - F _ Efird SI
1 m
D
Peden St
J A'entor SI
Perimeter Porn, f'
Boo NE
Reynolds Lilsd
E 341h SI
Essex Rd
Quail Dr
Vlctorxa St
utopia Rd
r;pM dirnlly n
Don Ave
Conley 51
Ne wporl 0I
Cayuga St
:srsitti
Ray nolds
AIr,t
Ogbum
Station
September 17, 2021
• Project Boundary
• Buffered Project Boundary
Managed Area (MAREA)
Page 3 of 3
0
0
Sources: Esri, HEF
FAO, NPS, NRCAN.
METI, Esri China (
User Community