20210372 Ver 1_401 Application_20211213

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20210372
Version* 1
Is this project a public transportation project?* Yes
• No
Reviewer List: * Sue Homewood:eads\slhomewood
Select Reviewing Office: * Winston-Salem Regional Office - [phone]
Submittal Type:* 401 Application
Does this project require a request for payment to be sent?*
Yes
No
How much is owed?* $240.00
$570.00

Project Submittal Form
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Type: * For the Record Only (Courtesy Copy)
New Project
Modification/New Project with Existing ID
More Information Response
Other Agency Comments
Pre -Application Submittal
Re-Issuance\Renewal Request
Stream or Buffer Appeal
Project Contact Information
Name: Heather LaGamba
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Gladstone
Is this a public transportation project?
Yes
No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
County (ies)
Forsyth
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
2770.2_Gladstone_PCN_12.13.21.pdf 13.89MB
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
PCN or 401 WQC
Sign and Submit
By checking the box and signing box below, I certify that:
• I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief.
• I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
• I agree that submission of this online form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act');

• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act');
• 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 online form.
Signature:
0. 16�11-11 ,
Submittal Date: Is filled in automatically.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW -
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Robinhood Rd
Begin Date (Date Received): 12.13.21
Assign Action ID Number in ORM ❑
2. Work Type: VPrivate ❑Institutional ❑Government ❑Commercial
3. Project Description / Purpose [PCN Form 133d and 133e]:
attached
4. Property Owner / Applicant [PCN Form A3 or A41: RS Parker Homes, LLC
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Brad Luckey, Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form 135b]:
7. Project Location — Coordinates, Street Address, and/or Location Description [PCN Form B lb]:
36.116301,-80.387595
8. Project Location —Tax Parcel ID [PCN Form Bla]: 5896-04-1054
9. Project Location — County [PCN Form A2b]: Forsyth
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Winston Salem
11. Project Information — Nearest Waterbody [PCN Form 132a]: Tomahawk Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03040101
Authorization: Section 10 ❑ Section 404 ❑✓
Regulatory Action Type:
❑ Standard Permit
❑✓ Nationwide Permit #
Regional General Permit #
Jurisdictional Determination Request
Section 10 and 404 ❑
❑Pre -Application Request
❑ Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: NWP 14/58 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
N 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes N No
For the record only for Corps Permit:
❑ Yes N No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Robingood Rd
2b.
County:
Forsyth
2c.
Nearest municipality / town:
Winston Salem
2d.
Subdivision name:
Gladstone
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
IRS Parker Homes, LLC
3b.
Deed Book and Page No.
00345/01561
3c.
Responsible Party (for LLC if
applicable):
Mr. Greg Garrett
3d.
Street address:
PO Box 5967
3e.
City, state, zip:
High Point, North Carolina 27263
3f.
Telephone no.:
336.399.7197
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ❑ Other, specify:
4b.
Name:
4c.
Business name
(if applicable):
4d.
Street address:
4e.
City, state, zip:
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Bradley Luckey
5b.
Business name
(if applicable):
Pilot Environmental, Inc.
5c.
Street address:
PO Box 128
5d.
City, state, zip:
Kernersville, NC 27285
5e.
Telephone no.:
336.708.4997
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
5896-04-1054
1 b. Site coordinates (in decimal degrees):
Latitude: 36.11630 Longitude: --80.38759
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
63 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Tomahawk Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
Class C
2c. River basin:
Yadkin
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The site contains a single family residence, fields and undeveloped wooded land. Glad Acres Road transects the central
portion of the site. The site is located within a rural and residential area of Winston Salem, Forsyth County, North
Carolina.
3b. List the total estimated acreage of all existing wetlands on the property:
Wetland=-1.0 Ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Streams=-3,000 LF.
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to provide access and utilities to the Gladstone subdivision, a 92 lot single family
residenital neighborhood.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of Gladstone subdivision, a 92 lot single family residential subdivision. In
order to provide utilities and access, it is necessary to have stream crossings. To facilitate the development of the site,
clearing and grading the site is necessary. Graders, haulers, excavators and other heavy equipment will be used during
grading and construction of the site.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes ❑ No El Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
®Preliminary ❑Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: Pilot Enviromental, Inc.
Name (if known): Bradley Luckey/Michael Brame
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
USACE Field Verification 6.7.17, PJD pending.
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
Impacts to streams/wetlands, outside of those proposed in this application, are not anticipated as a result of the proposed
project.
Page 4 of 12
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non-404, other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments: Wetland impacts are not proposed.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ®T
Culvert
Replacement
Unnamed
® PER
❑INT
® Corps
❑ DWQ
12
48/117
Fill/De-watering
S2 ®P ®T
Culvert
Replacement
Unnamed
❑ PER
® INT
❑ Corps
❑ DWQ
10
42/82
Fill/De-watering
S3 ❑ P ®T
Sewer Utility
Unnamed
® PER
❑ INT
❑ Corps
❑ DWQ
12
10
S4 ❑ P ®T
Sewer Utility
Unnamed
❑ PER
® INT
❑ Corps
❑ DWQ
10
10
S5 ❑ P ®T
Water Utility
Unnamed
® PER
❑ INT
❑ Corps
❑ DWQ
12
10
S6 ❑ P ®T
Water Utility
Unnamed
❑ PER
® INT
❑ Corps
❑ DWQ
10
10
3h. Total stream and tributary impacts
90/239
3i. Comments: Cumulative project impacts include the permanent net loss fill to 90 linear feet of perennial and intermittent
stream channel associated with culvert replacements, temporarily impact 199 linear feet of stream channel associated with de -
watering and temporarily impact 40 linear feet with open/backfill utility installation.
Page 5 of 12
PCN Form — Version 1.3 December 10, 2008 Version

Stream Impact 1 consists of the replacement of a 60" CMP with a 10' box culvert. The net loss fill from the culvert
replacement will permanently impact 48 linear feet (619SF) of perennial stream channel. To facilitate construction of the
culvert replacement and provide temporary driveway access to adjacent landowners, 117 linear feet of stream channel will be
temporarily bypassed.
Stream Impact 2 consists of the replacement of a 60" CMP with a 8' box culvert. The net loss fill from the culvert replacement
will permanently impact 42 linear feet (412SF) of intermittent stream channel. To facilitate construction of the culvert
replacement and provide temporary driveway access to adjacent landowners, 86 linear feet of stream channel will be
temporarily bypassed.
Stream Impacts 3, 4, 5 & 6 consists of the temporary impact to perennial/intermittent streams associated with excavate/back-
fill water and sewer line installation.
Stream diversions are proposed for no longer than 60 days. Temporary impacts to streams associated with stream
bypass/diversion and/or utility installation will be restored to similar pre -construction grade and stabilized with matting and
native herbaceous seed mix. Mitigation is not proposed for stream impacts.
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments: Open water impacts are not proposed.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 6 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar -Pamlico ❑ Other: Yadkin
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
re uired?
B1 ❑P❑T
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments: Buffer impacts are not proposed.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The applicant has designed the proposed residential sub -division to avoid other impact to streams and wetlands. The
applicant is crossing streams in a location of existing culverts instead of proposing crossings in new locations. The applicant
has designed the proposed box culverts to utilize head/end walls to further minimize stream impacts. The applicant has
coordinated with Winston Salem/Forsyth County Erosion Control to determine construction sequence, stream diversions and
locations/type of sediment and erosion control devices to reduce down -gradient impact to waters.
Approximately 1 acre of wetlands and the remaining 2,671 linear feet of perennial and intermittent stream channel are being
avoided.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The clearing limits will be staked and surveyed in the field. Sediment and erosion control devices and other best management
practices will be utilized during site development activities to prevent down -gradient sedimentation into waters. The applicant
will divert stream flow to construct a temporary driveway crossing to provide access to adjacent residential properties during
culvert replacement and installation. During culvert replacement and installation, the existing culverts will be removed.
Proposed culverts will be set in the dry. Following culvert replacement and installation, the temporary driveway will be
removed and the proposed sewer/water lines will be installed. Temporary impacts to streams associated with utility
installation and/or stream diversions will be restored to similar pre -construction grade and stabilized with matting and
herbaceous seed mixture.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
❑ Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
ElPayment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
Page 7 of 12
PCN Form — Version 1.3 December 10, 2008 Version

3.
Complete if Using a Mitigation Bank
3a.
Name of Mitigation Bank:
3b.
Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments: The applicant does not propose mitigation for impacts to streams.
4.
Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b.
Stream mitigation requested:
linear feet
4c.
If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d.
Buffer mitigation requested (DWQ only):
square feet
4e.
Riparian wetland mitigation requested:
acres
4f.
Non -riparian wetland mitigation requested:
acres
4g.
Coastal (tidal) wetland mitigation requested:
acres
4h.
Comments:
5.
Complete if Using a Permittee Responsible Mitigation Plan
5a.
If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b.
If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g.
If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h.
Comments:
Page 8 of 12
PCN Form — Version 1.3 December 10, 2008 Version

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
12 %
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why: The project is low density. This estimate
accounts for anticipated impervious from lot development. Curb and gutter pavement
that discharges to plunge pools, in
accordance with diffuse flow requirements and/or vegetative swales are proposed adjacent
to road infrastructure.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
® Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
WS/Forsyth Co.
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4.
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 12
PCN Form — Version 1.3 December 10, 2008 Version

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes
® No
use of public (federal/state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c.
If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes
® No
letter.)
Comments: A NEPA or SEPA is not required as part of this project.
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑ Yes
® No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes
® No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance
with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
We are not aware of additional development that will result which will impact nearby downstream water quality.
4.
Sewage Disposal (DWQ Requirement)
4a.
Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Impacts from wastewater generation outside of those proposed within this application are not proposed.
Page 10 of 12
PCN Form — Version 1.3 December 10, 2008 Version

5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b.
Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c.
If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d.
What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The IPaC report for the site identifies the following federally protected endangered or threatened species: Northern -long
eared Bat (NLEB) (T) and Schweinitz's sunflower (E) as protected species that could proximate to the site.
The project area contains an approximate 40 year old hardwood forest and an area of 2 existing road crossings. Suitable
habitat for Schweinitz's sunflower is not located within the proposed project area. Therefore, we have made a
determinaton of no effect for this species.
Percussionary, vibratory or blasting activties are not proposed. The project area is located greater than 90 miles from
known NLEB hibernacula or summer r000sting trees. Therefore, we have made a determination the proposed project is
not likely to adversely affect NLEB.
6.
Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b.
What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat.
7.
Historic or Prehistoric Cultural Resources (Corps Requirement)
7a.
Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b.
What data sources did you use to determine whether your site would impact historic or archeological resources?
We reviewed the SHPO Map (http://gis.ncdcr.gov/hpoweb/) to identify cultural resources of the site. The map does not
identify listed or eligible for listing properties on or nearby the site. A copy of the map is included as an attachment.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
® Yes ❑ No
8b.
If yes, explain how project meets FEMA requirements: Floodplain development permit approved by WS/Forsyth Co. on
9.29.21
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM (Drawing 4, attached)
Digitally signed by Bradley Luckey
Bradley DIN: cn-Bradley Luckey, co —Pilot
�+
Bradley S. Luckey, PWJ
Enviromental, Inc., ou,
[e-mail],
1 2.1 3.21
Lucke
Date:2021.12.13 08:35:01-05'00'
Date
Applicant/Agent's Printed Name
A IicantiA ent's Signature
Page 11 of 12
PCN Form — Version 1.3 December 10, 2008 Version

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TmB ..Ra D LEGEND
Site Boundary

Drawing 2A Published Soil Map
fIP
Robinhood Road
USDA Soil Survey '•'� .F�-= f
of Forsyth County, NC Approximate 61.2 Acre Tract
Published 1976, Sheets 21 & 28 ��pT Winston-Salem, Forsyth County, NC
Not to Scale�0T ENVIRONMENTAL.INC Pilot Project2770

L7
r
Drawing 3
USFWS NWI
Wetlands Mapper
Not to Scale
0
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i
P I L 0 7 E N V I R O N M E N T A L, I N[
a
LEGEND
5ite Boundary
Freshwater Emergent
FreshwaterForested/Shrub
Estuarine and Marine Deepwater
Estuarine and Marine
Freshwater Pond
Lake
Riverine
Other
s 14-rs�
NWI Map
Robinhood Road
Approximate 61.2 Acre Tract
Winston-Salem, Forsyth County, NC
Pilot Project 2770

4E X
)NL AL
ZONE X
Drawing 4
FEMA FIRM Panels
3710589600J & 3710588600.1,
Effective 01/02/2009
Not to Scale
F
ZOI I AEIJ
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t,
ZC N E X --
L
ZONE AE
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r
fIIL GTL O T E N V I R O N M E N T A L. I N C
LEGEND
Approximate Site Boundary
SPECIAL FLOOD HAZARD AREAS (SFHAS) SUBJECT TO
ti:s'^ INt1NDATTON BY THE 1% ANNUAL CHANCE FLOOD EVENT
the L%annual chance Mad (t0 -MF flndd] also known as the base N"d, Is the Mod #Wt
had a 1%chance d being Equaled a ea Nkd in any ylmn yF r.. The SpEdal Flood HaajN
Ama K 12rc a a sut3em to f4WIng by the 1% annual chance %W. Areas of Spedal Flood
tWaard IndU(le 7One5 A, Aer AH, A11. AR, A9% V. and VE; The Base FTppd Eke a K the
H tw•sorf ce ulevadun of tt a 1% annual dunce tlood-
ZONE R Np Base FWd ElevatCn &WMir1W.
ZONE At
Base F10p0 EC abws W m+reE.
ZONE AN FLOW depths of 1 l0 3 feet (.wally anM of pYdng); Base Fund Elevatloas
dwefminea.
20NE AO Fkaod depths of 1 W 3 fee[ (usualty sheet fimv m slop r p t 1.); a —age
Depths Oetemlined. For areas of alluvial fan =iflg, v6N:iyts also
detwmined.
ZONE AR SpWal Fk d Haterd Area %fine.ty pobmted from the L% dmNial chance
floss 6y a Mod contra sygwn #wt was wWWe tre dmennr. d- Zone AR
hdk. es dW the fpfmEr tocd —rd system m hdng resmred to pr-Ide
protecbm From the 1% annual chance a greater hood.
ZONE A99 Areas W be protected frpn 1% annual chance Mud by a Fe tal RWd
pugw Wrt undw conWwam, rho base Flmd Elevatlmsdwennnei-
ZONE VE Coastal flood aooe with veloOSy hazard (wave wtlm); Base Fkhd Eleradats
d6Mnninel
FLOODWAY AREAS IN ZONE AE
The flcodway Is the dwmd of a strain phis any adpa floodplaln areas Uut must he kept
free of oabxhment W that tie 1% annual cmnx flood on to carried rAltm Sulastutial
n eases N Hood roghu.
OTHER FLOOD AREAS
ZONE X Aras of 0.2% annual chance Mod; areas of 1% annual ge chance flood with
N&a&DVK of seas tan 1 (Oat W with dtalnW areas IpSS than 1 SgWM
nJe; and areal pr.tected try k-M flpn 1%M.0 chance flood.
OTHER AREAS
ZONE Areas delercitirhM tc ee dM1side Ve 0.2%a uk Oa—h Wlhn.
Z*NE v A e v.11kh flied hfearo err ur�utttm:wd, tea pamek-
® COASTAL BARRIER RE5OEIROES SYSTEM (BR.S) AREA_
OTHERWISE PROTECTED AREAS (OPAS)
CM area and OPAS are normally h2wd wahin a adjacent m WW1 Fkwd H—d Ar®
1% W", 04fwwplan ppyMary
0.2%annul was M"41 [.nary
nccd.af t.ndav
-- ZWDt.ndary
..................••• CORS aM OBs[.nary
Ba na ry drvtlm Spwal F" ma Aft Za and uur u
dtddNq SI.-I�F � H d A— deawa a 8aie Rtad
9v1 5. flmd*Pthsw hslOd s�{JCVas.
^^^^ 5T3 ^^^^ use Flaps r3eremn R1eam slue; eltredpnn ket•
iEL 9871 ll� Fl qw el 1°l.. wh_.Nfovo wahln mr: eLe e[cn n
felt•
• 0M —d w the Nord Merkari wdko DaN f 068
♦�� CKCS KNC.1 Yne
4 fl
6ro1`aD-. Fi'[i-u 1 OMMPhC
*7 4 aft rKdMOld t0 Bf NON Amd . Wins f
83(W4275n''• 230p-nxfd Al .a1 TRI— Mtt[atn gM tick; mne 17
1477 WO FEET moot gnd+awas' Clean lzrokna Sate Funs mp nW*rystvn
(RPSZQW E RM. $Me Plane N 83 /eet)
BM55T0 14�0 CaNW 000XW Survey t h madr (f0 rcwre .+k..0bW
x rtvth�Nmmrma�en<.m1
BM55S0® p1a1 aam `"n'a'' —h mangy cfor more wdvmayah r,vt
A�1a'aaAm]
113S•58 GM 2.5cm V.WA Camd wia aCabacmr•EAXW d
BM55TO®Wxh
1 Cfa hrnre an au. volt
• M1.5 raver NFe
FEMA FIRM
Robinhood Road
Approximate 61.2 Acre Tract
Winston-Salem, Forsyth County, NC
Pilot Project 2770

Min -_
LEGEND
w r
Site Boundary -
Intermittent Stream ++3
,;. Perennial Stream
Wetlands
-
sA 1-s Flag Number
1
DP-1 Q Data Point
N
- Culvert
op
_ Y
.a .-
41.
JIM
r
WA 1-17
r
• n .
WAA 1-14
DP-1
DP-2 •
Marginal Intermittent/Ephemeral Feature; DP-3
Subject to Agency Verification
Ili
Surveyor To
Stream SA;
Surveyor To
Loc
I I
PMf a FLAG NUMBERS/INFO
. WETLAND FLAGS
I 7�*qS =
STREAM FLAGS =
Stream Flags = 8
LWetland Flags = 31
. Total Flags = 41
1E LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY HAVE NOT BEEN VERIFIED BY THE USACE
ND/OR THE NCDEQ-DWR. THEY HAVE NOT BEEN SURVEYED OR GEOLOCATED.
Drawing 5 ! Wetland Map
�..r. `. N _
2017 Aerial Photograph from Google Robinhood Road
Earth and Pilot Field Notes Approximate 61.2 Acre Tract
Scale: 1" = 400' p�Er �' Winston-Salem, Forsyth County, NC
Date:04.28.17 PILOT ENVIRONMENTAL-INC Pilot Project2770
I

m

Water Resources
Environmental Quality
July 24, 2017
Mr. Michael T. Brame
Pilot Environmental Inc.
P.O. Box 128
Kernersville, NC 27285
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: On -Site Determination for Applicability to the Mitigation Rules (15A NCAC 2H .0500)
Subject Property: Robinhood Rd site, Winston Salem NC, Forsyth County
Dear Mr. Brame:
On June 7, 2017, at your request, Sue Homewood conducted an on -site determination to review features
located on the subject project for stream determinations with regards to the above noted state regulations.
Jean Gibby with the US Army Corps of Engineers was also present during the site visit.
The Division acknowledges the areas and boundaries identified as jurisdictional wetlands by the USACE.
The attached map accurately depicts all stream determinations conducted during the site visit.
Please note that at the time of this letter, all perennial stream channels and jurisdictional wetlands found on
the property are subject to the mitigation rules cited above. These regulations are subject to change in the
future.
The owner (or future owners) should notify the Division (and other relevant agencies) of this decision in
any future correspondences concerning this property. This on -site determination shall expire five (5) years
from the date of this letter.
Landowners or affected parties that dispute a determination made by the Division or Delegated Local
Authority that a surface water exists and that it is subject to the buffer rule may request a determination by
the Director. A request for a determination by the Director shall be referred to the Director in writing c/o
401 & Buffer Permitting Branch, 1650 Mail Service Center, Raleigh, NC 27699-1650. Individuals that
dispute a determination by the Division or Delegated Local Authority that "exempts" surface water from
the buffer rule may ask for an adjudicatory hearing. You must act within 60 days of the date that you
receive this letter. Applicants are hereby notified that the 60-day statutory appeal time does not start until
the affected party (including downstream and adjacent landowners) is notified of this decision. The
Division recommends that the applicant conduct this notification in order to be certain that third party
appeals are made in a timely manner. To ask for a hearing, send a written petition, which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, N.C. 27699-6714. This determination is final and binding unless you ask for a
hearing within 60 days.
State of North Carolina I Environmental Quality
450 West Hanes Mill Road, Suite 300 1 Winston-Salem, North Carolina 27105
336-776-9800

This letter only addresses the applicability to the mitigation rules and the buffer rules and does not approve
any activity within Waters of the United States or Waters of the State or their associated buffers. If you
have any additional questions or require additional information, please contact me at 336-776-9693 or
sue.homewoodkncdenr. og_v.
Sincerely,
Sue Homewood
Winston-Salem Regional Office
Enclosures: USGS Topo Map
Pilot Environmental Stream Map
Cc: Gladys Doub/Richard Doub - Executer, 5934 Glad Acres Rd, Pfafftown NC 27040- property owner
Jean Gibby, USACE Raleigh Regulatory Field Office (via email)
DWR, Winston-Salem Regional Office

Drawing 1
USGS Topographic Map
Clemmons, Rural Hall, Vienna &
Winston-Salem West, NC Quadrangles
Scale: 1" = 2,000'
USGS Topographic Map
;i
k�. Robinhood Road
Approximate 61.2 Acre Tract
PILO1' Winston-Salem, Forsyth County, NC
PILOT LNVIRONMENTAL.INC Pilot Project2770

Intermittent Stream
FLAG NUMBERS/INFO
WETLAND FLAGS =
W STREAM FLAGS =
Stream Flags = 8
,r DP_3 O Wetland Flags = 31
Total Flags = 41
_. ., F
HE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THE DELINEATION WAS VERIFIED BY MS. JEAN
IBBY WITH THE USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ-DWR ON JUNE 7, 2017. THEY HAVE NOT BEEN SURVEYED OR
EOLOCATED.
F1 i . K� 0 > .
Drawing 5 Wetland Map
�`.
2017 Aerial Photograph from Google, ,:� Robinhood Road
Earth and Pilot Field Notes _ - Approximate 61.2 Acre Tract
Scale: 1" = 400' PILM '! Winston-Salem, Forsyth County, NC
Date: 04.28.17 PILOT ENVIRONMfNTAL.INC Pilot Project 2770