20220229 Ver 1_401 Application_20220208

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID#* Version* 1
20220229
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: Burlington Rd/Hudson Way
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 (es)
Guilford
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
6341.1—Burlington Rd_PCN_2.8.22.pdf 11.88MB
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
PCN for 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- 2021-02294 Begin Date (Date Received): 2.8.22
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Burlington Road/Hudson Way
2. Work Type: VPrivate ❑Institutional ❑Government ❑Commercial
3. Project Description / Purpose [PCN Form 133d and 133e]:
See Attached
4. Property Owner / Applicant [PCN Form A3 or A41: See Attached
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Bradley 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]:
Burlington Road
36.07592/-79.55868
8. Project Location —Tax Parcel ID [PCN Form Bla]: See Attached
9. Project Location — County [PCN Form A2b]: Guilford
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Whitsett
11. Project Information — Nearest Waterbody [PCN Form 132a]: Back Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03030002
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 29 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:
Burlington Rd
2b.
County:
Guilford
2c.
Nearest municipality / town:
Whitsett
2d.
Subdivision name:
Hudson Way
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Keystone Group Inc.
3b.
Deed Book and Page No.
8134/00066
3c.
Responsible Party (for LLC if
applicable):
Mr. Scott Wallace
3d.
Street address:
3708 Alliance Drive
3e.
City, state, zip:
Greensboro, NC 27407
3f.
Telephone no.:
336.856.0111
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page 1 of 13
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 13
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):
8834468997
1 b. Site coordinates (in decimal degrees):
Latitude: 36.07590 Longitude: --79.55860
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
25 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Back Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS-IV, NSW
2c. River basin:
Cape Fear
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The site contains undeveloped wooded land and fields. Structures are not located on the site. The site is located within a
rural and residential area of Whitsett, Guilford County, North Carolina.
3b. List the total estimated acreage of all existing wetlands on the property:
Wetland=0.21 acres 404 & 0.27 acres non-404 isolated
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Streams=610LF
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to development the site with Hudson Way, a 116 unit townhome neighborhood.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of Hudson Way, a 116 unit townhome neighborhood. In order to facilitate
the proposed development and access the site, it is necessary to impact streams and wetlands temporarily and
permanently. 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: SAW-2021-02294
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): David Brame
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW-2021-02294 dated 12.17.21
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 13
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 13
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
Page 5 of 13
PCN Form — Version 1.3 December 10, 2008 Version

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
Fill
® Yes
❑ No
❑ Corps
® DWQ
0.27
W2 ® P ❑ T
Fill
® Yes
❑ No
® Corps
❑ DWQ
0.003
W3 ®P ❑ T
Fill
® Yes
❑ No
® Corps
❑ DWQ
0.001
W4 ❑ P ®T
Sewer
® Yes
❑ No
® Corps
❑ DWQ
0.023
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.297
2h. Comments: Wetland Impact #1 will permanently impact 0.27 acres of non-404 jurisdictional/isolated wetlands with fill. The
applicant intends to rely on a non -reporting NCDEQ-DWR IWGP100000 for Wetland Impact #1 and does not request written
approval from NCDEQ-DWR for this impact.
Wetland Impact #2 will permanently impact 146SF/0.003ac of wetlands associated with fill from the construction of a
bottomless arch culvert and head/end walls.
Wetland Impact #3 will permanently impact 60SF/0.001 ac of wetlands associated from fill from upgrades from Burlington
Road.
Wetland Impact #4 will temporarily impact 992SF/0.023ac of wetlands associated with open-cut/back-fill sewer line installation.
Areas of temporary impact will be restored to similar pre -construction grade and stabilized with natural material/biodegradable
matting and native herbaceous seed mix/live stakes.
Mitigation is not proposed for wetland impacts.
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
Temp Access
Unnamed
® PER
❑ INT
® Corps
❑ DWQ
Variable
27
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
Page 6 of 13
PCN Form — Version 1.3 December 10, 2008 Version

3h. Total stream and tributary impacts
27
3i. Comments: Stream Impact 1 will temporarily impact 27 linear feet of stream channel with a temporary stream crossing to
be utilized during construction of the site and installation of a bottomless arch culvert to be utilized as a permanent crossing.
Permanent impacts are not proposed. Areas of temporary impact will be restored to similar pre -construction grades and
stabilized with matting and native herbaceous seed mix. Mitigation is not proposed for proposed 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 7 of 13
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: Jordan
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: A buffer authorization from local delgated authority will be obtainined prior to impacts occuring.
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 neighborhood to avoid other impact to streams, wetlands and open water
ponds. The applicant has selected the stream crossing in a location in an area the stream is narrow and straight with few
meanders. The applicant designed the road crossing to utilize approximate 7-foot head/end walls and a bottomless arch
culvert that would avoid permanent fill impact to the stream.
The remaining 0.20 acres of wetlands and 583 linear feet of 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 temporary
stream crossing will be removed and stream banks will be restored to pre -construction grade, stabilized with matting and
seeded with native herbaceous seed mix. Additionally, temporary impacts to wetlands will be restored to pre -construction
grade to maintain existing hydrologic flows, stabilized with bio-degradable/natural fiber matting as needed and seeded with
native herbaceous seed mix.
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
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
Page 8 of 13
PCN Form — Version 1.3 December 10, 2008 Version

3c. Comments: The applicant does not propose mitigation for impacts to wetlands or 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 9 of 13
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: Local Delgated Authority -Part of SWMP
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
%
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why: The project is high density. A SWMP will
be be approved by Guilford County prior to impacts occuring.
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?
Guilord County
® 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 10 of 13
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 in this application are not proposed.
Page 11 of 13
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 species that could be proximate to project area:
Small whorled pogonia (Isotria medeoloides) (T).
The project area contains a field that portions are overgown with immature saplings and dense mid -story vegetion.
Suitable habitat for Small whorled pogonia is not located within the proposed project area. Therefore, we have made a
determinaton of no effect for this species.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat. Best
management practices and the construction of stormwater BMPs will prevent sediment from entering down -gradient
waterbodies which may contain fish.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ 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 identifies
GF 8174-Ingle House as a surveyed only property north of the project area. According to SHPO HPO, GF 8174-Ingle
House was determined ineligible for listing in 2013/ER11-0578. The structure identified on the SHPO HPO map as GD-
8174-Ingle House was not present on or near the project area during our site assessments. Eligible for listing or listed
properties are not identified on or within 1,000 feet of the project area. 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:
8c. What source(s) did you use to make the floodplain determination? FEMA NHFL (Drawing 4, attached)
Bradley Digitally signed by Bradley Luckey
DN: cn=Bradley Luckey, o=Pilot
2 $ 22
Bradley S. Luckey, PWS
Enviromental, Inc., ou,
Luckey email=[e-mail],c=US
Date: 2022.02.08 10:09:39-05'00'
Date
Page 12 of 13
PCN Form — Version 1.3 December 10, 2008 Version

AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address: a3a ~��r11�00-i
Se
Owner Information: K6Ve�j,J6- 6�-oop,TMC,
Address: Aul Aiq cc I.
Telephone Number: " ®1 i I
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Fax Number:
on
E-mail Address:�'���`�
JURISDICTIONAL DETERMINATION REQUEST
D. PROPERTY ACCESS CERTIFICATION
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property. 1
Print Name
Capacity: Owner _Authorized Agent
Date — 10
i7? , y911r � -pws)d4i
Signatur

Guilford County, NC - Property Report Convert to PDF 11/29/2020
Parcel ID Property Address I Legal Description
103367 7232 Burlington Rd I GREENSBORO JOINT STOCK LAND BANK L015-19
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Owner Information
Owner Name
Mailing Address
City, State Zip
KEYSTONE GROUP INC
3708 ALLIANCE DR
I GREENSBORO, NC 27407
Parcel Information
PIN
Zoning
Use
Tax District
8834488997-000
AG -Agricultural
RESIDENTIAL
0
Parcel Size
Appraisal Nbrhood
Plat/Condo Bk & P
24.50
8834ROl
9-59
Recent Sales
Book & Page
Sale Date
Sale Price
Qualified?
Improved?
00813400088
3/12/2019
$515,000
Yes
Yes
Appraisal Values
Land
Buildings Extra Features
Total Value
$147,000
$109,600 $0
$256,600
Disclaimer. Map and parcel data are believed to be accurate, but accuracy is not guaranteed. This is not a legal document
and should not be substituted for a title search, appraisal, survey, or for zoning verification.
Appraisal Detail (Building 1 of 1)
Bldg#
Description
Bldg Use
Yr Built
Eff Yr Bit
Units
1
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1932
1989
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United States Department of the Interior
FISH AND WILDLIFE SERVICE
Raleigh Ecological Services Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Phone: [phone] Fax: [phone]
In Reply Refer To:
Project Code: 2022-0004664
Project Name: Hudson Way
February 08, 2022
Subject: List of threatened and endangered species that may occur in your proposed project
location or may be affected by your proposed project
To Whom It May Concern:
Attachment(s):
• Official Species List

02/08/2022
Official Species List
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Raleigh Ecological Services Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
[phone]

02/08/2022
Project Summary
Project Code: 2022-0004664
Event Code: None
Project Name: Hudson Way
Project Type: Commercial Development
Project Description: Residential neighborhood
Project Location:
Approximate location of the project can be viewed in Google Maps: https:
www. google.com/maps/(a)36.07572295,-79.55867798550909,14z
n- ,
Counties: Guilford County, North Carolina

02/08/2022 3
Endangered Species Act Species
There is a total of 2 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
Fisheriesi, as USFWS does not have the authority to speak on behalf of NOAA and the
Department of Commerce.
See the "Critical habitats" section below for those critical habitats that lie wholly or partially
within your project area under this office's jurisdiction. Please contact the designated FWS office
if you have questions.
1. 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.
Insects
NAME
Monarch Butterfly Danaus plexippus
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9743
Flowering Plants
NAME
Small Whorled Pogonia Isotria medeoloides
Population:
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/1890
STATUS
Candidate
STATUS
Threatened
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

02/08/2022
IPaC User Contact Information
Name: Bradley Luckey
Address: 743 Park Lawn Court
City:
Kernersville
State:
NC
Zip:
27285
Email
[e-mail]
Phone:
3367084997

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LEGEND
Site Boundary
' USGS Topographic Map
Drawing 1 7232 Burlington Road
USGS Topographic Map " '
'___ - Approximate 25-Acre Tract
Gibsonville, NC Quadrangle �1. Whitsett, Guilford County, NC
Scale: 1" — 2,000' pILOT�ENVIR0NMENTAL,INC Pilot Project 6341

i
Site Boundary
Drawing 2 Web Soil Map
USDA Web Soil Survey V 7232 Burlington Road
f I Approximate 25-Acre Tract
of Guilford County, NC PILL ,
Whitsett, Guilford County, NC
Scale: 1 =400 PILOT ENVIRONMENTAL,INC Pilot Project6341

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11WhB2
4 � mow�
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Drawing 2A .;
USDA Soil Survey
of Guilford County, NC'
Published 1977, Sheet 24 and 30 PILOT
Scale: 1„=400, PILOT ENVIRONMENTAL INC
MhB?-
Oe
00440, 1
.96
r
' LEGEND
r Site Boundary
Published Soil Map
7232 Burlington Road
Approximate 25-Acre Tract
Whitsett, Guilford County, NC
Pilot Project 6341

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LEGEND
Site Boundary
-Y
Freshwater Emergent
Freshwater Forested/Shrub
Mar
Estuarine and Marine Deepv,water
;r Estuarine and Marine
Freshwater Pond
Lake
Riverire
Other
A
Drawing 3
7232 Burlington Road
USFWS NWI
-Acre Tract
Wetlands Mapper Approximate 25
Pamir Whitsett, Guilford County, NC
Scale: 1" = 400' PILOT 0 T E N V I R 0 N M E N T A L I M C
fL NWI Map
Pilot Project 6341

.Site Boundary
f";J1%Annual Chance Flood Hazard
Regulatory Floodvay
�::i� *Speaal Flood,�ray
Area of Undetermined Flood Hazard
0.2%Annual Chance Flood Hazard
•Fdure Conditions 1%Annual Chance Flood Hazard
► Area with Reduced Risk Due to Levee
Drawing 4
National Flood Hazard Layer
from FEMA Web Map Service
Scale: 1" = 400'
V
f f�-
PILOT
P I L O T E N V I R 0 N M E N T A L I N C
FEMA FIRM
7232 Burlington Road
Approximate 25-Acre Tract
Whitsett, Guilford County, NC
Pilot Project 6341

LEGEND
Site Boundary
Wetland
Perennial Stream
THE LOCATIONS OF'FEATURES
-SHOWN ON THIS MAP HAVE BEEN -,� WA 1-5 Flag Number
VERIFIED BY U3A[E ]D 3AVV 202l'02294 DATED 12.17.21.
� .2l. THIS MAP
INCLUDES GP3LOCATIONS OFDELINEATED FEATURE3� '� ���' op��� DataPoint
Drawing 5 Wetland Map
Aerial Imagery from ESR| 7232Burlington Road
and Pi|otGPS Data `` Approximate 25-AcreTract
Scale: 1"= 250' PILOT VVhitsett,Guilford County, NC

.-�L ai'mDM ILIA,
23
W B 1- 13
0.21 Ac.
RUG 91D-v W
,J 7,0
Site Boundary
Wetland
Perennial Stream
LOCATIONS OF FEATURES SHOWN ON THIS MAP HAVE BEEN WA 1-5 Flag Number
FIED BY USACE JD SAW-2021-02294 DATED 12.17.21. THIS MAP AM
DP-1 0 Data Point
UIDES GPS LOCATIONS OF DELINEATED FEATURES.
.
Drawing 5
Wetland Map
2018 Aerial Imagery from ESRI 7232 Burlington Road
and Pilot GPS Data Approximate 24.5-Acre Tract
Scale: 1" = 250'�DDWhitsett, Guilford County, NC
Date: 12.17.21 1 P I LOT E N V I R ON MENTAL,IMC Pilot Project 6341

9
DP-1 Q
USACE NON-404 Wetland
WA 1-8
0.24 Ac.
1113 GM117e�7
THE LOCATIONS OF FEATURES SHOWNM ON THIS MAP HAVE BEEN
VERIFIED BY USACE JD SAW-2021-02294 DATED 12.17.21. THIS MAP
INCLUDES GPS LOCATIONS OF DELINEATED FEATURES.
Drawing 5.1
2018 Aerial Imagery from ESRI
and Pilot GPS Data PLOT --
Scale: 1" = 50'
P I L O T E N V I R O N M E N T A L, I N C
Date: 12.17.21
USACE PJD Area
N
Site Boundary
Wetland
Perennial Stream
WA 1-5 Flag Number
DP-1 Q Data Point
Wetland Map
7232 Burlington Road
Approximate 0-5-Acre Tract
Whitsett, Guilford County, NC
Pilot Project 6341