20220455 Ver 1_401 Application_20220318

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20220455
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: Trinity Meadows
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)
Randolph
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
4660.1-Trinity Meadows -Finch Farm Rd_USACE
28.29MB
PCN and JD Request_3.18.22.pdf
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:
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]: Finch Farm Rd
2. Work Type:
Private ❑ Institutional
Begin Date (Date Received):
Assign Action ID Number in ORM n
Government
3. Project Description / Purpose [PCN Foitii B3d and B3e]:
The site is being considered for development with a residential subdivision.
Commercial
4. Property Owner / Applicant [PCN Form A3 or A4]: Keystone Group, Inc.
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
David Brame/Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location — Coordinates, Street Address, and/or Location Description [PCN Folios B lb]:
Finch Farm Road
35.865630 ° /-80.026378 °
8. Project Location — Tax Parcel ID [PCN Form Bla]: 6797412387, 6797519006 and 6797613814
9. Project Location — County [PCN Form A2b]: Randolph
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Trinity
11. Project Information — Nearest Waterbody [PCN Form B2a]: Little Uwharrie River (Wheatmore Pond)
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]: Lower Yadkin/03040103
Authorization: Section 10 ❑ Section 404 n Section 10 and 404 n
Regulatory Action Type:
F7Standard Permit ❑ Pre -Application Request
✓ Nationwide Permit # F7 Unauthorized Activity
Regional General Permit # n Compliance
Jurisdictional Determination Request ri No Permit Required
Revised 20150602

NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. [Click to enter.]
DWR project no. Click enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.865239°
Longitude (DD.DDDDDD): 80.027400°
Form Version 1.5, September 2020
Date received: [Click to enter.]
Date received: [Click to enter.]
Pre -Construction Notification (PCN) Form
(Ver. 1.5, September 2020)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all mandatory
questions are answered.
The online help file may be found at this link:
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
The help document may be found at this link:
http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as DWR will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used to satisfy 40
C.F.R. Section 121.4(a) which states "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to the certifying authority
at least 30 days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
DWR ID # Click to enter. Version Click to enter. (If applicable)
A. Processing Information
County (counties) where project is located: *
Randolph Additional (if needed).
Is this a public transportation project? *
(Publicly funded municipal, state, or federal road, rail,
or airport project)
❑ Yes ❑x No
Is this a NCDOT project? *
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number: *
Click to enter.
1 a.
Type(s) of approval sought from the Corps:
III Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Page 1 of 21
PCN Form - Version 1.5, September 2020

1b. Permit type(s)?
El Nationwide Permit (NWP)
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as separate attachments
and submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes 0 No
NWP number(s):
NWP 29
RGP number(s):
Click to enter
1d. Type(s) of approval sought from the DWR (check all that apply):
0 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
1 e. Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: *
❑ Yes 0 No
For the record only for Corps Permit:
❑ Yes 0 No
1f. Is this an after -the -fact permit/certification application?
❑ Yes 0 No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
� Yes 0 No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h. Is the project located in any of NC's twenty coastal counties?
❑ Yes 0 No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
Yes 0 No Unknown
1j. Is the project located in a designated trout watershed?
❑ Yes 0 No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 2 of 21 PCN Form - Version 1.5, September 2020

B. Applicant Information
1 a.
Who is the primary contact? *
Scott Wallace
lb.
Primary Contact Email: *
[e-mail]
lc.
Primary Contact Phone: * (###)###-####
[phone]
1 d.
Who is applying for the permit/certification?
all that apply)
(check
@ Owner ❑Applicant (other than owner)
le.
Is there an agent/consultant for this project?
0 Yes ❑ No
2. Landowner Information
2a. Name(s) on Recorded Deed: *
Keystone Group Inc.
2b. Deed Book and Page No.:
002753-01955 and 002753-01955 and 002753-01955
2c. Responsible Party (for corporations):
Scott Wallace
2d. Address i
Street Address:
3708 Alliance Drive
Address line 2:
Click to entr.
City:
Greensboro
State/ Province/ Region:
NC
Postal/ Zip Code:
27407
Country:
United States
2e. Telephone Number: * (t/##)#tttt-####
[phone]
2f. Fax Number: (###)###-####
Click to enter
2g. Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
Same as LO
3b.
Business Name (if applicable):
Click to enter.
3c.
Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
Page 3 of 21
PCN Form - Version 1.5, September 2020

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

C. Project Information and Prior Project History
1.
Project Information
1 a.
Name of project: *
Trinity Meadows
1 b.
Subdivision name (if appropriate):
none
lc.
Nearest municipality/town: *
Trinity, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
6797613814 and 6797519006 and 6797412387
2b.
Property size (in acres):
106-Acre
2c.
Project Address:
Street Address:
Finch Farm Road
Address line 2:
Click to enter.
City:
Trinity
State/ Province/ Region:
NC
Postal/ Zip Code:
27406
Country:
U.S.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.865239°
Longitude (-DD.DDDDDD): *-80.027400°
3.
Surface Waters
3a.
Name of nearest body of water to proposed project: *
Uwharrie River
3b.
Water Resources Classification of nearest receiving
water: *
WS-III
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
3c.
In what river basin(s) is your project located?*
Yadkin-PeeDee
Choose additional (if needed)
3d.
Please provide the 12-digit HUC in which the project is
located: *
030401030402
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85a0c6d644a0b97cd069db238ac3
Page 5 of 21 PCN Form - Version 1.5, September 2020

4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application: *
The site contains wooded land and agricultural fields. The site is currently undeveloped. Ponds are not
located on the site. Streams are located throughout the site. The majority of the streams have
continuous and well-defined channels, evidence of ordinary high water marks, meanders, evidence of
aquatic fauna and flowing water. Based on the stream characteristics, they appear to be perennial
with the exception of streams ISAD and ISAF. Streams ISAD and ISAF did not contain aquatic fauna
and contained little to no flow at the time of our site visit. Streams ISAD and ISAF appear to be
intermittent. Wetlands are located adjacent to the streams in several areas. The wetlands are
separated from surrounding uplands by distinct topographic, vegetative, and/or soil breaks. The
surrounding properties consists of a highway, residential and commercial properties.
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past? *
0 Yes x❑ No Unknown
4c. If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
[Click to enter.]
.[Click to enter.]
Attach any pertinent project history documentation
4d. Attach an 8% x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8% x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
property:
2.103 acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property:
9,260 linear feet
4g1. List the total estimated acreage of all existing open waters on the
property:
0 acres
4h. Explain the purpose of the proposed project:
The purpose of the proposed project is to construct a residential subdivsion.
4i. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of the Trinity Meadows residential subdivision. The residential subdivision
will consist of 214 townhome units and associated amenities and 98 single family residential lots. The site will be
located on 106 acres and contain 2.9 units per acre with 26.5 built upon acres. The site will contain 3 permanent
stormwater ponds. The site will connect to existing sewer infrastructure in 4 locations. One culverted stream crossing
is proposed in order to facilitate the proposed development and provide access to the northern portion of the site. To
facilitate the development of the site, clearing and grading the site is necessary. Graders, haulers, excavators and
other heavy equipment will be used during grading and construction of the site.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or in
proposed impact areas?
Yes ❑ No ❑ Unknown
Comments:
The site was delineated by Pilot Environmental in May, 2019.
Page 6 of 21
PCN Form - Version 1.5, September 2020

5b. If 5a is yes, who delineated the jurisdictional
areas?
Name (if known): David Brame/Michael Brame
Agency/Consultant Company: Pilot Environmental
Other: Click to enter
5c. If the Corps made a jurisdictional determination,
what type of determination was made?
❑ Preliminary ❑ Approved ❑ Emailed Concurrence
x❑ Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
Click to enter
5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
UIICK to enter.
5d1. Attach jurisdictional determinations.
Page 7 of 21 PCN Form - Version 1.5, September 2020

6. Future Project Plans
6a. Is this a phased project?
0 Yes El No
6b. If yes, explain.
The site is a proposed single phase development. No additional phases are proposed or anticipated.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to authorize
any part of the proposed project or related activity? This includes other separate and distant crossings for linear
projects that require Department of the Army authorization but don't require pre -construction notification.
No other permits are intended to be used.
Page 8 of 21 PCN Form - Version 1.5, September 2020

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

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #*
3a.
Impact Reason/
Type
3b.
Impact
Duration
3d.
Stream Name"
3e.
Stream
Type
3f.
Jurisdiction
Type
3g.
Stream Width
(avg ft)
3h.
Impact length
(linear ft)
S1
Crossing/ Culvert
Permanent
SA
Perennial
Both
6.65
114
S2
Fill (Incl. Riprap)
Permanent
SA
Perennial
Both
6.65
14
S3
Dewatering
Temporary
SA
Perennial
Both
6.29
7
S4
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch impact:
Click to enter. linear ft
3i2. Total permanent stream impacts:
128 linear ft
3i3. Total temporary stream impacts:
7 linear ft
3i4. Total stream and ditch impacts:
35 linear ft
3j. Comments:
The proposed stream crossing will permamently impact 114 If (759 SF) of stream with the culvert and headwalls
and endwalls; permanelty impact 14 If (96 SF) of stream with rip rap that will be keyed into the stream bed at
existing elevation; and, temporary impact 7 If (44 SF) of stream with a coffer dam for dewatering during
construction.
Page 10 of21 PCN Form - Version 1.5, September 2020

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
Site #
4b.
Impact Reason/
Type
4c.
Impact
Duration
4d.
Waterbody Name
4e.
Waterbody
Type
4e1.
Jurisdiction
Type
4f.
Impact area (ac)
01
Choose one
Click to enter.
Choose one
Choose one
Click to enter
02
Choose one
amps
Perm
Click to enter.
Choose one
Choose one
Click to enter
03
Choose one
Temp/
Perm
Click to enter.
Choose one
Choose one
Click to enter
04
Choose one
Temp/
Perm
Click to enter.
Choose one
Choose one
Click to enter
4g. Total temporary open water impacts
Click to enter. ac
4g. Total permanent open water impacts
Click to enter. ac
4g. Total open water impacts
Click to enter. ac
4h. Comments:
Open water impacts are not proposed.
5. Pond or Lake Construction
If pond or lake construction is proposed, complete the table below. (*This does NOT include offline stormwater
management ponds.)
5a.
Pond ID
#
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (ac)
5d.
Stream Impacts (ft)
5e.
Upland
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
UIIcK to
enter.
P2
Choose one
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
5f. Total
Click to
en+cr
Click to
erifnr
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
5g. Comments:
Pond or lake construction is not proposed.
5h. Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i. Expected pond surface area (acres):
Click to enter.
5j. Size of pond watershed (acres):
Click to enter.
5k. Method of construction:
Click to enter.
Page 11 of21 PCN Form - Version 1.5, September 2020

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
* (Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: .6K to entE
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
B1
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
The project is located within the Yadkin — Pee Dee basin. Buffer impacts are not proposed.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of21 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1.
Avoidance and Minimization
1 a.
Specifically describe measures taken to avoid or minimize the proposed impacts through project design: *
The applicant has designed the proposed development to avoid impacts to wetlands and the remaining streams
located on the site. In order to access the northern portion of the site, the proposed impact could not be avoided as
there is no other potential access without crossing streams or wetlands.
1 b.
Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques: *
Headwalls and endwalls will be constructed to minimize the length of culvert required. The clearing limits will be
surveyed, staked and silt fencing and clearing limit fencing will be used. Disturbed areas will be seeded and mulched
to limit sediment from entering downgradient waters. Slope matting will be used on steep slopes.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? *
(check all that apply)
❑ DWR ❑ Corps
2b. If yes, which mitigation option(s) will be used for this
project? * (check all that apply)
❑ Mitigation Bank
❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank (Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Mitigation is not proposed
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested:
Click to enter linear feet
4c. If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO:RP:P27 BUTTON KEY:O
4d. Buffer mitigation requested (DWR only):
Click to enter. square feet
4e. Riparian wetland mitigation requested:
Click to enter. acres
4f. Non -riparian wetland mitigation requested:
Click to enter. acres
4g. Coastal (tidal) wetland mitigation requested:
Click to enter. acres
Page 13 of21
PCN Form - Version 1.5, September 2020

4h. Comments:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including the amount of mitigation proposed.
,lick to enter
5b. Attach mitigation plan/documentation.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a. Will the project result in an impact within a protected riparian buffer
that requires buffer mitigation?
® Yes x❑ No
If yes, please complete this entire section — please contact DWR for more information.
6b. If yes, identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required in the table below.
Zone
6c.
Reason for impact
6d.
Total impact (square
feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g. If buffer mitigation is required, is payment to a mitigation bank or
NC Division of Mitigation Services proposed?
❑ No
►1 Yes
6h. If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i. Comments:
Buffer mitigation is not proposed.
Page 14 of21 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers
identified within one of the NC Riparian Buffer Protection Rules?
� Yes ❑x No
1 b.
All buffer impacts and high ground impacts require diffuse flow or other forms of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
What Type of SCM are you
providing?
(Check all that apply)
❑ Level Spreader
IIIVegetated Conveyance (lower seasonal high water table- SHWT)
❑ Wetland Swale (higher SHWT)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here:
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
❑Yes ❑x No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?*
El Yes ❑x No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20quality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
IS the project over an acre?
❑x Yes ❑ No
2d.
Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state-
approved local government stormwater program?
❑x Yes ❑ No
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2e.
Which of the following stormwater management program(s) apply?
(Check all that apply) *
x❑ Local Government
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Page 15 of21
PCN Form - Version 1.5, September 2020

Local Government Stormwater Programs *
El Phase II
❑ NSW
El USMP
x❑ Water Supply
Please identify which local government stormwater program you are using.*
Trinity
State Stormwater Programs *
El Phase II
❑ Coastal Counties
El HOW or ORW
❑ Other
Comments:
A SWMP has been submitted to Trinity for review and approval.
Page 16 of 21 PCN Form - Version 1.5, September 2020

G. Supplementary Information
1.
Environmental Documentation
la.
Does the project involve an expenditure of public (federal/state/local)
funds or the use of public (federal/state) land?
❑ Yes
x❑ No
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 (North Carolina) Environmental
Policy Act (NEPA/SEPA)?
❑ Yes
❑ No
lc.
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 letter.)
❑ Yes
❑ No
Comments:
A NEPA or SEPA is not required.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
DWR Surface Water or Wetland Standards or Riparian Buffer Rules
(15A NCAC 2B .0200)?
❑ Yes x❑ No
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
;lick to enter.
3.
Cumulative Impacts (DWR Requirement)
3a.
Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
downstream water quality? *
❑ Yes x❑ No
3b.
If you answered "no", provide a short narrative description:
Additional development as a result of the proposed development is not anticipated.
3c.
If yes, attach a qualitative or quantitative cumulative impact analysis (.pdf) in accordance with the most recent
DWR policy.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
Yes ❑No ❑N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Sewage will be discharged into existing sewer lines that are located throughout the site. Additional impacts associated
with sewage disposal are not proposed.
Page 17 of21
PCN Form - Version 1.5, September 2020

5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will this project occur in or near an area with federally protected
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ [fws.gov])*
►1 Yes ❑ No
5b.
Have you checked with the USFWS concerning Endangered SpeciesEl
Act impacts?
Yes x❑ No
5c.
If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d.
Is another federal agency involved?
❑ Yes x❑ No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e.
Is this a DOT project located within Divisions 1-8? *
❑ Yes x❑ No
5f.
Will you cut any trees in order to conduct the work in waters of the
U.S.?
Yes ❑ No
5g.
Does this project involve bridge maintenance or removal? *
❑ Yes x❑ No
Link to NLEB SLOPES document: http://saw-req.usace.armv.mil/NLEB/1-30-17-signed NLEB-
SLOPES&apps.pdf
5h.
Does this project involve the construction/ installation of a wind
turbine(s)? *
El Yes El No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i.
Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?
❑ Yes x❑ No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j.
What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat?
US Department of the Interior — Fish and Wildlife Service Official Species List from IPaC
3 listed species are identified on the IPaC report (attached). The Schweinitz's Sunflower, Monarch butterfly and
Atlantic pigtoe are included by the IPaC as federally listed species identified within the project area. Neither the
crossing nor the areas proximate to the crossing contain suitable habitat for these species. According to the natural
heritage program, documented occurrences of Schweinitz's sunflower are located 6.5 miles and further from the site.
Documented occurrences of the Atlantic pigtoe are located 9.5 aerial miles and further and not within waters that
receive drainage from the site.
Attach consultation documentation.
6.
Essential Fish Habitat (Corps Requirement)
6a.
Will this project occur in or near an area designated as
an Essential Fish Habitat?
III Yes
El No
Are there submerged aquatic vegetation (SAV) around
the project vicinity? *
❑ Yes
❑x No
❑ Unknown
Page 18 of21
PCN Form - Version 1.5, September 2020

Will this project affect submerged aquatic vegetation?
❑ Yes x❑ No ❑ Unknown
Explain: Click to enter.
6b.
What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper — NOAA Fisheries
Page 19 of21 PCN Form - Version 1.5, September 2020

7.
Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis.ncdcr.gov/hpoweb/
7a.
Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)?
0 Yes El No
7b.
What data source(s) did you use to determine whether your site would impact historic or archeological
resources?
NC Historic Preservation Office's HPOWEB 2.0. Historic properties were not identified on the site or proximate to
stream crossing. A copy of the SHPO Map is included as an attachment.
7c.
Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
0] Yes
El No
8b. If yes, explain how the project meets FEMA requirements.
:lick to enter
8c. What source(s) did you use to make the floodplain determination?
National Flood Hazard Layer from FEMA Web Map Service — Drawing 4 (Attached)
Page 20 of21 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
Please let me know if you need additional information in order to process this application.
Attach pertinent documentation or attachments not previously requested
I. Signature*
x❑ By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * David S. Brame
Signature: * 1 g
3/18/2022
Page 21 of 21 PCN Form - Version 1.5, September 2020

n
Proposal for Environmental Services
Pilot Proposal 4660.1
January 26, 2022
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:
Owner Information:
Address:
Telephone Number:
Fax Number:
E-mail Address:
Trinity Meadows - Finch Farm Road
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.
Scott Wallace
Print Name
Capacity: "Owner Authorized Agent
Date ker9(0,74e
Signatur
5

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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: 2022-0021171
Project Name: Trinity Meadows
March 17, 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:
The enclosed species list identifies threatened, endangered, proposed and candidate species, as
well as proposed and final designated critical habitat, that may occur within the boundary of your
proposed project and/or may be affected by your proposed project. The species list fulfills the
requirements of the U.S. Fish and Wildlife Service (Service) under section 7(c) of the
Endangered Species Act (Act) of 1973, as amended (16 U.S.C. 1531 et seq.).
New information based on updated surveys, changes in the abundance and distribution of
species, changed habitat conditions, or other factors could change this list. Please feel free to
contact us if you need more current information or assistance regarding the potential impacts to
federally proposed, listed, and candidate species and federally designated and proposed critical
habitat. Please note that under 50 CFR 402.12(e) of the regulations implementing section 7 of the
Act, the accuracy of this species list should be verified after 90 days. This verification can be
completed formally or informally as desired. The Service recommends that verification be
completed by visiting the ECOS-IPaC website at regular intervals during project planning and
implementation for updates to species lists and information. An updated list may be requested
through the ECOS-IPaC system by completing the same process used to receive the enclosed list.
The purpose of the Act is to provide a means whereby threatened and endangered species and the
ecosystems upon which they depend may be conserved. Under sections 7(a)(1) and 7(a)(2) of the
Act and its implementing regulations (50 CFR 402 et seq.), Federal agencies are required to
utilize their authorities to carry out programs for the conservation of threatened and endangered
species and to determine whether projects may affect threatened and endangered species and/or
designated critical habitat.
A Biological Assessment is required for construction projects (or other undertakings having
similar physical impacts) that are major Federal actions significantly affecting the quality of the
human environment as defined in the National Environmental Policy Act (42 U.S.C. 4332(2)
(c)). For projects other than major construction activities, the Service suggests that a biological

03/17/2022 2
evaluation similar to a Biological Assessment be prepared to determine whether the project may
affect listed or proposed species and/or designated or proposed critical habitat. Recommended
contents of a Biological Assessment are described at 50 CFR 402.12.
If a Federal agency determines, based on the Biological Assessment or biological evaluation, that
listed species and/or designated critical habitat may be affected by the proposed project, the
agency is required to consult with the Service pursuant to 50 CFR 402. In addition, the Service
recommends that candidate species, proposed species and proposed critical habitat be addressed
within the consultation. More information on the regulations and procedures for section 7
consultation, including the role of permit or license applicants, can be found in the "Endangered
Species Consultation Handbook" at:
http://www.fws.gov/endangered/esa-library/pdfiTOC-GLOS.PDF
Migratory Birds: In addition to responsibilities to protect threatened and endangered species
under the Endangered Species Act (ESA), there are additional responsibilities under the
Migratory Bird Treaty Act (MBTA) and the Bald and Golden Eagle Protection Act (BGEPA) to
protect native birds from project -related impacts. Any activity, intentional or unintentional,
resulting in take of migratory birds, including eagles, is prohibited unless otherwise permitted by
the U.S. Fish and Wildlife Service (50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)). For more
information regarding these Acts see https://www.fws.gov/birds/policies-and-regulations.php.
The MBTA has no provision for allowing take of migratory birds that may be unintentionally
killed or injured by otherwise lawful activities. It is the responsibility of the project proponent to
comply with these Acts by identifying potential impacts to migratory birds and eagles within
applicable NEPA documents (when there is a federal nexus) or a Bird/Eagle Conservation Plan
(when there is no federal nexus). Proponents should implement conservation measures to avoid
or minimize the production of project -related stressors or minimize the exposure of birds and
their resources to the project -related stressors. For more information on avian stressors and
recommended conservation measures see https://www.fws.gov/birds/bird-enthusiasts/threats-to-
birds.php.
In addition to MBTA and BGEPA, Executive Order 13186: Responsibilities of Federal Agencies
to Protect Migratory Birds, obligates all Federal agencies that engage in or authorize activities
that might affect migratory birds, to minimize those effects and encourage conservation measures
that will improve bird populations. Executive Order 13186 provides for the protection of both
migratory birds and migratory bird habitat. For information regarding the implementation of
Executive Order 13186, please visit https://www.fws.gov/birds/policies-and-regulations/
executive-orders/e0-13186. php.
We appreciate your concern for threatened and endangered species. The Service encourages
Federal agencies to include conservation of threatened and endangered species into their project
planning to further the purposes of the Act. Please include the Consultation Code in the header of
this letter with any request for consultation or correspondence about your project that you submit
to our office.

03/17/2022 3
Attachment(s):
• Official Species List

03/17/2022 1
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]

03/17/2022 2
Project Summary
Project Code: 2022-0021171
Event Code: None
Project Name: Trinity Meadows
Project Type: Residential Construction
Project Description: The site is an approximate 106 acre located in Trinity, Randolph County,
NC and is being developed with a residential subdivision. A stream
crossing and USACE permit are required to access a portion of the site.
Project Location:
Approximate location of the project can be viewed in Google Maps: https://
www.goog1e.com/maps/@35.86562275,-80.02764660598154,14z
:uanrl
Gaaniry
CNd
T.
c
Counties: Randolph County, North Carolina

03/17/2022 3
Endangered Species Act Species
There is a total of 3 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
Fisheriesl, 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.
Clams
NAME
Atlantic Pigtoe Fusconaia masoni
There is final critical habitat for this species. The location of the critical habitat is not available.
Species profile: https://ecos.fws.gov/ecp/species/5164
Insects
NAME
Monarch Butterfly Danaus plexippus
No critical habitat has been designated for this species.
Species profile: https://ecos.fws.gov/ecp/species/9743
Flowering Plants
NAME
STATUS
Threatened
STATUS
Candidate
STATUS
Schweinitz's Sunflower Helianthus schweinitzii
No critical habitat has been designated for this species.
Species profile: https://ecos.fws.gov/ecp/species/3849
Endangered
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

03/17/2022 4
IPaC User Contact Information
Agency: Pilot Environmental, Inc
Name: David Brame
Address: 743 Park Lawn Court
City: Kernersville
State: NC
Zip: 27284
Email [e-mail]
Phone: [phone]

Alexander
Gray House
T.A. Finch
House
(Gone?)
T.J. Finch
House
(Gone?)
Underwocd
Farm
Jeduthan
Harper
Source: Esri. UicitaICIobe. 3ecEye. Earthstar3eographics. CH E SiAirbus DS. USDA.
USCS.AEX, Getmapping.Aeregrid, I3hi. 13P. srisstopo.and the CIS User
Community

Legend
NCHPOpoints
• <all other values>
Status, LocalStat, HDstatus
• National Register individual listing
N NR and Local Landmark
• NR Listing, Gone
• NR and Landmark, Gone
* NR Historic District center point
Study List individual entry
❑ SL and Landmark
• SL entry, Gone
O SL and Landmark, Gone
* SL Historic District center point
SL and DOE
I1 SL, DOE, and Landmark
♦ SL and DOE, Gone
IA SL, DOE, Landmark, Gone
• SL and DOE Historic District center point
♦ Determined Eligible - DOE
n DOE and Landmark
♦ DOE, Gone
■ DOE, Landmark, Gone
* DOE Historic District center point
Surveyed Only
r 7 Surveyed, Local Landmark
Surveyed in NRHD
r7 Surveyed, Landmark, in NRHD
• Surveyed, Gone
• Surveyed in NRHD, Gone
7 Surveyed Landmark, Gone
M Surveyed, Landmark, NRHD, Gone
Blockface
Blockface in NRHD
Surveyed Area center point
Surveyed Area center point in NRHD
* Local Historic Distric center point
NCHPO NR SL DOE Boundaries
STATUS
El NR
El NRD
El SL
SLDOE
El DOE
.• Local_ District_ Boundaries
QSite Boundary

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW -
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Finch Farm Rd
2. Work Type: Private ❑ Institutional Government
3. Project Description / Purpose [PCN Foitii B3d and B3e]:
The site is being considered for development with a residential subdivision.
Begin Date (Date Received):
Assign Action ID Number in ORM n
Commercial
4. Property Owner / Applicant [PCN Form A3 or A4]: Keystone Group, Inc.
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
David Brame/Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location — Coordinates, Street Address, and/or Location Description [PCN Folios B lb]:
Finch Farm Road
35.865630 ° /-80.026378 °
8. Project Location — Tax Parcel ID [PCN Form Bla]: 6797412387, 6797519006 and 6797613814
9. Project Location — County [PCN Form A2b]: Randolph
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Trinity
11. Project Information — Nearest Waterbody [PCN Form B2a]: Little Uwharrie River (Wheatmore Pond)
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]: Lower Yadkin/03040103
Authorization: Section 10 ❑ Section 404 n Section 10 and 404 n
Regulatory Action Type:
F7Standard Permit ❑ Pre -Application Request
Nationwide Permit # F7 Unauthorized Activity
Regional General Permit # n Compliance
Jurisdictional Determination Request ri No Permit Required
Revised 20150602

Jurisdictional Determination Request
US Army Corps
of Engineers
VVil•niri5Ely n Dieari
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www. saw.usace.army.mil/Missions/RegulatoryPermitProgram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
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 also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: Finch Farm Road
City, State: Trinity, NC
County: Randolph
Parcel Index Number(s) (PIN): See Attached
B. REQUESTOR INFORMATION
Name: David Brame, Pilot Environmental, Inc.
Mailing Address: Post Office Box 128
Telephone Number:
Electronic Mail Address:
Select one:
Kernersville, NC 27285
336-310-4527
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION`
Name: Keystone Group, Inc. - Scott Wallace
Mailing Address: 3708 Alliance Drive
Greensboro, NC 27407
Telephone Number: 336-362-1997
Electronic Mail Address: [e-mail]
I Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GTS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION3,4
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.
See Attached
Print Name
Capacity: ❑ Owner ❑ Authorized Agents
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
nI intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
nI intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
nI intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
nA Corps JD is required in order obtain my local/state authorization.
nI intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
1
I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
Size of Property or Review Area 106 acres.
nThe property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017
Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
n
Project Coordinates (Decimal Degrees): Latitude: 35.865630°
Longitude: -80.026378°
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 11x17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
• North Arrow
• Graphical Scale
• Boundary of Review Area
• Date
• Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
• Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
• Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
• Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
• Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Pro gram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
Completed appropriate Jurisdictional Determination fottii
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDs, please complete an Approved Jurisdictional Determination Form'
✓❑ Vicinity Map
Aerial Photograph
USGS Topographic Map
n Soil Survey Map
u
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
nOther Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/JD/RGL 08-02 App A Prelim JD Form fillable.pdf
' Please see http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department ofJustice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's web site
and on the Headquarters USAGE web site.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

n
Proposal for Environmental Services
Pilot Proposal 4660.1
January 26, 2022
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:
Owner Information:
Address:
Telephone Number:
Fax Number:
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.
Print Name
Capacity: "Owner Authorized Agent
Date ker9(0,74e
Signatur
5

Drawing 1
USGS Topographic Map
High Point West and Fair Grove,
NC Quadrangles
Scale: 1" = 2,000'
PILOT .
PILOT E N P i R O' M E N T A L, I N C
USGS Topographic Map
Finch Farm Road
Approximate 106-Acre Tract
Trinity, Randolph County, NC
Pilot Project 4660.1

Drawing 2
USDA Web Soil Survey
of Randolph County, NC
Scale: 1" = 800'
PILOT
PILOT I N V I R O Y M E N T A L, 113 C
LEGEND
Site Boundary
Web Soil Map
Finch Farm Road
Approximate 106-Acre Tract
Trinity, Randolph County, NC
Pilot Project 4660.1

Drawing 2A
USDA Published Soil Survey
of Randolph County, NC
Published 2006,
Sheet 6
Not to Scale
PILOT E N V i R O Y M E N T A L, 1 13 C
Published Soil Map
Finch Farm Road
Approximate 106-Acre Tract
Trinity, Randolph County, NC
Pilot Project 4660.1

410
111406-11,110
•
r
,0y , } -
or:,..wM ,J E .1".:
,a !-* t irk
- 16:44,
i
ff�
LEGEND
Site Boundary
Freshwater Emergent
Freshwater Forested/Shrub
Estuarine and Marine Deepwater
Estuarine and Marine
Freshwater Pond
Lake
Riverine
Other
Drawing 3
USFWS NWI
Wetlands Mapper
Scale: 1" = 800'
PILOT
PILOT I N V I R O Y M E N T A L, 113 C
NWI Map
Finch Farm Road
Approximate 106-Acre Tract
Trinity, Randolph County, NC
Pilot Project 4660.1

IMF
PANEL
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eff. 3' 16'20O{,}
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371 Off? )7OOJ
eff. 11212008
PANEL,
- '3,710670600J
,eff. 11212008
LEGEND
Site Boundary
1 %Annual Chance Flood Hazard
t• 1111Regulatory Floodvay
Sped al Floodvay
Area of Undetermined Flood Hazard
0.2%Annual Chance Flood Hazard
Ftture Conditions 1 %Annual Chance Flood Hazard
I4 Area with Reduced Risk Due to Levee
=V1
Drawing 4
National Flood Hazard Layer
from FEMA Web Map Service
Scale: 1" = 800'
PILOT
PILOT E N V i R O Y M E N T A L, I N C
FEMA FIRM
Finch Farm Road
Approximate 106-Acre Tract
Trinity, Randolph County, NC
Pilot Project 4660.1

Fir
LEGEND
SADA/
660 LF
SCA
WAD 9-18 ISAD WC 18-27 40 LF
0.15 ac. /, 150 LF WAD 19-26 0.57 ac.
/0.10 ac.
• /SAD
���((( 510 LF
WAD 1-8 SAA
0.33 ac. 210 LF
SAB2
WA 18-26 120 LF
0.11 ac.
SABZ
60LF��
WA 12-17
0.054 ac.
Site Boundary
Perennial Stream
Intermittent Stream
Wetland
Data Point
Flag Number/Feature ID
DP-1 0
WCB 1-4/
0.013 ac.
-1\
WA 1-11
0.19 ac.
ISAF
40 LF
4,890 LF
SAE
380 LF
\
SC
550 LF
WC 1-17
0.54 ac.
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY THE USACE. THEY HAVE NOT
BEEN SURVEYED. DELINEATION CONDUCTED BY PILOT PERSONNEL ON 5.8.19.
S
Drawing 5
2018 Aerial Imagery from ESRI
and Pilot GPS Data
Scale: 1" = 700'
Date: 5.9.19
PILOT
PILOT I N V I R O Y M E N T A L, 113 C
Wetland Map
Finch Farm Road
Approximate 106-Acre Tract
Trinity, Randolph County, NC
Pilot Project 4660.1

WA 1-11 North Carolina
WA 12-17 North Carolina
WA 18-26 North Carolina
WAD 1-8 North Carolina
WAD 9-18 North Carolina
WAD 19-26 North Carolina
WB 1-5 North Carolina
WC 1-17 North Carolina
WAC 18-27 North Carolina
WCB 1-4 North Carolina
ISAF North Carolina
SAE North Carolina
SA North Carolina
59 North Carolina
5C North Carolina
5CA North Carolina
5C9 North Carolina
SAD North Carolina
!SAD North Carolina
SADA North Carolina
SAA North Carolina
SA91 North Carolina
SAB2 North Carolina
Cowardn_Code
PFO RIVERINE Area
P FO RIVERINE Area
P FO RI VERINE Area
P FO RI VERINE Area
P FO RI VERINE Area
P FO RI VERINE Area
P FO RI VERINE Area
P FO RI VERINE Area
P FO RI VERINE Area
P FO RI VERINE Area
R4 I4 VERINE Linear
R5 RI VERINE Linear
R5 RI VERINE Linear
R5 RI VERINE Linear
R5 RI VERINE Linear
R5 RI VERINE Linear
R5 RI VERINE Linear
R5 RIVERINE Linear
R4 RIVERINE Linear
R5 RIVERINE Linear
R5 RIVERINE Linear
R5 RIVERINE Linear
R5 RIVERINE Linear
019 ACRE PJD404
0054 ACRE PJ0404
011 ACRE PJ0404
033 ACRE PJ0404
015 ACRE PJ0404
01 ACRE PJ0404
0046 ACRE PJ0404
054 ACRE PJ0404
057 ACRE PJ0404
0013 ACRE PJ0404
40 FOOT PJ0404
380 FOOT PJ0404
4,898 FOOT PJ0404
620 FOOT PJ0404
550 FOOT PJ0404
40 FOOT PJ0404
1,030 FOOT PJ0404
510 FOOT PJ0404
150 FOOT PJ0404
660 FOOT PJD404
210 FOOT PJD404
60 FOOT PJD404
120 FOOT PJD404
NWPR_Beiermine_Code
35863260° -80029073°
35862902° -80030334°
35863204° -80029645°
35865122° -80029075°
35865524° -80029645°
35865360° -80029045°
3586596T -80023675°
35865281° -80025480°
35865338° -80025766°
3586462T -80026339°
35867674° -80018866°
35867523° -80022683°
35866893° -80021273°
35866550° -80023121°
3586612T -80023635°
35865941° -80024827
35863844° -80026366°
35864945° -80028766°
35865736° -80029717
35865863° -80030767
35863944° -80028953°
35862960° -80030151°
35863578° -80029126°
Uwharrie River
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver
Uwharrie Rver

U.S. Army Corps of Engineers
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R
Requ/cement Control Symbol
EXEMPT
(Authority: AR 33545,
paragraph 5-2a)
Project/Site: Finch Farm Road
Applicant/Owner: Keystone
City/County: Trinity/Randolph
Investigator(s): DB/SH - Pilot
Landform (hillside, terrace, etc.): Floodplain
Section, Township, Range:
Sampling Date: 5.8.19
State: NC Sampling Point: DP-1
Local relief (concave, convex, none): Concave Slope (%): 1
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 35.865272°
Soil Map Unit Name: Mecklenburg loam (MaC)
Long: -80.025403° Datum: wgs 84
Are climatic / hydrologic conditions on the site typical for this time of year?
NWI classification: none
Yes X No (If no, explain in Remarks.)
Are Vegetation , Soil , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation , Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Yes X No
Yes X No
Yes X No
Is the Sampled Area
within a Wetland? Yes X No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Primary Indicators (minimum of one is required; check all that apply)
Secondary Indicators (minimum of two required)
Surface Soil Cracks (B6)
Surface (B8)
(C2)
Imagery (C9)
(D1)
(D4)
_
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave
_ _ _
X High Water Table (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
_ _
X Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (B16)
_ _
Water Marks (B1) Presence of Reduced Iron (C4) Dry -Season Water Table
_ _ _
Sediment Deposits (B2) Recent Iron Reduction in Tilled Soils (C6) Crayfish Burrows (C8)
_ _ _
Drift Deposits (B3) Thin Muck Surface (C7) Saturation Visible on Aerial
_ _ _
Algal Mat or Crust (B4) Other (Explain in Remarks) Stunted or Stressed Plants
_ _ _
Iron Deposits (B5) Geomorphic Position (D2)
_ _
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
_ _
Water -Stained Leaves (B9) Microtopographic Relief
_ _
Aquatic Fauna (B13) X FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No X Depth (inches):
Wetland Hydrology Present?
Yes
X
No
Water Table Present? Yes X No Depth (inches): 4
Saturation Present? Yes X No Depth (inches): 0
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
ENG FORM 6116A-SG, JUL 2018
Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata)- Use scientific names of plants.
Sampling Point:
DP-1
Tree Stratum (Plot size: 30
1. Frax/nus pennsylvanica
2. Acerrubrum
3. U/mus americans
4.
5.
6.
7.
50% of total cover:
Sapling/Shrub Stratum (Plot size: 30 )
1. Acerrubrum
Absolute
% Cover
10
10
10
Dominant Indicator
Species? Status
Yes FACW
Yes FAC
Yes FACW
30 =Total Cover
15 20% of total cover: 6
2. Liquidambars/yraciflua
3. P/a/anus occiden/a/is
4. Frax/nus pennsylvanica
5. Ligus/rum sinense
6.
7.
8.
9.
5 Yes FAC
5 Yes FAC
5 Yes FACW
5 Yes FACW
2 No FACU
22 =Total Cover
50% of total cover: 11 20% of total cover: 5
Herb Stratum (Plot size: 10 )
1. Carex in/umescens
2. ✓uncus effusus
3. Pan`henoc/ssus quinquefo/ia
4. Onocrea sensibi/is
5.
6.
7.
8.
9.
10.
11.
30 Yes FACW
15 Yes FACW
5
5
No
No
55 =Total Cover
FACU
FACW
50% of total cover: 28 20% of total cover: 11
Woody Vine Stratum (Plot size:
1.
2.
3.
4.
5.
Vi/is rotund/lobe
30
5
Yes
5 =Total Cover
FAC
50% of total cover: 3 20% of total cover: 1
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 10 (A)
Total Number of Dominant
Species Across All Strata: 10 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: 100.0% (A/B)
Prevalence Index worksheet:
Total % Cover of: Multiply by:
OBL species 0 x 1 = 0
FACW species 80 x 2 = 160
FAC species 25 x 3 = 75
FACU species 7 x 4 = 28
UPL species 0 x 5 = 0
Column Totals: 112 (A) 263 (B)
Prevalence Index = B/A = 2.35
Hydrophytic Vegetation Indicators:
1 - Rapid Test for Hydrophytic Vegetation
X 2 - Dominance Test is >50%
X 3 - Prevalence Index is <_3.01
4 - Morphological Adaptations (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation (Explain)
Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree- Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft
(1 m) tall.
Herb - All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody Vine - All woody vines greater than 3.28 ft in
height.
Hydrophytic
Vegetation
Present? Yes X No
Remarks: (Include photo numbers here or on a separate sheet.)
ENG FORM 6116-4-SG, JUL 2018
Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: DP-1
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
(inches)
Matrix
Color (moist)
0/0
0-18 10YR 4/2 75
Redox Features
Color (moist) % Type' Loc2
Texture Remarks
7.5YR 5/6 25 C M Loamy/Clayey Prominent redox concentrations
Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Histosol (A1)
_ Histic Epipedon (A2)
Black Histic (A3)
_ Hydrogen Sulfide (A4)
_ Stratified Layers (A5)
_ 2 cm Muck (A10) (LRR N)
_ Depleted Below Dark Surface (A11)
_ Thick Dark Surface (Al2)
_ Sandy Mucky Mineral (S1)
_ Sandy Gleyed Matrix (S4)
_ Sandy Redox (S5)
_ Stripped Matrix (S6)
Dark Surface (S7)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Mucky Mineral (F1) (MLRA 136)
_ Loamy Gleyed Matrix (F2)
X Depleted Matrix (F3)
_ Redox Dark Surface (F6)
_ Depleted Dark Surface (F7)
_ Redox Depressions (F8)
_ Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
Umbric Surface (F13) (MLRA 122, 136)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 147, 148)
Indicators for Problematic Hydric Soils3:
_ 2 cm Muck (A10) (MLRA 147)
Coast Prairie Redox (A16)
(MLRA 147, 148)
_ Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
_ Red Parent Material (F21)
(outside MLRA 127, 147, 148)
Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present?
Yes X No
Remarks:
ENG FORM 6116-4-SG, JUL 2018
Eastern Mountains and Piedmont — Version 2.0

U.S. Army Corps of Engineers
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R
Requ/cement Control Symbol
EXEMPT
(Authority: AR 33545,
paragraph 5-2a)
Project/Site: Finch Farm Road
Applicant/Owner: Keystone
City/County: Trinity/Randolph
Investigator(s): DB/SH - Pilot
Landform (hillside, terrace, etc.): Side slope
Section, Township, Range:
Sampling Date: 5.8.19
State: NC Sampling Point: DP-2
Local relief (concave, convex, none): convex Slope (%): 4
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 35.865252° Long: -80.025255° Datum: wgs 84
Soil Map Unit Name: Mecklenburg loam (MaC)
Are climatic / hydrologic conditions on the site typical for this time of year?
NWI classification: None
Yes X No (If no, explain in Remarks.)
Are Vegetation , Soil , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation , Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes No X
Hydric Soil Present? Yes No X
Wetland Hydrology Present? Yes No X
Is the Sampled Area
within a Wetland?
Yes No X
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Primary Indicators (minimum of one is required; check all that apply)
Secondary Indicators (minimum of two required)
Surface Soil Cracks (B6)
Surface (B8)
(C2)
Imagery (C9)
(D1)
(D4)
_
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave
_ _ _
High Water Table (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
_ _ _
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (B16)
_ _ _
Water Marks (B1) Presence of Reduced Iron (C4) Dry -Season Water Table
_ _ _
Sediment Deposits (B2) Recent Iron Reduction in Tilled Soils (C6) Crayfish Burrows (C8)
_ _ _
Drift Deposits (B3) Thin Muck Surface (C7) Saturation Visible on Aerial
_ _ _
Algal Mat or Crust (B4) Other (Explain in Remarks) Stunted or Stressed Plants
_ _ _
Iron Deposits (B5) Geomorphic Position (D2)
_ _
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
_ _
Water -Stained Leaves (B9) Microtopographic Relief
_ _
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No X Depth (inches):
Wetland Hydrology Present?
Yes
No
X
Water Table Present? Yes No X Depth (inches):
Saturation Present? Yes No X Depth (inches):
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
ENG FORM 6116A-SG, JUL 2018
Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata)- Use scientific names of plants.
Sampling Point:
DP-2
Tree Stratum (Plot size: 30
1. Liriodendron /u//p/fera
2. Ca/ya tomentosa
3. Liquidambars/yraciflua
4.
5.
6.
7.
50% of total cover:
Sapling/Shrub Stratum (Plot size: 30 )
1. L/gus/rum sinense
Absolute
% Cover
10
10
10
Dominant Indicator
Species? Status
Yes FACU
Yes UPL
Yes FAC
30 =Total Cover
15 20% of total cover: 6
2. Liquidambars/yraciflua
3. Carya tomentosa
4. Sassafras a/b/dum
5. Quercus falcate
6. //ex opaca
7.
8.
9.
5 Yes FACU
5 Yes FAC
10 Yes UPL
2 No FACU
2 No FACU
5 Yes FACU
29 =Total Cover
50% of total cover: 15 20% of total cover: 6
Herb Stratum (Plot size: 10 )
1. L onicera japonica
2. Microstegium uimineum
3. Pan`henoc/ssus quinquefo/ia
4. Smilax rotundifo/ia
5.
6.
7.
8.
9.
10.
11.
5
5
2
2
Yes FACU
Yes
No
No
14 =Total Cover
FAC
FACU
FAC
50% of total cover: 7 20% of total cover: 3
Woody Vine Stratum (Plot size:
1.
2.
3.
4.
5.
Vi/is rotund/To/la
30
2
No
2 =Total Cover
FAC
50% of total cover: 1 20% of total cover: 1
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 3 (A)
Total Number of Dominant
Species Across All Strata: 9 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC: 33.3% (A/B)
Prevalence Index worksheet:
Total % Cover of: Multiply by:
OBL species 0 x 1 = 0
FACW species 0 x 2 = 0
FAC species 24 x 3 = 72
FACU species 31 x 4 = 124
UPL species 20 x 5 = 100
Column Totals: 75 (A) 296 (B)
Prevalence Index = B/A = 3.95
Hydrophytic Vegetation Indicators:
1 - Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%
3 - Prevalence Index is <_3.01
4 - Morphological Adaptations (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation (Explain)
Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree- Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft
(1 m) tall.
Herb - All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody Vine - All woody vines greater than 3.28 ft in
height.
Hydrophytic
Vegetation
Present? Yes No X
Remarks: (Include photo numbers here or on a separate sheet.)
ENG FORM 6116-4-SG, JUL 2018
Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: DP-2
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
(inches)
Matrix
Color (moist)
0/0
0-18 7.5YR 4/6 100
Redox Features
Color (moist) % Type' Loc2
Texture Remarks
Loamy/Clayey
Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Histosol (A1)
_ Histic Epipedon (A2)
Black Histic (A3)
_ Hydrogen Sulfide (A4)
_ Stratified Layers (A5)
_ 2 cm Muck (A10) (LRR N)
_ Depleted Below Dark Surface (A11)
_ Thick Dark Surface (Al2)
_ Sandy Mucky Mineral (S1)
_ Sandy Gleyed Matrix (S4)
_ Sandy Redox (S5)
_ Stripped Matrix (S6)
Dark Surface (S7)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Mucky Mineral (F1) (MLRA 136)
_ Loamy Gleyed Matrix (F2)
_ Depleted Matrix (F3)
_ Redox Dark Surface (F6)
_ Depleted Dark Surface (F7)
_ Redox Depressions (F8)
_ Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
Umbric Surface (F13) (MLRA 122, 136)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 147, 148)
Indicators for Problematic Hydric Soils3:
_ 2 cm Muck (A10) (MLRA 147)
Coast Prairie Redox (A16)
(MLRA 147, 148)
_ Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
_ Red Parent Material (F21)
(outside MLRA 127, 147, 148)
Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present?
Yes No X
Remarks:
ENG FORM 6116-4-SG, JUL 2018
Eastern Mountains and Piedmont — Version 2.0

Randolph County, NC
6797111369
NC HWY 62
6797111369
6797200253
6797239972
NC HW_y;62
6797445001
6797412387
1' �o
`p — 1'85 SB EXIT RAMP FINCH'. •
1 vRSTASE
6797_412387
WEIeBORNI'RD
6797525853
6797519006
REID
PIN
TAXED ACREAGE
PROPERTY DESCRIPTION
DEED BOOK & PAGE
PLAT BOOK & PAGE
OWNER
OWNER ADDRESS
5205
6797412387
76.66
R85;BOTH
002753/01955
KEYSTONE GROUP INC
3708 ALLIANCE DR
OWNER ADDRESS2
OWNER CITY
OWNER STATE
OWNER ZIP
LOCATION ADDRESS
LOCATION ZIP
DATA REFRESHED
GREENSBORO
NC
27407
No Physical Address
No ZIP
Disclaimer: This map was compiled from recorded deeds, plats, and other public records
and data. Users of this data are hereby notified that the aforementioned public information
sources should be consulted for verification of the information. Randolph County, its
agents and employees make no warranty as to the accuracy of the information on this map.
Map Scale
1 inch = 667 feet

Randolph County, NC
6797412387
6797412387
6797519006
WELBORN•RD —
LU
w
vie, BORN; Ro
REID
PIN
TAXED ACREAGE
PROPERTY DESCRIPTION
DEED BOOK & PAGE
PLAT BOOK & PAGE
OWNER
OWNER ADDRESS
5250
6797519006
32.70
J.D. ELLIOTT ES
002753/01955
KEYSTONE GROUP INC
3708 ALLIANCE DR
OWNER ADDRESS2
OWNER CITY
OWNER STATE
OWNER ZIP
LOCATION ADDRESS
LOCATION ZIP
DATA REFRESHED
GREENSBORO
NC
27407
No Physical Address
No ZIP
Disclaimer: This map was compiled from recorded deeds, plats, and other public records
and data. Users of this data are hereby notified that the aforementioned public information
sources should be consulted for verification of the information. Randolph County, its
agents and employees make no warranty as to the accuracy of the information on this map.
Map Scale
1 inch = 333 feet

Randolph County, NC
6797412387
6797412387
6797525853
6797519006
6797613814
6796882674
6797815230
6797815230
6796882674
REID
PIN
TAXED ACREAGE
PROPERTY DESCRIPTION
DEED BOOK & PAGE
PLAT BOOK & PAGE
OWNER
OWNER ADDRESS
5325
6797613814
31.26
R85;S
002753/01955
KEYSTONE GROUP INC
3708 ALLIANCE DR
OWNER ADDRESS2
OWNER CITY
OWNER STATE
OWNER ZIP
LOCATION ADDRESS
LOCATION ZIP
DATA REFRESHED
GREENSBORO
NC
27407
No Physical Address
No ZIP
Disclaimer: This map was compiled from recorded deeds, plats, and other public records
and data. Users of this data are hereby notified that the aforementioned public information
sources should be consulted for verification of the information. Randolph County, its
agents and employees make no warranty as to the accuracy of the information on this map.
Map Scale
1 inch = 667 feet

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD:
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: David Brame, Pilot Environmental, Inc.
Post Office Box 128, Kernersville, North Carolina 27285
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, Finch Farm Rd, SAW 2021-
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The site is located east of Finch Farm Road in
Trinity, NC. The site contains wooded land. The site is proposed for commercial development.
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: North Carolina County/parish/borough: Randolph County City: Trinity
Center coordinates of site (lat/long in degree decimal format): Lat.: 35.865630° Long.: -80.026378°
Universal Transverse Mercator: WGS 84
Name of nearest waterbody: Uwharrie River
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
['Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
Number
Latitude (decimal
degrees)
Longitude
(decimal degrees)
Estimated amount of
aquatic resources in
review area (acreage
and linear feet, if
applicable
Type of aquatic
resources (i.e.,
wetland vs. non-
wetland waters)
Geographic authority to
which the aquatic resource
"may be" subject (i.e.,
Section 404 or Section
10/404)
WA 1-11
35.863260°
-80.029073°
0.19 acres
wetland
404
WA 12-17
35.862902°
-80.030334°
0.054 acres
wetland
404
WA 18-26
35.863204°
-80.029645°
0.11 acres
wetland
404
WAD 1-8
35.865122°
-80.029075°
0.33 acres
wetland
404
WAD 9-18
35.865524°
-80.029645°
0.15 acres
wetland
404
WAD 19-
26
35.865360°
-80.029045°
0.10 acres
wetland
404
WB 1-5
35.865967°
-80.023675°
0.046 acres
wetland
404
WC 1-17
35.865281°
-80.025480°
0.54 acres
wetland
404

WAC 18-
27
35.865338°
-80.025766°
0.57 acres
wetland
404
WCB 1-4
35.864627°
-80.026339°
0.013 acres
wetland
404
ISAF
35.867674°
-80.018866°
40 linear feet
Non -wetland
water
404
SAE
35.867523°
-80.022683°
380 linear feet
Non -wetland
water
404
SA
35.866893°
-80.021273°
4,890 linear feet
Non -wetland
water
404
SB
35.866550°
-80.023121°
620 linear feet
Non -wetland
water
404
SC
35.866127°
-80.023635°
550 linear feet
Non -wetland
water
404
SCA
35.865941°
-80.024822°
40 linear feet
Non -wetland
water
404
SCB
35.863844°
-80.026366°
1,030 linear feet
Non -wetland
water
404
SAD
35.864945°
-80.028766°
510 linear feet
Non -wetland
water
404
ISAD
35.865736°
-80.029717°
150 linear feet
Non -wetland
water
404
SADA
35.865863°
-80.030762°
660 linear feet
Non -wetland
water
404
SAA
35.863944°
-80.028953°
210 linear feet
Non -wetland
water
404
SAB 1
35.862960°
-80.030151°
60 linear feet
Non -wetland
water
404
SAB2
35.863578°
-80.029126°
120 linear feet
Non -wetland
water
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 fmds 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:
® 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
® Natural Resources Conservation Service Soil Survey. Citation: Drawings 2 & 2A
® National wetlands inventory map(s). Cite name • Drawing 3
❑ State/local wetland inventory map(s):
® FEMA/FIRM maps: Drawing 4
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
® Photographs: ®Aerial (Name & Date): Drawing 5
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.
Signature and date of Regulatory
staff member completing PJD
17241 March 18, 2022
Signature and date of person
requesting PJD (REQUIRED,
unless obtaining the signature
is impracticable)1
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester does not respond within the
established time frame, the district may presume concurrence and no additional follow up is necessary prior to finalizing
an action.