20220598 Ver 1_401 Application_20220421

Staff Review Form
NORTH CAROLINA
Envlronm¢ntcl Qvofiry
Updated September 4, 2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID#*
20220598
Version* 1
Is this project a public transportation project?*
Reviewer List:*
Select Reviewing Office: *
Submittal Type:*
Yes
• No
Sue Homewood:eads\slhomewood
Winston-Salem Regional Office - [phone]
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
Pre -Filing Meeting Date Request was submitted on:
10/4/2021
Project Contact Information
Name:
Heather LaGamba
Who is submitting the information?
Email Address: [e-mail]
Project Information
...................................
Project Name: Rock Creek Station Apartments (Burlington Rd)
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)
Guilford
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
6757.1-7239 Burlington Road_PCN_4.21.22.pdf 8.48MB
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:
rif 00. �Zaf.
Submittal Date: Is filled in automatically.

NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2021-02241
DWR project no. _Click enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 36.080135°
Longitude (DD.DDDDDD): -79.561315°
Form Version 1.5. September 2020
Date received: 4/21/2022
Date received: 4/21/2022
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/WaterResou rces/0/edoc/624704/PCN%20HeI p%20File%202018-1-30. pdf
The help document may be found at this link:
http://www.saw. usace.armv.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.
Date of Pre -filing Meeting Request (MM/DD/YYYY) : 10/4/2021
DWR ID # Click to enter. Version Click to enter. (If applicable)
A. Processing Information
County (counties) where project is located:
Guilford 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:
❑x 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

1 b. Permit type(s)?
❑x 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 ❑x No
NWP number(s):
NWP 29
RGP number(s):
Click to enter.
1 d. Type(s) of approval sought from the DWR (check all that apply): *
❑x 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: *
❑ Yes ❑x No
For the record only for Corps Permit: *
❑ Yes ❑x No
1f. Is this an after -the -fact permit/certification application?
❑ Yes ❑x No
1 g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
• Yes ❑x 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 ❑x No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
El Yes ❑x No El Unknown
1j. Is the project located in a designated trout watershed?
❑ Yes ❑x 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?
Dino Hackett
1 b.
Primary Contact Email:
[e-mail]
1 c.
Primary Contact Phone: (###)###-####
[phone]
1 d.
Who is applying for the permit/certification?
all that apply)
(check
• Owner 0 Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
■I Yes ❑ No
2. Landowner Information
2a. Name(s) on Recorded Deed:
John and Clyde Ingle
2b. Deed Book and Page No.:
002602/00323
2c. Responsible Party (for corporations):
Click to enter.
2d. Address
Street Address:
6199 SEQUOIA DR
Address line 2:
Click to enter.
City:
PORT ORANGE
State/ Province/ Region:
Florida
Postal/ Zip Code:
32127
Country:
U.S.
2e. Telephone Number: (###)###-####
Click to enter.
2f. Fax Number: (###)###-####
Click to enter.
2g. Email Address: *
Click to enter.
3.
Applicant Information (if different from owner)
3a.
Name:
Dino Hackett
3b.
Business Name (if applicable):
Hackett Properties, Inc.
3c.
Address:
Street Address:
1152 Kearns -Hackett Road
Address line 2:
Click to enter.
City:
Pleasant Garden
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27313
Country
U.S
3d.
Telephone Number: * (###)###-####
[phone]
3e
Fax Number: (###)###-####
[phone]
Page 3 of 21
PCN Form - Version 1.5, September 2020

3f. Email Address:
[e-mail]
4. Agent/ Consultant (if applicable)
4a. Name: *
Michael T. Brame
4b. Business Name:
Pilot Environmental, Inc.
4c. Address: *
Street Address:
743 Park Lawn Court
Address line 2:
Click to enter.
City:
Kernersville
State/ Province/ Region:
NC
Postal/ Zip Code:
27284
Country:
U.S.
4d. Telephone Number: (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to enter.
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:
httbs://www.saw. usace.armv. 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:
Rock Creek Station Apartments
1 b.
Subdivision name (if appropriate):
Rock Creek Station
1 c.
Nearest municipality/town: *
Gibsonville, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
8834481508-000
2b.
Property size (in acres):
19
2c.
Project Address:
Street Address:
7239 Burlington Road
Address line 2:
Click to enter
City:
Gibsonville
State/ Province/ Region:
NC
Postal/ Zip Code:
27249
Country:
U.S.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD):
36.080135°
Longitude (-DD.DDDDDD):
--79.561315°
3.
Surface Waters
3a.
Name of nearest body of water to proposed project:
Back Creek
3b.
Water Resources Classification of nearest receiving
water:
WS V; NSW
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcgis.com/apes/webappviewer/index.html?id=6e125ad7628f494694e259c8Odd64265
3c.
In what river basin(s) is your project located? *
Cape Fear
Choose additional (if needed)
3d.
Please provide the 12-digit HUC in which the project is
located:
030300020305
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apes/PublicInformation/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. The southern and northern portions of the site consist predominately of
hardwoods with scattered pines. These forested areas are approximately 40-50 years old. The central portion of
the site consists predominately of pines with scattered hardwoods. This forested area is approximately 25 years
old. The site is located in a residential area of Gibsonville.
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past?
• Yes ❑x No ❑ Unknown
4c. If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
SAW-2021-02241
jClick 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:
0.594 acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property:
270 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 an apartment complex on the site.
4i. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of nine apartment buildings, a clubhouse, an office, a pool and associated
parking areas. In order to facilitate the proposed development and access the site, it is necessary to cross a portion of
a wetland. In order to connect to sanitary sewer lines, it is necessary to temporarily impact a stream. 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 on April 21, 2021. The site was verified by Mr. James Lastinger via
desktop review and a PJD was issued on November 23, 2021 (SAW 2021-02241).
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?
❑x Preliminary ❑ Approved ❑ Emailed Concurrence
❑ Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
SAW — 2021-02241
Page 6 of 21
PCN Form - Version 1.5, September 2020

5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
USACE issued a PJD on November 23, 2021.
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?
■ Yes ❑x No
6b. If yes, explain.
'lick to enter.
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):
O Wetlands
❑ Buffers
❑ Pond Construction
O 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
Fill (Incl.
Riprap)
Permanent
Unnamed (WA)
Bottomland
Hardwood
Forest
Yes
Both
0.033
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
0.033 ac
2g3. Total wetland impacts
0.033 ac
2h. Comments:
In order to access the site, it is necessary to impact 0.033 acres of wetland. The upper reach of the wetland is included
as it is considered a total loss due to the small amount that is not being impacted by the road/grading limits of the slope.
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
Other
Temporary
Unnamed (SC)
Perennial
Both
5
8/15
S2
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
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:
Click to enter. linear ft
3i3. Total temporary stream impacts:
23 linear ft
3i4. Total stream and ditch impacts:
Click to enter. linear ft
3j. Comments:
In order to connect to existing sanitary sewer lines, it is necessary to cross a stream. A proposed coffer
dam/pump around will temporarily impact 15 linear feet (75 square feet) of stream channel. The proposed sewer
line will be buried beneath the stream channel and will impact 8 linear feet (40 square feet) of stream channel.
The impacts will be temporary and the stream channel will be restored to grade after the sewer line has been
buried. Rip rap that will be used to stabilize the stream and banks will be keyed in. The coffer dam will be
removed following the construction/stabilization measures.
Page 10 of 21 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)k
01
Choose one
Temp/
Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Choose one
Temp/
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 tL.
enter.
Click tk.
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click 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
enter.
Click to
enter.
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 of 21 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
❑x Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to enter.
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
Utility Lines
Temp/ Perm
Unnamed (SC)
No
600
400
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
remp/ 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: 400 sq ft
6h. Total permanent impacts:
Zone 1: 600 sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: 600 sq ft
Zone 2: 400 sq ft
6i. Comments:
Buffer authorization will be obtained from Gibsonville.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 21 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1.
Avoidance and Minimization
la.
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 other streams and wetlands. A bridge mat
has been designed to span the stream and avoid impacts at the sewer line crossing location to access and install the
sewer line on the other side of the stream. Rip rap is being keyed in to the existing bed to maintain the current stream
bed. The crossing locations were selected to minimize and avoid impacts to larger wetlands and stream meanders.
The remaining roads, lots and utilities have been designed to avoid additional impacts to jurisdictional areas.
1 b.
Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The clearing limits will be surveyed, staked and silt fencing and clearing limit fencing will be used. Coffer dams will be
used to minimize sediment discharge during construction activities. 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 being 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.armv.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
Page 13 of 21
PCN Form - Version 1.5, September 2020

4g. Coastal (tidal) wetland mitigation requested:
Click to enter. acres
4h. Comments:
Mitigation is not being proposed.
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.
Click 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.
:,hoose one
:,lick to enter.
Zone 2
Click to enter.
Click to enter.
:,hoose 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?
❑ Yes ❑ No
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 of 21 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 ❑ 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-
quidance/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
El Vegetated Conveyance (lower seasonal high water table- SHVVT)
❑ Wetland Swale (higher SHWT)
❑x 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 of 21
PCN Form - Version 1.5, September 2020

Local Government Stormwater Programs
❑Phase II ❑ USMP
❑x NSW ❑x Water Supply
Please identify which local government stormwater program you are using.
Gibsonville
State Stormwater Programs
El Phase II El HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
A stormwater pond is designed on the northeastern portion of the site. The stormwater pond will discharge into a
plunge pool to diffuse flow before stormwater reaches the buffers.
Page 16 of 21 PCN Form - Version 1.5, September 2020

G. Supplementary Information
1.
Environmental Documentation
1 a.
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):
Click 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 to the north. The sewer line will cross a stream. Proposed impacts
are detailed in Section D.
Page 17 of 21
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/ ffws.govl)
►11 Yes ❑ No
5b.
Have you checked with the USFWS concerning Endangered Species
Act impacts?
❑ Yes ❑x No
5c.
If yes, indicate the USFWS Field Office you have contacted.
:,hoose 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.?
aYes El 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 ❑x 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)
Page 18 of 21 PCN Form - Version 1.5, September 2020

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
2 listed species are identified on the IPaC report (attached). Monarch Butterfly (Candidate) and Small Whorled
Pogonia (Threatened) are listed as federally protected species.
The areas where the impacts will occur (including areas within 100 feet of the proposed impact) consist of a 40 to 50
year old mixed pine/hardwood forest. The area of wetland impact has been previously disturbed as the wetland that is
being impacted is located within a road bed that has been left fallow. The under -story and mid -story are moderately
dense. The area of the stream crossing is vegetated predominately of hardwood species. The understory is
dominated by Japanese stilt -grass, Chinese privet, Russian olive and Japanese honeysuckle that is moderate to
densely vegetated.
The monarch butterfly's habitat is open fields and meadows with milkweed. Habitat is not present within the area of
impact or within 100 feet of the area of impact.
Small whorled pogonia can be limited by shade. The species seems to require small light gaps, or canopy breaks, and
generally grows in areas with sparse to moderate ground cover. Too many other plants in an area can be harmful to
this plant. This orchid typically grows under canopies that are relatively open or near features that create long -
persisting breaks in the forest canopy such as a road or a stream. It grows in mixed -deciduous or mixed-
deciduous/coniferous forests that are generally in second- or third -growth successional stages. The soils in which it
lives are usually acidic, moist, and have very few nutrients. The USFWS Fact Sheet indicates that: "This orchid grows
in older hardwood stands of beech, birch, maple, oak and hickory that have an open understory. Sometimes it grows
in stands of softwoods such as hemlock. It prefers acid soils with a thick layer of dead leaves, often on slopes near
small streams."
The forested areas that are being impacted are estimated to be approximately 40-50 year old forest. The mid and
understory are moderate to dense. The dominant hardwood species are poplar, sweetgum and maple. Eastern red
cedar, loblolly pine and Virginia pine are scattered amongst the hardwoods. Based on our observations, the impact
areas and areas within 100 feet of the impact areas are not suitable habitat for this species. Additionally, we did not
observe orchids growing in the areas during an April site visit.
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?
El Yes ❑x No
Are there submerged aquatic vegetation (SAV) around
the project vicinity?
El Yes ❑x No
El Unknown
Will this project affect submerged aquatic vegetation?
❑ Yes ❑x No
Explain: ''lick to Pnter.
❑ Unknown
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 of 21 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://q is. n cd cr.g ov/h powe b/
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)?
❑Yes ❑x No
7b.
What data source(s) did you use to determine whether your site would impact historic or archeological
resources?
NC Historic Preservation Offices HPOWEB 2.0. Historic properties were not identified in the area of the impact or on
the site. Historic properties are identified south of the site, across Burlington Road. 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? *
❑x No
• Yes
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
National Flood Hazard Layer froom FEMA Web Map Service — Drawing 4 (Attached)
Page 20 of 21 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
Thank -you for your assistance.
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: Michael T. Brame
Michael Digitally sig°e M1y MicM1ael9rame
DN: rn=MicM1ael Brame, °=Pilot
Signature:
Brame DateII 202M1209.21112.98090900,c=U5
4/21/2022
Page 21 of 21 PCN Form - Version 1.5, September 2020

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:
`723 vv-(v,r,h„j
rtmajWif_4 `3csVi�,\l�� rr'( 27a[S
1_1v}c I ' n Pv'es rtw`
Owner Information: ow>t,� cl� U
Address:
Telephone Number:
Fax Number:
E-mail Address:
tuf n i2w s 20
Pkya-e,,wS. - 2 7 31 3
- - 3�2 -2°Y1
- 67,4— 2 -3
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
onsite 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
-,23- 2
Date
Signature

4/7/2021 Property Report
Guilford County, NC - Property Report Convert to PDF 4/7/2021
Parcel ID
Property Address
Legal Description
104252
7239 Near Burlington Rd
19.04 AC TYSOR US 70 A WILL 99E-915
Mobile
Maps
Owner Information
Owner Name
Mailing Address
City, State Zip
INGLE, JOHN W;INGLE, CLYDE R
6199 SEQUOIA DR
PORT ORANGE, FL 32127
Parcel Information
PIN
Zoning
Use
Tax District
8834481508-000
AG -Agricultural
RESIDENTIAL
0
Parcel Size
Appraisal Nbrhood
Plat/Condo Bk & Pg
19.04
8834C01
N/A
Recent Sales
Book & Page
Sale Date
Sale Price
Qualified?
Improved?
00260200323
$0
Yes
Yes
Appraisal Values
Land
Buildings
Extra Features
Total Value
$183,900
so
so
$183,900
Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not guaranteed. This is not a legal document
and should not be substituted for a title search, appraisal, survey, or for zoning verification.
Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not guaranteed. This is not a legal document
and should not be substituted for a title search, appraisal, survey, or for zoning verification.
gis.guilfordcountync.gov/PropertyCardjs/Default.aspx?pin=104252&maplmage=_ags_ee07e68eac564ee5ad054b02de407fcd.jpg&isTinyScreen=false... 1/1

DWR Pre -Filing Meeting Request Form
NORTH CAROLINA
Environmental Qualify
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Heather LaGamba
[e-mail]
Keystone Group, Inc.
7232 Burlington Road
Guilford
Owner Address: * Street Address
3708 Alliance Drive
Address Line 2
City State / Province / Region
Greensboro NC
Postal / Zip Code Country
27407 USA
Is this a transportation project?* Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - 401 Water Quality Certification -
Regular Express
Individual Permit Modification
Shoreline Stabilization
Does this project have an existing project ID#?*
Yes No
Do you know the name of the staff member you would like to request a meeting with?
Sue Homewood
Please give a brief project description below and include location information.*
The applicant does not request a meeting. The applicant may submit a
request for 401 WQC.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401
Certification Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting
location and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you
can submit an application.

Signature*
f .16*A 5
Submittal Date 10/4/2021

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2021-02241 County: Guilford U.S.G.S. Quad: NC-Gibsonville
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Requestor: Pilot Environmental
Michael Brame
Address: PO Box 128
Kernersville, NC 27285
Telephone Number: 336-310-4527
E-mail: mbrame(a,pilotenviro.com
Size (acres) 19 Nearest Town Whitsett
Nearest Waterway Back Creek River Basin Cape Fear
USGS HUC 03030002 Coordinates Latitude: 36.0802
Longitude: -79.5613
Location description: The project site is located at 7239 Burlington Road, Gibonnville, Guildford County, North Carolina.
Indicate Which of the Following Apply:
A. Preliminary Determination
® There appear to be waters, including wetlands on the above described project area/property, that may be subject to Section 404
of the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). The
waters, including wetlands have been delineated, and the delineation has been verified by the Corps to be sufficiently accurate
and reliable. The approximate boundaries of these waters are shown on the enclosed delineation map dated 4/27/2021. Therefore
this preliminary jurisdiction determination may be used in the permit evaluation process, including determining compensatory
mitigation. For purposes of computation of impacts, compensatory mitigation requirements, and other resource protection
measures, a permit decision made on the basis of a preliminary JD will treat all waters and wetlands that would be affected in any
way by the permitted activity on the site as if they are jurisdictional waters of the U.S. This preliminary determination is not an
appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part 331). However, you may
request an approved JD, which is an appealable action, by contacting the Corps district for further instruction.
❑ There appear to be waters, including wetlands on the above described project area/property, that may be subject to Section 404
of the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403).
However, since the waters, including wetlands have not been properly delineated, this preliminary jurisdiction determination
may not be used in the permit evaluation process. Without a verified wetland delineation, this preliminary determination is
merely an effective presumption of CWA/RHA jurisdiction over all of the waters, including wetlands at the project area, which
is not sufficiently accurate and reliable to support an enforceable permit decision. We recommend that you have the waters,
including wetlands on your project area/property delineated. As the Corps may not be able to accomplish this wetland
delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by the Corps.
B. Approved Determination
❑ There are Navigable Waters of the United States within the above described project area/property subject to the permit
requirements of Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act
(CWA)(33 USC § 1344). Unless there is a change in law or our published regulations, this determination may be relied upon for
a period not to exceed five years from the date of this notification.
❑ There are waters, including wetlandson the above described project area/property subject to the permit requirements of Section
404 of the Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ We recommend you have the waters, including wetlands on your project area/property delineated. As the Corps may not be
able to accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that
can be verified by the Corps.
❑ The waters, including wetlands on your project area/property have been delineated and the delineation has been verified by
the Corps. The approximate boundaries of these waters are shown on the enclosed delineation map dated DATE. We strongly
suggest you have this delineation surveyed. Upon completion, this survey should be reviewed and verified by the Corps. Once

SAW-2021-02241
verified, this survey will provide an accurate depiction of all areas subject to CWA jurisdiction on your property which, provided
there is no change in the law or our published regulations, may be relied upon for a period not to exceed five years.
❑ The waters, including wetlands have been delineated and surveyed and are accurately depicted on the plat signed by the
Corps Regulatory Official identified below onDATE. Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ There are no waters of the U.S., to include wetlands, present on the above described project area/property which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (CAMA).
You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to determine their
requirements.
Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material, construction or
placement of structures, or work within navigable waters of the United States without a Department of the Army permit may
constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If you have any questions
regarding this determination and/or the Corps regulatory program, please contact James Lastin2er at 919-554-4884 ext 32 or
James.C.Lastinger(ausace.army.mil.
C. Basis For Determination: Basis For Determination: See the preliminary jurisdictional determination
form dated 11/23/2021.
D. Remarks:
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination may not be valid for the wetland conservation provisions of the Food Security
Act of 1985. If you or your tenant are USDA Program participants, or anticipate participation in USDA programs, you should request
a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B.
above)
If you object to this determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed
you will find a Notification of Appeal Process (NAP) fact sheet and Request for Appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Mr. Philip A Shannin
Administrative Appeal Review Officer
60 Forsyth Street SW, Floor M9
Atlanta, Georgia 30303-8803
AND
[e-mail]
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by Not applicable.
**It is not necessary to submit an RFA form to the Di ision Office if you do not object to the determination in this correspondence.**
Corps Regulatory Official:
Date of JD: 11/23/2021 Expiration Date of JD: Not applicable

SAW-2021-02241
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete the Customer Satisfaction Survey located at
http://corpsmapu.usace.army.mil/cmapex/f?p=136:4:0
Copy fumished:
Property Owner:
John Ingle
Address: 6199 Sequoia Drive
Port Orange, FL 32127
Telephone Number:
E-mail:

PROCESS AND
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND
REQUEST FOR APPEAL
Applicant: Pilot Environmental, Michael Brame File Number: SAW-2021-02241 Date: 11/23/2021
Attached is:
See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission)
A
PROFFERED PERMIT (Standard Permit or Letter of permission)
B
PERMIT DENIAL
C
APPROVED JURISDICTIONAL DETERMINATION
D
PRELIMINARY JURISDICTIONAL DETERMINATION
I - The following identifies your rights and options regarding an administrative appeal
information may be found at or http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx
E
of the above decision.
x
SECTION
Additional
or the
Corps regulations aQ3 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for fmal
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED
•
signature
rights
•
this
PERMIT: You may accept or appeal the permit
ACCEPT: If you received a Standard Permit, you may sign the permit document and return
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and
on the Standard Permit or acceptance of the LOP means that you accept the permit
to appeal the permit, including its terms and conditions, and approved jurisdictional
permit.
APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of
you may appeal the declined permit under the Corps of Engineers Administrative Appeal
it to the district engineer for fmal
your work is authorized. Your
in its entirety, and waive all
determinations associated with the
certain terms and conditions therein,
Process by completing Section II of
the division engineer within 60 days
form and sending the form to the division engineer. This form must be received by
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers
completing Section II of this form and sending the form to the division engineer. This form
engineer within 60 days of the date of this notice.
Administrative Appeal Process by
must be received by the division
D: APPROVED
information.
•
•
JURISDICTIONAL DETERMINATION: You may accept or appeal the
ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify
date of this notice, means that you accept the approved JD in its entirety, and waive all
APPEAL: If you disagree with the approved JD, you may appeal the approved JD under
Administrative Appeal Process by completing Section II of this form and sending the form
approved JD or provide new
the Corps within 60 days of the
rights to appeal the approved JD.
the Corps of Engineers
to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JURISDICTIONAL DETERMINATION:
preliminary JD. The Preliminary JD is not appealable. If you
You do not need to respond to the Corps regarding the
wish, you may request an approved JD (which may be appealed),
you may provide new information for further consideration by the
by contacting the Corps district for further instruction. Also
Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS
TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your
proffered permit in clear concise statements. You may attach
objections are addressed in the administrative record.)
reasons for appealing the decision or your objections to an initial
additional information to this form to clarify where your reasons or
ADDITIONAL INFORMATION: The appeal is limited to a
record of the appeal conference or meeting, and any supplemental
clarify the administrative record. Neither the appellant nor the
review of the administrative record,
the Corps memorandum for the
officer has determined is needed to
or analyses to the record.
is already in the administrative
information that the review
Corps may add new information
the location of information that
However, you may provide additional information to clarify
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
appeal process you may contact:
District Engineer, Wilmington Regulatory Division
Attn: James Lastinger
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
If you only have questions regarding the appeal process you may
also contact:
MR. PHILIP A. SHANNIN
ADMINISTRATIVE APPEAL REVIEW OFFICER
CESAD-PDS-O
60 FORSYTH STREET SOUTHWEST, FLOOR M9
ATLANTA, GEORGIA 30303-8803
PHONE: [phone]; FAX [phone]
EMAIL: [e-mail]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel,
consultants, to conduct investigations of the project site during the course of the appeal process.
notice of any site investigation, and will have the opportunity to participate in all site investi
and any government
You will be provided a 15-day
ations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: James Lastinger , 69 Darlington Avenue, Wilmington, North
Carolina 28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Philip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 11/23/2021
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Pilot Environmental, Michael Brame, PO
Box 128, Kernersville, NC 27285
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District, 7239 Burlington Road site,
SAW-2021-02241
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The project site is located at 7239
Burlington Road, Gibonsville, Guildford County, North Carolina.
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES
AND/OR AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County: Guilford City: Whitsett
Center coordinates of site (lat/long in degree decimal format): Latitude: 36.0802 Longitude: -79.5613
Universal Transverse Mercator:
Name of nearest waterbody: Back Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
Z Office (Desk) Determination. Date: November 23, 2021
❑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.,
Section4D4 or Section
10/4D4)
WA 1-37
36.078844°
-79.560266°
0.D99 acres
Wetland
404
WB 1-7
36.078641°
-79.561179°
0.017 acres
Wetland
404
WD 1-22
36.082138°
-79.561516°
0.473 acres
Wetland
404
=
36.08198?°
-79.562083°
27D linear feet
Non -wetland
•:,=

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

SUPPORTING DATA. Data reviewed for PJD (check all that apply) Checked items are included in the administrative
record and are appropriately cited:
▪ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: attached
▪ Data sheets prepared/submitted by or on behalf of the PJD requestor. Datasheets:
▪ 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: Gibonsville Quad
▪ Natural Resources Conservation Service Soil Survey. Citation: USDA Websoil Survey
▪ National wetlands inventory map(s). Cite name. USFWS NWI Manner
❑ State/local wetland inventory map(s):
▪ FEMA/FIRM maps: NC FIRM
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date): 2018 ESRI Satellite imagery
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.
ignature and date of Regulatory
staff member completing PJD
11/23/2021
71444.__
October 15, 2021
Signature and date of person requesting PJD
(REQUIRED, unless obtaining the signature is
impracticable)'
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.

FLAG NUMBERS/INFORMATION
WETLAND FLAGS =
STREAM FLAGS =
Wetland Flags = 70
Stream Flags = Flagged at intersections
with the site boundary; surveyor locate
IZ77V777A
I///////21
LEGEND
DP-1 0
WA 1-2
Site Boundary
Perennial Stream
Wetland
Data Point
Flag Number/Feature ID
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY THE USACE OR NCDEQ-DWR.
THIS EXHIBIT INCLUDES GPS LOCATIONS OF DELINEATED FEATURES. DELINEATION CONDUCTED BY PILOT PERSONNEL ON 4/21/21.
Drawing 5
2018 Satellite Imagery from ESRI
and Pilot GPS Data
Scale: 1" = 200'
Date: 4.27.21
PILOT ENIONMNTALINC
Wetland Map
7239 Burlington Road
Approximate 19-Acre Tract
Gibsonville, Guilford County, NC
Pilot Project 6757

LOCATION OF STREAM/WETLAND
IMPACTS
TEMPORARY IMPACTS
UTILITY PIPE INSTALLATION
COFFER DAM/DIVERSION AND
UTILITY EXCAVATION IMPACTS
20 FT PERMANENT UTILITY
EASEMENT
PERMANENT WETLANDS IMPACTS
1430 SF ROAD/CULVERT IMPACT
0' 125' 250'
SCALE: 1' = 250'
500'
IFININIF
- N
I RE
PERENNIAL STREAM/ WETLAND IMPACT
LOCATION MAP
ROCK CREEK STATION APARTMENTS
WET
DETENTION
POND
PLUNGE POOL
%%%%%%%%% 1111111111//„„%%
CAR
HACKETT PROPERTIES, INC.
200 D PAMONA DRIVE
GREENSBORO, NC 27407
Tel: [phone]
[e-mail]
GREEN
MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE #P-0826
www.greenmountainengineers.com
E-rnaiLmntact@greenmcuntair ugh mrs.mm

NOTE
11-111-1
EXISTING CONDITIONS
' 20' 40' 80'
SCALE: 1' = 40'
w
d
1430 SF
PERMANENT
GRADING/FILL
IMPACT
II
1I
II
1I
I I
I �
I II
PERENNIAL STREAM/ WETLAND
IMPACT MAP
ROCK CREEK STATION APARTMENTS.
CA R
1. WETLANDS AND STREAM DELINEATED BY PILOT
ENVIRONMENTAL INC. ON APRIL 21, 2021 AND USACE
VERIFIED APRIL 23, 2021. GREEN MOUNTAIN ENGINEERING,
PLLC. FIELD LOCATED THE VERIFIED WETLAND AND STREAM
FLAGS PLACED BY PILOT ENVIRONMENTAL INC.
2. THIS DEVELOPMENT HAS BEEN ACCEPTED BY THE CITY OF
GIBSONVILLE AS A HIGH DENSITY STORMWATER PROJECT,
WITH FLOODPLAIN DEVELOPMENT AND EROSION CONTROL
PLAN APPROVALS BY GUILFORD COUNTY.
PROPOSED CONDITIONS
HACKETT PROPERTIES, INC.
200 D PAMONA DRIVE
GREENSBORO, NC 27407
Tel: [phone]
[e-mail]
GREEN
MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE #P-0826
www.greenmountainengineers.com
E-ma1l:contact@greenmountaii n igii tus.com

IMPACT
LOCATION
ID
TYPE
LINEAR STREAM
IMPACT
(FEET)
LINEAR STREAM
IMPACT
(SQUARE FEET)
WETLAND IMPACT
ZONE
(SQUARE FEET)
1
STORM/ROAD
CROSSING
0
0
1430
1430 SF
ROAD/CULVERT
IMPACT
SCALE: 1' = 30'
HACKETT PROPERTIES, INC.
200 D PAMONA DRIVE
GREENSBORO, NC 27407
Tel: [phone]
[e-mail]
PERENNIAL WETLAND
IMPACT MAP
GREEN
MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE #P-0826
www.greenmountainengineers.com
E-maiLmntact@greenmcuntair ugh urs.mm

20 FT PERMANENT
SANITARY SEWER PUBLIC
UTILITY EASEMENT
8FT
•
:/••
is
TEMPORARY
COFFER DAM WITH
PUMP —AROUND
TEMPORARY STREAM
CROSSING — BRIDGE MATS
..4*"•
• i i� i• .
..
````���,,,,,, r r, u , u I r', �,,,,,,�,,,-
CA R�,,
TOP OF BANK (TYPICAL)
CENTERLINE OF STREAM
30 FT STREAM BUFFER
sier=151
/
7
/
PROPOSED CONDITIONS
IMPACT
LOCATION
ID
TYPE
LINEAR STREAM
IMPACT
(FEET)
STREAM IMPACT
(SQUARE FEET)
WETLAND IMPACT
ZONE
(SQUARE FEET)
1
TEMP UTILITY PIPE
(SEWER)
8
40
0
2
TEMP COFFER DAM
15
75
0
PERENNIAL STREAM/
WETLAND IMPACT MAP
NOTE
1. WETLANDS AND STREAM DELINEATED BY PILOT
ENVIRONMENTAL INC. ON APRIL 21, 2021 AND USACE
VERIFIED APRIL 23, 2021. GREEN MOUNTAIN ENGINEERING,
PLLC. FIELD LOCATED THE VERIFIED WETLAND AND STREAM
FLAGS PLACED BY PILOT ENVIRONMENTAL INC.
2. THIS DEVELOPMENT HAS BEEN ACCEPTED BY THE CITY OF
GIBSONVILLE AS A HIGH DENSITY STORMWATER PROJECT,
WITH FLOODPLAIN DEVELOPMENT AND EROSION CONTROL
PLAN APPROVALS BY GUILFORD COUNTY.
CONSTRUCTION SEQUENCE
1. INSTALL TEMP. BRIDGE MAT FOR STREAM CROSSING
ACCESS.
2. WHEN READY TO INSTALL SEWER OUTFALL — INSTALL
TEMP. COFFER DAM AND PUMP —AROUND AS NEEDED.
3. INSTALL SEWER MAIN VIA OPEN CUT.
4. STABILIZE STREAM AND BANKS.
5. REMOVE COFFER DAM AND BRIDGE MAT.
6. STABILIZE DISTURBED BANKS.
HACKETT PROPERTIES, INC.
200 D PAMONA DRIVE
GREENSBORO, NC 27407
Tel: [phone]
[e-mail]
0' 10' 20' 40'
SCALE: 1' = 20'
GREEN
MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE #P-0826
www.greenmountainengineers.com
E-maiLmntact@greenmcuntairugh mrs.mm

SSMH-01
RIM:640.24
INV. IN: 633.55(SSP-02)
INV. OUT: 633.45(SSP-01)
EX\ST�P �GRO�ND
SURF
'III/
SSMH—DH
RIM: 643.50.
Ai
1
IIINV.
IN: 632.00(SSP-01)
gum
I
CE0NTER/IFTMIN.
STREAM
2.%
CNVERTOVERAGEOF
//o�iiiiiiiii
':
-,
111
0
92%
1+00
STREAM CROSSING
(SEWER)
0' 20' 40' 80'
SCALE: 1' = 40'
30
28
PERENNIAL STREAM/
WETLAND IMPACT PROFILE
llllllllllll
FEs "
HACKETT PROPERTIES, INC.
200 D PAMONA DRIVE
GREENSBORO, NC 27407
Tel: [phone]
[e-mail]
GREEN
MOUNTAIN
ENGINEERING, PLLC
7A WENDY CT
GREENSBORO, NC 27409
Tel: [phone]
CERTIFICATE #P-0826
www.greenmountainengineers.com
E-maiL•contact®greenmcuntair ler fir E-ers mm

s
CD
SURFACE FLOW
DIVERSION
a
PERSPECTIVE VIEW
1 //44 SUPPORTED
'IIEIII
iIIAII�IIII�II�II�II� I�
111 11 11911EIIIIEIII
,11E11E11E11 .
II,�II1IIEIIE III
1.1 l-
NW-
T
V
BRIDGEMAT
SIDE VIEW
ORARY STR
MIN. 25 FT
SILT FENCE
SEE PLAN FOR
PLACEMENT,
TYPICAL
o
5' - .
1 /4 SUPPORTED
1111
SURFACE FLOW
DIVERSION
EmEHEIIEHEHEII=nl 111= i�fil=1
+f1=11=1I1=1I I —I I1=1I1=1I1=1I1=1I1=1I1=1I1=1I1=1I1-1I1=' � i=1I1-1I1-1 �'
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��ORIGINAL =
STREAMBANK
=AV
CROSS
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BR
INSTALLATION NOTES:
1. REFER TO "NORTH CAROLINA DIVISION OF FOREST
RESOURCES" LITERATURE, INSTALLATION
MAINTENANCE GUIDELINES, & "NORTH CAROLINA
FORESTRY BMP MANUAL-2006".
2. USE A BULLDOZER, KNUCKLEBOOM LOADER, OR
SKIDDER TO INSTALL & REMOVE DRAGLINE MATS.
3. KEEP HEAVY EQUIPMENT OUT OF STREAM.
4. INSTALL WATER DIVERSION DEVICES (WATER
BARS, TURNOUTS, BROAD —BASED DIPS, ETC.) ON
BOTH SIDES OF THE MATS.
5. STABILIZE EXPOSED MINERAL SOIL WITH TREE
TOPS OR BRUSH DURING MAT INSTALLATION, AND
SEEDING/MULCH AFTER MAT REMOVAL.
6. INSTALL MATS TO CREATE A MINIMUM TEN FOOT
BRIDGE WIDTH.
MAINTENANCE NOTES:
1. KEEP MATS' SURFACE FREE OF MINERAL SOIL
AND DEBRIS THAT COULD ENTER STREAM.
2. PERIODICALLY CHECK MAT HARDWARE; RETIGHTEN
NUTS & CABLE CLAMPS AS NECESSARY TO
MAINTAIN BRIDGE STRENGTH AND INTEGRITY.
3. IMMEDIATELY REMOVE ANY DEBRIS WHICH ENTERS
THE STREAM AT THE CROSSING LOCATION.
REMOVAL NOTES:
1. CLEAN OFF BRIDGE SURFACE.
2. REMOVE MATS BY USING MAT CABLE LOOP OR
SKIDDER GRAPPLE.
3. PERMANENTLY STABILIZE DISTURBED PORTIONS
OF STREAM BANK AND APPROACH ROADS WITH
PERENNIAL GRASSES/MULCH (OR WETLAND MIX
WHEN APPLICABLE).
4. LEAVE APPROPRIATE WATER DIVERSION
STRUCTURES IN PLACE ON BOTH SIDES OF
STREAM.
DC
V
AT)
NOT TO SCALE

IMPOUNDED WATER
TO BE PUMPED
TOP OF BANK-\
SANDBAG
COFFERDAM
TOP OF BANK
BOTTOM OF BANK
FLOW
DIRECTION
STREAM BOTTOM -\
BOTTOM OF BANK
TOP OF BANK
ANDBAGS
PUMP
PUMP INTAKE \
-SANDBAGS
8 FT
SANDBAG
COFFERDAM
SCALE: NTS
GENERAL NOTES
1. PLACE SANDBAGS ON ALTERNATING HEADER COURSES
AND STRETCHER COURSES
2. SIZE PUMP ACCORDING TO FLOW
3. SIZE FILTER SOCK ACCORDING TO PUMP CAPACTfY
4. AVOID WORK WITHIN STREAM AREA DURING TIMES OF
ANTICIPATED RAINFALL
FILTER SOCK
TEMPORARY SANDBAG STREAM
COFFER DAM AND PUMP -AROUND
DIVERSION DETAIL

•
LEGEND
Site Boundary
1 , its--- .:_--
4NM
Drawing 1
USGS Topographic Map
Gibsonville, NC Quadrangle
Scale: 1" = 2,000'
P1I.01®�
P I LOT f N V I P O N M E N T A L. I N C
USGS Topographic Map
7239 Burlington Road
Approximate 19-Acre Tract
Gibsonville, Guilford County, NC
Pilot Project 6757

Drawing 2
USDA Web Soil Survey
of Guilford County, NC
Scale: 1" = 200'
P1I.01®�
P I LOT f N V I P O N M E N T A L. I N C
Web Soil Map
7239 Burlington Road
Approximate 19-Acre Tract
Gibsonville, Guilford County, NC
Pilot Project 6757

Drawing 2A
USDA Published Soil Survey
of Guilford County, NC
Published 1977
Sheets 24 and 30
Not to Scale
P1I.01®�
P I LOT f N V I P O N M E N T A L. I N C
LEGEND
Site Boundary
Published Soil Map
7239 Burlington Road
Approximate 19-Acre Tract
Gibsonville, Guilford County, NC
Pilot Project 6757

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" = 200'
P1I.01®�
P I LOT f N V I P O N M E N T A L. I N C
NWI Map
7239 Burlington Road
Approximate 19-Acre Tract
Gibsonville, Guilford County, NC
Pilot Project 6757

NIMAL F.I!OOD
LEGEND
Site Boundary
▪ 1 %Annual Chance Flood Hazard
R egulatory Floodvay
* Special Floodvay
Area of Undetermined Flood Hazard
0.2%Annual Chance Flood Hazard
▪ Future Conditions 1 %Annual Chance Flood Hazard
IA Area with Reduced Risk Due to Levee
Drawing 4
National Flood Hazard Layer
From FEMA Web Map Service
Scale: 1" = 400'
P1I.01®�
P I LOT f N V I P O N M E N T A L. I N C
FEMA FIRM
7239 Burlington Road
Approximate 19-Acre Tract
Gibsonville, Guilford County, NC
Pilot Project 6757

FLAG NUMBERS/INFORMATION
WETLAND FLAGS =
STREAM FLAGS =
Wetland Flags = 70
Stream Flags = Flagged at intersections
with the site boundary; surveyor locate
V 2VV///1
I///////A
LEGEND
Site Boundary
Perennial Stream
1 Wetland
DP-1 • Data Point
WA 1-2 Flag Number/Feature ID
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE APPROXIMATE. THE DELINEATION WAS CONDUCTED BY PILOT PERSONNEL ON
4.21.2021. THE DELINEATION WAS VERIFIED VIA DESKTOP REVIEW BY MR. JAMES LASTINGER WITH THE USACE (SAW 2021-02241, DATED
11.23.2021. THIS EXHIBIT INCLUDES GPS LOCATIONS OF DELINEATED FEATURES.
Drawing 5
2018 Satellite Imagery from ESRI
and Pilot GPS Data
Scale: 1" = 200'
Date: 4.27.21
P1I.01®�
P I LOT f N V I P O N M E N T A L. I N C
Wetland Map
7239 Burlington Road
Approximate 19-Acre Tract
Gibsonville, Guilford County, NC
Pilot Project 6757

NCSHPO HPO
tj c, .. ..maps.arcgn.comhpostxehapp.we• rdexhlm171E1,79effi71eixk.G(391000a2AdS15ed7
HPOWEB 2.0 General Audience

KYE.p T {Ds ry
-
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: 2022-0033301
Project Name: Rock Creek Station Apartments
April 19, 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.). If your project area
contains suitable habitat for any of the federally -listed species on this species list, the proposed
action has the potential to adversely affect those species. If suitable habitat is present, surveys
should be conducted to determine the species' presence or absence within the project area. The
use of this species list and/or North Carolina Natural Heritage program data should not be
substituted for actual field surveys.
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

04/19/2022 2
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
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/pdf/TOC-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 hops://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.

04/19/2022 3
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.
Attachment(s):
• Official Species List
• Migratory Birds

04/19/2022 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]

04/19/2022 2
Project Summary
Project Code: 2022-0033301
Event Code: None
Project Name: Rock Creek Station Apartments
Project Type: Residential Construction
Project Description: The site is located at 7239 Burlington Road. The site contains wooded
land. The site is proposed for development with an apartment complex.
Project Location:
Approximate location of the project can be viewed in Google Maps: https://
www.google.com/maps/@36.0800846,-79.56128446093169,14z
Counties: Guilford County, North Carolina

04/19/2022 3
Endangered Species Act Species
There is a total of 2 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
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.
Insects
NAME STATUS
Monarch Butterfly Danaus plexippus Candidate
No critical habitat has been designated for this species.
Species profile: https://ecos.fws.gov/ecp/species/9743
Flowering Plants
NAME
Small Whorled Pogonia Isotria medeoloides
Population:
No critical habitat has been designated for this species.
Species profile: https://ecos.fws.gov/ecp/species/1890
STATUS
Threatened
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

04/19/2022
Migratory Birds
Certain birds are protected under the Migratory Bird Treaty Act1 and the Bald and Golden Eagle
Protection Actz.
Any person or organization who plans or conducts activities that may result in impacts to
migratory birds, eagles, and their habitats should follow appropriate regulations and consider
implementing appropriate conservation measures, as described below.
1. The Migratory Birds Treaty Act of 1918.
2. The Bald and Golden Eagle Protection Act of 1940.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
The birds listed below are birds of particular concern either because they occur on the USFWS
Birds of Conservation Concern (BCC) list or warrant special attention in your project location.
To learn more about the levels of concern for birds on your list and how this list is generated, see
the FAQ below. This is not a list of every bird you may find in this location, nor a guarantee that
every bird on this list will be found in your project area. To see exact locations of where birders
and the general public have sighted birds in and around your project area, visit the E-bird data
mapping tool (Tip: enter your location, desired date range and a species on your list). For
projects that occur off the Atlantic Coast, additional maps and models detailing the relative
occurrence and abundance of bird species on your list are available. Links to additional
information about Atlantic Coast birds, and other important information about your migratory
bird list, including how to properly interpret and use your migratory bird report, can be found
below.
For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, click on the PROBABILITY OF PRESENCE
SUMMARY at the top of your list to see when these birds are most likely to be present and
breeding in your project area.
NAME
BREEDING
SEASON
Bald Eagle Haliaeetus leucocephalus
This is not a Bird of Conservation Concern (BCC) in this area, but warrants attention
because of the Eagle Act or for potential susceptibilities in offshore areas from certain types
of development or activities.
Red-headed Woodpecker Melanerpes erythrocephalus
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
and Alaska.
Wood Thrush Hylocichla mustelina
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
and Alaska.
Breeds Sep 1 to
Jul 31
Breeds May 10
to Sep 10
Breeds May 10
to Aug 31

04/19/2022 2
Probability Of Presence Summary
The graphs below provide our best understanding of when birds of concern are most likely to be
present in your project area. This information can be used to tailor and schedule your project
activities to avoid or minimize impacts to birds. Please make sure you read and understand the
FAQ "Proper Interpretation and Use of Your Migratory Bird Report" before using or attempting
to interpret this report.
Probability of Presence (■)
Each green bar represents the bird's relative probability of presence in the 10km grid cell(s) your
project overlaps during a particular week of the year. (A year is represented as 12 4-week
months.) A taller bar indicates a higher probability of species presence. The survey effort (see
below) can be used to establish a level of confidence in the presence score. One can have higher
confidence in the presence score if the corresponding survey effort is also high.
How is the probability of presence score calculated? The calculation is done in three steps:
1. The probability of presence for each week is calculated as the number of survey events in
the week where the species was detected divided by the total number of survey events for
that week. For example, if in week 12 there were 20 survey events and the Spotted Towhee
was found in 5 of them, the probability of presence of the Spotted Towhee in week 12 is
0.25.
2. To properly present the pattern of presence across the year, the relative probability of
presence is calculated. This is the probability of presence divided by the maximum
probability of presence across all weeks. For example, imagine the probability of presence
in week 20 for the Spotted Towhee is 0.05, and that the probability of presence at week 12
(0.25) is the maximum of any week of the year. The relative probability of presence on
week 12 is 0.25/0.25 = 1; at week 20 it is 0.05/0.25 = 0.2.
3. The relative probability of presence calculated in the previous step undergoes a statistical
conversion so that all possible values fall between 0 and 10, inclusive. This is the
probability of presence score.
Breeding Season ( )
Yellow bars denote a very liberal estimate of the time -frame inside which the bird breeds across
its entire range. If there are no yellow bars shown for a bird, it does not breed in your project
area.
Survey Effort (I)
Vertical black lines superimposed on probability of presence bars indicate the number of surveys
performed for that species in the 10km grid cell(s) your project area overlaps. The number of
surveys is expressed as a range, for example, 33 to 64 surveys.
No Data (—)
A week is marked as having no data if there were no survey events for that week.
Survey Timeframe

04/19/2022 3
Surveys from only the last 10 years are used in order to ensure delivery of currently relevant
information. The exception to this is areas off the Atlantic coast, where bird returns are based on
all years of available data, since data in these areas is currently much more sparse.
-
probability of presence breeding season 1 survey effort — no data
SPECIES JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Bald Eagle
1111 1111 Mil 1111 1111 1111 1111 ----1111 1111 1111 1111
Vulnerable
Red-headed
Woodpecker
BCC Rangewide ---- ---- --I- -----III 11111111111111-- ----
(CON)
Wood Thrush
BCC Rangewide ---- —III
111111111111---- ----
(CON)
Additional information can be found using the following links:
• Birds of Conservation Concern https://www.fws.gov/program/migratory-birds/species
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/library/
collections/avoiding-and-minimizing-incidental-take-migratory-birds
• Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.pdf
Migratory Birds FAQ
Tell me more about conservation measures I can implement to avoid or minimize impacts
to migratory birds.
Nationwide Conservation Measures describes measures that can help avoid and minimize
impacts to all birds at any location year round. Implementation of these measures is particularly
important when birds are most likely to occur in the project area. When birds may be breeding in
the area, identifying the locations of any active nests and avoiding their destruction is a very
helpful impact minimization measure. To see when birds are most likely to occur and be breeding
in your project area, view the Probability of Presence Summary. Additional measures or permits
may be advisable depending on the type of activity you are conducting and the type of
infrastructure or bird species present on your project site.
What does IPaC use to generate the migratory birds potentially occurring in my specified
location?
The Migratory Bird Resource List is comprised of USFWS Birds of Conservation Concern
(BCC) and other species that may warrant special attention in your project location.

04/19/2022 4
The migratory bird list generated for your project is derived from data provided by the Avian
Knowledge Network (AKN). The AKN data is based on a growing collection of survey, banding,
and citizen science datasets and is queried and filtered to return a list of those birds reported as
occurring in the 10km grid cell(s) which your project intersects, and that have been identified as
warranting special attention because they are a BCC species in that area, an eagle (Eagle Act
requirements may apply), or a species that has a particular vulnerability to offshore activities or
development.
Again, the Migratory Bird Resource list includes only a subset of birds that may occur in your
project area. It is not representative of all birds that may occur in your project area. To get a list
of all birds potentially present in your project area, please visit the AKN Phenology Tool.
What does IPaC use to generate the probability of presence graphs for the migratory birds
potentially occurring in my specified location?
The probability of presence graphs associated with your migratory bird list are based on data
provided by the Avian Knowledge Network (AKN). This data is derived from a growing
collection of survey, banding, and citizen science datasets .
Probability of presence data is continuously being updated as new and better information
becomes available. To learn more about how the probability of presence graphs are produced and
how to interpret them, go the Probability of Presence Summary and then click on the "Tell me
about these graphs" link.
How do I know if a bird is breeding, wintering, migrating or present year-round in my
project area?
To see what part of a particular bird's range your project area falls within (i.e. breeding,
wintering, migrating or year-round), you may refer to the following resources: The Cornell Lab
of Ornithology All About Birds Bird Guide, or (if you are unsuccessful in locating the bird of
interest there), the Cornell Lab of Ornithology Neotropical Birds guide. If a bird on your
migratory bird species list has a breeding season associated with it, if that bird does occur in your
project area, there may be nests present at some point within the timeframe specified. If "Breeds
elsewhere" is indicated, then the bird likely does not breed in your project area.
What are the levels of concern for migratory birds?
Migratory birds delivered through IPaC fall into the following distinct categories of concern:
1. "BCC Rangewide" birds are Birds of Conservation Concern (BCC) that are of concern
throughout their range anywhere within the USA (including Hawaii, the Pacific Islands,
Puerto Rico, and the Virgin Islands);
2. "BCC - BCR" birds are BCCs that are of concern only in particular Bird Conservation
Regions (BCRs) in the continental USA; and
3. "Non -BCC - Vulnerable" birds are not BCC species in your project area, but appear on
your list either because of the Eagle Act requirements (for eagles) or (for non -eagles)
potential susceptibilities in offshore areas from certain types of development or activities
(e.g. offshore energy development or longline fishing).

04/19/2022 5
Although it is important to try to avoid and minimize impacts to all birds, efforts should be made,
in particular, to avoid and minimize impacts to the birds on this list, especially eagles and BCC
species of rangewide concern. For more information on conservation measures you can
implement to help avoid and minimize migratory bird impacts and requirements for eagles,
please see the FAQs for these topics.
Details about birds that are potentially affected by offshore projects
For additional details about the relative occurrence and abundance of both individual bird species
and groups of bird species within your project area off the Atlantic Coast, please visit the
Northeast Ocean Data Portal. The Portal also offers data and information about other taxa besides
birds that may be helpful to you in your project review. Alternately, you may download the bird
model results files underlying the portal maps through the NOAA NCCOS Integrative Statistical
Modeling and Predictive Mapping of Marine Bird Distributions and Abundance on the Atlantic
Outer Continental Shelf project webpage.
Bird tracking data can also provide additional details about occurrence and habitat use
throughout the year, including migration. Models relying on survey data may not include this
information. For additional information on marine bird tracking data, see the Diving Bird Study
and the nanotag studies or contact Caleb Spiegel or Pam Loring.
What if I have eagles on my list?
If your project has the potential to disturb or kill eagles, you may need to obtain a permit to avoid
violating the Eagle Act should such impacts occur.
Proper Interpretation and Use of Your Migratory Bird Report
The migratory bird list generated is not a list of all birds in your project area, only a subset of
birds of priority concern. To learn more about how your list is generated, and see options for
identifying what other birds may be in your project area, please see the FAQ "What does IPaC
use to generate the migratory birds potentially occurring in my specified location". Please be
aware this report provides the "probability of presence" of birds within the 10 km grid cell(s) that
overlap your project; not your exact project footprint. On the graphs provided, please also look
carefully at the survey effort (indicated by the black vertical bar) and for the existence of the "no
data" indicator (a red horizontal bar). A high survey effort is the key component. If the survey
effort is high, then the probability of presence score can be viewed as more dependable. In
contrast, a low survey effort bar or no data bar means a lack of data and, therefore, a lack of
certainty about presence of the species. This list is not perfect; it is simply a starting point for
identifying what birds of concern have the potential to be in your project area, when they might
be there, and if they might be breeding (which means nests might be present). The list helps you
know what to look for to confirm presence, and helps guide you in knowing when to implement
conservation measures to avoid or minimize potential impacts from your project activities,
should presence be confirmed. To learn more about conservation measures, visit the FAQ "Tell
me about conservation measures I can implement to avoid or minimize impacts to migratory
birds" at the bottom of your migratory bird trust resources page.

04/19/2022 6
IPaC User Contact Information
Agency: Pilot Environmental, Inc.
Name: Michael Brame
Address: 743 Park Lawn Court
City: Kernersville
State: NC
Zip: 27284
Email [e-mail]
Phone: [phone]