20220896 Ver 1_401 Application_20220630

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20220896
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:
4/19/2022
Project Contact Information
Name: Heather LaGamba
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Long Creek Village (Mizpah Church 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)
Forsyth
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
5462.1_Long Creek Village_PCN_6.30.22.pdf 18.01MB
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:
,t 00. Ea+a€r
Submittal Date: Is filled in automatically.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW - 2022 - 00653 Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Mizpah Church Road- Long Creek Village
2. Work Type: ❑✓ Private ❑ Institutional ❑ Government ❑ Commercial
3. Project Description / Purpose [PCN Form 133d and 133e]:
The site is an approximate 150-acre tract located off of Mizpah Church Road in Rural Hall, Forsyth County, North Carolina that is
proposed for residential development. The site contains wooded land and timbered land.
4. Property Owner / Applicant [PCN Form A3 or A41: BHR Land Holdings/Carolina Developement Service:
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Pilot Environmental / David Brame
6. Related Action ID Number(s) [PCN Form B5b]: SAW - 2022 - 00653
7. Project Location— Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Mizpah Church Road in Rural Hall, Forsyth County, North Carolina
36.205437°,-80.320500'
8. Project Location— Tax Parcel ID [PCN Form Bla]: 6809-96-6493
9. Project Location — County [PCN Form A2b]: Forsyth County
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Rural Hall
11. Project Information — Nearest Waterbody [PCN Form 132a]: Muddy Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: Yadkin Pee Dee / 03040101
Authorization: Section 10 ❑ Section 404 ❑✓
Regulatory Action Type:
❑ Standard Permit
✓ Nationwide Permit #
Regional General Permit #
Jurisdictional Determination Request
Section 10 and 404 ❑
❑ Pre -Application Request
❑ Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

NJ STAT� �
y
I>
NORTH CAROLINA
Environmentaf Quality
Water Resources
Office Use Only
Corps Action ID no. [Click to enter.] Date received: [Click to enter.]
DWR project no. Click enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 36.205302'
Longitude (DD.DDDDDD): 80.319172'
Form Version 1.5, September 2020
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.deg.nc.goviWaterResources/0/edocl6247041PCN%2OHelp%2OFile%202018-1-30.pdf
The help document may be found at this link:
http://www.saw.usace.army. mil/Missions/Reg ulatory-Permit-Program/Permits/2017-Nationwide- Perm its/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.
4/19/2022
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,
❑ Yes ❑x No
or airport project)
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.
❑x Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Page 1 of 21 PCN Form -Version 1.5, September 2020

0 Nationwide Permit (NWP)
1 b. Permit type(s)? *
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as separate attachments
and submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps? *
❑ Yes 0 No
NWP number(s):
NWP 29
RGP number(s):
Click to enter.
1d. Type(s) of approval sought from the DWR (check all that apply):
0 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
1 e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: *
❑ Yes 0 No
For the record only for Corps Permit: *
❑ Yes 0 No
1f. Is this an after -the -fact permit/certification application? *
❑ Yes 0 No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
® Yes ❑ No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h. Is the project located in any of NC's twenty coastal counties? *
❑ Yes 0 No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑ Yes 0 No ❑ Unknown
1j. Is the project located in a designated trout watershed? *
❑ Yes 0 No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.miI/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? *
Jonathan McCall
1 b.
Primary Contact Email: *
[e-mail]
1 c.
Primary Contact Phone: i (###)###-####
[phone]
1 d.
Who is applying for the permit/certification? _ (check
all that apply)
❑ Owner 0 Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
Z Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed: *
BHR Land Holdings, LLC
2b.
Deed Book and Page No.:
003501 - 00374
2c.
Responsible Party (for corporations):
Ben Russell
2d.
Address i
Street Address:
4389 Indian Trail Fairview Road
Address line 2:
k-BUK LU C[R
City:
Indian Trail
State/ Province/ Region:
NC
Postal/ Zip Code:
28079
Country:
United States
2e.
Telephone Number: * (###)###-####
707-288-7826
2f.
Fax Number: (###)###-####
Click to enter.
2g.
Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
Jonathan McCall
3b.
Business Name (if applicable):
Carolina Development Services, LLC
3c.
Address:
Street Address:
2627 Breckenridge Centre Dr
Address line 2:
Click to ent�,
City:
Monroe
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
28110
Country
US
3d.
Telephone Number: (###)###-####
704-774-1964
3e
Fax Number: (###)###-####
Click to enter.
Page 3 of 21 PCN Form - Version 1.5, September 2020

3f. Email Address: [e-mail]
4. Agent/ Consultant (if applicable)
4a. Name: *
David S. Brame
4b. Business Name:
Pilot Environmental, Inc.
4c. Address: *
Street Address:
743 Park Lawn Court
Address line 2:
Click to enter.
City:
Kernersvi Ile
State/ Province/ Region:
NC
Postal/ Zip Code:
27284
Country:
U.S.
4d. Telephone Number: * (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to ente
4f. Email Address: *
[e-mail]
Agent Authorization Letter:*
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw. usace.army.miI/Missions/Reg ulatory-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
1a. Name of project: *
Long Creek Village
1 b. Subdivision name (if appropriate):
none
1c. Nearest municipality/town: *
Rurall Hall, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
6809-96-6493
2b.
Property size (in acres):
150
2c.
Project Address:
Street Address:
Mizpah Church Road
Address line 2:
Click to enter.
City:
Rurall Hall
State/ Province/ Region:
NC
Postal/ Zip Code:
27045
Country:
U.S.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 36.205302°
Longitude (-DD.DDDDDD): *-80.319172°
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Muddy Creek
3b. Water Resources Classification of nearest receiving
C
water: *
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcgis.com/apes/webappviewer/index.html?id=6el25ad7628f494694e259c8Odd64265
Yadkin-PeeDee
3c. In what river basin(s) is your project located?
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030401011302
located:
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apes/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
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 timbered land and wooded land. A pond, designated as Paitts Lake, is located on the
western portion of the site. Several streams are located throughout the site, including Muddy Creek
on the western portion. Wetlands are located adjacent to the streams. The wetlands are separated
from surrounding uplands by topographic, vegetation and/or soil breaks. The surrounding properites
consists of roads, wooded lands and residential development.
4b.
Have Corps permits or DWR certifications been obtained for this
i] Yes X No ❑ Unknown
project (including all prior phases) in the past? *
4c.
If yes, please give the DWR Certification number and/or Corps
[Click to enter.]
Action ID (ex. SAW-0000-00000):
[Click to enter.]
Attach any pertinent project history documentation
4d.
Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.
Attach an 8'h 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
5.24 acres
property:
4g.
List the total estimated linear feet of all existing streams (intermittent
7,150 linear feet
and perennial) on the property:
4g1.
List the total estimated acreage of all existing open waters on the
13.5 acres
property:
4h.
Explain the purpose of the proposed project:
The purpose of the proposed project is to construct a residential subdivsion.
4i.
Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the proposed construction of the Long Creek Village residential subdivision. The
residential subdivision will consist of 325 single family residential lots, 59 apartment units and associated amenities.
The site will be located on 110 acres and contain 3.5 units per acre with 30.6 built upon acres. The site will contain 6
permanent stormwater ponds. The site will connect to existing sewer infrastructure on the site. Four entrances, two to
the residential subdivision and 2 to the apartment complex are required to satisfy development and safety ordinances.
Two culverted stream/wetland crossings are proposed in order to facilitate the proposed development and provide dual
access to the residential subdivision. Wetland impacts are proposed to facilitate construction of the roadways,
sidewalk and lots. 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
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
The site was delineated by Pilot Environmental in December 2019.
Name (if known): David Brame/Michael Brame
5b. If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental
areas?
Other: Click to enter.
Page 6 of 21 PCN Form - Version 1.5, September 2020

5c. If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved 0 Emailed Concurrence
what type of determination was made? *
❑ Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
SAW-2022-00653
5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
March 25, 2022 — confirmed by Ms. Samantha Dailey. E-mail concurrence attached
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.
The site is a proposed single phase development. No additional phases are proposed.
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
Impacts Summary
0 Wetlands 0 Streams - tributaries
la. Where are the impacts associated with your project ❑ Buffers ❑ Open Waters
(check all that apply):
❑ Pond Construction
2.
Wetland Impacts
If there are wetland impacts proposed
on the site, complete this table for each wetland area impacted.
2a.
2a1.
2b.
2c.
2d.
2e.
2f.
2g.
Site #*
Impact
Impact
Wetland Name*
Wetland Type*
Forested
Jurisdiction
Impact Area
Reason/Type*
Duration*
?*
Type*
(ac)*
W1
Culvert
Permanent
DWA
Bottomland
Yes
Both
0.156
Hardwood
Forest
W2
Culvert
Permanent
DWC
Bottomland
Yes
Both
0.130
Hardwood
Forest
W3
Fill (Incl.
Permanent
DWA
Bottomland
Yes
Both
0.047
Riprap)
Hardwood
Forest
W4
Fill (Incl.
Permanent
DWA
Bottomland
Yes
Both
0.078
Riprap)
Hardwood
Forest
W5
Fill (Incl.
Permanent
DWB
Headwater
Yes
Both
0.0867
Riprap)
Forest
W6
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
2g1.
Total temporary wetland impacts
0 ac
2g2.
Total permanent wetland impacts
0.499 ac
2g3.
Total wetland impacts
0.499 ac
2h.
Comments:
Five wetland impacts are proposed.
Wetland impact W1 (W1A/W1B) is for impact associated with the northern
entranceway and required bottomless arch culvert and riprap dissipater. Wetland impact W2 is for impact associated
with the eastern entranceway and required traditional culvert and riprap dissipater. Wetland impacts W3 and W4 are
for impact associated with side slopes to accommodate lots 41, 42 and the cul-de-sac. Wetland impact W5 is for
impact associated with the construction
of Bearskin Loop roadway and associated sidewalks and lots 191, 209 and
210.
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
3a.
3b.
3d.
3e.
3f.
3g.
3h.
Site #*
Impact Reason/
Impact
Stream Name*
Stream
Jurisdiction
Stream Width
Impact length
Type*
Duration*
Type*
Type*
(avg ft) *
(linear ft)
S1
Other
Temporary
DSB
Perennial
Both
4
0
S2
Fill (Ind. Riprap)
Permanent
DSB
Perennial
Both
4
15
S3
Dewatering
Temporary
DSB
Perennial
Both
4
5
S4
Dewatering
Temporary
DSB
Perennial
Both
4
20
S5
Crossing/ Culvert
Permanent
DSD
Perennial
Both
1.5
202
S6
Fill (Ind. Riprap)
Permanent
DSD
Perennial
Both
1.5
15
S7
Dewatering
Temporary
DSD
Perennial
Both
1.5
5
S8
Dewatering
Temporary
DSD
Perennial
Both
1.5
15
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:
232 linear ft
M.
Total temporary stream impacts:
45 linear ft
34.
Total stream and ditch impacts:
277 linear ft
3j.
Comments:
S1 — Stream location 1 includes installation of a bottomless arch culvert. There will be no permanent or
temporary fill associated with installation of the bottomless arch culvert.
S2 — Stream location 2 includes 15 LF (60 SF) of fill associated with a riprap dissipater downstream of the
bottomless arch culvert. Riprap will be installed flush with the existing stream bed.
S3 — Stream location 3 includes 5 LF (20 SF) of temporary fill for coffer dam located downstream of the
bottomless arch culvert if needed during installation of the bottomless arch culvert.
S4 — Stream location 4 includes 20 LF (80SF) of temporary fill for coffer dam located upstream of the bottomless
arch culvert if needed during installation of the bottomless arch culvert.
S5 — Stream location 5 includes 202LF (303 SF) of permanent fill for the installation of a traditional culvert,
headwalls and endwalls at the eastern crossing.
S6 — Stream location 6 includes 15 LF (22.5 SF) of permanent fill with a riprap dissipater downstream of the
traditional culvert to be installed flush with the exisiting stream bed.
S7 — Stream location 7 includes 5 LF (7.5 SF) of temporary fill for coffer dam located downstream of the
traditional culvert.
S8 — Stream location 8 includes 15 LF (22.5 SF) of temporary fill for coffer dam located upstream of the traditional
culvert.
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.
4b.
4c.
4d.
4e.
4e1.
4f.
Site #
Impact Reason/
Impact
Waterbody Name
Waterbody
Jurisdiction
Impact area (ac)
Type
Duration*
Type*
Type*
01
Choose one
Temp/
slick to enter.
Choose one
Choose one
Click to enter
Perm
02
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter
Perm
03
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter
Perm
04
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter
Perm
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.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts (ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
clicK to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enf—
pnfcr
enter.
enter.
enter.
enter.
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
❑ 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)
131
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: :lick to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Click to enter.
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
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The applicant has designed the proposed development to avoid impacts to the remaining streams and wetlands
located on the site. In order to develop the site and provide the required dual access and to construct the project, the
proposed impacts could not be avoided. Civil design, such as minimizing the entranceway widths, use of headwalls
and endwalls and use of retaining walls were used to further reduce impacts to streams and wetlands.
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. Disturbed areas will
be promptly 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? * 0 DWR 0 Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ® Mitigation Bank
project? * (check all that apply) ❑ 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:
Brushy Mountatin Mitigation Bank
3b. Credits purchased/requested:
Type: Riparian Wetland
Quantity 0.499
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
A Statement of Availability (SoA) provided by Restoration Systems, LLC is attached.
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
Click to enter. linear feet
4c.
If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO: RP:P27 BUTTON KEY:O
4d.
Buffer mitigation requested (DWR only):
Click to enter. square feet
4e.
Riparian wetland mitigation requested:
Click to enter. acres
4f.
Non -riparian wetland mitigation requested:
Click to enter. acres
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter. acres
Page 13 of 21 PCN Form - Version 1.5, September 2020

4h. Comments:
DMS has been contacted and will used to secure wetland mitigation credits should private bank credits not be
available at the time of purchase.
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
❑ Yes X No
that requires buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact (square
Multiplier
Required mitigation
feet)
(square feet)
Zone
1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone
2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes
❑ No
NC Division of Mitigation Services proposed?
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
❑ Yes 0 No
identified within one of the NC Riparian Buffer Protection Rules?
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://deg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ 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 0 No
2b. Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
El Yes 0 No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c. IS the project over an acre?
0 Yes ❑ No
2d. Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state-
0 Yes ❑ No
approved local government stormwater program?
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?
❑ Local Government
(Check all that apply) *
0 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

x❑ Phase II ❑ USMP
Local Government Stormwater Programs
❑ NSW ❑ Water Supply
Please identify which local government stormwater program you are using.*
City of Winston-Salem
x❑ Phase II ❑ HQW or ORW
State Stormwater Programs
❑ Coastal Counties ❑ Other
Comments:
A SWMP has been submitted to the City of Winston-Salem for review and approval.
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)
❑ Yes X No
funds or the use of public (federal/state) land? *
1 b. If you answered "yes" to the above, does the project require
preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental
❑Yes ❑ No
Policy Act (NEPA/SEPA)? *
1 c. 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
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
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 ❑Yes X No
(15A NCAC 2B .0200)? *
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
❑ Yes X No
downstream water quality? *
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? * I ® 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 an existing sewer line that is located on the site. The sewer line will be bored beneath
Muddy Creek. Additional impacts associated with sewage disposal are not proposed.
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
® Yes ❑ No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl)
5b.
Have you checked with the USFWS concerning Endangered Species
❑ Yes M No
Act impacts? *
5c.
If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d.
Is another federal agency involved? *
❑ Yes M No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e.
Is this a DOT project located within Divisions 1-8? *
❑ Yes M No
5f.
Will you cut any trees in order to conduct the work in waters of the
U.S.? *
®Yes ❑ No
5g.
Does this project involve bridge maintenance or removal? *
❑ Yes M No
Link to NLEB SLOPES document: http://saw-re.g.usace.army.miI/NLEB/1-30-17-signed NLEB-
SLOPES&apps.pdf
5h.
Does this project involve the construction/ installation of a wind
turbine(s)? *
El Yes 0 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,
❑ Yes 0 No
mechanized pile drivers, etc.? *
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j.
What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
US Department of the Interior — Fish and Wildlife Service Official Species List from IPaC
4 listed species are identified on the IPaC report (attached). The Northern long-eared bat, bog turtle, Schweinitz's
Sunflower and Monarch butterfly are included by the IPaC as federally listed species identified within the project area.
Bat hibernacula is not located on the site. The site contains areas of limited or low quality suitable summer roosting
habitat. Similar or higher quality suitable summer roosting habitat was observed on surrounding properties.
Percussive activities including blasting or driving piles are not anticipated as a result of construction of the proposed
project. Based on a review of the June _1_2016_NLEB _HUC12 NLEB shapefiles obtained from the Asheville
Ecological Services Field Office website, the 12-digit HUC with the nearest confirmed hibernation and/or maternity sites
is located more than 75 miles from the site. Based on the distance from known hibernacula and roost trees and the
availability of similar suitable habitat on nearby properties, the proposed project is not likely to adversely affect the
Northern long-eared bat.
Neither the crossing nor the areas proximate to the crossing contain suitable habitat for the remaining species.
According to the natural heritage program, documented occurrences of Schweinitz's sunflower are located 12.5 miles
and farther from the site. The bog turtle is listed due to similarity of appearance and the Monarch butterfly is a
candidate species.
Attach consultation documentation.
Page 18 of 21 PCN Form - Version 1.5, September 2020

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat? *
❑Yes
x❑ No
Are there submerged aquatic vegetation (SAV) around
the project vicinity? *
El Yes
0 No El Unknown
Will this project affect submerged aquatic vegetation?
❑ Yes
X No ❑ Unknown
Explain:
Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper — NOAA Fisheries
Page 19 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://gis. ncdcr..qov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
®Yes x❑ No
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
NC Historic Preservation Office's HPOWEB 2.0. Historic properties that are listed or are eligible for listing on the
National Register for Historic Places were not identified on the site or proximate to stream and wetland impacts. 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? *
® Yes X No
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 from FEMA Web Map Service — Drawing 4 (Attached)
Page 20 of 21 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
Please let me know if you need additional information in order to process this application.
Attach pertinent documentation or attachments not previously requested
I. Signature *
X By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * David S. Brame
Signature:
6/30/2022
Page 21 of 21 PCN Form - Version 1.5, September 2020

Proposal for Environmental Services
Pilot Proposal 5462.1
February 24, 2022
AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address: ZpQtl-,
Applicant Information:
Name:
Address:
Telephone Number
Fax Number:
E-mail Address:
—((, L4 - `i--1 L-f - 4 <i w
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V
A
Signature V,10 I U Date: 3­ (- 2-0 ZZ-
C
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DocuSign Envelope ID: 8F24AF5B-8852-44D7-9DC5-C1938DFE43DF
Proposal for Environmental Services
Pilot Proposal5462.1
February 24, 2022
AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address: Mizpah Church Road
Winston Salem. NC
Owner Information: BHR Land Holdings, LLC
Address: 4389 Indian Trail Fairvew Road, Indian Trail, NC 28079
Telephone Number: 704-288-7826
Fax Number:
E-mail Address: [e-mail]
JURISDICTIONAL DETERMINATION REQUEST
D. PROPERTY ACCESS CERTIFICATION
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: _X Owner _ Authorized Agent
3/7/2022
cuftned by:
bull, Kkss(R
Signature
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THE LOCATIONS OF FEATURES SHOWN ON THIS MAP WERE VERIFIED BY MS. SAMANTHA DAILEY WITH THE USACE (SAW-2022-00653). TH
EXHIBIT INCLUDES GPS LOCATIONS OF DELINEATED FEATURES. DELINEATION CONDUCTED BY PILOT PERSONNEL ON 12.18.19.
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Scale: 1" = 750' 'a • = Rural Hall, Forsyth County, NC
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P 119 i i% 5' A V Y V t N I A L. M C

United States Department of the Interior
FISH AND WILDLIFE SERVICE
Asheville Ecological Services Field Office
160 Zillicoa Street
Asheville, NC 28801-1082
Phone: [phone] Fax: [phone]
In Reply Refer To:
Project Code: 2022-0055608
Project Name: Long Creek Village
June 17, 2022
Subject: List of threatened and endangered species that may occur in your proposed project
location or may be affected by your proposed project
To Whom It May Concern:
The enclosed species list identifies threatened, endangered, proposed and candidate species, as
well as proposed and designated critical habitat, that may occur within the boundary of your
proposed project and/or may be affected by your proposed project. The enclosed 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.).
Please note that new species information can change your official species list. 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. The Service recommends you visit the ECOS-IPaC website at
regular intervals during project planning and implementation to ensure your species list is
accurate or obtain an updated species list.
The purpose of the Act is to provide a means whereby threatened and endangered species and the
ecosystems upon which they depend may be conserved. Under sections 7(a)(1) and 7(a)(2) of the
Act and its implementing regulations (50 CFR 402 et seq.), Federal agencies are required to
utilize their authorities to carry out programs for the conservation of threatened and endangered
species and to determine whether projects may affect threatened and endangered species and/or
designated critical habitat.
A biological assessment (BA) or biological evaluation (BE) should be completed for your
project. A BA is required for major construction activities (or other undertakings having similar
physical impacts) considered to be 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))
(NEPA). For projects other than major construction activities, the Service suggests that a BE be
prepared to determine effects of the action and whether those effects may affect listed species
and/or designated critical habitat. E?ects of the action are all consequences to listed species or
critical habitat that are caused by the proposed action, including the consequences of other

06/17/2022
activities that are caused by the proposed action. A consequence is caused by the proposed action
if it is reasonably certain to occur and would not occur "but for" the proposed action..
Recommended contents of a BA/BE are described at 50 CFR 402.12. More information and
resources about project review and preparing a BABE can be found at the following web link:
https://www.fws. gov/office/asheville-ecological-services/asheville-field-office-online-review-
process-overview.
If a Federal agency determines 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. The Service is not required to concur with "no effect" determinations from Federal action
agencies. If consultation is required, the Service recommends that candidate species, proposed
species, proposed critical habitat, and at -risk species be addressed within the consultation. More
information on the regulations and procedures for section 7 consultation, including the role of
permit or licensed applicants, can be found in the "Endangered Species Consultation Handbook"
at the following web link: https://www.fws.gov/media/endangered-species-consultation-
handbook.
Migratory Birds: In addition to responsibilities to protect threatened and endangered species
under the Act, 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 Service (50 C.F.R. Sec. 10.12
and 16 U.S.C. Sec. 668(a)). More information about MBTA and BGEPA can be found at the
following web link: https://www.fws.gov/program/migratory-birds.
We appreciate your consideration of Federally listed species. The Service encourages Federal
agencies to include conservation of threatened and endangered species in their project planning
to further the purposes of the Act. Please contact our staff at 828-258-3939, if you have any
questions. In any future correspondence concerning this project, please reference the
Consultation Code which can be found in the header of this letter.
Attachment(s):
• Official Species List
• USFWS National Wildlife Refuges and Fish Hatcheries
• Migratory Birds
• Wetlands

06/17/2022
Official Species List
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Asheville Ecological Services Field Office
160 Zillicoa Street
Asheville, NC 28801-1082
[phone]

06/17/2022
2
Project Summary
Project Code: 2022-0055608
Event Code: None
Project Name: Long Creek Village
Project Type: Residential Construction
Project Description: The site is an approximate 150 acre tract that is being considered for
residential development.
Project Location:
Approximate location of the project can be viewed in Google Maps: https:
www. google.com/maps/(a)36.2054687,-80.32430593638288,14z
L""rc�ILrhn r.�
0
Counties: Forsyth County, North Carolina

06/17/2022 3
Endangered Species Act Species
There is a total of 4 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
Fisheriesi, as USFWS does not have the authority to speak on behalf of NOAA and the
Department of Commerce.
See the "Critical habitats" section below for those critical habitats that lie wholly or partially
within your project area under this office's jurisdiction. Please contact the designated FWS office
if you have questions.
1. NOAA Fisheries, also known as the National Marine Fisheries Service (NMFS), is an
office of the National Oceanic and Atmospheric Administration within the Department of
Commerce.
Mammals
NAME STATUS
Northern Long-eared Bat Myotis septentrionalis Threatened
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9045
Reptiles
NAME
STATUS
Bog Turtle Glyptemys muhlenbergii
Similarity of
Population: U.S.A. (GA, NC, SC, TN, VA)
Appearance
No critical habitat has been designated for this species.
(Threatened)
Species profile: https:Hecos.fws.gov/ecp/species/6962
Insects
NAME STATUS
Monarch Butterfly Danaus plexippus Candidate
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9743

06/17/2022
4
Flowering Plants
NAME
Schweinitz's Sunflower Helianthus schweinitzii
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/3849
STATUS
Endangered
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

06/17/2022
USFWS National Wildlife Refuge Lands And Fish
Hatcheries
Any activity proposed on lands managed by the National Wildlife Refuge system must undergo a
'Compatibility Determination' conducted by the Refuge. Please contact the individual Refuges to
discuss any questions or concerns.
THERE ARE NO REFUGE LANDS OR FISH HATCHERIES WITHIN YOUR PROJECT AREA.

06/17/2022
Migratory Birds
Certain birds are protected under the Migratory Bird Treaty Act! and the Bald and Golden Eagle
Protection Act2.
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 Treat. 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.
BREEDING
NAME 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.
Black -billed Cuckoo Coccyzus erythropthalmus
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
and Alaska.
https:Hecos.fws.gov/ecp/species/9399
Breeds Sep 1 to
Jul 31
Breeds May 15
to Oct 10

06/17/2022
2
BREEDING
NAME
SEASON
Cerulean Warbler Dendroica cerulea
Breeds Apr 28
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
to Jul 20
and Alaska.
https:Hecos.fws.gov/ecp/species/297
Eastern Whip -poor -will Antrostomus voci ferns
Breeds May 1
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
to Aug 20
and Alaska.
Kentucky Warbler Oporornis formosus Breeds Apr 20
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA t0 Aug 20
and Alaska.
Prairie Warbler Dendroica discolor Breeds May 1
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Jul 31
and Alaska.
Prothonotary Warbler Protonotaria citrea Breeds Apr 1 to
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA Jul 31
and Alaska.
Red-headed Woodpecker Melanerpes erythrocephalus Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Sep 10
and Alaska.
Rusty Blackbird Euphagus carolinus Breeds
This is a Bird of Conservation Concern (BCC) only in particular Bird Conservation Regions elsewhere
(BCRs) in the continental USA
Wood Thrush Hylocichla mustelina Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Aug 31
and Alaska.
Probability Of Presence Summary
The graphs below provide our best understanding of when birds of concern are most likely to be
present in your project area. This information can be used to tailor and schedule your project
activities to avoid or minimize impacts to birds. Please make sure you read and understand the
FAQ "Proper Interpretation and Use of Your Migratory Bird Report" before using or attempting
to interpret this report.
Probability of Presence (■)
Each green bar represents the bird's relative probability of presence in the 10km grid cell(s) your
project overlaps during a particular week of the year. (A year is represented as 12 4-week
months.) A taller bar indicates a higher probability of species presence. The survey effort (see
below) can be used to establish a level of confidence in the presence score. One can have higher
confidence in the presence score if the corresponding survey effort is also high.

06/17/2022 3
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 (1)
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
Surveys from only the last 10 years are used in order to ensure delivery of currently relevant
information. The exception to this is areas off the Atlantic coast, where bird returns are based on
all years of available data, since data in these areas is currently much more sparse.
■ probability of presence breeding season I survey effort — no data
SPECIES JAN FEB MAR APR MAY JUN I JU1LI I IA IUGI SSEPy OCT NOV DEC
Bald Eagle +
Non -BCC I I I Ilill lill Jill
`
Vulnerable I I I I I I1Cuckooilled I++++ ++++ 4;7 7777 ITIT 1117 i±11 11++ +T++ ++++

06/17/2022
4
BCC Rangewide
(CON)
Cerulean Warbler ++++
BCC Rangewide tt tt R
(CON)
Eastern Whip -poor- ++4 I I I +++ +++
Whip -poor -
Will
BCC Rangewide
(CON)
Kentucky Warbler ++++ ++++ ++++ ++�i
BCC Rangewide
(CON)
++ ++++ ++0111111111 #+++ ++++ ++++ ++++
-++ ++4
++ ++++ ++++ ++++
Prairie Warbler ++++
BCC Rangewide ++++ ++++ I ITT +++TT I +T+T ++++ ++++
(CON)
Prothonotary ++++ ++++ ++++
Warbler
BCC Rangewide
(CON)
Red-headed
Woodpecker * T T T
BCC Rangewide
(CON)
444 III ++++ ++++ d I
Rusty Blackbird BCC -BCR T T+++ 01 +000
Wood Thrush BCC Rangewide 1110 ++++ ++++ ++++ TI I II T' IM 111104 ++++ ++++
(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/avoidins--and-minimizins--incidental-take-mis-ratorv-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

06/17/2022 5
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
(BCQ and other species that may warrant special attention in your project location.
The migratory bird list generated for your project is derived from data provided by the Avian
Knowledge Network (AKN). The AKN data is based on a growing collection of survey, banding,
and citizen science datasets and is queried and filtered to return a list of those birds reported as
occurring in the 10km grid cell(s) which your project intersects, and that have been identified as
warranting special attention because they are a BCC species in that area, an eagle (Eagle Act
requirements may apply), or a species that has a particular vulnerability to offshore activities or
development.
Again, the Migratory Bird Resource list includes only a subset of birds that may occur in your
project area. It is not representative of all birds that may occur in your project area. To get a list
of all birds potentially present in your project area, please visit the AKN Phenology Tool.
What does IPaC use to generate the probability of presence graphs for the migratory birds
potentially occurring in my specified location?
The probability of presence graphs associated with your migratory bird list are based on data
provided by the Avian Knowledge Network (AKN). This data is derived from a growing
collection of survey, banding, and citizen science datasets .
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);

06/17/2022 6
2. 'BCC - BCR" birds are BCCs that are of concern only in particular Bird Conservation
Regions (BCRs) in the continental USA; and
3. "Non -BCC - Vulnerable" birds are not BCC species in your project area, but appear on
your list either because of the Eagle Act requirements (for eagles) or (for non -eagles)
potential susceptibilities in offshore areas from certain types of development or activities
(e.g. offshore energy development or longline fishing).
Although it is important to try to avoid and minimize impacts to all birds, efforts should be made,
in particular, to avoid and minimize impacts to the birds on this list, especially eagles and BCC
species of rangewide concern. For more information on conservation measures you can
implement to help avoid and minimize migratory bird impacts and requirements for eagles,
please see the FAQs for these topics.
Details about birds that are potentially affected by offshore projects
For additional details about the relative occurrence and abundance of both individual bird species
and groups of bird species within your project area off the Atlantic Coast, please visit the
Northeast Ocean Data Portal. The Portal also offers data and information about other taxa besides
birds that may be helpful to you in your project review. Alternately, you may download the bird
model results files underlying the portal maps through the NOAA NCCOS Integrative Statistical
Modeling and Predictive Mapping of Marine Bird Distributions and Abundance on the Atlantic
Outer Continental Shelf project webpage.
Bird tracking data can also provide additional details about occurrence and habitat use
throughout the year, including migration. Models relying on survey data may not include this
information. For additional information on marine bird tracking data, see the Diving Bird Study
and the nanotag studies or contact Caleb Spiegel or Pam Lorin.
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,

06/17/2022
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.

06/17/2022
Wetlands
Impacts to NWI wetlands and other aquatic habitats may be subject to regulation under Section
404 of the Clean Water Act, or other State/Federal statutes.
For more information please contact the Regulatory Program of the local U.S. Army Corps of
Engineers District.
Please note that the NWI data being shown may be out of date. We are currently working to
update our NWI data set. We recommend you verify these results with a site visit to determine
the actual extent of wetlands on site.
RIVERINE
• Riverine
FRESHWATER FORESTED/SHRUB WETLAND
• Palustrine

06/17/2022
IPaC User Contact Information
Agency: Pilot Environmental, Inc
Name: David Brame
Address: 743 Park Lawn Court
City:
Kernersville
State:
NC
Zip:
27284
Email
[e-mail]
Phone:
3363104527

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David Brame
From: Heather LaGamba
Sent: Tuesday, April 19, 2022 4:11 PM
To: Homewood, Sue; Montalvo, Sheri A
Subject: Pre -File Notice - Long Creek Village (Mizpah Church Rd - 5462.1)
Sue/Sherri,
We would like to submit a Pre -filing Notice for the following project:
Project Name: Long Creek Village (Mizpah Church Rd - 5462.1)
Project Owner: Carolina Development Services
Project Owner's Address: 2627 Brekenridge Centre Drive, Monroe, North Carolina 28110
Project County: Forsyth
Type of project/Approval Sought: 401 WQC, Pre -Application Request Meeting Declined
Sincerely,
Heather LaGamba
336.345.9536 (c)
336.310.4527 (o)
P.O. Box 128
Kernersville, NC 27285
www.pilotenviro.com
[e-mail]

Restoration Systems, LLC
1101 Haynes St. Suite 211
Raleigh, North Carolina
Ph: [phone]
Fx: [phone]
Statement of Mitigation Credit Availability
Brushy Mountain Mitigation Bank
June 27, 2022, 2022
Army Corps of Engineers
Re: Availability of Compensatory Wetland Credits
Project: Long Creek Village
Project Location: Minzpah Church Road, Winston-Salem, Forsyth County, NC - Yadkin 03040101
Permittee: Mr. Johnathan McCall
Carolina Development Services, LLC
2627 Brekonridge Centre Drive
Monroe, North Carolina 28110
This document confirms that 1 Wetland Credits (Credits) from the Brushy Mountain Mitigation
Bank (Bank) are currently available and all or a portion may be used, once transferred, for
compensatory mitigation relative to the Long Creek Village project.
The Applicant may ultimately purchase the Credits, if they are available, following Permit issuance.
Should the Applicant purchase the Credits at that time, we will complete and execute the Mitigation
Credit Transfer Certificate (Certificate) within five (5) days of receipt of the full purchase price.
We will additionally provide copies of the completed and executed Certificate to the Applicant, the
Division of Water Resources (DWR) and, if needed, other regulatory agencies. In addition, we will
provide DWR with an updated copy of the Bank's Ledger, reflecting the transaction. Transaction
information in the updated Bank Ledger will include relevant Permit and Applicant information as
well as the number and resource type of the debited Credits.
Should your office have any questions, please contact me at 919.334.9118.
Sincerely,
BARRETT JENKINS
Restoration Systems, LLC
[e-mail]