20221692 Ver 1_401 Application_20221130

Staff Review Form
NORTH CAROLINA
Ertrlmnmertlrtl Quality
Updated September 4, 2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20221692
Version* 1
Is this project a public transportation project?*
Reviewer List:*
Select Reviewing Office: *
Submittal Type:*
Yes
No
Sue Homewood:eads\slhomewood:[e-mail]
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:
9/2/2022
Project Contact Information
Name:
Heather LaGamba
Who is submitting the information?
Email Address: [e-mail]
Project Information
...................................
Project Name: Beckett Townes Subdivision/Johnson Street
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
6573.3-Johnson Street Becket Town Homes_SAW-
2022-01124_PCN Request_11.30.22.pdf
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
PCN for 401 WQC
Sign and Submit
4.54MB
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: 11/30/2022
Is filled in automatically.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 9: SAW- 2022-01124 Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Beckett Townes Subdivision/Johnson Street
2. Work Type: ✓❑Private ❑Institutional ❑Government ❑Commercial
3. Project Description / Purpose [PCN Form 133d and B3e]:
The site is proposed for residential development.
4. Property Owner / Applicant [PCN Form A3 or A4]: Leoterra Johnson Street, LLC
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Pilot Environmental Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Johson Street
36.0393930/-80.0226430
8. Project Location —Tax Parcel ID [PCN Form Bla]: 6893747800
9. Project Location —County [PCN Form A2b]: Guilford
10. Project Location —Nearest Municipality or Town [PCN Form A2c]: High Point
11. Project Information —Nearest Waterbody [PCN Form 132a]: West Fork Deep River (Oak Hollow
RPSPrvoir)
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03030003
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
Standard Permit
✓ Nationwide Permit 9
Regional General Permit 9
Jurisdictional Determination Request
Section 10 and 404 ❑
Pre -Application Request
Unauthorized Activity
Compliance
No Permit Required
Revised 20150602

FATr'
4.
N•:3-�1 H CARD-INA
EUArGnme �Qua4iy
WaiV REeEuJrLes
Office Use Only
Corps Action I D no. [Click to enter.] Date received: [Click to enter.]
DWR project no. Click enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 36.039669'
Longitude (DD.DDDDDD):-80.022490'
Form Version 4.3, April 20, 2022
Pre -Construction Notification (PCN) Form
(Ver. 4.2, January31, 2022)J
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 PCN help document may be found at this link:
httas://edocs.dea.nc.aov/WaterResources/DocView.asax?dbid=0&id=2196924&cr=1
Please ensure you have submitted a pre -filing meeting request at least 30 days prior to submitting this
form, as DWR will not be able to accept your application without documentation of this important first step.
The Division has developed a Pre -filing Meeting Request email address 401 PreFile(a)ncdenr.clov to accept
the federally required pre -filing meeting request and provide confirmation receipt of submittal . This receipt
or similar documentation will 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) : 9/22/2022
Page 1 of 22 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located: *
Guilford Additional (if needed).
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
❑ Yes 0 No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes N No
or airport project)
Is this a NCDOT project?
❑ Yes N No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to ente
N 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)
Has this PCN previously been submitted? *
❑ Yes N No
Please provide the date of the previous submission. *
Click to enter a date.
N Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
❑ Regional General Permit (RGP)
authorization?
❑ 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 attachments and
submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps? *
❑ Yes N No
NWP number(s) (list all numbers ):
NWP 29
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes N No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
Click to enter text
1d. Type(s) of approval sought from DWR (check all that apply):
N 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes 0 No
1e. Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification:
❑ Yes N No
For the record only for Corps Permit:
❑ Yes N No
1f. Is this an after -the -fact permit/certification application?
❑ Yes N No
Page 2 of 22 PCN Form Version 4.3-April 20, 2022

1 g.
Is payment into a mitigation bank or in -lieu fee program proposed for
❑ Yes
0 No
mitigation of impacts?
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
N No
1i.
Is the project located within an NC DCM Area of Environmental
❑ Yes
N No ❑ Unknown
Concern (AEC)? *
1j.
Is the project located in a designated trout watershed?
❑ Yes
N 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: httr)://www.saw.usace.army.miI/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of22 PCN Form Version 4.3-April 20, 2022

B. Applicant Information
1a.
Who is the primary contact? *
Clay Mize
1b.
Primary Contact Email: *
[e-mail]
1c.
Primary Contact Phone: * (###)###-####
336-967-6260
1d.
Who is applying for the permit/certification? * (check
all that apply)
® Owner ❑ Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?*
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed: *
Leoterra Johnson Street, LLC
2b.
Deed Book and Page No.:
008518-00991
2c.
Contact Person (for corporations):
Clay Mize
2d.
Address *
Street Address:
110A Shields Park Drive
Address line 2:
Click to enter.
City:
Kernersville
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27284
Country:
United States
2e.
Telephone Number: (###)###-####
336-967-6260
2f.
Fax Number: (###)###-####
Click to enter.
2g.
Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name: *
Click to enter.
3b.
Business Name (if applicable):
Click to enter.
3c.
Address: *
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: * (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
3f.
Email Address: *
Click to enter.
Page 4 of 22 PCN Form Version 4.3-April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name:
David Brame
4b. Business Name:
Pilot Environmental, Inc.
4c. Address:
Street Address:
743 Park Lawn Court
Address line 2:
Click to entr
City:
Kernersville
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27284
Country:
United States
4d. Telephone Number: (###)###-####
336/708-4617
4e Fax Number: (###)###-####
Click to entr
4f. Email Address:
[e-mail]
Agent Authorization Letter:
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw.usace.army. mil/Missions/Reg ulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of22 PCN Form Version 4.3-April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
Beckett Townes Subdivsion
1 b. Subdivision name (if appropriate):
Click to enter.
1c. Nearest municipality/town: *
High Point
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
6893747800-000
2b.
Property size (in acres):
44.5
2c.
Project Address:
Street Address:
Johnson Street
Address line 2:
Click to enter.
City:
High Point
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27265
Country:
United States
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 36.039669°
Longitude (-DD.DDDDDD): *--80.022490°
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
West Fork Deep River (Oak Hollow Reservoir)
3b. Water Resources Classification of nearest receiving
WS-IV, CA*
water: *
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
Cape Fear
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
030300030101
located: *
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 22 PCN Form Version 4.3- April 20, 2022

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 consists of a single family residence and associated outbuildings, agricultural fields and wooded land.
Streams are located on the northern and southern portions of the site. Wetlands are located on the western and
southern portions of the site proximate to the streams. The surrounding properties contain townhomes, single
family residences, wooded land and fields.
4b.
Have Corps permits or DWR certifications been obtained for this
❑ Yes X No ❑ Unknown
project (including all prior phases) in the past?
If yes, please give the DWR Certification number and/or Corps
[Click to enter.]
Action ID (ex. SAW-0000-00000):
IClick to enter.]
Attach any pertinent project history documentation
4b2.
Is any portion of the work already complete? *
❑ Yes X No
If yes, describe the completed work.
Click to enter text.
4c.
List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
NA
4d.
Attach an 8'Y2 x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.
Attach an 8'Y2 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
4.652 acres
property:
4g.
List the total estimated linear feet of all existing streams (intermittent
1,875 linear feet
and perennial) on the property:
4g1.
List the total estimated acreage of all existing open waters on the
0 acres
property:
4h.
Explain the purpose of the proposed project:
The purpose of the proposed project is to construct a residential subdivision.
4i.
Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the proposed construction of a residential tonwhome development. The
development will consist of 57 buildings that will contain a total of 278 townhomes and associated parking lots,
driveways, lawns and common areas. The development will contain 14.42 total built -upon acres and maintain
over 67 percent as pervious surface consisting of lawns and wooded land. The site will connect to the existing
High point sewer system located along Skeet Club Road. Two entrances from Johnson Street and one from
Basswood Avenue are proposed for site access. The roadway from Basswood Avenue is a requirement to
provide roadway connectivity and is a requirement of the City for site development. It should be noted that the
site does not rely on Basswood Avenue Drive for access and could operate independently should it not be a
requirement of the City for roadway connectivity. The placement of fill within wetlands within the western
entranceway from Basswood Drive and sideslope lot fill for building 18 is required to facilitate the proposed
roadway and development. Temporary wetland impacts will be required in several locations to facilitate
construction activities. Temporary impacts will be left at native elevations and returned to preconstruction
conditions upon completion. 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.
Page 7 of22 PCN Form Version 4.3-April 20, 2022

4k. Will this activity involve dredging in wetlands or waters? * ❑ Yes X No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
UlICK to enter tek,
Page 8 of22 PCN Form Version 4.3-April 20, 2022

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on
the property or in
M Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
Delineated by David Brame/Michael Brame
5b.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved 0 Emailed concurrence
what type of determination was made?
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2022-01124
Name (if known): David Brame/Michael Brame
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental
areas?
Other: Click to enter
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
E-mail concurrence dated August 8, 2022 from Mr. David Bailey is attached.
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes 0 No
6b. If yes, explain.
Click 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
7. Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
North:
HIATT, BILLY CLYDE
4405 JOHNSON ST
HIGH POINT, NC 27265
East:
MOORE, LEE VARRICK JR;LONG, ROBIN MICHELLE
4302 JOHNSON ST
HIGH POINT, NC 27265
8. Scheduling of activity:
To be completed upon receipt of all necessary approvals within the next 1 year.
Page 9 of22 PCN Form Version 4.3-April 20, 2022

D. Proposed Impacts Inventory
Impacts Summary
0 Wetlands 0 Streams - tributaries
1 a. 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.
Site # `
2a1.
Impact
Reason/Type
2b.
Impact
Duration
2c.
Wetland Type
2d.
Wetland Name
2e.
Forested
?
2f.
Jurisdiction
Type
2g.
Impact Area
(ac)
W1
Road/
Driveway
Crossing
Permanent
Headwater
Forest
WD
Yes
Both
0.18
W2
Fill (Incl.
Riprap)
Permanent
Headwater
Forest
WD
Yes
Both
0.01
W3
Grading
Temporary
Headwater
Forest
WC
Yes
Both
0.03
W4
Grading
Temporary
Headwater
Forest
WE
Yes
Both
0.02
W5
Grading
Temporary
Non -tidal
Freshwater
Marsh
WF
No
Both
0.05
W6
Grading
Temporary
Headwater
Forest
WA
Yes
Both
0.01
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/'
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/.
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
"'"'
Choose one
Click to enter
2g1. Total temporary wetland impacts
0.11 ac
2g2. Total permanent wetland impacts
0.19 ac
2g3. Total wetland impacts
0.30 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Page 10 of22 PCN Form Version 4.3-April 20, 2022

Clean earthen fill. Approximately 6,000 cubic yards.
2i. Comments:
6 wetland impacts are proposed.
W1— includes 0.18 acres of wetland fill associated with the western entranceway.
W2 — includes 0.01 acres of wetland fill for side slope fill to accommodate building 8.
W3 — includes 0.03 acres of grading for temporary construction activities associated with construction of a
retaining wall. Disturbed areas will be restored to native elevations, stabilized, reseeded with a native wetland
seed mix and allowed to naturally regenerate back to forested conditions.
W4 - includes 0.02 acres of grading for temporary construction activities associated with construction of a
retaining wall. Disturbed areas will be restored to native elevations, stabilized, reseeded with a native wetland
seed mix and allowed to naturally regenerate back to forested conditions.
W5 — includes 0.03 acres of grading for installation of the sewer line through an emergent wetland. Disturbed
areas will be restored to native elevations, stabilized and reseeded with a native wetland seed mix.
W6 - includes 0.01 acres of grading for temporary construction activities associated with construction of a
retaining wall. Disturbed areas will be restored to native elevations, stabilized, reseeded with a native wetland
seed mix and allowed to naturally regenerate back to forested conditions.
Page 11 of22 PCN Form Version 4.3-April 20, 2022

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 #X
3a
Impact
Reason*
3b.
Impact
Duration*
3c.
Impact Type
3d.
Stream Name
3e.
Stream
Type*
3f.
Jurisdiction
Type
3g.
Stream Width
(avg ft)
3h.
Impact length
(linear ft)
Si
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
dick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
lick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
lick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
0 linear ft
3i2. Total permanent stream
impacts:
0 linear ft
M. Total temporary stream
impacts:
0 linear ft
34. Total stream and ditch
impacts:
0 linear ft
3j. Comments:
Stream impacts are not proposed. The sewer line crossing will be an aerial line over the stream and will not
require temporary or permanent impacts to the stream.
Page 12 of22 PCN Form Version 4.3-April 20, 2022

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 #*
4a1.
Impact Reason
4b.
Impact
Duration*
4c.
Waterbody Name*
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
0 ac
4g.
Total permanent open water impacts
0 ac
4g.
Total open water impacts
0 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.
P3
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
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Click to enter.
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:
Pond or lake construction is not proposed.
Page 13 of 22 PCN Form Version 4.3- April 20, 2022

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 X Randleman
❑ Other: Click to ente
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
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.
133
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
134
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.
136
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
137
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
138
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.
1311
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Buffer impacts associated with installation of the sewer line are proposed. However, we are not requesting
authorization as part of this 401 and 404 request. A buffer authorization is being requested from the City of High
Point by the civil designer as part of the TRC review and may be subject to amendments as part of that review.
Buffer impacts will not be implemented until all appropriate authorizations are received from the City.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 14 of22 PCN Form Version 4.3-April 20, 2022

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
A considerable amount of streams and wetlands are located on the site. The applicant has designed the
proposed development to avoid permanent impacts to all streams located on the site and the remaining 4.432
acres of wetland located on the site. In order to develop the site and provide connectivty to Basswood Avenue,
the proposed impacts could not be avoided. The development does not rely on the adjacent subdivision for
access and functions as a single development. However, connection to the subdivision is required to provide
connectivity to alleviate traffic, for emergency purposes and other city services such as waste collection. The
northwestern portion of the site is being left undeveloped to avoid having an additional stream and/or wetland
crossing. Civil design, including the use of retaining walls, 2:1 and 3:1 sideslopes were used to further reduce
impacts to streams and wetlands. Three retaining walls were installed to avoid wetland impacts.
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) 0 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:
Click to enter.
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
INC 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
Page 15 of22 PCN Form Version 4.3-April 20, 2022

4d.
Buffer mitigation requested (DWR only):
Click to enter. square feet
4e.
Riparian wetland mitigation requested:
0.19 acres
4f.
Non -riparian wetland mitigation requested:
Click to enter. acres
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter. acres
4h.
Comments:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
lick to enter.
5b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffer
❑ Yes ❑ 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
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
.;lick to enter.
Zone 2
Click to enter.
Click to enter
Choose one
Click to enter.
6f. Total buffer mitigation required
lick 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 authorization (and any necessary buffer mitigation) is being sought separately from this request by the
civil designer as part of the TRC review by the City of High Point.
Page 16 of22 PCN Form Version 4.3-April 20, 2022

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 ❑ 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 form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc.,qov/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
0 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)? *
❑ Yes ❑x No
To look up low density requirements, click here:
http://reports.oah.state. nc.us/ncac/title%2015a%20-%20environmental%20guaIity/chapter%2002%20-
%20environmental%20manage ment/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑x Yes ❑ No
reviewed and approved under a state stormwater program or state -
approved local government stormwater program?
❑ n/a — project disturbs < 1 acre
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.
2d.
Which of the following stormwater management program(s) apply?
X Local Government
(Check all that apply.)
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs
❑ Phase II ❑ USMP
❑ NSW X Water Supply
Page 17 of22 PCN Form Version 4.3-April 20, 2022

Please identify which local government stormwater program you are using.
Click to enter.
State Stormwater Programs ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
The stormwater management plan will be provided for review and approval by the City of High Point.
Page 18 of22 PCN Form Version 4.3-April 20, 2022

G. Supplementary Information
1. Environmental Documentation
1a. 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 X 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 X No
NEPA or SEPA final approval letter.)
Comments:
The project does not require a NEPA or SEPA.
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),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
❑ Yes X No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
AICK 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:
Click to enter.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdf)
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.
Wastewater will be discharged into an existing sewer line located on the southern portion of the site. Stream and
wetland impacts from the sewer line are included within this request.
Page 19 of22 PCN Form Version 4.3-April 20, 2022

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected
0 Yes 0 No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ [fws.govl)
5b. Have you checked with the USFWS concerning Endangered Species
❑ Yes 0 No
Act impacts? *
5c. If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d. Is another federal agency involved? *
❑ Yes 0 No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8?
❑ Yes 0 No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.? *
®Yes El No
5g. Does this project involve bridge maintenance or removal? *
❑ Yes 0 No
5g1. If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
❑ Yes ❑ No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed NLEB-SLOPES&apps.pdf
If you answered yes to 5g1, did you discover any signs of bat use? *
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h. Does this project involve the construction/ installation of a wind
turbine(s)? *
❑ 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
2 listed species and 1 candidate species are identified on the IPaC report (attached). The Schweinitz's
Sunflower, small -whorled pogonia and Monarch butterfly are included by the IPaC as federally listed species
identified within the project area. The impact areas contain dense wooded areas and an open maintained field
that are not suitable habitat for Schweinitz's sunflower or small -whorled pogonia. Additionally, according to the
Natural Heritage Program list of known occurrences, neither species has been identified within 10 miles of the
site. The Monarch butterfly is a candidate species. The proposed project is not likely to adversely impact
threatened or endangered species.
Attach consultation documentation.
Page 20 of22 PCN Form Version 4.3-April 20, 2022

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
Is 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 ente
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper — NOAA Fisheries
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
❑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.
Two sites that are identified as "ineligible" are located on the subject site and immediately to the north. 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.,qov/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.
slick to enter.
8c. What source(s) did you use to make the floodplain determination?
FEMA Firm Map (Drawing 4 of JD request)
H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested
Page 21 of22 PCN Form Version 4.3-April 20, 2022

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: * �0s--,
11 /30/2022
Page 22 of 22 PCN Form Version 4.3- April 20, 2022

Proposal for Environmental Services
Pilot Proposal 6573.3
September 6, 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: 1 aat Jt V 15vV�, �)r P+
I I Ac 6S
Ili I
Applicant Information:
Name:
Address:
V,10e
W -A
Telephone Number: _�>(j� 3 ,— 4C;2
Fax Number:
E-mail Address:
IJlA
am
Signature: Date:
4

Proposal for Environmental Services
Pilot Proposal 6573
February 11, 2021
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: q J � I
Owner Information: L e_a7P,( _TvAaas 77�,1?P7L ZZ-C
Address:
ke"w e4f-,--
Telephone Number: 33V cz� / 7 (7 ?ZIS
Fax Number:
E-mail Address: /h i 7_ / %20-1-Grrc_'Je'VeJ0 n?P�-1, lo"7
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.
C � r,-e LvAP,r L-, on
Print Name I
Capacity: Zowner —Authorized Agent
Date
Signature
7

David Brame
From: Bailey, David E CIV USARMY CESAW (USA) < [e-mail] >
Sent: Monday, August 8, 2022 1:31 PM
To: Michael Brame
Cc: Homewood, Sue
Subject: Delineation Confirmation RE: SAW-2022-01124 (4321 Johnson St. / High Point NC /
Guilford County)
Attachments: Pages from 20220517 PJD Request.pdf
Hi Michael. I reviewed the information you sent for the above referenced project. Based on your submittal and available
remotely sensed information I will proceed with an office verification of the delineation of potential waters of the US.
No field verification from the Corps is necessary.
I will use the map titled "Wetland Map" (attached) from your PJD request when processing the PJD and/or permit
application/request for this site.
Please let me know if you have any questions.
-Dave Bailey
David E. Bailey, PWS
Regulatory Project Manager
US Army Corps of Engineers
CE-SAW-RG-R
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Mobile: [phone]
Office: [phone], Ext. 30.
Fax: [phone]
Email: [e-mail]
We would appreciate your feedback on how we are performing our duties. Our automated Customer Service Survey is
located at: https://regulatory.ops.usace.army.mil/customer-service-survey/
Thank you for taking the time to visit this site and complete the survey.
From: RaleighNCREG <[e-mail]>
Sent: Wednesday, May 18, 2022 7:03 AM
To: Michael Brame <[e-mail]>
Cc: Bailey, David E CIV USARMY CESAW (USA)<[e-mail]>
Subject: SAW-2022-01124 (4321 Johnson St. / High Point NC / Guilford County)
Good Morning,
Your JD request has been received, assigned action ID SAW-2022-01124.
Please refer to the action ID in all correspondence.
Dave- docs forwarded in your folder

Thank you,
Josephine Schaffer
From: Michael Brame <[e-mail]>
Sent: Tuesday, May 17, 2022 4:32 PM
To: RaleighNCREG <[e-mail]>
Cc: David Brame <[e-mail]>; Bailey, David E CIV USARMY CESAW (USA)
<[e-mail]>; Homewood, Sue <[e-mail]>
Subject: [URL Verdict: Neutral][Non-DoD Source] Pilot Project 6573 -Johnson Street - Wetland Verification Request
Find attached a verification request for a site that we delineated in 2021. Please let me know if you need additional
information in order to process this request.
Sincerely,
micnael T. Brame
336.708-4620 (c)
336.310.4527 (o)
PO Box 128
Kernersville, NC 27285
wwwa com
mbrame(@r)ilotenviro.com

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THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE APPROXIMATE. MR. DAVID BAILEY
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REVIEW. THIS MAP INCLUDES GPS LOCATIONS OF DELINEATED FEATURES.
Drawing 5
Wetland Map
Aerial Imagery from ESRI Johnson Street
T.
and Pilot GPS Data Approximate 44.5-Acre Tract
Scale: 1" = 300' PIL131 High Point, Guilford County, NC
Date: 2.26.21 tFILOT ENVIRON MIN7AL.INC Pilot Project 6573

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ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MARC RECKTENWALD
Director
Clay Mize
Leoterra Johnson Street, LLC
110A Shields Park Drive
Kernersville, NC 27284
Project: Beckett Townes Subdivision
NORTH CAROLINA
Environmental Quality
November 1, 2022
Expiration of Acceptance: 5/1/2023
County: Guilford
The purpose of this letter is to notify you that the NCDEQ Division of Mitigation Services (DMS) is willing to
accept payment for compensatory mitigation for impacts associated with the above referenced project as
indicated in the table below. Please note that this decision does not assure that participation in the DMS in -
lieu fee mitigation program will be approved by the permit issuing agencies as mitigation for project impacts.
It is the responsibility of the applicant to contact permitting agencies to determine if payment to the DMS will
be approved. You must also comply with all other state, federal or local government permits, regulations or
authorizations associated with the proposed activity including G.S. § 143-214.11.
This acceptance is valid for six months from the date of this letter and is not transferable. If we have not
received a copy of the issued 404 Permit/401 Certification within this time frame, this acceptance will
expire. It is the applicant's responsibility to send copies of the permits to DMS. Once DMS receives a copy
of the permit(s) an invoice will be issued based on the required mitigation in that permit and payment must
be made prior to conducting the authorized work. The amount of the in -lieu fee to be paid by an applicant is
calculated based upon the Fee Schedule and policies listed on the DMS website.
Based on the information supplied by you in your request to use the DMS, the impacts for which you are
requesting compensatory mitigation credit are summarized in the following table. The amount of mitigation
required and assigned to DMS for this impact is determined by permitting agencies and may exceed the
impact amounts shown below.
River Basin
Impact Location
8-di it HUC
Impact Type
Impact Quantity
Cape Fear
03030003
Riparian Wetland
0.19
Upon receipt of payment, DMS will take responsibility for providing the compensatory mitigation. The
mitigation will be performed in accordance with the In -Lieu Fee Program instrument dated July 28, 2010.
Thank you for your interest in the DMS in -lieu fee mitigation program. If you have any questions or need
additional information, please contact [e-mail].
Sincerely, j
FOR James. B Stanfill
Deputy Director
cc: David Brame, agent
North Carolina Department of Environmental Quality I Division of Mitigation Services
217 West Jones Street 1 1652 Mail Service Center I Raleigh, North Carolina 27699-1652
h(h�TH :.AROI iRA IV
o �nmmmenni w�a 919,707,8976

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: 2023-0010994
Project Name: Beckett Townes Subdivision
November 01, 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

11/01/2022
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 https://www.fws.gov/birds/bird-enthusiasts/threats-to-
birds.php.
In addition to MBTA and BGEPA, Executive Order 13186: Responsibilities of Federal Agencies
to Protect Migratory Birds, obligates all Federal agencies that engage in or authorize activities
that might affect migratory birds, to minimize those effects and encourage conservation measures
that will improve bird populations. Executive Order 13186 provides for the protection of both
migratory birds and migratory bird habitat. For information regarding the implementation of
Executive Order 13186, please visit https://www.fws.gov/birds/policies-and-regulations/
executive-orders/e0-13186. php.

11/01/2022
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

11/01/2022
Official Species List
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Raleigh Ecological Services Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
[phone]

11/01/2022
KA
Project Summary
Project Code: 2023-0010994
Project Name: Beckett Townes Subdivision
Project Type: Residential Construction
Project Description: The site is being developed with a residential subdivision. A NWP permit
from the USACE will be required for wetland impacts. The project is
expected to begin upon receipt of permits.
Project Location:
Approximate location of the project can be viewed in Google Maps: https:
www. google.com/maps/(a)36.0389074,-80.02276716113147,14z
f4}+k1Ja4ar �1 r
ti
k 1. r6- t
Counties: Guilford County, North Carolina

11/01/2022 3
Endangered Species Act Species
There is a total of 3 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
Fisheriesi, as USFWS does not have the authority to speak on behalf of NOAA and the
Department of Commerce.
See the "Critical habitats" section below for those critical habitats that lie wholly or partially
within your project area under this office's jurisdiction. Please contact the designated FWS office
if you have questions.
1. NOAA Fisheries, also known as the National Marine Fisheries Service (NMFS), is an
office of the National Oceanic and Atmospheric Administration within the Department of
Commerce.
Insects
NAME
Monarch Butterfly Danaus plexippus
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9743
Flowering Plants
NAME
Schweinitz's Sunflower Helianthus schweinitzii
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/3849
Small Whorled Pogonia Isotria medeoloides
Population:
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/1890
STATUS
Candidate
STATUS
Endangered
Threatened
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

11/01/2022
Migratory Birds
Certain birds are protected under the Migratory Bird Treaty Act! 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 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 Breeds Sep 1 to
This is not a Bird of Conservation Concern (BCC) in this area, but warrants attention Jul 31
because of the Eagle Act or for potential susceptibilities in offshore areas from certain types
of development or activities.
Chimney Swift Chaetura pelagica Breeds Mar 15
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Aug 25
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.

11/01/2022
BREEDING
NAME SEASON
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.
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( )

11/01/2022
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 JUL
AUG SEP OCT NOV DEC
Bald Eagle
Jill
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Jill
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Jill
Jill
Jill
Jill
Vulnerable
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Chimney Swift
FEE ■���
++++ ++++ ++++ IN1N
Jill
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W11111-1
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BCC Rangewide
(CON)
Prothonotary
Warbler
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+ +
++ + ++++ + ++
Jill
"'�
Jill
1111
+ + + +—�+
--- +�
—�—� ���+
BCC Rangewide
(CON)
Red-headed
+ + ++ —++
++ + +++, + ++ ++++, 1
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Jill
Jill
+—�+
1+--4-Woodpecker
—�—� ���+
BCC Rangewide
(CON)
Rusty Blackbird
++++ +,++
++—+ +­+
— — — — ---+
BCC-BCR
Wood Thrush
BCC Rangewide
++++ ++++ ++++ +++' ++++ —++Jill
Jill
++—+ +­+
— — — — — — —+
(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-mi rator.

11/01/2022 4
• 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 list of migratory birds that potentially occur 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 Rapid Avian Information
Locator (RAIL,) 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 or migrating in my 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 query your location using the RAIL Tool and look

11/01/2022
at the range maps provided for birds in your area at the bottom of the profiles provided for each
bird in your results. 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).
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

11/01/2022 6
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.

11/01/2022
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: Friday, September 2, 2022 10:51 AM
To: 401 [e-mail]
Subject: Pre -File Notice - Johnson Street Subdivision (6573.3)
We would like to submit a Pre -filing Notice for the following project:
Project Name: Johnson Street Subdivision (6573.3)
Project Owner: LeoTerra Development
Project Owner's Address: 110-A Shield Park Drive, Kernersville, NC 27284
Project County: Guilford
Type of project/Approval Sought: 401 WQC, Pre -Application Request Meeting Declined
Thank you and have a wonderful day!
Sincerely,
Heather LaGamba
336.345.9536 (c)
336.310.4527 (o)
P.O. Box 128
Kernersville, NC 27285
www.pilotenviro.com
[e-mail]