20230165 Ver 1_401 Application_20230126

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# *
20230165
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:
9/26/2022
Project Contact Information
Name:
Heather LaGamba
Who is submitting the information?
Email Address: [e-mail]
Project Information
...................................
Project Name: High Meadows (Maverick Trail)
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)
Stokes
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
8567_High Meadows(Maverick Trail)_PCN and JD
Request_1.26.23.pdf
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
PCN for 401 WQC
Sign and Submit
7.95MB
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: 1/26/2023
Is filled in automatically.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- 2022-
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Maverick Trail Drive
Begin Date (Date Received):
Assign Action ID Number in ORM ❑
2. Work Type: ❑✓ Private ❑ Institutional ❑ Government ❑ Commercial
3. Project Description / Purpose [PCN Form 133d and 133e]:
The site contains undeveloped land. The site is proposed for residential development.
4. Property Owner / Applicant [PCN Form A3 or A41: PR -King Development
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
David Brame/Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location— Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Maverick Trail Drive
36.284948 ° /-80.332256 °
8. Project Location— Tax Parcel ID [PCN Form Bla]: 6902752380
9. Project Location — County [PCN Form A2b]: Stokes
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: King
11. Project Information — Nearest Waterbody [PCN Form 132a]: Muddy Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: Upper Yadkin/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

srAre c�
NORTH CAROLINA
Enviranmental Quality
Water Resources
Office Use Only
Corps Action ID no. [Click to enter.] Date received: 12/23/2022
DWR project no. lick enter.] Date received: lick to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 36.285326'
Longitude (DD.DDDDDD):-80.332924'
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) : 9/26/2022
Page 1 of 21 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located: *
Stokes 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 21 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 of21 PCN Form Version 4.3-April 20, 2022

B. Applicant Information
1 a.
Who is the primary contact? *
Robert Wooten
1b.
Primary Contact Email: *
[e-mail]
1c.
Primary Contact Phone: * (###)###-####
336-922-4000
1d.
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?*
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed: *
PR King Development, LLC
2b.
Deed Book and Page No.:
740/425
2c.
Contact Person (for corporations):
Robert Wooten
2d.
Address *
Street Address:
5121 N. Causeway Drive
Address line 2:
Click to enter.
City:
Winston-Salem
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27106
Country:
United States
2e.
Telephone Number: (###)###-####
336-922-4000
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 21 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/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of21 PCN Form Version 4.3-April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
High Meadows
1 b. Subdivision name (if appropriate):
High Meadows
1c. Nearest municipality/town: *
King
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
6902752380
2b.
Property size (in acres):
14.5
2c.
Project Address:
Street Address:
Merriweather Drive
Address line 2:
Click to enter.
City:
King
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27021
Country:
United States
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 36.285326°
Longitude (-DD.DDDDDD): *--80.332924°
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.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
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/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 21 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 undeveloped land. The site has been timbered with the exception of a 30 foot buffer
adjacent to the stream. One stream crosses the central portion of the site. Wetlands are not located on the site.
The surrounding properties contain residential development, fields and wooded land.
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
[CI] ;K Lo 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.
Clink tn 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'/ x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'/ x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
0 acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
800 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 development.
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 development. The development will
consist of 19 resifdential lots and associated roads. The site will tie into existing sewer infrastructure located on
adjacent streets for wastewater discharge from the development. Four access from surrounding roads are
proposed and are required to access the site. One stream crossing is required to provide neighborhood and
street interconnectivity and to accommodate emergency and municipal services. 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.
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.
Click to enter text
Page 7 of21 PCN Form Version 4.3-April 20, 2022

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
The wetlands were delineated by Pilot Environmental. A USACE JD request has been provided in conjunction
with this PCN request and is attached.
5b.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made?
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
Click to enter
Name (if known): David Brame/Michael Brame
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental
areas?
Other: flick to enter
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
A JD request is attached. A JD has not been issued.
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes X No
6b. If yes, explain.
'lick tn 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)
Parcel Number 6902757338
Owner Name LEDFORD, AMBER NICOLE
Mailing Address 313 TURKEY HILL DR
Mailing Address City KING
Mailing Address State NC
Mailing Address Zip 27021
8. Scheduling of activity:
To be completed within the next 3-8 months.
Page 8 of21 PCN Form Version 4.3-April 20, 2022

D. Proposed Impacts Inventory
Impacts Summary
❑ 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
Choose one
emp/ Perm
Choose one
Click to enter
Y/N
;hoose one
Click to enter
W2
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W3
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W5
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
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
Y/N
Choose one
Click to enter
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
Click to enter. ac
2g3. Total wetland impacts
Click to enter. ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
Wetland impacts are not proposed
Page 9 of21 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
3a
3b.
3c.
3d.
3e.
3f.
3g.
3h.
Site #n
Impact
Impact
Impact Type
Stream Name*
Stream
Jurisdiction
Stream Width
Impact length
Reason
Duration*
Type
Type
(avg ft)
(linear ft)
S1
Temp
Temporary
Dewatering
SA
Perennial
Both
3.4
25
Const/Pump
Around
S2
Culvert
Permanent
Crossing/
SA
Perennial
Both
4.3
144
Culvert
S3
RipRap
Permanent
Fill (Incl.
SA
Perennial
Both
6.4
15
Riprap)
S4
Temp
Temporary
Dewatering
SA
Perennial
Both
8.3
15
Const/Pump
Around
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Click 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
Click 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
Click 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
0 linear ft
impact:
3i2. Total permanent stream
159 linear ft
impacts:
M. Total temporary stream
40 linear ft
impacts:
34. Total stream and ditch
199 linear ft
impacts:
Page 10 of21 PCN Form Version 4.3-April 20, 2022

3j. Comments:
S1 — Stream location 1 includes 25 LF (85 SF) of temporary fill for coffer dam and pump around located
upstream of the culvert.
S2 — Stream location 2 includes 144 LF (619 SF/0.014 Ac.) of permanent fill for the culvert.
S3 — Stream location 3 includes 15 LF (96 SF/0.002 Ac.) of permanent impact with riprap that will be keyed into
the existing stream bed elevation.
S4 — Steam location 4 includes 15 LF (125 SF) of temporary fill for coffer dam and pump around located
downstream of the culvert.
Page 11 of 21 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
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.
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:
Ponds are not being constructed.
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 12 of 21 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
X❑ Jordan ❑ Goose Creek ❑ 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 on the site are associated with the construction of the turning lane. Based on the activity (road
crossing) and quantity of the impacts, the buffer impacts are allowable without mitigation. Timmons is working
with the local government to get approval for the proposed buffer impacts.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 13 of21 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:
The applicant has designed the proposed development to avoid impacts to the remainder of the stream located
on the site. In order to develop the site and provide connectivty to Maverick Trail Drive, the proposed impacts
could not be avoided. Connection to the Maverick Trail Drive and the adjacent subdivision is required to provide
connectivity to alleviate traffic, for emergency purposes and other municipal services such as waste collection.
The sewer line location has been moved to avoid impacts to the stream and its buffers to the south of the site.
Sewer will need to be lifted to accommodate the new sewer alignment as a result. A 30 foot buffer will remain on
the remainder of the stream.
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? * ❑ DWR ❑ 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:
Click to ente,
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Mitigation is not proposed.
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested:
Click to ente. 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. miI/ribits apex/f?p=107:27:2734709611497::NO: RP:P27 BUTTON KEY:O
4d. Buffer mitigation requested (DWR only):
Click to ente square feet
Page 14 of21 PCN Form Version 4.3-April 20, 2022

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
4h. Comments:
Mitigation is not proposed.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
-11UN LU CI III --I
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
Multiplier
Required mitigation
(square 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:
Mitigation is not proposed.
Page 15 of21 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 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 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
❑ 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)? *
0 Yes ❑ 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)
0 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?
❑ 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 ❑ Water Supply
Page 16 of21 PCN Form Version 4.3-April 20, 2022

Please identify which local government stormwater program you are using.
Guilford County
State Stormwater Programs ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Click to enter.
Page 17 of21 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:
Additional development is not anticipated as a result of the proposed project.
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 existing sewer lines in proposed and existing roadways. Additional surface
water, buffer or wetland impacts are not proposed associated with wastewater.
Page 18 of21 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
® Yes ❑ 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 0 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)
Page 19 of21 PCN Form Version 4.3-April 20, 2022

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
The gray bat (endangered), northern long-eared bat (endangered), tri-colored bat (Proposed Endangered),
Schweinitz's sunflower (Endangered), and monarch butterfly (Candidate) are included by the IPaC as federally listed
species that have been identified within the vicinity of the site.
Bat hibernacula is not located on the site. Trees that could afford suitable summer roosting habitat are present within
wooded stream buffers and will remain in the buffer areas on the site. Limited clearing will be required to install the
culvert. Additionally, similar habitat can be found on adjoining properties and installation is expected to occur prior to
the summer roosting season and known occurrences are not identified within 2 miles of the site. Based on the small
amount of clearing that will be required and the presence of similar habitat on nearby properties, the proposed project
is not likely to adversely affect bat species that occur in the area.
The areas of proposed impacts and areas immediately adjacent to the proposed impacts contain a wooded buffer and
recently harvested wooded land. Suitable habitat for the sunflower is not located on the site.
The Monarch butterfly is a candidate species that is not subject to provisions of the ESA or consultation with the
service. The proposed project is not likely to adversely impact this species.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat? *
El Yes x❑ No
Is there submerged aquatic vegetation (SAV) around
the project vicinity? *
❑Yes 0 No ❑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
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://,qis.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
El 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.
Page 20 of21 PCN Form Version 4.3-April 20, 2022

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.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
FEMA Firm Map (Drawing 4)
H. Miscellaneous
Comments:
Click to enter.
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: * �2-0z!-,
1 /26/2023
Page 21 of 21 PCN Form Version 4.3- April 20, 2022

Environmental Services Proposal
Pilot Proposal 8567
September 21, 2022
AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address:
Owner Information:
Name:
PC- lc� ) V1
Address: C (- /y, (qy w Lk r (2 J
Telephone Number: j Z2 -- L (?yy
Fax Number:
E-mail Address: G C 0 r W � O J
Signature: Date:
`]

Environmental Services Proposal
Pilot Proposal 8567
September 21, 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: fy) -e_ C Ir % VJ e_ 0.V�_4 r bIrNVe
Owner Information: -�i V1T 1)�e v_e i 6A',I j
Address: C q 0 S&-f C�v� r
Telephone Number: `5 .3(, 2--L/o00
Fax Number:
E-mail Address: C LC CA G S �N 0 1 C 0 od. C&
JURISDICTIONAL DETERMINATION REQUEST
D. PROPERTY ACCESS CERTIFICATION
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: _ Owner Authorized Agent
Date c.-I "Z-2 - Z 1—
Signature
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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: 2023-0038468
Project Name: High Meadows
January 26, 2023
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

01/26/2023
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 BA/BE 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

01/26/2023
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]

01/26/2023
Project Summary
Project Code: 2023-0038468
Project Name: High Meadows
Project Type: Residential Construction
Project Description: The site is an approximate 14.5 acre tract that will be developed with a
residential subdivision. A permit will be required by the USACE for a
single stream crossing.
Project Location:
Approximate location of the project can be viewed in Google Maps: https:
www. google.com/maps/(a)36.2849411,-80.33237361908584,14z
Counties: Stokes County, North Carolina

01/26/2023 3
Endangered Species Act Species
There is a total of 5 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
Gray Bat Myotis grisescens
Endangered
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/6329
Northern Long-eared Bat Myotis septentrionalis
Endangered
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9045
Tricolored Bat Perimyotis subflavus
Proposed
No critical habitat has been designated for this species.
Endangered
Species profile: https:Hecos.fws.gov/ecp/species/10515
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
Flowering Plants
NAME
STATUS
Schweinitz's Sunflower Helianthus schweinitzii
Endangered
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/3849

01/26/2023
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

01/26/2023
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.

01/26/2023
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.
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

01/26/2023
BREEDING
NAME
SEASON
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.
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.
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:
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

01/26/2023 3
(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 JUL AUG SEP OCT NOV DEC
Bald Non -BCC IIII IIII IIII IIII li�� ���� �� � +�++AMEN MEMi
Vulnerable
Cerulean Warbler � +�
BCC Rangewide +—++ ++++ ++�— +—++ ' lqqq —++— — — — — — — — — --++ +++—
(CON)
Chimney Swift ++++ I I iiii loll Ill"-" "' 11
BCC Rangewide + + ++ ++++ ++++
(CON)
Prairie Warbler
BCC Rangewide ++++ ++++ TTTT TIP + ++++ ++++ ++++ ++++ ++++
(CON)
Red-headed
Woodpecker ++++ ++++ ++++ ++++ +++$ ++++ ++++ ++++ +,,, ,+++ ++++ ++++
BCC Rangewide
(CON)
Rusty Blackbird ++ 1 1 1 1 1 1 1 1 1 1 1++` 1 1 1 1 1 1 1 1 1 1 +— +—++ ++++ ++++ ++—+ ++++
BCC-BCR

01/26/2023
4
Wood Thrush ++++ ++++ ++++ +1 I I I I I III 111+ ++++ 111111++ ++++ ++++
BCC Rangewide
(CON)
Additional information can be found using the following links:
• Birds of Conservation Concern https://www.fws.gov/program/migratory-birds/species
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/library
collections/avoiding-and-minimizing-incidental-take-migratory-birds
• Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.Ddf
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?

01/26/2023 5
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
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.

01/26/2023 6
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,
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.

01/26/2023
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.
THERE ARE NO WETLANDS WITHIN YOUR PROJECT AREA.

01/26/2023
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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1/26/2023, 1:33:53 PM
Surveyed Only individual resources & centerpoints
Surveyed Only
Counties (outline)
1:9,028
0 0.05 0.1 0.2 mi
0 0.1 0.2 0.4 km
State of North Carolina DOT, Esri, HERE, Garmin, INCREMENT P, Intermap,
NGA,USGS
North Carolina State Historic Preservation Office
State of North Carolina DOT, Esri, HERE, Garmin, INCREMENT P, Intermap, NGA, USGS

David Brame
From: Heather LaGamba
Sent: Monday, September 26, 2022 9:41 AM
To: 401 [e-mail]
Subject: Pre -File Notice - High Meadows - Maverick Trail (8567)
We would like to submit a Pre -filing Notice for the following project:
Project Name: High Meadows - Maverick Trail (8567)
Project Owner: PR -King Development
Project Owner's Address: Post Office Box 10, Bethania, North Carolina 27010
Project County: Stokes
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]

Jurisdictional Determination Request
US Army Corps
ai Engineers
VViPnirUbri DnAiial
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.aM.mil/Missions/Re ul�atoryPermitProaram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: Maverick Trail Drive
City, State: King, North Carolina
County: Stokes
Parcel Index Number(s) (PIN): 6902752380
B. REQUESTOR INFORMATION
Name: David Brame, Pilot Environmental, Inc.
Mailing Address: Post Office BOX 128
Telephone Number:
Electronic Mail Address:
Select one:
Kernersville, NC 27285
336-310-4527
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION`
Name: PR -King Development
Mailing Address: 5121 North Causeway Drive
Winston-Salem, NC 27106
Telephone Number: 336-922-4000
Electronic Mail Address: [e-mail]
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GTS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION',4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: ❑✓ Owner [:]Authorized Agents
Date
Attached
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑✓ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a projector perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑ A Corps JD is required in order obtain my local/state authorization.
❑ I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
' If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
❑� I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
Size of Property or Review Area — 14.6 acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude
Longitude
36.2849480
-80.3322560
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than l 1x17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
ul Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
e Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Pro gram/Jurisdiction/
Version: May 2017 Page 5

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

Environmental Services Proposal
Pilot Proposal 8567
September 21, 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: fy) -e_ C Ir % VJ e_ 0.V�_4 r bIrNVe
Owner Information: -�i V1T 1)�e v_e i 6A',I j
Address: C q 0 S&-f C�v� r
Telephone Number: `5 .3(, 2--L/o00
Fax Number:
E-mail Address: C LC CA G S �N 0 1 C 0 od. C&
JURISDICTIONAL DETERMINATION REQUEST
D. PROPERTY ACCESS CERTIFICATION
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: _ Owner Authorized Agent
Date c.-I "Z-2 - Z 1—
Signature
M.

PR-RING DEVELOPMENT LLC
X
Parcel Number
.Alternate Parcel Number
Owner Name
Improved Value
Land Value
Parcel Value
Mailing .Address
Mailing Address Unit Number
I -Jailing .Address Oita
Mailing Address State
Mailing .Address Zip
Full Site Address
Site .Address Unit Number
Site Address City
GIS .Acres
Structure Indicator
I,1L1ltiple Structures
Last Sale Date
Last Sale Date Text
Full Legal Description
Tax Parcel Use Code
Tax Parcel Use Code
Description
Second Tax Parcel Use Code
Second Tax Parcel Use
Description
Type of',,lalue Reported
Owner Type
Record .Area Number
Re cordAre a Text
Revised Date
Source Document Reference
Source Document Date
Source Document Date Text
Subdivision Name
National Parcel Number
County Name
County RIPS Code
State FIPS Code
State -County FIPS Code
GNIS Identifier
Information Source
Transform Date
Mailing Address Prefix
IJailing.Address Number
Mailing Street Full Name
I'vlailing .Address Street Name
FAQ i I i n n AHHr000 Q+rna+Ciifiiv
A;L i0L
6902752380
690202752380
PR -KING DE',rELOPIMIENT
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0
203700
203700
5121 N CAUSEWAY DR
WINSTON-SALEIMI
NC
27106
0 OFF M E RRIWEATH E R. DR
14.60871
N
N
91112021
P L5-49 7
VACANT
.Appraised
14.85
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Deed BooWPage 7401425
91112021
37169_6902752380
Stokes
169
37
37169
1008506
Stokes County Assessor
1212912022

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_ LEGEND
Site Boundaryi'USMT co
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Drawing 1 _¢r; K . " USGS Topographic Map
USGS Topographic Map" _ Maverick Trail Drive
King, NC Quadrangles
Approximate 14.6-Acre Tract
r F;
Scale: 1" - 2 000' .5 King, Stokes County, NC
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Scale: 1" = 300'
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LEGEND
ILSite Boundary
Web Soil Map
Maverick Trail Drive
Approximate 14.6-Acre Tract
PILGTAKing, Stokes County, NC
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hi L 0 T E R 0 11 M : N T A L . 1% C Pilot Project 8567

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Drawing 2A
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Of Stokes County, NC
Published 1995, Sheet 39
Not To Scale
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LEGEND
Site Boundary
i
Published Soil Map
Maverick Trail Drive
` iJ; Approximate 14.6-Acre Tract
King, Stokes County, NC
T''"
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Drawing 3 NWI Map
Maverick Trail Drive
USFWWetlandsMapSlper s - i Approximate 14.6-Acre Tract
Scale: 1" - 400' ILO AM King, Stokes County, NC
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Site Boundary F w;�„ fit, 'r V
1 %Annual Chance Flood Hazard
+#Lr • s r
Regulatory Floodvay
�Sped al Floodvay 's
Area of Undetermined Flood Hazard f t �'_ k •'w
0.2%Annual Chance Flood Hazard _ 3
! Future Conditions 1 %Annual Chance Flood Hazard ;# � -
iAreawith Reduced Risk Due to Levee w,t
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k .,'•° FEMA FIRM
Drawing 4
J`-
k` Maverick Trail Drive
National Flood Hazard Layer
,'� »s f Approximate 14.6-Acre Tract
From FEMA Web Map Service
Scale: 1" - 400' King, Stokes County, NC
- PILOT E%V-PONN-NT?L. KC Pilot Project8567

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DP-1 O Data Point � -
x
SA 1-5 Flag Number/Feature ID ,
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY THE USACE. THIS EXHIBIT
INCLUDES GPS LOCATIONS OF DELINEATED FEATURES. DELINEATION CONDUCTED BY PILOT PERSONNEL ON 10.12.22.
Drawing 5 �.{.. Wetland Map
2019 Satellite Imagery from ESRI , Maverick Trail Drive
and Pilot GPS Data -- �- Approximate 14.6-Acre Tract
Scale: 1" = 200' PIL King, Stokes County, NC
Date:10.13.22 RILOT Ex5"9nNRI=1qTr1: ITC Pilot Project8567

U.S. Army Corps of Engineers Requirement Control Symbol
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region EXEMPT
(Authority: AR 335-15,
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R paragraph 5-2a)
Project/Site: Maverick Trail Drive City/County: King/Stokes Sampling Date: 10.12.2022
Applicant/Owner: State: NC Sampling Point: DP-1
Investigator(s): Pilot Environmental, Inc Section, Township, Range: N/A
Landform (hillside, terrace, etc.): slope Local relief (concave, convex, none): None Slope (%): 1-2
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.285055' Long:-80.333288° Datum: WGS-84
Soil Map Unit Name: Fairview -Poplar Forest complex/FpD2 NWI classification: None
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required: check all that apply)
—Surface Soil Cracks (136)
_Surface Water (Al) _True
Aquatic Plants (1314)
_Sparsely Vegetated Concave Surface (138)
—High Water Table (A2) —Hydrogen
Sulfide Odor (Cl)
—Drainage Patterns (1310)
_ Saturation (A3) —Oxidized
Rhizospheres on Living Roots (C3)
_ Moss Trim Lines (1316)
—Water Marks (131) —Presence
of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
_Sediment Deposits (132) _Recent
Iron Reduction in Tilled Soils (C6)
_Crayfish Burrows (C8)
_Drift Deposits (133) _Thin
Muck Surface (C7)
_Saturation Visible on Aerial Imagery (C9)
_Algal Mat or Crust (134) _Other
(Explain in Remarks)
_Stunted or Stressed Plants (D1)
_Iron Deposits (135)
_Geomorphic Position (D2)
_Inundation Visible on Aerial Imagery (137)
_Shallow Aquitard (D3)
—Water-Stained Leaves (139)
Microtopographic Relief (D4)
Aquatic Fauna (1313)
FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No
X Depth (inches):
Water Table Present? Yes No
X Depth (inches):
Saturation Present? Yes No
X Depth (inches):
Wetland
Hydrology Present? Yes No X
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: DP-1
Tree Stratum (Plot size: 30 )
1. Acer rubrum
2. Liquidambar styraciflua
3. Quercus rubra
4.
5.
6.
7.
50% of total cover: 28
SaDlina/Shrub Stratum (Plot size: 15 )
1. Carpinus caroliniana
2. Carya tomentosa
3. Lindera benzoin
4.
5.
6.
7.
8.
9.
50% of total cover: 8
Herb Stratum (Plot size: 5 )
1. Athyrium asplenioides
2. Polystichum acrostichoides
3. Smilax rotundifolia
4.
5.
6.
7.
8.
9.
10.
11.
50% of total cover: 13
Woody Vine Stratum (Plot size: 30 )
1.
2.
3.
4.
5.
ADSOmie
uominam
% Cover
Species?
25
Yes
20
Yes
10
No
idicator
Status
Dominance Test worksheet:
FAC
Number of Dominant Species
FAC
That Are OBL, FACW, or FAC:
6 (A)
FACU
Total Number of Dominant
Species Across All Strata:
8 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC:
75.0% (A/B)
55 =Total Cover
20% of total cover: 11
5 Yes FAC
5 Yes UPL
5 Yes FAC
15 =Total Cover
20% of total cover: 3
15 Yes FAC
5 Yes FACU
5 Yes FAC
25 =Total Cover
20% of total cover: 5
=Total Cover
50% of total cover: 20% of total cover:
Remarks: (Include photo numbers here or on a separate sheet.)
Total % Cover of: Multiply by:
OBL species 0 x 1 = 0
FACW species 0 x 2 = 0
FAC species 75 x 3 = 225
FACU species 15 x 4 = 60
UPL species 5 x 5 = 25
Column Totals: 95 (A) 310 (B)
Prevalence Index = B/A = 3.26
Hydrophytic Vegetation Indicators:
_ 1 - Rapid Test for Hydrophytic Vegetation
X 2 - Dominance Test is >50%
-3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft
(1 m) tall.
Herb - All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody Vine - All woody vines greater than 3.28 ft in
height.
Hydrophytic
Vegetation
Present? Yes X No
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont - Version 2.0

SOIL Sampling Point: DP-1
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type Lo C2 Texture Remarks
0-6 10YR 4/4 100 Loamy/Clayey
6-18 7.5YR 4/6 100 Loamy/Clayey
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
Histosol (Al)
Polyvalue Below Surface (S8) (MLRA 147, 148)
2 cm Muck (A10) (MLRA 147)
Histic Epipedon (A2)
_Thin Dark Surface (S9) (MLRA 147, 148)
_Coast Prairie Redox (A16)
—Black Histic (A3)
—Loamy Mucky Mineral (F1) (MLRA 136)
(MLRA 147, 148)
—Hydrogen Sulfide (A4)
—Loamy Gleyed Matrix (F2)
—Piedmont Floodplain Soils (F19)
_Stratified Layers (A5)
_Depleted Matrix (F3)
(MLRA 136, 147)
_2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
—Red Parent Material (F21)
—Depleted Below Dark Surface (A11)
—Depleted Dark Surface (F7)
(outside MLRA 127, 1479 148)
_Thick Dark Surface (Al2)
_Redox Depressions (F8)
_Very Shallow Dark Surface (F22)
_Sandy Mucky Mineral (S1)
_Iron -Manganese Masses (F12) (LRR N,
_Other (Explain in Remarks)
Gleyed Matrix (S4)
MLRA 136)
_Sandy
—Sandy Redox (S5)
_ Umbric Surface (F13) (MLRA 122, 136)
3Indicators of hydrophytic vegetation and
_Stripped Matrix (S6)
_Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present,
Dark Surface (S7)
Red Parent Material (F21) (MLRA 127, 1479 148)
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No X
Remarks
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: January 26, 2023
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: David Brame, Pilot Environmental, Inc.
Post Office Box 128, Kernersville, North Carolina 27285
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, Maverick Trail Drive, SAW 2022-
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The site is located north of Maverick Trail Drive
in King, NC. The site contains wooded land. The site is proposed for commercial development.
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: North Carolina County/parish/borough: Stokes County City: King
Center coordinates of site (lat/long in degree decimal format): Lat.: 36.284948' Long.:-80.332256'
Universal Transverse Mercator: WGS 84
Name of nearest waterbody: Muddy Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
Number
Latitude (decimal
degrees)
Longitude
(decimal degrees)
Estimated amount of
aquatic resources in
review area (acreage
and linear feet, if
applicable
Type of aquatic
resources (i.e.,
wetland vs. non-
wetland waters)
Geographic authority to
which the aquatic resource
"may be" subject (i.e.,
Section 404 or Section
10/404
SA
36.2853850
-80.3322730
798 linear feet
Non -wetland
404

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

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources below where
indicated for all checked items:
❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:
® Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: Drawing 1
® Natural Resources Conservation Service Soil Survey. Citation: Drawings 2 & 2A
® National wetlands inventory map(s). Cite name: Drawing 3
❑ State/local wetland inventory map(s):
® FENWFIRM maps: Drawing 4
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
® Photographs: ®Aerial (Name & Date): Drawing 5
or ❑Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily been
verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of Regulatory
staff member completing PJD
January 26, 2023
Signature and date of person
requesting PJD (REQUIRED,
unless obtaining the signature
is impracticable)1
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester does not respond within the
established time frame, the district may presume concurrence and no additional follow up is necessary prior to finalizing
an action.