20230468 Ver 1_6863.2_Jackson Lake_PCN_03.27.23_20230327

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 9: SAW- 2021-02150
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Jackson Lake Road
Begin Date (Date Received): 03.27.23
Assign Action ID Number in ORM ❑
2. Work Type: ❑✓ Private ❑Institutional ❑Government ❑ Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
The site contains wooded land. The site is proposed for development.
4. Property Owner / Applicant [PCN Form A3 or A4]: Leoterra Jackson Lake, LLC
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Michael 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]:
Jackson Lake Road
35.9385830/-79.9523830
8. Project Location —Tax Parcel ID [PCN Form Bla]: 7719772964, 7719874848
9. Project Location —County [PCN Form A2b]: Guilford
10. Project Location —Nearest Municipality or Town [PCN Form A2c]: High Point
11. Project Information —Nearest Waterbody [PCN Form 132a]: Mile Branch (Two Mile Branch) (Jackson
I akP) 0
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03030003
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
❑ Standard Permit
✓ Nationwide Permit 9
Regional General Permit 9
Jurisdictional Determination Request
Section 10 and 404 ❑
❑ Pre -Application Request
::]Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

nA�
NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2021-02150 Date received: 3/27/2023
DWR project no. Click enter.] Date received: 3/27/2023
Site Coordinates:
Latitude (DD.DDDDDD): 35.938583'
Longitude (DD.DDDDDD):-79.952383'
Form Version 1.5, September 2020
Pre -Construction Notification (PCN) Form
(Ver. 1.5, September 2020)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all mandatory
questions are answered.
The online help file may be found at this link:
https:Hedocs.deg.nc.gov/WaterResources/0/edocl6247041PCN%2OHelp%2OFile%202018-1-30.pdf
The help document may be found at this link:
http://www.saw. usace.army. mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as DWR will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used to satisfy 40
C.F.R. Section 121.4(a) which states "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to the certifying authority
at least 30 days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) *: 11/17/2022
DWR ID # Click to enter. Version Click to enter. (If applicable)
A. Processing Information
County (counties) where project is located:
Guilford Additional (if needed).
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes ❑x No
or airport project)
Is this a NCDOT project?
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to enter.
❑x Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Pagel of 22 PCN Form - Version 1.5, September 2020

❑x Nationwide Permit (NWP)
1 b. Permit type(s)?
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as separate attachments
and submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes ❑x No
NWP number(s):
NWP 29
RGP number(s):
Click to enter.
1 d. Type(s) of approval sought from the DWR (check all that apply):
❑x 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: *
❑ Yes ❑x No
For the record only for Corps Permit: *
❑ Yes ❑x No
1f. Is this an after -the -fact permit/certification application?
❑ Yes ❑x No
1 g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
❑ Yes ❑ No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h. Is the project located in any of NC's twenty coastal counties?
❑ Yes ❑x No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
❑ Yes ❑x No ❑ Unknown
1j. Is the project located in a designated trout watershed?
❑ Yes ❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 2 of 22 PCN Form - Version 1.5, September 2020

B. Applicant Information
1 a.
Who is the primary contact?
Clay Mize
1 b.
Primary Contact Email:
[e-mail]
1 c.
Primary Contact Phone: (###)###-####
[phone]
1 d.
Who is applying for the permit/certification? (check
all that apply)
❑ Owner 0 Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed:
Leoterra Jackson Lake, LLC
2b.
Deed Book and Page No.:
008584-00962
2c.
Responsible Party (for corporations):
Clay Mize
2d.
Address
Street Address:
110-A Shields Park Drive
Address line 2:
-;licktu IVI RIM.
City:
Kernersville
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27284
Country:
United States
2e.
Telephone Number: * (###)###-####
[phone]
2f.
Fax Number: (###)###-####
Click to eniei.
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.
Page 3 of 22 PCN Form - Version 1.5, September 2020

3f. Email Address: Click to enter.
4. Agent/ Consultant (if applicable)
4a. Name: *
Michael T. Brame
4b. Business Name:
Pilot Environmental, Inc.
4c. Address: *
Street Address:
743 Park Lawn Court
Address line 2:
Click to enter.
City:
Kernersville
State/ Province/ Region:
NC
Postal/ Zip Code:
27284
Country:
U.S.
4d. Telephone Number: (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to enter.
4f. Email Address: *
[e-mail]
Agent Authorization Letter:
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw. usace.army. mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 4 of 22 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project:
Jackson Lake Subdivision
1 b. Subdivision name (if appropriate):
Jackson Lake
1 c. Nearest municipality/town: *
High Point, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
7719870767 & 70719781656
2b.
Property size (in acres):
74
2c.
Project Address:
Street Address:
Jackson Lake Road
Address line 2:
Click to ente,
City:
High Point
State/ Province/ Region:
NC
Postal/ Zip Code:
27263
Country:
U.S.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point):
Latitude (DD.DDDDDD): 35.938583'
Longitude (-DD.DDDDDD):--79.952383°
3. Surface Waters
3a. Name of nearest body of water to proposed project:
Richland Creek & Mile Branch
3b. Water Resources Classification of nearest receiving
WS IV*
water:
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
Cape Fear
3c. In what river basin(s) is your project located?
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030300030103
located:
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 5 of 22 PCN Form - Version 1.5, September 2020

4.
Project Description and History
4a.
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application:
The site contains undeveloped, wooded land. A sewer line crosses the southern portion of
the site. The site is located in a residential area of High Point.
4b.
Have Corps permits or DWR certifications been obtained for this
❑ Yes ❑x No ❑ Unknown
project (including all prior phases) in the past?
4c.
If yes, please give the DWR Certification number and/or Corps
SAW-2021-02150
Action ID (ex. SAW-0000-00000):
jClick to enter.]
Attach any pertinent project history documentation
4d.
Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.
Attach an 8'h x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f.
List the total estimated acreage of all existing wetlands on the
2.538 acres
property:
4g.
List the total estimated linear feet of all existing streams (intermittent
1,580 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 99 lot single family residential subdivision.
4i.
Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of a 97 lot single family residential subdivision and a 63 lot townhome (4
units) community. In order to facilitate the proposed development and construct the roads necessary to construct the
subdivision, it is necessary to impact wetlands on the site. To facilitate the development of the site, clearing and
grading the site is necessary. Graders, haulers, excavators and other heavy equipment will be used during grading
and construction of the site.
4j.
Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
The site was delineated by Pilot Environmental in June, 2021 (Pilot Project 6863, report dated June 28, 2021). The
site was verified by Mr. David Bailey with the USACE via desktop review (e-mail dated October 18, 2021). A PJD has
not been received for the site. Mr. Bailey concurred with the delineation as depicted on Drawing 5 (attached).
Name (if known): Michael Brame
5b.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental
areas?
Other: r;lick to enter
5c.
If the Corps made a jurisdictional determination,
❑x Preliminary ❑ Approved ❑ Emailed Concurrence
what type of determination was made?
❑ Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
SAW — 2021-02150
Page 6 of 22 PCN Form - Version 1.5, September 2020

5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
USACE — October 18, 2021 Desktop Review — PJD not issued.
5d1. Attach jurisdictional determinations.
Page 7 of 22 PCN Form - Version 1.5, September 2020

6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x No
6b. If yes, explain.
The site is a proposed single phase residential development. A road is stubbed onto adjacent property to the
west as required for site plan approval. The applicant does not own the property where the road is stubbed and
does not have intentions to develop it. There are no mapped jurisdictional features in the immediate vicinity of
the termination point of the road.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to authorize
any part of the proposed project or related activity? This includes other separate and distant crossings for linear
projects that require Department of the Army authorization but don't require pre -construction notification.
No other permits are intended to be used.
Page 8 of 22 PCN Form - Version 1.5, September 2020

D. Proposed Impacts Inventory
Impacts Summary
❑x Wetlands
1 a. Where are the impacts associated with your project ❑ Buffers
(check all that apply):
❑ Pond Construction
❑ Streams - tributaries
❑ Open Waters
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
2a1.
2b.
2c.
2d.
2e.
2f.
2g.
Site #
Impact
Impact
Wetland Name
Wetland Type
Forested
Jurisdiction
Impact Area
Reason/Type
Duration
?
Type
(ac)
W1
Fill (Incl.
Permanent
WE 1-132
Bottomland
Yes
Both
0.01
Riprap)
Hardwood
Forest
W2
Fill (Incl.
Permanent
WE 1-132
Bottomland
Yes
Both
0.016
Riprap)
Hardwood
Forest
W3
Fill (Incl.
Permanent
WE 1-132
Bottomland
Yes
Both
0.056
Riprap)
Hardwood
Forest
W4
Fill (Incl.
Permanent
WC 1-28
Bottomland
Yes
Both
0.005
Riprap)
Hardwood
Forest
W5
Fill (Incl.
Permanent
WA 1-38
Bottomland
Yes
Both
0.001
Riprap)
Hardwood
Forest
Fill (Incl.
Permanent
WE 1-132
Bottomland
Yes
Both
0.011
W6
Riprap)
Hardwood
Forest
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
0.099 ac
2g3. Total wetland impacts
0.099 ac
2h. Comments:
The wetland impacts are associated with proposed roads that will provide access to the site and the associated grading
limits necessary to bring the roads to grade. Mitigation is not proposed.
Page 9 of 22 PCN Form - Version 1.5, September 2020

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #
3a.
Impact Reason/
Type
3b.
Impact
Duration
3d.
Stream Name
3e.
Stream
Type
3f.
Jurisdiction
Type
3g.
Stream Width
(avg ft)
3h.
Impact length
(linear ft)
S1
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch impact:
Click to enter. linear ft
3i2. Total permanent stream impacts:
Click to enter. linear ft
36. Total temporary stream impacts:
Click to enter. linear ft
3i4. Total stream and ditch impacts:
Click to enter. linear ft
3j. Comments:
The streams on the site are being avoided. There are no proposed impacts to streams on the site.
Page 10 of 22 PCN Form - Version 1.5, September 2020

4.
Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
4b.
4c.
4d.
4e.
4e1.
4f.
Site #
Impact Reason/
Impact
Waterbody Name
Waterbody
Jurisdiction
Impact area (ac)'
Type
Duration
Type*
Type
01
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
02
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
03
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
04
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Open waters are not present on the site. 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 tL
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Pond or lake construction is not proposed.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter.
Page 11 of 22 PCN Form - Version 1.5, September 2020

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
(Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑x Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
B1
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Buffer impacts are being avoided. There are no buffer impacts proposed.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 22 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The applicant has designed the proposed development to avoid impacts to the remainder of the wetlands on the site,
all of the streams and associated buffers. As is clear from review of the site plan, development has been planned
around the central and eastern portions of the site where there are large jurisdictional areas. Additionally, a
substantial number of lots have been sacrificed under the proposed design to avoid stream, buffer and wetland
impacts. The remaining roads, lots and utilities have been designed to avoid additional impacts to jurisdictional areas.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The clearing limits will be surveyed, staked and silt fencing and clearing limit fencing will be used. Disturbed areas will
be seeded and mulched to limit sediment from entering downgradient waters. Slope matting will be used on steep
slopes.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? ❑ 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 enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
Click to enter. linear feet
4c.
If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO: RP: P27 BUTTON KEY:O
4d.
Buffer mitigation requested (DWR only):
Click to enter. square feet
4e.
Riparian wetland mitigation requested:
Click to enter. acres
4f.
Non -riparian wetland mitigation requested:
Click to enter. acres
Page 13 of 22 PCN Form - Version 1.5, September 2020

4g. Coastal (tidal) wetland mitigation requested: Click to enter. acres
4h. Comments:
Click LU eniei.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including the amount of mitigation proposed.
Click to enter.
5b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffer
❑ Yes ❑x No
that requires buffer mitigation?
If yes, please complete this entire section — please contact DWR for more information.
6b.
If yes, identify the square feet of impact to each zone of the riparian buffer that requires
mitigation. Calculate the
amount of mitigation required in the table below.
6c.
6d.
6e.
Zone
Reason for impact
Total impact (square
Multiplier
Required mitigation
feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
:,hoose one
:,lick to enter.
Zone 2
Slick to enter.
Click to enter.
:,hoose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ 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:
Click to enter.
Page 14 of 22 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
® Yes ❑ No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other forms of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc.gov/about/divisions/energv-mineral-land-resources/energv-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
❑x 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?
El Yes ❑x No
2b. Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?
❑x Yes ❑ No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c. IS the project over an acre?
❑x Yes ❑ No
2d. Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state-
❑x Yes ❑ No
approved local government stormwater program?
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2e. Which of the following stormwater management program(s) apply?
❑x Local Government
(Check all that apply)
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Page 15 of 22 PCN Form - Version 1.5, September 2020

❑x Phase II ❑ USMP
Local Government Stormwater Programs
❑ NSW ❑ Water Supply
Please identify which local government stormwater program you are using.
High Point
❑ Phase II ❑ HQW or ORW
State Stormwater Programs
❑ Coastal Counties ❑x Other
Comments:
A SWMP is required and will be submitted to the City of High Point for review and approval.
Page 16 of 22 PCN Form - Version 1.5, September 2020

G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x No
funds or the use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require
preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental
❑ Yes ❑ No
Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been
finalized by the State Clearing House? (If so, attach a copy of the
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
A NEPA or SEPA is not required.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
DR Surface Water or Wetland Standards or Riparian Buffer Rules El Yes ❑x No
W
(15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
Click to enter.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
❑ Yes ❑x No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
Additional development as a result of the proposed development is not anticipated.
3c. If yes, attach a qualitative or quantitative cumulative impact analysis (.pdo in accordance with the most recent
DWR policy.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? I ® Yes ❑ No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Sewage will be discharged into existing sewer lines. The sewer connections were designed to avoid impacts to
streams and wetlands.
Page 17 of 22 PCN Form - Version 1.5, September 2020

5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will this project occur in or near an area with federally protected
® Yes ❑ No
species or habitat? (IPAC weblink: hftps://www.fws.gov/ipac/ Ifws.govl)
5b.
Have you checked with the USFWS concerning Endangered Species
❑ Yes ❑x No
Act impacts?
5c.
If yes, indicate the USFWS Field Office you have contacted.
:,hoose one
5d.
Is another federal agency involved?
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e.
Is this a DOT project located within Divisions 1-8?
❑ Yes ❑x No
5f.
Will you cut any trees in order to conduct the work in waters of the
U.S.?
❑ Yes ❑x No
5g.
Does this project involve bridge maintenance or removal? *
❑ Yes ❑x No
Link to NLEB SLOPES document: http://saw-reg.usace. army. mil/NLEB/1-30-17-signed NLEB-
SLOPES&apps.pdf
5h.
Does this project involve the construction/ installation of a wind
turbine(s)?
❑ Yes ❑x No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdo
5i.
Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes ❑x 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 .pdo
Page 18 of 22 PCN Form - Version 1.5, September 2020

5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat?
US Department of the Interior — Fish and Wildlife Service Official Species List from IPaC
4 listed species are identified on the IPaC report (attached). Tri-colored bat, Monarch butterfly, Schweinitz's sunflower
and Small whorled pogonia are federally listed species.
The areas where impacts are occurring were clear-cut in 2009. The vegetation has naturally regenerated and is
densely vegetated with mixed hardwood/pine saplings and low-lying herbaceous species. The sapling species
observed include red maple, green ash, sycamore, sweet gum, Virginia pine, box -elder, Chinese privet, dogwood,
eastern red cedar and American hornbeam. Herbaceous species and vines observed include blackberry, greenbriar,
trumpet creeper, poison ivy, Japanese stilt -grass, sedges and rush.
Tri-colored bat - Hibernacula was not observed within the proposed project areas (within 100 feet of the proposed
impacts). Wooded areas and mature trees that could afford suitable summer roosting habitat are not present within the
project areas. Additionally, the wooded land on the site is dense and is not considered summer roosting habitat.
Caves, mines or culverts that could be considered suitable winter habitat for the tri-colored bat were not observed.
Based on our observations, we have made a determination of no effect for this species.
Monarch butterfly — The monarch butterfly is identified by the IPaC report as a candidate species for listing under the
Endangered Species Act. Although the provisions of Section 7 of the ESA do not currently apply to candidate species
or other non -listed pollinators, the service recommends avoiding impacts to the monarch butterfly and assisting in the
protection and reestablishment of the butterfly and its habitat by use of seeds native to natural communities for soil
stabilization or revegetation of disturbed areas during project construction. Additionally, we did not observe milkweed
within the project areas.
Schweinitz's sunflower — Utility easements and roadsides are not located within the project areas. Areas are not
burned or otherwise maintained. The wooded areas included by the proposed project areas are densely vegetated
with various saplings and low-lying herbaceous species that would not provide suitable habitat for Schweinitz's
sunflower. Pilot also reviewed NCNHP GIS natural resources data layer to identify the closest known population of
Schweinitz's sunflower. According to the NCNHP GIS natural resources data layer, there are no known populations of
Schweinitz's sunflower within 3.5 miles of the site. Based on our field observations and the distance to known
populations, we have made a determination of no effect for this species.
Small Whorled Pogonia - Small whorled pogonia can be limited by shade. The species seems to require small light
gaps, or canopy breaks, and generally grows in areas with sparse to moderate ground cover. Too many other plants in
an area can be harmful to this plant. This orchid typically grows under canopies that are relatively open or near
features that create long -persisting breaks in the forest canopy such as a road or a stream. It grows in mixed -
deciduous or mixed-deciduous/coniferous forests that are generally in second- or third -growth successional stages.
The soils in which it lives are usually acidic, moist, and have very few nutrients. The USFWS Fact Sheet indicates that:
"This orchid grows in older hardwood stands of beech, birch, maple, oak and hickory that have an open understory.
Sometimes it grows in stands of softwoods such as hemlock. It prefers acid soils with a thick layer of dead leaves,
often on slopes near small streams." The wooded areas that are being impacted are 13 years old. The vegetation is
dense throughout. Based on our observations, the impact areas and areas within 100 feet of the impact areas are not
suitable habitat for this species. Therefore, we have made a determination of no effect for this species.
Potential habitat for these species is not located within the proposed project areas.
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?
❑ Yes ❑x No
Are there submerged aquatic vegetation (SAV) around
the project vicinity?
El Yes ❑x No El Unknown
Page 19 of 22 PCN Form - Version 1.5, September 2020

Will this project affect submerged aquatic vegetation?
❑ Yes ❑x No ❑ Unknown
Explain: Dlick to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper— NOAA Fisheries
Page 20 of 22 PCN Form - Version 1.5, September 2020

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
hftp://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
❑ 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 were not identified on the site or within 1,500 feet
of the site. A surveyed "gone" residence is identified approximately 450 feet northeast of the site. A copy of the SHPO
Map is included as an attachment.
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
i] Yes ❑x No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
National Flood Hazard Layer froom FEMA Web Map Service — Drawing 4 (Attached)
Page 21 of 22 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
Please let me know if you need additional information in order to process this application.
Attach pertinent documentation or attachments not previously requested
I. Signature *
❑x By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: Michael T. Brame
DigR.11y zig-d byM h-I Brame
UN:rn-M h-I Brame,. —Pilot
Signature: Michael Brame Eoviroomeotzl,l--
mail- S..a@pilotenNro. -US
Date: 2D23.03.27 14:27 D7-00'
03/27/2023
Page 22 of 22 PCN Form - Version 1.5, September 2020

DocuSign Envelope ID: 4E8CC3C4-ED4C-41 E9-A6DE-2683C84C9604
Proposal for Environmental Services
Pilot Proposal 6863.2
November 18, 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: 1326 Cox Ave.
H4gh PO4 Rt , P!C 27263
Applicant Information:
LeoTerra Jackson Lake, LLC
Name:
Address: 110-A Shields Park Dr., Kernersville, NC 27284
336-971-3574
Telephone Number:
Fax Number:
[e-mail]
E-mail Address: m
D�occuSigne1d by:
Signature: 011" �bpuIr �&,S Date: 11/29/2022
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Michael Brame
From: 401 PreFile <401 [e-mail]>
Sent: Thursday, November 17, 2022 3:41 PM
To: Heather LaGamba
Subject: Automatic reply: [External] Pre -File Notice - Jackson Lake Rd (6863.2)
This email confirms receipt of your pre -filing meeting request. Please retain this email for your records and
submit this documentation as part of your 401 application (PCN Application) as required by federal law. DWR
will not be able to accept your application without this federally required documentation. 401 applications
received without documentation that a pre -filing meeting request was submitted at least 30 days prior will be
returned as incomplete.
Responses to this email are not monitored.
If you need to contact 401/Buffer Permitting Staff, please use the following link(s) to access of staff contact
list(s).
For Non -Transportation Central Staff:
https://deg.nc.gov/about/divisions/water-resources/water-quality-permitting/401-buffer-permitting/401-
buffer-permitting-contacts
For Non -Transportation Regional
Staff: https://edocs.deg.nc.gov/WaterResources/DocView.aspx?dbid=0&id=2162034&cr=1
For all Transportation Projects Including NCDOT Projects:
https://deg.nc.gov/about/divisions/water-resources/water-resources-permits/transportation-
pe r m itt i ng/sta ff-co nta cts

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Drawing 2
USDA Web Soil Survey
of Guilford, NC p'I 01,
Scale: 1" = 400'
PILOT E N Y I R 0 N M E N 7 A L. I N C
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High Point, Guilford County, NC
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Drawing 3NWI Map
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Wetlands Mapper I" High Point, Guilford County, NC
Scale: 1" = 400' P11.O� ��"�
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Drawing 4
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Dewberry Engineers Inc.
9300 Harris Corners Pkwy - Suite 220
Charlotte, NC 28269
Phone: [phone]
Fax: [phone]
www.dewberry.com
NCBELS #F-0929
NCBOLA #C-478
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REVISIONS
NO. I DATE I BY I DESCRIPTION
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TITLE
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OVERALL MAP
(SHEET 1 OF 5)
DEI PROJECT NO: 50156833
SHEET NO.
C2001

a n n n r
Dewberry
Dewberry Engineers Inc.
9300 Harris Corners Pkwy - Suite 220
Charlotte, NC 28269
Phone: [phone]
Fax: [phone]
www.dewberry.com
NCBELS #F-0929
NCBOLA #C-478
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PHONE: [phone]
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PRELIMINARY - DO NOT
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KEY PLAN:
SCALE: 1" =40'
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REVISIONS
NO. I DATE I BY I DESCRIPTION
DRAWN BY
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APPROVED BY
BML
CHECKED BY
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DATE MARCH 22, 2023
TITLE
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MAP
(SHEET 2 OF 5)
DEI PROJECT NO: 50156833
SHEET NO.
C2002

a n n n r
Dewberry
Dewberry Engineers Inc.
9300 Harris Corners Pkwy - Suite 220
Charlotte, NC 28269
Phone: [phone]
Fax: [phone]
www.dewberry.com
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NCBOLA #C-478
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PHONE: [phone]
SEAL
PRELIMINARY - DO NOT
USE FOR CONSTRUCTION
KEY PLAN:
SCALE: 1" =40'
0' 20' 40' 80,
REVISIONS
NO. I DATE I BY I DESCRIPTION
DRAWN BY
JEB
APPROVED BY
BML
CHECKED BY
BML
DATE MARCH 22, 2023
TITLE
STREAM AND
NETLAN D IMPACT
MAP
(SHEET 3 OF 5)
DEI PROJECT NO: 50156833
SHEET NO.
C2mO3

a n n n r
Dewberry
Dewberry Engineers Inc.
9300 Harris Corners Pkwy - Suite 220
Charlotte, NC 28269
Phone: [phone]
Fax: [phone]
www.dewberry.com
NCBELS #F-0929
NCBOLA #C-478
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MR. CLAY MIZE
LEOTERRA DEVELOPMENT, INC.
110-A SHIELDS PARK DR.
KERNERSVILLE, NC 27284
PHONE: [phone]
SEAL
PRELIMINARY - DO NOT
USE FOR CONSTRUCTION
KEY PLAN:
SCALE: 1" =40'
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REVISIONS
NO. I DATE I BY I DESCRIPTION
DRAWN BY
JEB
APPROVED BY
BML
CHECKED BY
BML
DATE MARCH 22, 2023
TITLE
STREAM AND
NETLAN D IMPACT
MAP
(SHEET 4 OF 5)
DEI PROJECT NO: 50156833
SHEET NO.
C2004

a n n n r
Dewberry
Dewberry Engineers Inc.
9300 Harris Corners Pkwy - Suite 220
Charlotte, NC 28269
Phone: [phone]
Fax: [phone]
www.dewberry.com
NCBELS #F-0929
NCBOLA #C-478
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MR. CLAY MIZE
LEOTERRA DEVELOPMENT, INC.
110-A SHIELDS PARK DR.
KERNERSVILLE, NC 27284
PHONE: [phone]
SEAL
PRELIMINARY - DO NOT
USE FOR CONSTRUCTION
KEY PLAN:
SCALE: 1" =40'
0' 20' 40' 80,
REVISIONS
NO. I DATE I BY I DESCRIPTION
DRAWN BY
JEB
APPROVED BY
BML
CHECKED BY
BML
DATE MARCH 22, 2023
TITLE
STREAM AND
NETLAN D IMPACT
MAP
(SHEET 5 OF 5)
DEI PROJECT NO: 50156833
SHEET NO.
C2mO5

United States Department of the Interior
FISH AND WILDLIFE SERVICE
Raleigh Ecological Services Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Phone: [phone] Fax: [phone]
In Reply Refer To:
Project Code: 2023-0019754
Project Name: Jackson Lake Subdivision
F7YJ4 h ti1.liy'Hr%,N,V Jkt.
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November 29, 2022
Subject: List of threatened and endangered species that may occur in your proposed project
location or may be affected by your proposed project
To Whom It May Concern:
The enclosed species list identifies threatened, endangered, proposed and candidate species, as
well as proposed and final designated critical habitat, that may occur within the boundary of your
proposed project and/or may be affected by your proposed project. The species list fulfills the
requirements of the U.S. Fish and Wildlife Service (Service) under section 7(c) of the
Endangered Species Act (Act) of 1973, as amended (16 U.S.C. 1531 et seq.). If your project area
contains suitable habitat for any of the federally -listed species on this species list, the proposed
action has the potential to adversely affect those species. If suitable habitat is present, surveys
should be conducted to determine the species' presence or absence within the project area. The
use of this species list and/or North Carolina Natural Heritage program data should not be
substituted for actual field surveys.
New information based on updated surveys, changes in the abundance and distribution of
species, changed habitat conditions, or other factors could change this list. Please feel free to
contact us if you need more current information or assistance regarding the potential impacts to
federally proposed, listed, and candidate species and federally designated and proposed critical
habitat. Please note that under 50 CFR 402.12(e) of the regulations implementing section 7 of the
Act, the accuracy of this species list should be verified after 90 days. This verification can be
completed formally or informally as desired. The Service recommends that verification be
completed by visiting the ECOS-IPaC website at regular intervals during project planning and
implementation for updates to species lists and information. An updated list may be requested
through the ECOS-IPaC system by completing the same process used to receive the enclosed list.
The purpose of the Act is to provide a means whereby threatened and endangered species and the
ecosystems upon which they depend may be conserved. Under sections 7(a)(1) and 7(a)(2) of the
Act and its implementing regulations (50 CFR 402 et seq.), Federal agencies are required to
utilize their authorities to carry out programs for the conservation of threatened and endangered

11/29/2022
species and to determine whether projects may affect threatened and endangered species and/or
designated critical habitat.
A Biological Assessment is required for construction projects (or other undertakings having
similar physical impacts) that are major Federal actions significantly affecting the quality of the
human environment as defined in the National Environmental Policy Act (42 U.S.C. 4332(2)
(c)). For projects other than major construction activities, the Service suggests that a biological
evaluation similar to a Biological Assessment be prepared to determine whether the project may
affect listed or proposed species and/or designated or proposed critical habitat. Recommended
contents of a Biological Assessment are described at 50 CFR 402.12.
If a Federal agency determines, based on the Biological Assessment or biological evaluation, that
listed species and/or designated critical habitat may be affected by the proposed project, the
agency is required to consult with the Service pursuant to 50 CFR 402. In addition, the Service
recommends that candidate species, proposed species and proposed critical habitat be addressed
within the consultation. More information on the regulations and procedures for section 7
consultation, including the role of permit or license applicants, can be found in the "Endangered
Species Consultation Handbook" at:
http://www.fws.gov/endangered/esa-library/pdf/TOC-GLOS.PDF
Migratory Birds: In addition to responsibilities to protect threatened and endangered species
under the Endangered Species Act (ESA), there are additional responsibilities under the
Migratory Bird Treaty Act (MBTA) and the Bald and Golden Eagle Protection Act (BGEPA) to
protect native birds from project -related impacts. Any activity, intentional or unintentional,
resulting in take of migratory birds, including eagles, is prohibited unless otherwise permitted by
the U.S. Fish and Wildlife Service (50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)). For more
information regarding these Acts see https://www.fws.govibirds/policies-and-regulations.php.
The MBTA has no provision for allowing take of migratory birds that may be unintentionally
killed or injured by otherwise lawful activities. It is the responsibility of the project proponent to
comply with these Acts by identifying potential impacts to migratory birds and eagles within
applicable NEPA documents (when there is a federal nexus) or a Bird/Eagle Conservation Plan
(when there is no federal nexus). Proponents should implement conservation measures to avoid
or minimize the production of project -related stressors or minimize the exposure of birds and
their resources to the project -related stressors. For more information on avian stressors and
recommended conservation measures see https://www.fws.govibirds/bird-enthusiasts/threats-to-
birds.php.
In addition to MBTA and BGEPA, Executive Order 13186: Responsibilities of Federal Agencies
to Protect Migratory Birds, obligates all Federal agencies that engage in or authorize activities
that might affect migratory birds, to minimize those effects and encourage conservation measures
that will improve bird populations. Executive Order 13186 provides for the protection of both
migratory birds and migratory bird habitat. For information regarding the implementation of
Executive Order 13186, please visit https://www.fws.govibirds/policies-and-regulations/
executive-orders/e0-13186.php.

11/29/2022
We appreciate your concern for threatened and endangered species. The Service encourages
Federal agencies to include conservation of threatened and endangered species into their project
planning to further the purposes of the Act. Please include the Consultation Code in the header of
this letter with any request for consultation or correspondence about your project that you submit
to our office.
Attachment(s):
■ Official Species List
• Migratory Birds

11/29/2022
Official Species List
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Raleigh Ecological Services Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
[phone]

11/29/2022
Project Summary
Project Code: 2023-0019754
Project Name: Jackson Lake Subdivision
Project Type: Residential Construction
Project Description: The site is proposed for residential development.
Project Location:
Approximate location of the project can be viewed in Google Maps: https:
www.google.com/maps/(a)35.93859085.-79,95219248770596.14z
Counties: Guilford County, North Carolina

11/29/2022
Endangered Species Act Species
There is a total of 4 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
Fisheries1, 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
STATUS
Tricolored Bat Perimyotis subflavus Proposed
No critical habitat has been designated for this species. Endangered
Species profile: htips: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
Small Whorled Pogonia Isotria medeoloides
Threatened
Population:
No critical habitat has been designated for this species.
Species profile: htips:Hecos.fws.gov/ecp/species/1890

11/29/2022
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

11/29/2022
Migratory Birds
Certain birds are protected under the Migratory Bird Treaty Act! and the Bald and Golden Eagle
Protection Act2.
Any person or organization who plans or conducts activities that may result in impacts to
migratory birds, eagles, and their habitats should follow appropriate regulations and consider
implementing appropriate conservation measures, as described below.
1. The Migratory Birds Treaty Act of 1918.
2. The Bald and Golden Eagle Protection Act of 1940.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
The birds listed below are birds of particular concern either because they occur on the
USFWS Birds of Conservation Concern (BCC) list or warrant special attention in your
project location. To learn more about the levels of concern for birds on your list and how this
list is generated, see the FAQ below. This is not a list of every bird you may find in this location,
nor a guarantee that every bird on this list will be found in your project area. To see exact
locations of where birders and the general public have sighted birds in and around your project
area, visit the E-bird data mapping tool (Tip: enter your location, desired date range and a species
on your list). For projects that occur off the Atlantic Coast, additional maps and models detailing
the relative occurrence and abundance of bird species on your list are available. Links to
additional information about Atlantic Coast birds, and other important information about your
migratory bird list, including how to properly interpret and use your migratory bird report, can be
found below.
For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, click on the PROBABILITY OF PRESENCE
SUMMARY at the top of your list to see when these birds are most likely to be present and
breeding in your project area.
NAME BREEDING SEASON
Chimney Swift Chaetura pelagica Breeds Mar 15 to Aug 25
This is a Bird of Conservation Concern (BCC) throughout its range in the
continental USA 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 (■)

11/29/2022
Each green bar represents the bird's relative probability of presence in the 10km grid cell(s) your
project overlaps during a particular week of the year. (A year is represented as 12 4-week
months.) A taller bar indicates a higher probability of species presence. The survey effort (see
below) can be used to establish a level of confidence in the presence score. One can have higher
confidence in the presence score if the corresponding survey effort is also high.
How is the probability of presence score calculated? The calculation is done in three steps:
1. The probability of presence for each week is calculated as the number of survey events in
the week where the species was detected divided by the total number of survey events for
that week. For example, if in week 12 there were 20 survey events and the Spotted Towhee
was found in 5 of them, the probability of presence of the Spotted Towhee in week 12 is
0.25.
2. To properly present the pattern of presence across the year, the relative probability of
presence is calculated. This is the probability of presence divided by the maximum
probability of presence across all weeks. For example, imagine the probability of presence
in week 20 for the Spotted Towhee is 0.05, and that the probability of presence at week 12
(0.25) is the maximum of any week of the year. The relative probability of presence on
week 12 is 0.25/0.25 = 1; at week 20 it is 0.05/0.25 = 0.2.
3. The relative probability of presence calculated in the previous step undergoes a statistical
conversion so that all possible values fall between 0 and 10, inclusive. This is the
probability of presence score.
Breeding Season( )
Yellow bars denote a very liberal estimate of the time -frame inside which the bird breeds across
its entire range. If there are no yellow bars shown for a bird, it does not breed in your project
area.
Survey Effort (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

11/29/2022 3
Chimney Swift
BCC Rangewide ——'— —'------'--�------- --�—
(CON) ---- ---
Additional information can be found using the following links:
■ Birds of Conservation Concern https://www.fws.goy/program/migratory-birds/species
■ Measures for avoiding and minimizing impacts to birds https://www.fws.gov/librgM/
collections/avoidine-and-minimizine-incidental-take-migratorv-birds
■ Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.odf
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
BCC 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?

11/29/2022
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.

11/29/2022
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 LOr1nQ.
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.

11/29/2022
IPaC User Contact Information
Agency: Pilot Environmental, Inc.
Name: Michael Brame
Address: 743 Park Lawn Court
City:
Kernersville
State:
NC
Zip:
27284
Email
[e-mail]
Phone:
3367084620

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