20230508 Ver 1_ePCN Application_20230402

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Initial Review
Has this project met the requirements for acceptance in to the review process?
Yes
No
Is this project a public transportation project?*
Yes No
Change only If needed.
Pre -Filing Meeting Date Request was submitted on:
3/2/2023
BIMS # Assigned
20230508
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
la. Name of project:
Brentwood 126K
la. Who is the Primary Contact?*
Mr. Tom Flanagan
1b. Primary Contact Email: *
[e-mail]
Date Submitted
4/2/2023
Nearest Body of Water
Richland Creek
Basin
Cape Fear
Water Classification
WS-IV
Site Coordinates
Latitude:
35.941058
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Guilford
Is this a NCDMS Project
Yes No
Longitude:
-79.974656
Version#*
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Seren Homer:[e-mail]
1c. Primary Contact Phone: *
[phone]
O

Is this project a public transportation project?*
Yes No
1a.Type(s)of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 39 - Commercial/Institutional Developments
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
401 Water Quality Certification - Express
Riparian Buffer Authorization
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: Yes No
For the record only for Corps Permit: Yes No
1f. Is this an after -the -fact permit application? *
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
EJG Randleman Road, LLC
2b. Deed book and page no.:
007662/00726, 007662/00728, and 007673/01463
2c. Contact Person:
Mr. Tom Flanagan

2d. Address
Street Address
5826 Samet Drive
Address Line 2
Suite 105
city
High Point
Postal / Zip Code
27265
2e. Telephone Number:
[phone]
2g. Email Address:'
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Joseph (Jay) S. Lawson III
4b. Business Name:
Progress Environmental (an HRP Company)
4c.Address
Street Address
120 Fayette Street
Address Line 2
city
Winston-Salem
Postal / Zip Code
27101
4d. Telephone Number:
[phone]
4f. Email Address:"
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
High Point
2. Project Identification
2a. Property Identification Number:
192804/192801/180722
2c. Project Address
Street Address
2005 Brentwood St. / 2023 Brentwood St. 1521 Townsend Avenue
Address Line 2
city
High Point
Postal / Zip Code
27263
3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
Richland Creek
3b. Water Resources Classification of nearest receiving water:
WS-IV
3c. What river basin(s) is your project located in?"
Cape Fear
State / Province / Region
NC
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
[phone]
2b. Property size:
33.76
State / Province / Region
NC
Country
USA
O

3d. Please provide the 12-digit HUC in which the project is located.
030300030103
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 is located at 2005 Brentwood Street, 2023 Brentwood Street, and 521 Townsend Avenue in High Point, Guilford County, North Carolina. The Guilford County GIS identifies the
properties as:
PN 192804, located at 2023 Brentwood Street, undeveloped and comprising approximately 19.35 acres;
• PN 192801, located at 2005 Brentwood Street, undeveloped and comprising approximately 4.11 acres; and,
PN 180722, located at 521 Townsend Avenue, undeveloped and comprising approximately 10.3 acres.
The property is undeveloped (i.e., a mix of cleared and wooded areas) and consists of a total of approximately 33.76 acres (managed forest). Timber was recently removed from the site
and it is characterized by vegetative overgrowth and woody debris scattered throughout the property. The remnants of a dam associated with a former pond are located on the western
portion of the site. The site includes a sanitary sewer right-of-way and NCDOT right-of-way in the vicinity of the northern property boundary. The remnants of an apparent logging road
approximately bisects the site from west to east. Access to the site is from an unimproved entrance on the western portion of the property along Brentwood Street.
The subject site is located within a commercial area of High Point, North Carolina. Progress observed the following land uses on properties in the immediate vicinity of the subject property:
North - Business I-85 North/US Highway 311 On Ramp. A vacant commercial building is located to the northwest.
East - EAS High Point Fabrication Plant (mechanical contractor/HVAC manufacturer) with additional commercial development beyond.
South - Golden Doors Conference & Event Center, Exact Commerce (home goods store), Carolina Southern (trucking), and Reptile Basics (pet supply) with Townsend Avenue beyond.
West - Brentwood Street with a motel and television station beyond.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
1.1
4g. List the total estimated linear feet of all existing streams on the property:
3,220
4h. Explain the purpose of the proposed project:
To construct a 126K speculative building and private drive to access the building.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The project will utilize conventional equipment to install a stream crossing to access the property located at 2023 Breentwood Street. In order to complete the project, including the stream
crossing, a portion of the stream and zones 1, 2, and 3 of the stream buffer will be impacted. Conventional equipment will be utilized for the removal of trees, installation of the culverts and
backfilling of the culverts at the stream crossing. As part of the project, a portion of the stream buffers will be disturbed to install site utilities, stormwater control device outlet structures, and
a portion of the fill slopes.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2022-00988
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Jay Lawson
Agency/Consultant Company: Progress Environmental
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
Site visit with USACE and NCDEQ on 07/05/2022.
USACE confirmation via email dated 07/06/2022.
State confirmation via "On -Site Determination for Applicability to Mitigation Rules (15A NCAC 02H .0506(c))" letter dated July 22, 2022.
6. Future Project Plans
6a. Is this a phased project?*
Yes No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?

D. Proposed Impacts Inventory
0
V
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries 0 Buffers
Open Waters Pond Construction
3. Stream Impacts
F I
3a. Reason for impact (?)
3b.lmpact type"
3c. Type of impact"
3d. S. name*
3e. Stream Type*
?)
3f. Type of
Jurisdiction*
3g. S. width
3h. Impact
length*
g1
Stream impact for access
road
Permanent
Culvert
ffto Richland Creek
Perennial
Both
Averege (feet)
149
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
3i. Total temporary stream impacts:
149
0
3i. Total stream and ditch impacts:
0
3j. Comments:
Stream impact for driveway crossing to allow access to building. The proposed location appeared to be the least impactful following evaluation of
alternate alignments.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
Neuse
Tar -Pamlico
Catawba
Randleman
Goose Creek
Jordan Lake
Other
6b. Impact Type
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
Allowable w mitigation
P
UT-1 to Richland Creek
Yes
13,980
18,007
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 13,980.00 18,007.00
Zone 1 Zone 2
Total combined buffer impacts: 13,980.00 18,007.00
61. Comments:
A portion of the stream buffers will be disturbed to install site utilities, stormwater control device outlet structures, and a portion of the fill slopes.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The stream crossing was analyzed in various locations, and the proposed location appeared to be the least impactful. Double culverts were used as
opposed to one larger to reduce the amount of fill required to get over the stream crossing. Head walls have also been used to reduce the stream
impacts as much as possible.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Retaining walls have been utilized throughout the site to minimize the impacts for the stream buffers.
O
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State

2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
Yes No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
< 150 linear feet of stream impact.
6b. If yes, then identify the square feet of impact.
r7l��impact
6d. Total impact (square
feet)
Multiplier
6e. Required miti
(square feet)
Zone 1
Stream crossing for access road, utilities, spillway
13,980
3
41,940
Zone 2 Stream crossing for access road, utilities, spillway, fill 18,007 1.5 27,011
6f. Total buffer mitigation required
68951
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
Yes No
6j. Comments:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Other SCM that removes minimum 30 % nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
2d. Which of the following stormwater management program(s) apply:
Local Government State
Local Government Stormwater Programs
Phase II NSW USMP Water Supply
Please identify which local government stormwater program you are using.
High Point
Comments:
Primary SCM is wet pond.
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes No
2. Violations (DWR Requirement)
Al

2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?
Yes No
3b. If you answered "no," provide a short narrative description.
Project is located in an already developed (industrial/commercial) area.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?"
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?
Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?"
Yes No Unknown
5e. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
IPaC
https://i pac.ecosphere.fws.gov/?state=y9mG5NMmJbFL4JcBapKO3rsT2Ms5Z
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?'
Site is located within Piedmont.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
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? "
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC Historic Preservation Office (NCHPO)
https://nc.maps.arcgis.com/apps/webappviewer/index.html?id=79ea671 ebdcc45639f0860257d5f5ed7
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
Yes No
8b. If yes, explain how project meets FEMA requirements:
Fill will be placed in the Flood plain with the stream crossing, so the project will have to meet City of High Point requirements which will most likely a
require a flood study.

8c. What source(s) did you use to make the floodplain determination?"
FEMA Flood Map Service
https://msc.fema.gov/portal/search#searchresultsanchor
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
Final Upload Docs.pdf 43.7MB
File must be PDF or KMZ
Comments
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• 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 have given true, accurate, and complete information on this form;
• I agree 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");
• 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 PCN form.
Full Name:
Joseph Stebbins Lawson III
Signature
Date
4/2/2023
6