20230549 Ver 1_Green Apts_USACE PCN Application_4.17.23_20230417

Office Use Only
Corps Action ID no.\[Click to enter.\]Date received:\[Click to enter.\]
DWR project no.\[Click enter.\]Date received:\[Click to enter.\]
Site Coordinates:
Latitude (DD.DDDDDD):36.164432°
Longitude (DD.DDDDDD):79.722963°
Form Version4.3,April 20, 2022
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a redasterisk*are required. The form is not considered complete until all
mandatory questions are answered.
ThePCNhelp documentmay be found at this link:
https://edocs.deq.nc.gov/WaterResources/DocView.aspx?dbid=0&id=2196924&cr=1
Please ensure you have submitteda pre-filing meeting request at least 30 days prior to submitting this
form,as DWR will not be able to accept your application withoutdocumentation ofthis important first step.
TheDivision has developed a Pre-filing Meeting Request email [e-mail] accept
the federally required pre-filing meeting request and provide confirmation receipt of submittal . Thisreceipt
or similardocumentation willsatisfy 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)*:1/24/2023
Page1of21PCN FormVersion 4.3-April 20,2022

A.ProcessingInformation
County (counties) where project is located:*GuilfordAdditional (ifneeded).
Is this aNCDMSproject?*
YesNo
(Click yes only ifNCDMS is the applicant or co-
applicant)
Is this a public transportation project?*
YesNo
(Publicly funded municipal, state, or federal road, rail,
or airport project)
Is this a NCDOT project?*
YesNo
If yes, NCDOT TIP or state project number:Click to enter.
If yes, NCDOT WBS number:*Click to enter.
Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
1a.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?*YesNo
Click to enter a date.
Please provide the date of the previoussubmission.*
Nationwide Permit (NWP)
1b.Whattype(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/ individualpermit 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.
1c.Has the NWP or GP number been verified by the Corps?*YesNo
NWP number(s)(list all numbers ):NWP 29
RGP number(s)(list all numbers ):Click to enter.
Are you a federal applicant?YesNo
If yes, please provide a statement concerning compliance with the Coastal ZoneManagement Act*
Click to entertext.
1d.Type(s) of approval sought fromDWR(check all that apply):*
401 Water Quality Certification–Regular401 Water Quality Certification–Express
Non-404 Jurisdictional GeneralPermitRiparian Buffer Authorization
Individual401 Water Quality Certification
Is this a courtesy copy notificationYesNo
1e.Is this notification solely for the record because written approval is not required?*
For the record only for DWR401 Certification:*YesNo
For the record only for Corps Permit:*YesNo
1f.Is this an after-the-fact permit/certificationapplication?*YesNo
Page2of21PCN FormVersion 4.3-April 20,2022

1g.Is payment into a mitigation bank or in-lieu fee program proposed for
YesNo
mitigation of impacts?
If yes, attach the acceptance letter from mitigation bank or in-lieu fee program.
1h.Is the project located in any of NC’s twenty coastal counties?*YesNo
1i.Isthe project located within anNC DCM Area of Environmental
YesNoUnknown
Concern (AEC)?*
1j.Is the project located in a designated trout watershed?*YesNo
If yes, you mustattacha copy ofthe approval letter fromthe 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
Page3of21PCN FormVersion 4.3-April 20,2022

B.Applicant Information
1a.Who is the primary contact?*Jay Gaffney
1b.Primary Contact Email:*[e-mail]
1c.Primary Contact Phone:*(###)###-####336-579-0880
1d.Who is applying for the permit/certification?*(check
OwnerApplicant (other than owner)
all that apply)
1e.Isthere an agent/consultant for this project?*YesNo
2.Landowner Information
2a.Name(s) on Recorded Deed:*Greens Apartment, LLC
008643-02677/
2b.Deed Book and Page No.:
2c.Contact Person(for corporations):Patrick Daly, Jr.
2d.Address*
Street Address:108 State Street, Suite 300
Address line 2:Click to enter.
City:Greensboro
State/ Province/ Region:NorthCarolina
27408
Postal/ Zip Code:
Country:United States
2e.Telephone Number:*(###)###-####434-483-2050
2f.Fax Number: (###)###-####Click to enter.
2g.Email Address:*[e-mail]
3.ApplicantInformation (if different from owner)
3a.Name:*Jay Gaffney
3b.Business Name (if applicable):Blu Ladder Construction, LLC
3c.Address:*
Street Address:108 State Street, Suite 300
Address line 2:Click to enter.
City:Greensboro
State/ Province/ Region:North Carolina
Postal/ Zip Code:27408
CountryUnited States
3d.Telephone Number:*(###)###-####336-579-0880
3eFax Number: (###)###-####Click to enter.
3f.Email Address:*[e-mail]
Page4of21PCN FormVersion 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 enter.
City:Kernersville
State/ Province/ Region:North Carolina
Postal/ Zip Code:27284
Country:United States
4d.Telephone Number:*(###)###-####336/708-4617
4eFax Number: (###)###-####Click to enter.
4f.Email Address:*[e-mail]
Agent Authorization Letter:*
Attacha completed/signedagentauthorizationformor 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/
Page5of21PCN FormVersion 4.3-April 20,2022

C.Project Information and Prior Project History
1.Project Information
1a.Name of project:*Greens Village
1b.Subdivision name (if appropriate):Click to enter.
1c.Nearestmunicipality/town:*Greensboro
2.Project Identification
7887697696
2a.Property identification number (tax PIN or parcel ID):
2b.Property size(in acres):21.3
2c.Project Address:
Street Address:4717 4733 US HIGHWAY 29 N
Addressline 2:Click to enter.
City:Greensboro
State/ Province/ Region:North Carolina
Postal/ Zip Code:27405
Country:United States
Latitude (DD.DDDDDD):*36.164432°
2d.Site coordinates in decimal degrees (using 4-6 digits
after the decimal point):*
Longitude (-DD.DDDDDD):*-79.722963°
3.Surface Waters
3a.Name of nearest body of water to proposed project:*Reedy Fork
3b.Water Resources Classification of nearest receivingWS-V;NSW
water:*
TheSurface Water Classificationmap may be found at this link:
https://ncdenr.maps.arcgis.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 is030300020107
located:*
The FindYour HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/PublicInformation/index.html?appid=ad3a85a0c6d644a0b97cd069db238ac3
Page6of21PCN FormVersion 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 ofapropane gas company, paved and gravel parking lots, foundation remnants froma former
restaurantbuilding andundeveloped wooded land.A stream crosses thecentralportion of the site.Wetlands
are located in pockets adjacent tothe site.The surrounding properties containindustrial, residential and wooded
land, a highway and a gas station.
4b.Have Corps permits or DWR certifications been obtained for this
YesNoUnknown
project (including all prior phases) in the past?*
\[Click to enter.\]
If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):\[Click to enter.\]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete?*YesNo
If yes, describe the completed work.
Click to entertext.
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 8½ x 11” excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.Attach an 8½ 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
0.085acres
property:
4g.List the totalestimated linear feet of all existing streams (intermittent
1,060linear feet
and perennial) on the property:
4g1.List the total estimated acreage of all existing open waters on the
0acres
property:
4h.Explain the purpose of the proposed project:*
The purpose of the proposed project is to constructmulti-familyresidentialapartmentbuildings.
4i.Describe the overall project in detail, including the type of equipment to be used:*
The overall project includes the proposed construction of 7 apartment buildings, a clubhouse and pool, 2
stormwater ponds, parking lots and driveways, open landscaped areas, and tree conservation areas. Of the 21.3
acre site, the suite will contain 6.79 built-upon acres.The site will tie to the municipal sanitary sewer easement.
The site will be accessed from the east from the Highway 29 Access Road and from the south from Esterwood
Road. A stream crossing and associated culvert installation is required to facilitate the proposed driveway and
interconnection of the proposed development. 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 dredgingin wetlands or waters?*YesNo
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter text.
Page7of21PCN FormVersion 4.3-April 20,2022

5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or in
YesNoUnknown
proposed impact areas?*
Comments:
Click to enter text.
PreliminaryApprovedEmailed concurrence
5b.If the Corps made a jurisdictional determination,
what type of determination was made?*
Not VerifiedUnknownn/a
Corps AID number (ex. SAW-0000-00000):SAW-2023-00402
Name (if known):David Brame/Michael Brame
5c.If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company:Pilot Environmental
areas?
Other:Click to enter.
5d.List thedates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
Determination has not been conducted. JDrequestwas submitted separately onFebruary 13, 2023.
5d1.Attachjurisdictional determinations.
6.Future Project Plans
6a.Is this a phased project?YesNo
6b.If yes, explain.
Click to enter.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to
authorize any part of the proposed project or related activity? This includes other separate and distant crossings
for linear projects that require Department of the Army authorization but don’t require pre-construction
notification.
Noadditional development has been planned at this time.
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)
DALY MANAGEMENT LLC
108 STATE ST STE 300
GREENSBORO, NC 27408
8.Scheduling of activity:
To begin uponall necessary authorizations in the next 2 to 3 months and to becompleted within the next 1 to 2
years.
Page8of21PCN FormVersion 4.3-April 20,2022

D.Proposed Impacts Inventory
1.Impacts Summary
WetlandsStreams-tributaries
1a.Where are the impacts associated with your project
BuffersOpen Waters
(check all that apply):
Pond Construction
2.Wetland Impacts
If there are wetland impacts proposed on the site, complete thistablefor each wetland area impacted.
2a.2a1.2b.2c.2d.2e.2f.2g.
Site #*ImpactImpactWetland Type*WetlandName*ForestedJurisdictionImpact Area
Reason/Type*Duration*?*Type*(ac)*
W1CulvertPermanentSeepWAYesBoth0.008
W2Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W3Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W4Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W5Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick toenter
W6Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W7Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W8Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W9Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W10Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W11Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W12Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W13Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W14Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
W15Choose oneTemp/ PermChoose oneClick to enterY/NChoose oneClick to enter
2g1.Total temporary wetland impacts0ac
2g2.Total permanent wetland impacts0.008ac
2g3.Total wetland impacts0.008ac
2h.Type(s) of material being discharged and the amount of each type in cubic yards:
Approximately 130 cubic yardsof soil.
2i.Comments:
Approximately 357 SF (0.008 Ac.) of wetland will be impacted by the crossing.
Page9of21PCN FormVersion 4.3-April 20,2022

3.Stream Impacts
If there are perennial or intermittent stream/ tributaryimpacts (including temporary impacts) proposed on the site,
complete thistablefor all stream/ tributarysites impacted.
** All Perennial or Intermittent streams must be verified byDWR or delegated local government
3a3b.3c.3d.3e.3f.3g.3h.
SiteImpact Reason*ImpactImpactStreamStreamJurisdictionStreamImpact
#*Duration*Type*Name*Type*Type*Width (avglength
ft)*(linear ft)*
S1Culvert/headwall/endwallPermanentCrossing/SAPerennialBoth5123
Culvert
S2Riprap DissipaterPermanentFill (Incl.SAPerennialBoth5.240
Riprap)
S3Pump and SandbagsTemporaryDewateringSAPerennialBoth5.510
S4
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S5
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S6
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S7
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S8
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S9
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S10
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S11
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S12
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S13
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S14
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S15
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S16
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S17
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S18
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
S19
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
Page10of21PCN FormVersion 4.3-April 20,2022

S20
Click to enterTemp/ChooseClick toPer/IntChooseClick toClick to
Permoneenteroneenterenter
3i1.Total jurisdictional ditch impact:0linear ft
3i2.Total permanent stream impacts:163linear ft
3i3.Total temporary stream impacts:10linear ft
3i4.Total stream and ditch impacts:173linear ft
3j.Comments:
S1–Stream location 1 includes 123LF (615 SF) of permanent impact for installation of the culvert/headwalls
and endwalls.
S2–Stream location 2 includes 40 LF (205 SF) of permanent fill associated with a riprap dissipater downstream
of the culvert. Riprap will be installed flush with the existing stream bed.
S3–Stream location 3 includes 10 LF (55 SF) of temporary fill for coffer dam and pump located upstream of the
culvert.
Page11of21PCN FormVersion 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 impactsin the tablebelow.
4a.4a1.4b.4c.4d.4e.4f.
Site #*Impact ReasonImpactWaterbody Name*ActivityType*WaterbodyImpact area
Duration*Type*(ac)*
O1
Click to enter.Temp/ PermClick to enter.ChooseoneChooseoneClick to enter.
O2
Click to enter.Temp/ PermClick to enter.ChooseoneChooseoneClick to enter.
O3
Click to enter.Temp/ PermClick to enter.ChooseoneChooseoneClick to enter.
O4
Click to enter.Temp/ PermClick to enter.ChooseoneChooseoneClick to enter.
O5
Click to enter.Temp/ PermClick to enter.ChooseoneChooseoneClick to enter.
4g.Total temporary open water impactsClick to enter.ac
4g.Total permanent open water impactsClick to enter.ac
4g.Total open water impactsClick to enter.ac
4h.Comments:
Open water impacts are not proposed.
5.Pond or Lake Construction
If pond or lake construction is proposed, complete thetablebelow.(*This does NOT include offline stormwater
management ponds.)
5a.5b.5c.5d.5e.
Pond IDProposed use orUpland
Wetland Impacts (ac)Stream Impacts (ft)
#purpose of pondImpacts(ac)
FloodedFilledExcavatedFloodedFilledExcavated
Click toClick toClick toClick toClick toClick toClick to
P1Chooseone
enter.enter.enter.enter.enter.enter.enter.
Click toClick toClick toClick toClick toClick toClick to
P2Chooseone
enter.enter.enter.enter.enter.enter.enter.
Click toClick toClick toClick toClick toClick toClick to
P3Chooseone
enter.enter.enter.enter.enter.enter.enter.
ClicktoClick toClick toClick toClick toClick toClick to
5f.Total
enter.enter.enter.enter.enter.enter.enter.
5g.Comments:
Click to enter.
5h.Is adam high hazard permit required?YesNo
If yes, permit ID no.:Click to enter.
5i.Expected pond surface area (acres):Click to enter.
5j.Sizeof pond watershed (acres):Click to enter.
5k.Method of construction:
Pond or lakeconstruction is not proposed.Stormwater ponds that are not locatedwithin waters or within Jordan
Lake buffers willbe constructued.
Page12of21PCN FormVersion 4.3-April 20,2022

6.Buffer Impacts (DWR requirement)
If projectwill impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
NeuseTar-PamlicoCatawba
6a.Project is in which protected basin(s)?
JordanGoose CreekRandleman
*(Check all that apply.)
Other:Click to enter.
6b.6c.6d.6e.6f.6g.
BufferZone 1 Impact*Zone 2 Impact*
Site #*Impact Type*Impact Duration*Stream Name*
Mitigation(sq ft)(sq ft)
Required?*
B1Crossing/ Culvert/PermanentNo
SA8,1124,238
Bridge
B2
ChooseoneTemp/ PermClick to enter.Y/NClick to enter.Click to enter.
B3
ChooseoneTemp/ PermClick to enter.Y/NClick to enter.Click to enter.
B4
ChooseoneTemp/ PermClick to enter.Y/NClick to enter.Click to enter.
B5
ChooseoneTemp/ PermClick to enter.Y/NClick to enter.Click to enter.
B6
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B7
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B8
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B9
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B10
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B11
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B12
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B13
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B14
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B15
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B16
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B17
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B18
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B19
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
B20
ChooseoneTemp/ PermClickto enter.Y/NClickto enter.Clickto enter.
6h.Total temporary impacts:Zone 1:Click to enter.sq ftZone 2:Click to enter.sq ft
6h.Total permanent impacts:Zone 1:8,112sq ftZone 2:4,238sq ft
6h.Total combined buffer impacts:Zone 1:8,112sq ftZone 2:4,238sq ft
6i.Comments:
The project is located withinthe Jordan Lakewatershed.The buffer impacts areallowed without mitigation.
Pleaseattachsupporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page13of21PCN FormVersion 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 impactsthrough projectdesign:*
The applicant has designed the proposeddevelopmentto avoid impacts to theremaining streamand wetlands
locatedon the site. In order to develop the site and provideaccess across the stream, the proposed impact
could not be avoided. Civil design, such asreducing the length of pipe byuse of headwalls and endwalls were
used to further reduce impacts to streams and wetlands.
1b.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 fencingwill 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 isitrequired?*
DWRCorps
(check all that apply)
Mitigation Bank
2b.If yes, which mitigation option(s) will be used for this
project?*(check all that apply)
InLieuFeeProgram
Permittee Responsible Mitigation
3.Complete if using a Mitigation Bank(Must satisfy NC GeneralStatute143-214.11 (d1).)
3a.Name ofmitigationbank:Click to enter.
3b.Creditspurchased/requested:Type:Choose oneQuantityClick to enter.
Type:Choose oneQuantityClick to enter.
Type:Choose oneQuantityClick to enter.
Attachreceipt and/or approval letter.
3c.Comments:
Click to enter.
4.Complete ifUsinganInLieu 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 thestream 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:0
4d.Buffer mitigation requested (DWRonly):Click to enter.square feet
4e.Riparian wetland mitigation requested:Click to enter.acres
4f.Non-riparian wetland mitigation requested:Click to enter.acres
4g.Coastal (tidal) wetland mitigation requested:Click to enter.acres
Page14of21PCN FormVersion 4.3-April 20,2022

4h.Comments:
Click to enter.
5.Complete ifProvidinga Permittee Responsible Mitigation Plan
5a.Ifproposinga permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigationcredits generated.
Click to enter.
5b.Attachmitigation 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
YesNo
that requires buffer mitigation?
If yes,please completethis entiresection–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 requiredin the table below.
6c.6d.6e.
ZoneReason for impactTotal impactMultiplierRequired mitigation
(square feet)
(square feet)
Zone 1Clickto enter.Click to enter.Choose oneClick to enter.
Zone 2Click to enter.Click to enter.Choose oneClick toenter.
6f.Total buffermitigationrequiredClick to enter.
6g.If buffer mitigation is required, is payment to a mitigation bank or
YesNo
NC Division of Mitigation Services proposed?
6h.If yes, attachthe acceptance letter from themitigation bank orNC Division of Mitigation Services.
6i.Comments:
Buffer mitigation is not proposed.
Page15of21PCN FormVersion 4.3-April 20,2022

F.Stormwater Management and Diffuse Flow Plan(DWR requirement)
1.Diffuse Flow Plan
1a.Does the projectinclude or is it adjacent toprotected riparian buffers
YesNo
identified within one of the NC Riparian Buffer Protection Rules?
1b.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/dispersedflow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
Level Spreader
Vegetated Conveyance (lowerseasonal high water table-SHWT)
What Type of SCM are you
Wetland Swale (higher SHWT)
providing?
Other SCM that removes minimum 30% nitrogen
(Check all that apply)
Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, clickhere.
Attach diffuse flow documentation.
2.Stormwater Management Plan
2a.Is this an NCDOT project subject to compliance with NCDOT’s
YesNo
Individual NPDES permit NCS000250?*
2b.Does this project meet the requirements for low density projects as
YesNo
defined in 15A NCAC 02H .1003(2)?*
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20quality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.Does this project have a stormwater management plan (SMP)
YesNo
reviewed and approved under a state stormwater program or state-
n/a–project disturbs < 1 acre
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.
Local Government
2d.Which of the following stormwater management program(s) apply?
(Check all that apply.)*
State
If you have local government approval, please include the SMP on their overall impact map.
Phase IIUSMP
Local Government Stormwater Programs*
NSWWater Supply
Page16of21PCN FormVersion 4.3-April 20,2022

Please identify which local government stormwater program you areusing.*
Post constructionstormwatermanagementis required. The stormwater plan will be submitted to the City of
Greensboro forreview and approval.
Phase IIHQW or ORW
State Stormwater Programs*
Coastal CountiesOther
Comments:
Click to enter.
Page17of21PCN FormVersion 4.3-April 20,2022

G.Supplementary Information
1.Environmental Documentation
1a.Does the project involve an expenditure of public (federal/state/local)
YesNo
funds or the use of public (federal/state) land?*
1b.If you answered “yes” to the above, does the project require
preparation of an environmental document pursuant tothe
YesNo
requirements of the National or State (North Carolina) Environmental
Policy Act (NEPA/SEPA)?*
1c.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
YesNo
NEPA or SEPA final approval letter.)*
Comments:
The project does not require a NEPA or SEPA.
2.Violations (DWRRequirement)
2a.Is the site in violation of DWRWater Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
Federally Non-JurisdictionalWetlands/Classified Surface Waters
YesNo
(15A NCAC 2H. 1400)DWRSurface 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):
Click to enter.
3.Cumulative Impacts (DWRRequirement)
3a.Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
YesNo
downstream water quality?*
3b.If you answered “no”, provide a short narrative description:
Click to enter.
3c.If yes,providea 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?*
YesNoN/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 betreated at a treatment plant, list the capacity
available at that plant.
Wastewater will be discharged into existing infrastructure located on the site. Additionalstream or wetland
impacts associated withthesewer line installation are not required.
Page18of21PCN FormVersion 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
YesNo
species or habitat?(IPAC weblink:https://www.fws.gov/ipac/ \[fws.gov\])*
5b.Have you checked with the USFWS concerning Endangered Species
YesNo
Act impacts?*
5c.If yes, indicate the USFWS Field Office you have contacted.Choose one
5d.Is another federal agency involved?*
YesNoUnknown
If yes, which federal agency?Click to enter.
5e.Is this a DOT project located within Divisions 1-8?*
YesNo
5f.Will you cut any trees in order to conduct the work in waters of the
YesNo
U.S.?*
5g.Does this project involve bridge maintenance or removal?*
YesNo
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
YesNo
can be found in theNLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in theNLEB 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 batuse?*YesNoUnknown
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
YesNo
turbine(s)?*
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,
YesNo
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)
Page19of21PCN FormVersion 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 tri-colored bat (Proposed Endangered), small whorled pogonia (Threatened), 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 affordsuitable 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, known occurrences are not identified within 2 miles of thesite. Based on the lack
of known occurrences proximate to the site 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 wooded land.
The wooded land consists of 15 to 25 year old trees. The dominant tree species within the wooded area include
Virginia pine, sweet gum, poplar, red maple, and American beech. The dominant saplings include oak, maple,
sweet gum and American beech. The understory is moderately dense with Japanese stilt-grass, Virginia creeper,
Christmas fern, Chinese privet, muscadine and green briar. The understory does not contain favorable
shade/sunlightconditions or vegetative densities that are considered to be potential habitat for small whorled
Pogonia.
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
YesNo
an Essential Fish Habitat?*
Isthere submerged aquatic vegetation (SAV) around
YesNoUnknown
the project vicinity?*
Will this project affect submerged aquatic vegetation?*
YesNoUnknown
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 theState Historic Preservation OfficeHistoric Properties Map (does not include archaeological data):
http://gis.ncdcr.gov/hpoweb/
7a.Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
YesNo
preservation status (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)?*
Page20of21PCN FormVersion 4.3-April 20,2022

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 forlisting 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.Attachhistoric 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?*
YesNo
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.
Attachpertinent documentation or attachments not previously requested
I.Signature*
Bychecking 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:*
4/17/2023
Page21of21PCN FormVersion 4.3-April 20,2022

HvjmgpseDpvouzHfphsbqijdJogpsnbujpoTztufn)HJT*btqbsdfm
jefoujgjdbujpoovncfs)QJO*
89987:87:7-89986::955-89986:6574boe8998696458
Blu Ladder Construction, Inc.
108 State St. Suite 300
Greensboro, NC 27408
336-579-0880
[e-mail]
1/23/2023

1

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6
GREENSBORO, NC 27408
STATE: NORTH CAROLINA
108 STATE STREET STE 300
COUNTY: GUILFORD
5
GREENS APARTMENT, LLC
CITY: GREENSBORO
OWNER INFORMATION:
PROJECT LOCATION:
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