20230754 Ver 1_856.3.1_Old Lexington Rd_PCN_5.26.23_20230526

Office Use Only:
Corps action ID no. _____________
DWQ project no. _______________
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1.Processing
1a.Type(s) of approval sought from the
Section 404 Permit Section 10 Permit
Corps:
1b. Specify Nationwide Permit (NWP) number: NWP 39 or General Permit (GP) number:
1c.Has the NWP or GP number been verified by the Corps?YesNo
1d.Type(s) of approval sought from the DWQ (check all that apply):
401 Water Quality Certification –RegularNon-404 Jurisdictional General Permit
401 Water Quality Certification –Express Riparian Buffer Authorization
For the record only for Corps Permit:
1e.Is this notification solely for the record For the record only for DWQ 401
because written approval is not required?Certification:
Yes No
Yes No
1f.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
YesNo
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
YesNo
1g.Is the project located in any of NC’s twenty coastal counties. If yes, answer 1h
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?YesNo
2.Project Information
2a.Name of project:Old Lexington Road
2b.County:Forsyth
2c.Nearest municipality / town:Winston Salem
2d.Subdivision name:
2e.NCDOT only, T.I.P. or state
project no:
3.Owner Information
3a.Name(s) on Recorded Deed:South Business Park, LLC
3b. Deed Book and Page No.1861/2481
3c.Responsible Party (for LLC if
Mr. Bruce Brown
applicable):
3d.Street address:3300 Old Lexington Road
3e.City, state, zip:Winston-Salem, NC 27107
3f.Telephone no.:336-331-4888
3g.Fax no.:
3h.Email address:[e-mail]
Page 1 of 12
PCN Form –Version 1.3 December 10, 2008 Version

4.Applicant Information (if different from owner)
4a.Applicant is:AgentOther, specify: Applicant
4b.Name:Mr. Bruce Brown
4c.Business name
SBP-C, LLC
(if applicable):
4d.Street address:3300 Old Lexington Road
4e.City, state, zip:Winston-Salem, NC27107
4f.Telephone no.:336-331-4888
4g.Fax no.:
4h.Email address:[e-mail]
5.Agent/Consultant Information (if applicable)
5a.Name:Bradley Luckey
5b.Business name
Pilot Environmental,Inc.
(if applicable):
5c.Street address:PO Box 128
5d.City, state, zip:Kernersville, NC 27285
5e.Telephone no.:336.708.4997
5f.Fax no.:
5g.Email address:[e-mail]
Page 2 of 12
PCN Form –Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1.Property Identification
1a.Property identification no. (tax PIN or parcel ID): 6834-70-1128
Latitude: 36.05251
Longitude: -80.22754
1b.Site coordinates (in decimal degrees):
(DD.DDDDDD) (-DD.DDDDDD)
1c.Property size:14.7acres
2.Surface Waters
2a.Name of nearest body of water (stream, river, etc.) to
Salem Creek
proposed project:
2b.Water Quality Classification of nearest receiving water:Class C
2c.River basin:Yadkin
3.Project Description
3a.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. Structures are not located on the site. The site is located within amixed
use area of Winston Salem,Forsyth County, North Carolina.
3b.List the total estimated acreage of all existing wetlands on the property:
Wetland=0Ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Streams=810 LF
3d.Explain the purpose of the proposed project:
The purpose of the proposed project is to construct anapproximate 157,500 square foot manufacturing facility,
associated truck and employee parking and stormwater retention device.
3e.Describe the overall project in detail, including the type of equipment to be used:
The overall project is to construct an approximate 157,500 square foot manufacturing facility, associated truck and
employee and stormwater retention device. In order to facilitate the proposed development and access employee/visitor
ng the site is necessary.
parking, it is necessary to have a stream crossing. For development of the site, clearing and gradi
Graders, haulers, excavators and other heavy equipment will be used during grading and construction of the site.
4.Jurisdictional Determinations
4a.Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
Yes NoUnknown
project (including all prior phases) in the past?
Comments: SAW-2022-02268
4b. If the Corps made the jurisdictional determination, what type
PreliminaryFinal
of determination was made?
4c. If yes, who delineated the jurisdictional areas?Agency/Consultant Company: Pilot Enviromental, Inc.
Name (if known): Bradley LuckeyOther:
4d.If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW-2022-02268, USACE Delineation Concurrence Email Dated 11.29.22(attached)
5.Project History
5a.Have permits orcertifications been requested or obtained for
Yes NoUnknown
this project (including all prior phases) in the past?
5b.If yes, explain in detail according to “help file” instructions.
Page 3 of 12
PCN Form –Version 1.3 December 10, 2008 Version

6.Future Project Plans
6a.Is this a phased project?Yes No
6b.If yes, explain.
Impacts to streams/wetlands, outside of those proposed in this application, are not anticipated as a result of the proposed
project.
Page 4 of 12
PCN Form –Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1.Impacts Summary
1a.Which sections were completed below for your project (check all that apply):
Wetlands Streams -tributariesBuffers
Open Waters Pond Construction
2.Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impactType of jurisdiction
number –Type of impactType of wetlandForested(Corps -404, 10Area of impact
Permanent (P) or (if known)DWQ –non-404, other)(acres)
Temporary (T)
Yes Corps
W1 PT
NoDWQ
Yes Corps
W2 PT
NoDWQ
Yes Corps
W3 PT
NoDWQ
Yes Corps
W4 PT
NoDWQ
Yes Corps
W5 PT
NoDWQ
Yes Corps
W6 PT
NoDWQ
2g. Total wetland impacts
2h. Comments: Wetland impacts are not proposed.
3.Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3g.
3a.3b.3c.3d.3e.3f.
Impact
Stream impact Type of impactStream namePerennial Type of jurisdictionAverage
length
number -(PER) orstream
(Corps -404, 10
(linear
Permanent (P) or intermittent width
DWQ –non-404,
feet)
Temporary (T)(INT)?
(feet)
other)
PER Corps
S1 PTFillUnnamed5.5104
INTDWQ
PER Corps
S2 PT
INTDWQ
PER Corps
S3 PT
INTDWQ
PER Corps
S4 PT
INTDWQ
PER Corps
S5 PT
INTDWQ
PER Corps
S6 PT
INTDWQ
104
3h.Total stream and tributary impacts
3i. Comments: Stream Impact 1 will permanently impact 104linear feet(575square feet)with earthen filland rip-rap
dissipater. Temporary impacts are not proposed. Mitigation for unavoidable stream impact is not proposed.
Page 5 of 12
PCN Form –Version 1.3 December 10, 2008 Version

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. then individually list all open water impacts below.
4a.4b.4c.4d.4e.
Open water Name of waterbody
impact number –(if applicable)Type of impactWaterbody typeArea of impact (acres)
Permanent (P) or
Temporary (T)
O1 PT
O2 PT
O3 PT
O4 PT
4f. Total open water impacts
4g. Comments: Open water impacts are not proposed.
5.Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.5d.5e.
Wetland Impacts (acres)Stream Impacts (feet)Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
FloodedFilled ExcavatedFloodedFilledExcavatedFlooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
Yes No If yes, permit ID no:
5i.Expected pond surface area (acres):
5j.Size of pond watershed (acres):
5k.Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below.If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUSTfill out Section D of this form.
6a.
NeuseTar-Pamlico Other: Yadkin
CatawbaRandleman
Project is in which protected basin?
6b.6c.6d.6e.6f.6g.
Buffer impact
Reason Buffer
number –Zone 1 impact Zone 2 impact
Permanent (P) or for Stream namemitigation (square feet)(square feet)
Temporary (T)impactrequired?
Yes
B1 PT
No
Yes
B2 PT
No
Yes
B3 PT
No
6h.Total buffer impacts
6i. Comments:
Page 6 of 12
PCN Form –Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The applicant has designed the proposed manufacturing facility based upon the requirements of the user. This includes
necessary manufacturing space, trailer docks and parking and the number/location of visitor and employee parking spaces.
The proposed project has been designed based upon the anticipated number of employees including shift changes. The
applicant prefers employee parking to be located as close to the manufacturing facility as possible. Initial designs included
significantly more net loss of stream from fill for employee parking lot/spaces than what is currently proposed. The applicant
has designed the proposed project such that fill for employee parking lot/spaces has been avoided. The applicant has
selected the stream crossing at the most up-gradient portion of the stream and has designed the crossing to utilize an
approximate 10' retaining wall, thusavoiding additional net loss to stream than proposed.
The applicant has designed the proposed project to rehydrate unimpacted stream from off-site drainage. The applicant's
design will culvert off-site drainage to the remaining unimpacted stream.
The remaining 706 linear feet of stream channel are being avoided.
1b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The clearing limits will be stakedand surveyed in the field. Sediment and erosion control devicesand other best management
practices will be utilized during site development activities to prevent down-gradientsedimentation into waters.
2.Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a.Does the project require Compensatory Mitigation for Yes No
impacts to Waters of the U.S. or Waters of the State?
2b.If yes, mitigation is required by (check allthat apply): DWQCorps
Mitigation bank
2c.If yes,which mitigation option will be used for this
Payment to in-lieu fee program
project?
Permittee ResponsibleMitigation
3.Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)Type Quantity
3c. Comments: The applicant does not propose mitigation for net lossto streams.
4.Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. Yes
4b.Stream mitigation requested:linear feet
4c.If using stream mitigation, stream temperature:warm cool cold
4d.Buffer mitigation requested (DWQ only):square feet
4e.Riparian wetland mitigation requested:acres
4f.Non-riparian wetland mitigation requested:acres
4g.Coastal (tidal) wetland mitigation requested:acres
4h. Comments:
5.Complete if Using a Permittee Responsible Mitigation Plan
5a.If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 12
PCN Form –Version 1.3 December 10, 2008 Version

6.Buffer Mitigation (State Regulated Riparian BufferRules) –required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires Yes No
buffer mitigation?
6b.If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c.6d.6e.
Reason for impactTotal impact MultiplierRequired mitigation
Zone
(square feet)
(square feet)
Zone 13 (2 for Catawba)
Zone 21.5
6f. Total buffer mitigation required:
6g.If buffer mitigation is required, discuss what type ofmitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 12
PCN Form –Version 1.3 December 10, 2008 Version

E. Stormwater Management and DiffuseFlow Plan (required by DWQ)
1.Diffuse Flow Plan
1a.Does the projectinclude or is it adjacent to protected riparian buffers identified
Yes No
within one of the NC Riparian Buffer Protection Rules?
1b.If yes, then is a diffuse flow plan included? If no, explain why.
Yes No
Comments:
2.Stormwater Management Plan
2a.What is the overall percent imperviousness of this project?51%
2b. Does this project require a Stormwater Management Plan? Yes No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The applicant will obtain SWMP approval from City of Winston Salem prior toproposedimpacts occuring.
Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?DWQ Stormwater Program
DWQ 401 Unit
3.Certified Local Government Stormwater Review
3a. In which local government’s jurisdiction is this project?City of Winston Salem
Phase II
NSW
3b.Which of the following locally-implemented stormwater management programs
USMP
apply (check all that apply):
Water Supply Watershed
Other:
3c. Has the approved Stormwater Management Plan with proof of approvalbeenYes No
attached?
4. DWQ Stormwater Program Review
Coastal counties
HQW
4a. Which of the following state-implemented stormwater management programs apply
ORW
(check all that apply):
Session Law 2006-246
Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
Yes No
attached?
5. DWQ 401 Unit Stormwater Review
5a.Does the Stormwater Management Plan meet the appropriaterequirements?
Yes No
5b. Have all of the 401 Unit submittal requirements been met?
Yes No
Page 9 of 12
PCN Form –Version 1.3 December 10, 2008 Version

F. Supplementary Information
1.Environmental Documentation (DWQ Requirement)
1a.Does the project involve an expenditure of public (federal/state/local) funds or the
Yes No
use of public (federal/state) land?
1b.If you answered “yes” to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or StateYes No
(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 NEPA orSEPA final approval
Yes No
letter.)
Comments: A NEPA or SEPA isnot required as part of this project.
2.Violations (DWQ Requirement)
2a.Is the site in violation of DWQ Wetland Rules (15A NCAC 2H.0500), Isolated
Yes No
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.Is this an after-the-fact permit application?Yes No
2c. If you answered “yes” to one or both of the above questions, provide an explanation of the violation(s):
3.Cumulative Impacts (DWQ Requirement)
3a.Will this project (based on past and reasonably anticipated future impacts) result in
Yes No
additional development, which could impact nearby downstream water quality?
3b.If you answered “yes” to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If youanswered “no,” provide a short narrative description.
We are not aware of additional development that will result which will impact nearby downstream water quality.
4.Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Impacts from wastewatergeneration are not proposed.
Page 10 of 12
PCN Form –Version 1.3 December 10, 2008 Version

5.Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.Will this project occur in or near an area with federally protected species or
Yes No
habitat?
5b.Have you checked with the USFWS concerning Endangered Species Act
Yes No
impacts?
Raleigh
5c.If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The IPaC report for the site identifies the following federally protected endangered or threatened species: Schweinitz's
sunflower (E) as protected species that could be proximate to the site.
The project area contains an approximate 30-40 year mixed pine/hardwood forest. Dense mid and understory vegetation
including kudzu and olive dominate the mid and understories. Suitable habitat for Schweinitz's sunflower is not located
within the proposed project area. Therefore, we have made a determination of no effect for this species.
6.Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?Yes No
6b.What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Based on our knowledge of the site, thesite is not located in or near an area designated as essential fish habitat. Best
management practices and the construction of stormwaterponds will prevent sediment from entering down-gradient
waterbodieswhich may contain fish.
7.Historic or PrehistoricCultural Resources (Corps Requirement)
7a.Will this project occur in or near an area that the state, federal or tribal
governments havedesignated as having historic or cultural preservation
Yes No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b.Whatdata sources did you use to determine whether your site would impact historic or archeological resources?
We reviewed the SHPO Map (http://gis.ncdcr.gov/hpoweb/)to identify culturalresources of the site. Themap does not
identifylisted oreligible for listing properties on or nearby the site.A copy of the map is included as an attachment.
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:
8c. What source(s) did you use to make the floodplain determination? FEMA NHFL (Drawing 4, attached)
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_______________________________
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Applicant/Agent's Signature
Applicant/Agent's Printed Name
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 12
PCN Form –Version 1.3 December 10, 2008 Version

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16037031346
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16037031347
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16037031348
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