20240963 Ver 1_401 Application_20240715

Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Type: * For the Record Only (Courtesy Copy)
New Project
Modification/New Project with Existing ID
More Information Response
Other Agency Comments
Pre -Application Submittal
Re-Issuance\Renewal Request
Stream or Buffer Appeal
Submittal Type:*
401 Application
Project Contact Information
Name: Heather LaGamba
Who is submitting the information?
Email Address:* [e-mail]
Project Information
Project Name: * Hermitage Dr
Is this a public transportation project?*
Yes
No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
Yes No Unknown
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and
Aquatic Weed Fund or involve the distribution or transmission of energy or fuel, including natural gas, diesel,
petroleum, or electricity?*
Yes No
Is this project connected with ARPA funding?*
Yes No
County (ies)*
Cabarrus

Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
10373.1—Hermitage Dr_PCN App_7.12.24.pdf 6.81MB
Only pdf or kmz files are accepted.
Describe the attachments or add comments:
PCN for 401 WQC
By checking the box and signing box below, I certify that:
• I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief.
• I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
• I agree that submission of this online form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a
written signature; AND
• I intend to electronically sign and submit the online form.
Signature. *
Submittal Date:

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 9: SAW- 2024-00528
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Hermitage Drive SE
Begin Date (Date Received): 3.7.24
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 a grassed parking area and gardens. The purpose of the project is to provide vehicular access from Hermitage Drive
to the gardens and pedestrian access from the parking area to the gardens.
4. Property Owner / Applicant [PCN Form A3 or A4]: Carolyn Tucker
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
David Brame/Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Hermitage Drive SE
35.399826/-80.562539
8. Project Location —Tax Parcel ID [PCN Form Bla]: See Attached
9. Project Location — County [PCN Form A2b]: Cabarrus
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Concord
11. Project Information —Nearest Waterbody [PCN Form 132a]: Threemile Branch
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: Yadkin Pee Dee/03040105
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

srArA-
n
pa
NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2024-00528 Date received: [Click to enter.]
DWR project no. ,lick enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.400108'
Longitude (DD.DDDDDD):-80.562284'
Form Version 4.3. 1210412023
Pre -Construction Notification (PCN) Form
(Ver. 4.2, 12IM2023)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all
mandatory questions are answered.
The PCN help document may be found at this link:
httas://edocs.dea.nc.aov/WaterResources/DocView.asax?dbid=0&id=2196924&cr=1
Page 1 of 20 PCN Form Version 4.3- December 4, 2023

A. Processing Information
County (counties) where project is located: *
Cabarrus Additional (if needed).
Is this an ARPA project? *
0 Yes 0 No
If yes, ARPA project number:
* The project number can be found on the "Letter of Intent to Fund"
(LOIF) or "Offer and Acceptance Lette('. If you are unable to locate
Click or tap here to enter text.
your DWI ARPA Funding Project Number. please contact Corey
Basinger at corey. basingera(-).ncdenr.gov for further assistance.
Is this a NCDMS project?
(Click yes only if NCDMS is the applicant or co-
❑ Yes 0 No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes 0 No
or airport project)
Is this a NCDOT project?
❑ Yes 0 No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to entF
0 Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑ Yes 0 No
Please provide the date of the previous submission. *
Click to enter a date.
0 Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
❑Regional General Permit (RGP)
authorization?
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as attachments and
submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps? *
❑ Yes 0 No
NWP number(s) (list all numbers ):
18
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes 0 No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
Click to enter text
1d. Type(s) of approval sought from DWR (check all that apply):
❑ 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
0 Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes 0 No
Page 2 of 20 PCN Form Version 4.3- December 4, 2023

1 e.
Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: *
❑ Yes
0 No
For the record only for Corps Permit: *
❑ Yes
0 No
1f.
Is this an after -the -fact permit/certification application?
❑ Yes
0 No
1 g.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
❑ Yes
0 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
0 No
1 i.
Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
❑ Yes
0 No ❑ Unknown
1j.
Is the project located in a designated trout watershed?
❑ Yes
0 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.miI/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 20 PCN Form Version 4.3- December 4, 2023

B. Applicant Information
1 a.
Who is the primary contact? *
Carolyn Tucker
1b.
Primary Contact Email: *
[e-mail]
1c.
Primary Contact Phone: * (###)###-####
704-560-9911
1d.
Who is applying for the permit/certification? * (check
all that apply)
® Owner ❑ 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: *
Robert B. Tucker
2b.
Deed Book and Page No.:
16406/0294
2c.
Contact Person (for corporations):
Carolyn Tucker
2d.
Address *
Street Address:
621 Hermitage Drive, SE
Address line 2:
Click to enter.
City:
Concord, NC
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
28025
Country:
us
2e.
Telephone Number: * (###)###-####
704-560-9911
2f.
Fax Number: (###)###-####
Click to enter.
2g.
Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
same
3b.
Business Name (if applicable):
Click to enter.
3c.
Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
3f.
Email Address:
Click to enter.
Page 4 of 20 PCN Form Version 4.3- December 4, 2023

4. Agent/ Consultant (if applicable)
4a. Name:
David S.Brame
4b. Business Name:
Pilot Environmental, Inc
4c. Address:
Street Address:
743 Park Lawn Court
Address line 2:
Click to entr
City:
Kernersville
State/ Province/ Region:
NC
Postal/ Zip Code:
27284
Country:
us
4d. Telephone Number: (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to entr
4f. Email Address:
[e-mail]
Agent Authorization Letter:
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw.usace.army. mil/Missions/Reg ulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 20 PCN Form Version 4.3- December 4, 2023

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
Hermitage Drive
1 b. Subdivision name (if appropriate):
NA
1c. Nearest municipality/town: *
Concord, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
56304308720000
2b.
Property size (in acres):
1.29
2c.
Project Address:
Street Address:
621 Hermitage Drive, SE
Address line 2:
Click to enter.
City:
Concord
State/ Province/ Region:
NC
Postal/ Zip Code:
28025
Country:
US
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.400108°
Longitude (-DD.DDDDDD): *-80.562284°
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Three Mile Branch
3b. Water Resources Classification of nearest receiving
C
water: *
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
Yadkin-PeeDee
3c. In what river basin(s) is your project located?
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030401050202
located: *
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 20 PCN Form Version 4.3- December 4, 2023

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 a maintained grassed lawn, wooded land and garden. The site is located in a
residential area of Concord.
4b. Have Corps permits or DWR certifications been obtained for this
❑ Yes X No ❑ Unknown
project (including all prior phases) in the past? *
If yes, please give the DWR Certification number and/or Corps
jClick to enter.]
Action ID (ex. SAW-0000-00000):
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete?
❑ Yes X No
If yes, describe the completed work.
Click to enter text.
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
�,IIGK io enter ie.
4d. Attach an 8'/ x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'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
0.015 acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
507 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 provide vehicular and pedestrian access to gardens on the site.
4i. Describe the overall project in detail, including the type of equipment to be used: *
The overall project includes the construction of a roadway for vehicle access and a walkway for pedestrian
access. The project will require the removal of an existing culvert and replacement with a larger culvert that can
accommodate the driveway and pathway. In order to construct the project, it is necessary to impact a stream
with fill associated with the driveway and pathway. To facilitate construction of the crossing, clearing and grading
is necessary. Graders, excavators and other heavy equipment will be used during grading of the site.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters? *
❑ Yes X No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter text
Page 7 of 20 PCN Form Version 4.3- December 4, 2023

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on the property or in
M Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
The site was delineated by Pilot in December 2023.
5b.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved 0 Emailed concurrence
what type of determination was made?
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2024-00528
Name (if known): David Brame/Michael Brame
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental, Inc
areas?
Other: Click to enter
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
E-mail concurrence was provided by Ms. Amber Lipsky dated March 18, 2024.
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes 0 No
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.
No
7. Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
The Tuckers are located downgradient of the impact.
8. Scheduling of activity:
Upon receipt of NWP and WQC.
Page 8 of 20 PCN Form Version 4.3- December 4, 2023

D. Proposed Impacts Inventory
Impacts Summary
❑ Wetlands 0 Streams - tributaries
1 a. Where are the impacts associated with your project ❑ Buffers ❑ Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site # `
2a1.
Impact
Reason/Type
2b.
Impact
Duration
2c.
Wetland Type
2d.
Wetland Name
2e.
Forested
?
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)
W1
Choose one
emp/ Perm
Choose one
Click to enter
Y/N
;hoose one
Click to enter
W2
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W3
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W5
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
"'N
Choose one
Click to enter
2g1. Total temporary wetland impacts
0 ac
2g2. Total permanent wetland impacts
0 ac
2g3. Total wetland impacts
0 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
Wetland impacts are not proposed
Page 9 of 20 PCN Form Version 4.3- December 4, 2023

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*
3b.
Impact
Duration*
3c.
Impact Type*
3d.
Stream Name*
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft)
S1
Culvert
Permanent
Fill (Incl.
Riprap)
SA
Perennial
Both
6.6
95.62
S2
Pump Around
Temporary
Dewatering
SA
Perennial
Both
10
5
S3
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
0 linear ft
3i2. Total permanent stream
impacts:
95.62 linear ft
M. Total temporary stream
impacts:
5 linear ft
34. Total stream and ditch
impacts:
100.62 linear ft
3j. Comments:
Lot 4470 Impacts (Northern Parcel addressed 1421 Hannaford Rd):
S1 — Includes 95.62 LF (634.08 SF) of permanent impact by culvert.
S2 —5 LF (50.95 SF) of temporary impact associated with coffer dam for dewatering.
Page 10 of 20 PCN Form Version 4.3- December 4, 2023

4.
Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
Site #*
4a1.
Impact Reason
4b.
Impact
Duration*
4c.
Waterbody Name*
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Open water impacts are not proposed.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete the table
below. (*This
does NOT include offline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Ponds are not being constructed.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter.
Page 11 of 20 PCN Form Version 4.3- December 4, 2023

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 ❑ Randleman
❑ Other: Click to ente
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
131
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
133
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
134
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
136
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
137
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
138
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
1311
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Buffer impacts are not proposed.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 20 PCN Form Version 4.3- December 4, 2023

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The applicant has used a headwall and selected placement within an existing culvert location. The remaining streams
and wetlands will not be impacted by the proposed development. There will be no secondary impacts by proposed
development. The width of the driveway and walkway were limited to the extent possible.
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 as necessary
to stabilize graded slopes.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? * ❑ DWR ❑ Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? * (check all that apply) ❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to ente,
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Mitigation is not proposed.
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
Click to 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. miI/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
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter. acres
Page 13 of 20 PCN Form Version 4.3- December 4, 2023

4h. Comments:
Mitigation is not proposed.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
,lick 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
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or INC Division of Mitigation Services.
6i.
Comments:
Buffer mitigation is not required.
Page 14 of 20 PCN Form Version 4.3- December 4, 2023

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
❑ Yes 0 No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc.,qov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here.
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
❑ Yes 0 No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
0 Yes ❑ No
To look up low density requirements, click here:
http://reports.oah.state. nc.us/ncac/title%2015a%20-%20environmental%20guaIity/chapter%2002%20-
%20environmental%20manage ment/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑ Yes 0 No
reviewed and approved under a state stormwater program or state -
approved local government stormwater program?
❑ n/a — project disturbs < 1 acre
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2d.
Which of the following stormwater management program(s) apply?
❑ Local Government
(Check all that apply.)
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs
❑ Phase II ❑ USMP
❑ NSW ❑ Water Supply
Page 15 of 20 PCN Form Version 4.3- December 4, 2023

Please identify which local government stormwater program you are using.
Click to enter.
State Stormwater Programs ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
The project is low density and does not require a stormwater management plan. Disturbance will be less than an
acre.
Page 16 of 20 PCN Form Version 4.3- December 4, 2023

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes X No
funds or the use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require
preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental
❑Yes ❑ 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),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
❑ Yes X No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
ACK 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
i] Yes X No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
There will be no additional impacts as a result of the proposed development.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdo
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? I ❑ Yes X 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 disposal is not required for this project.
Page 17 of 20 PCN Form Version 4.3- December 4, 2023

5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will this project occur in or near an area with federally protected
® Yes ❑ No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl)
5b.
Have you checked with the USFWS concerning Endangered Species
❑ Yes 0 No
Act impacts? *
5c.
If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d.
Is another federal agency involved?
❑ Yes 0 No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e.
Is this a DOT project located within Divisions 1-8? *
❑ Yes 0 No
5f.
Will you cut any trees in order to conduct the work in waters of the
U.S.? *
®Yes ❑ No
5g.
Does this project involve bridge maintenance or removal? *
❑ Yes 0 No
5g1.
If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
❑ Yes ❑ No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed
NLEB-SLOPES&apps.pdf
If you answered yes to 5g1, did you discover any signs of bat use? *
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h.
Does this project involve the construction/ installation of a wind
turbine(s)?
❑ Yes 0 No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i.
Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes 0 No
mechanized pile drivers, etc.?
If yes, please provide details to include type of percussive activity, purpose,
duration, and specific location of this
activity on the property (attach .pdf)
Page 18 of 20 PCN Form Version 4.3- December 4, 2023

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), Michaux's sumac (Endangered), Schweinitz's sunflower (Endangered),
and monarch butterfly (Candidate) are included by the IPaC as federally listed species that occur within the project
vicinity.
Bat hibernacula is not located on the site. Trees that could afford suitable summer roosting habitat are present on the
site. Limited clearing will be required to impact the stream. Additionally, known occurrences are not identified within 2
miles of the site. Based on the small amount of clearing required for installation, the proposed project is not likely to
adversely affect the TCB should it become a listed species prior to clearing activities.
Suitable habitat for Michaux's sumac and Schweinitz's sunflower will not be impacted by proposed impacts. The
disturbance areas contain wooded areas and regularly mowed lawns that are not suitable habitat. The proposed
project is not likely to adversely impact these species.
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 should it become listed.
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
Is there submerged aquatic vegetation (SAV) around
the project vicinity? *
El Yes 0 No El Unknown
Will this project affect submerged aquatic vegetation? *
❑ Yes X No ❑ Unknown
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper — NOAA Fisheries
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis. ncdcr.,qov/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 in the area of the impact or on
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:Hmsc.fema.,qov/portal/search
Page 19 of 20 PCN Form Version 4.3- December 4, 2023

8a. Will this project occur in a FEMA-designated 100-year floodplain? * 1 ❑ 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 from FEMA Web Map Service. A copy of the FEMA map is included as an
attachment.
H. Miscellaneous
Comments:
Thank -you for your assistance. Please contact David Brame at 336-708-4617 with any questions.
Attach pertinent documentation or attachments not previously requested
I. Signature *
X By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * David S. Brame
Signature: * P—O IT�_
Date: * 7/12/2024
Page 20 of 20 PCN Form Version 4.3- December 4, 2023

Environmental Services Proposal
Pilot Proposal 10373
November 20, 2023
AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address:
Owner Information:
Address:
Hermitage Drive
Concord, NC
Carolyn Tucker
621 Hermitage Dr., SE
Concord, NC 28025
Telephone Number: qD q- slonaq l
Fax Number:
E-mail Address: 01�' ad�� , 0_�
JURISDICTIONAL DETERMINATION REQUEST
D. PROPERTY ACCESS CERTIFICATION
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Carolyn Tucker
Print Name
Capacity: X Owner —Authorized Agent
February 5, 2024
Date
Signature
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United States Department of the Interior
FISH AND WILDLIFE SERVICE
Asheville Ecological Services Field Office
160 Zillicoa Street, Suite B
Asheville, NC 28801-1082
Phone: [phone] Fax: [phone]
https://www.fws.p,ov/office/asheville-ecolop,ical-services
In Reply Refer To: 07/01/2024 12:44:31 UTC
Project Code: 2024-0110568
Project Name: Hermitage Drive - Culvert Replacement
Subject: List of threatened and endangered species that may occur in your proposed project
location or may be affected by your proposed project
To Whom It May Concern:
The enclosed species list identifies threatened, endangered, proposed and candidate species, as
well as proposed and designated critical habitat, that may occur within the boundary of your
proposed project and/or may be affected by your proposed project. The enclosed species list
fulfills the requirements of the U.S. Fish and Wildlife Service (Service) under section 7(c) of the
Endangered Species Act (Act) of 1973, as amended (16 U.S.C. 1531 et seq.).
Please note that new species information can change your official species list. Under 50 CFR
402.12(e) of the regulations implementing section 7 of the Act, the accuracy of this species list
should be verified after 90 days. The Service recommends you visit the ECOS-IPaC website at
regular intervals during project planning and implementation to ensure your species list is
accurate or obtain an updated species list.
The purpose of the Act is to provide a means whereby threatened and endangered species and the
ecosystems upon which they depend may be conserved. Under sections 7(a)(1) and 7(a)(2) of the
Act and its implementing regulations (50 CFR 402 et seq.), Federal agencies are required to
utilize their authorities to carry out programs for the conservation of threatened and endangered
species and to determine whether projects may affect threatened and endangered species and/or
designated critical habitat.
A biological assessment (BA) or biological evaluation (BE) should be completed for your
project. A BA is required for major construction activities (or other undertakings having similar
physical impacts) considered to be Federal actions significantly affecting the quality of the
human environment as defined in the National Environmental Policy Act (42 U.S.C. 4332(2) (c))
(NEPA). For projects other than major construction activities, the Service suggests that a BE be
prepared to determine effects of the action and whether those effects may affect listed species
and/or designated critical habitat. Effects of the action are all consequences to listed species or

Project code: 2024-0110568 07/01/2024 12:44:31 UTC
critical habitat that are caused by the proposed action, including the consequences of other
activities that are caused by the proposed action. A consequence is caused by the proposed action
if it is reasonably certain to occur and would not occur "but for" the proposed action..
Recommended contents of a BA/BE are described at 50 CFR 402.12. More information and
resources about project review and preparing a BA/BE can be found at the following web link:
https://www.fws. gov/office/asheville-ecological-services/asheville-field-office-online-review-
process-overview.
If a Federal agency determines listed species and/or designated critical habitat may be affected
by the proposed project, the agency is required to consult with the Service pursuant to 50 CFR
402. The Service is not required to concur with "no effect" determinations from Federal action
agencies. If consultation is required, the Service recommends that candidate species, proposed
species, proposed critical habitat, and at -risk species be addressed within the consultation. More
information on the regulations and procedures for section 7 consultation, including the role of
permit or licensed applicants, can be found in the "Endangered Species Consultation Handbook"
at the following web link: https://www.fws.gov/media/endangered-species-consultation-
handbook.
Migratory Birds: In addition to responsibilities to protect threatened and endangered species
under the Act, there are additional responsibilities under the Migratory Bird Treaty Act (MBTA)
and the Bald and Golden Eagle Protection Act (BGEPA) to protect native birds from project -
related impacts. Any activity, intentional or unintentional, resulting in take of migratory birds,
including eagles, is prohibited unless otherwise permitted by the Service (50 C.F.R. Sec. 10.12
and 16 U.S.C. Sec. 668(a)). More information about MBTA and BGEPA can be found at the
following web link: https://www.fws.gov/program/migratory-birds.
We appreciate your consideration of Federally listed species. The Service encourages Federal
agencies to include conservation of threatened and endangered species in their project planning
to further the purposes of the Act. Please contact our staff at 828-258-3939, if you have any
questions. In any future correspondence concerning this project, please reference the
Consultation Code which can be found in the header of this letter.
Attachment(s):
• Official Species List
• USFWS National Wildlife Refuges and Fish Hatcheries
• Bald & Golden Eagles
• Migratory Birds
• Wetlands
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Project code: 2024-0110568 07/01/2024 12:44:31 UTC
OFFICIAL SPECIES LIST
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Asheville Ecological Services Field Office
160 Zillicoa Street, Suite B
Asheville, NC 28801-1082
[phone]
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PROJECT SUMMARY
Project Code: 2024-0110568
Project Name: Hermitage Drive - Culvert Replacement
Project Type: Culvert Repair/Replacement/Maintenance
Project Description: The project includes the replacement of a culvert for vehicular and public
access to gardens. The project is planned for completion in the next 2 to 4
months and will require a permit from the USACE.
Project Location:
The approximate location of the project can be viewed in Google Maps: https:
www. google.com/maps/(a)35.3998038,-80.56271156042706,14z
O
Counties: Cabarrus County, North Carolina
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Project code: 2024-0110568 07/01/2024 12:44:31 UTC
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
Fisheriesi, as USFWS does not have the authority to speak on behalf of NOAA and the
Department of Commerce.
See the "Critical habitats" section below for those critical habitats that lie wholly or partially
within your project area under this office's jurisdiction. Please contact the designated FWS office
if you have questions.
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.
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Project code: 2024-0110568 07/01/2024 12:44:31 UTC
MAMMALS
NAME STATUS
Tricolored Bat Perimyotis subflavus Proposed
No critical habitat has been designated for this species. Endangered
Species profile: https:Hecos.fws.gov/ecp/species/10515
INSECTS
NAME STATUS
Monarch Butterfly Danaus plexippus Candidate
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9743
FLOWERING PLANTS
NAME STATUS
Michaux's Sumac Rhus michauxii Endangered
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/5217
Schweinitz's Sunflower Helianthus schweinitzii Endangered
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/3849
CRITICAL HABITATS
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.
YOU ARE STILL REQUIRED TO DETERMINE IF YOUR PROJECT(S) MAY HAVE EFFECTS ON ALL
ABOVE LISTED SPECIES.
USFWS NATIONAL WILDLIFE REFUGE LANDS
AND FISH HATCHERIES
Any activity proposed on lands managed by the National Wildlife Refuge system must undergo a
'Compatibility Determination' conducted by the Refuge. Please contact the individual Refuges to
discuss any questions or concerns.
THERE ARE NO REFUGE LANDS OR FISH HATCHERIES WITHIN YOUR PROJECT AREA.
BALD & GOLDEN EAGLES
Bald and golden eagles are protected under the Bald and Golden Eagle Protection Acti and the
Migratory Bird Treaty Act2.
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Project code: 2024-0110568
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Any person or organization who plans or conducts activities that may result in impacts to bald or
golden eagles, or their habitats3, should follow appropriate regulations and consider
implementing appropriate conservation measures, as described in the links below. Specifically,
please review the "Supplemental Information on Migratory Birds and Eagles".
1. The Bald and Golden Eagle Protection Act of 1940.
2. The Migratory Birds Treat. Act of 1918.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
There are likely bald eagles present in your project area. For additional information on bald
eagles, refer to Bald Eagle Nesting and Sensitivity to Human Activity
For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, see the PROBABILITY OF PRESENCE
SUMMARY below to see when these birds are most likely to be present and breeding in your
project area.
NAME BREEDING SEASON
Bald Eagle Haliaeetus leucocephalus Breeds Sep 1 to
This is not a Bird of Conservation Concern (BCC) in this area, but warrants attention Jul 31
because of the Eagle Act or for potential susceptibilities in offshore areas from certain
types of development or activities.
https:Hecos.fws.gov/ecp/species/1626
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 "Supplemental
Information on Migratory Birds and Eagles", specifically the FAQ section titled "Proper
Interpretation and Use of Your Migratory Bird Report" before using or attempting to interpret
this report.
Probability of Presence ( 1)
Green bars; the bird's relative probability of presence in the 10km grid cell(s) your project
overlaps during that week of the year.
Breeding Season( )
Yellow bars; liberal estimate of the timeframe inside which the bird breeds across its entire
range.
Survey Effort (1)
Vertical black lines; the number of surveys performed for that species in the 10km grid cell(s)
your project area overlaps.
No Data (—)
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A week is marked as having no data if there were no survey events for that week.
■ probability of presence breeding season I survey effort — no data
SPECIES JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Bald
Non -BCC
e ��,� ±��� ��1�■:i i.tt t..� ���� ++�+ ���� Ills ���� ���
Vulnerable
Additional information can be found using the following links:
• Eagle Management https://www.fws.gov/program/eagle-management
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/library
collections/avoiding-and-minimizing-incidental-take-mi rator.
• Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.pdf
• Supplemental Information for Migratory Birds and Eagles in IPaC https://www.fws.gov/
media/supplemental-information-mi ratory-birds-and-bald-and-golden-ea les-may-occur-
project-action
MIGRATORY BIRDS
Certain birds are protected under the Migratory Bird Treaty Acti and the Bald and Golden Eagle
Protection ActZ.
Any person or organization who plans or conducts activities that may result in impacts to
migratory birds, eagles, and their habitats should follow appropriate regulations and consider
implementing appropriate conservation measures, as described in the links below. Specifically,
please review the "Supplemental Information on Migratory Birds and Eagles".
1. The Migratory Birds Treaty Act of 1918.
2. The Bald and Golden Eas71e Protection Act of 1940.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, see the PROBABILITY OF PRESENCE
SUMMARY below to see when these birds are most likely to be present and breeding in your
project area.
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Project code: 2024-0110568
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NAME
BREEDING
SEASON
Bald Eagle Haliaeetus leucocephalus Breeds Sep 1 to
This is not a Bird of Conservation Concern (BCC) in this area, but warrants attention Jul 31
because of the Eagle Act or for potential susceptibilities in offshore areas from certain types
of development or activities.
https:Hecos.fws.gov/ecp/species/1626
Cerulean Warbler Setophaga cerulea Breeds Apr 28
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA t0 Jul 20
and Alaska.
https:Hecos.fws.gov/ecp/species/297
Chimney Swift Chaetura pelagica Breeds Mar 15
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA t0 Aug 25
and Alaska.
https:Hecos.fws.gov/ecp/species/9406
Prairie Warbler Setophaga discolor Breeds May 1
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Jul 31
and Alaska.
https:Hecos.fws.gov/ecp/species/9513
Prothonotary Warbler Protonotaria citrea Breeds Apr 1 to
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA Jul 31
and Alaska.
https:Hecos.fws.gov/ecp/species/9439
Red-headed Woodpecker Melanerpes erythrocephalus Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA t0 Sep 10
and Alaska.
https:Hecos.fws.gov/ecp/species/9398
Rusty Blackbird Euphagus carolinus
Breeds
This is a Bird of Conservation Concern (BCC) only in particular Bird Conservation Regions
elsewhere
(BCRs) in the continental USA
https:Hecos.fws.gov/ecp/species/9478
Wood Thrush Hylocichla mustelina
Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
to Aug 31
and Alaska.
https:Hecos.fws.gov/ecp/species/9431
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 "Supplemental
Information on Migratory Birds and Eagles", specifically the FAQ section titled "Proper
Interpretation and Use of Your Migratory Bird Report" before using or attempting to interpret
this report.
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Probability of Presence (■)
Green bars; the bird's relative probability of presence in the 10km grid cell(s) your project
overlaps during that week of the year.
Breeding Season( )
Yellow bars; liberal estimate of the timeframe inside which the bird breeds across its entire
range.
Survey Effort (1)
Vertical black lines; the number of surveys performed for that species in the 10km grid cell(s)
your project area overlaps.
No Data (—)
A week is marked as having no data if there were no survey events for that week.
■ probability of presence breeding season I survey effort — no data
SPECIES JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Bald Eagle
Non -BCC ++� I I I IIII IIII I 1 I I 114+ ++++ ++�+ ��++ +++� ++++ ++++
Vulnerable
Cerulean Warbler hu Lis
BCC Rangewide +++. ++++ ++++ +++ +++ +�� ---+ +­+— ++++ +�—+
(CON)
Chimney Swift +++. ++++ +1pq i++' ++ +"—'�+'—+— ++++ +�—+
BCC Rangewide
(CON)
Prairie Warbler jiBCC Rangewide ++++ ++++ ++++ ++,+ ""11i
++.+ . .++ ++++ ++++ ++++
(CON)
Prothonotary
Warbler ++++ ++++ ++++ +++ +'.+ ..++ ++++ ++++ ++++
BCC Rangewide MEN EM
(CON)
Woodpecker
Rangewide +++. ++++ ++++ ++++ ++ +­+— ++++ +��+
(CON)
Rusty Blackbird +++. ++++ ++++ ++++ +—++ —++— —+++ —+-- ---+ +—+— ++'+ +��+
BCC -BCR
Wood Thrush
BCC Rangewide +++. ++++ ++++ ++++'—++ —++— —'++ —+-- ­4- +­+— ++++ 4 ­ 4-
(CON)
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Project code: 2024-0110568 07/01/2024 12:44:31 UTC
Additional information can be found using the following links:
• Eagle Management https://www.fws.gov/program/eagle-management
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/library
collections/avoiding-and-minimizing-incidental-take-migratory-birds
• Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.pdf
• Supplemental Information for Migratory Birds and Eagles in IPaC https://www.fws.gov/
media/supplemental-information-mi ratory-birds-and-bald-and-golden-ea les-may-occur-
project-action
WETLANDS
Impacts to NWI wetlands and other aquatic habitats may be subject to regulation under Section
404 of the Clean Water Act, or other State/Federal statutes.
For more information please contact the Regulatory Program of the local U.S. Army Corps of
Engineers District.
Please note that the NWI data being shown may be out of date. We are currently working to
update our NWI data set. We recommend you verify these results with a site visit to determine
the actual extent of wetlands on site.
RIVERINE
• R4SBC
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IPAC USER CONTACT INFORMATION
Agency: Pilot Environmental, Inc
Name: David Brame
Address: 743 Park Lawn Court
City:
Kernersville
State:
NC
Zip:
27284
Email
[e-mail]
Phone:
3363104527
12 of 12

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David Brame
From: Lipsky, Amber L CIV USARMY CESAW (USA) <[e-mail]>
Sent: Monday, March 18, 2024 2:27 PM
To: [e-mail]
Cc: Michael Brame
Subject: SAW-2024-00528 Hermitage Drive SE Delineation Concurrence
Attachments: SAW-2024-00528 Delineation Concurrence.pdf
Follow Up Flag: Follow up
Flag Status: Completed
Good afternoon Ms. Tucker,
Reference is made to Corps Action ID: SAW-2024-00528 for the above referenced project. Please reference this number
on any correspondence regarding this action.
We have reviewed the information provided by you concerning the aquatic resources, and by copy of this e-mail, are
confirming that the aquatic resources delineation has been verified by the Corps to be a sufficiently accurate and reliable
representation of the location and extent of aquatic resources within the identified review area. The location and extent
of these aquatic resources are shown on the delineation map entitled, "Wetland Map" and dated December 7, 2023.
Regulatory Guidance Letter (RGL) 16-01 https://usace.contentdm.ocic.org/utils/getfile/collection/pl602lco119/id/1256
provides guidance for Jurisdictional Determinations (JD) and states, "The Corps generally does not issue a JD of any type
where no JD has been requested." Currently, we are only verifying the delineation. This delineation may be relied upon
for use in the permit evaluation process, including determining compensatory mitigation. This verification does not
address nor include any consideration for geographic jurisdiction on aquatic resources and shall not be interpreted as
such. This delineation verification is not an Approved Jurisdictional Determination (AJD) and is not an appealable action
under the Regulatory Program Administrative Appeal Process (33 CFR Part 331). However, you may request an AJD,
which is an appealable action.
If you wish to receive a Preliminary Jurisdictional Determination (PJD), or an Approved Jurisdictional Determination (AJD)
please respond accordingly, otherwise nothing further is required, and we will not provide any additional
documentation.
Best Regards,
Amber Lipsky (she/her)
Regulatory Specialist, Charlotte Regulatory Field Office
U.S. Army Corps of Engineers, Wilmington District
8430 University Executive Park Drive, Suite 615
Charlotte, NC 28262
Email: [e-mail]
Office: [phone]
Mobile: [phone]

LEGEND
Site Boundary
Perennial Stream
Wetland
SA 1-5
Flag Number
DP-1 4D
Data Point
■
Culvert
;� �z
SA
507 LF
DP-1
WA 1-12
0.015 Ac.
0 DP-2
1
w �-
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE APPROXIMATE. THEY WERE VERIFIED BY
MS. AMBER LIPSKY WITH THE USACE (SAW-2024-00528) VIA DESKTOP REVIEW (E-MAIL
CONCURRENCE DATED 3.18.24). THIS MAP INCLUDES GPS LOCATIONS OF DELINEATED FEATURES.
DELINEATED BY PILOT ON DECEMBER 5, 2023.
Drawing 5 Wetland Map
Aerial Imagery from ESRI =` Hermitage Dr SE
and Pilot GPS Data -T
-- - Approximate 1.29-Acre Tract
Scale: 1" = 100' ��O1' ' Concord, Cabarrus County, NC
Date:12.7.2023 OT ENVIR0NMEN7AL,INO Pilot Project10373

USGS K�ap
Drawing Topographic
' Hermitage DrSE
USGSTopographic Map
` Approximate 1.29-AoreTraot
Cononod' NC Quadrangle —'
, , PILO Concord, CabarruaCounty, NC
Scale: 1 =ZOOO � � ������' �~~ ~�—~ �

Drawing 2 - ` ` _ '' _ v Y
USDA Web Soil Survey
of Cabarrus County, NC PIL011F wE
Scale: 1" = 200' P I L 0 i E N V I R 0 h Al E N 7 A L, I N[
LEGEND
Site Boundary III
9JAWW� -TI, ' ,-w-A
Web Soil Map
Hermitage Dr SE
Approximate 1.29-Acre Tract
Concord, Cabarrus County, NC
Pilot Project 10373

co,
s
El
CYP
I
E LEGEND
Site Boundary
Drawing 2A Y Published Soil Map
USDA Soil Survey ``s =<`. :. Hermitage Dr SE
of Cabarrus County, NC - - - Approximate 1.29-Acre Tract
Published 1988 PIL 111Concord, Cabarrus County, NC
Scale: 1"=400' PILOT ENVIRO\MENTAL.INC Pilot Project10373

Drawing 3
USFWS NWI
Wetlands Mapper
Scale: 1" = 200'
I
LEGEND
Site Boundary
Freshwater Emergent
s Freshwater ForestecVShrub
Estuarine and Marine Deepvaater
Estuarine and Marine
FFPSIlw81pE Pund
take
Rivcrinc
Other
NWI Map
Hermitage Dr SE
=° Approximate 1.29-Acre Tract
PILOT Concord, Cabarrus County, NC
PIL0T ENVIROtiMEN7AL,IN[ Pilot Project10373

LEGEND
Site Boundary
1 %Annual Chance Flood Hazard
Regulatory Floodvay
Sped al FloodSvay
Area of Undetermined Flood Hazard
0.2%Annual Chance Flood Hazard
' Future Conditions 1 %Annual Chance Flood Hazard
► Area with R educed Risk Due to Levee
Drawing 4
National Flood Hazard Layer A.. .
from FEMA Web Map Service PILOT
Scale: 1" = 200' P I L 0 i L IJ V 1 R 0 L Al 2 14 7 A L. I N[
FFJ
FEMA FIRM
Hermitage Dr SE
Approximate 1.29-Acre Tract
Concord, Cabarrus County, NC
Pilot Project 10373