20150342 Ver 2_401 Application_20161216

Montalvo, Sheri A
To: [e-mail]
Subject: Smith Crossing Project
Attachments: Agent Authorization Form.pdf
Importance: High
Mr. Cole,
We have received the PCN for the above project. The signature page 11 of 11 was signed by you so we will need a
completed agent authorization form to be filled out before I can forward it through the review process. I have attached one
for your use. Please complete and email back to me at sheri.montalvo c2ncdenr.gov. Once I receive it I can then take the
project off hold.
Thanks
sheyi MovvtaLvo
Administrative Assistant
401 & Buffer Permitting Branch
Division of Water Resources
North Carolina Department of Environmental Quality
919-807-6303 (office)
919 807-6494 (fax)
sheri.montalvoAncdenr.gov
Physical: 512 N. Salisbury St., Ste 942-D, Raleigh, NC 27604
Mailing: 1617 Mail Service Center, Raleigh, NC 27699-1617
`-Nothing Compares—,,
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

Montalvo, Sheri A
From: Jennifer Crank <[e-mail]>
Sent: Thursday, December 29, 2016 3:04 PM
To: Montalvo, Sheri A
Cc: Walter Cole
Subject: Agent Authorization document
Attachments: Agent Authorization.pdf
Dear Sheri,
Please find attached the Agent Authorization form for the Smith Crossing Project.
If you have any questions, please contact us at 919-872-2660.
Kindest Regards,
Jennifer Crank
Environmental Administrator -Raleigh
—1:1:1 D
S&ME, Inc.
3201 Spring Forest Road
Raleigh NC 27616Im:i
Ph: 919-872-2660
Fax: [phone]
icrankCcDsmeinc.com
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.

IN
_ n +
AGENT AUTHORIZATION AND RIGHT OF ENTRY FORM
Date: October 6, 2014
Project Information
S&ME Project Name: Smith Crossing Mixed Use Development
Type of Project: Commercial
Location: Kemersville, North Carolina
Property Owner/Representative Information
Business Name: Parr Construction
Mailing Address: P.O. Box 4088
City, State, Zip Code: Greensboro, NC 27404
Telephone No. [phone] email: chris@.parrinvestments.com
Contact: Chris Parr
Agent Information
Business Name: S&ME, Inc.
Street Address: 3201 Spring Forest Road
City, State, Zip Code: Raleigh, NC 27616
Telephone No. 919-872-2660
Contact: Walter Cole
Authorization: 1 , on behalf
of
(Contact Signature
(Name of Landowner or Representative)
a duly authorized owner of record of the property/ properties identified herein, hereby authorize
S&ME to act as agent with the USCAE in connection with the above-mentioned project_
I also authorize representatives of the Wilmington District, U.S. Army Corps of Engineers
(Corps) to enter upon the property herein described for the purposes of conducting on-site
investigations and issuing a determination associated with Waters of the U.S. subject to Federal
jurisdiction under Section 404 of the Clean Water Act and/ or Section 10 of the Rivers and
Harbors Act of 1889.

k-AD
e er 22, 2016
United States Army Corps of Engineers S�
D�
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105 v
Wake Forest, NC 28801-5006
Attention: Mr. John Thomas Jr. 12 0 V
_ D
N.C. Division of Water Resources DF C 2 2 2016
401 and Buffer Permitting Branch
512 North Salisbury Street D1 FFR RES UR S
Raleigh, North Carolina 27604
Archdale Building — 9t' Floor
Attention: Ms. Jennifer Burdette
Reference: Permit Modification Application for Nationwide Permit No. 39/Water
Quality Certification No. 3890 (Additional Impacts)
Smith Crossing Project, Union Cross Road
Kernersville, Forsyth County, North Carolina
S&ME Project 4305-14-228 CO -2
USACE Action ID No. SAW -2013-01674
DWR No. 15-0342
Dear Mr. Thomas and Ms. Burdette:
On behalf of our client, Parr Construction, S&ME, Inc. (S&ME) is submitting this
Preconstruction Notification Form for the above -referenced project and requesting a
permit modification for a U.S. Army Corps of Engineers (USACE) Nationwide Permit
No. 39 (NWP 39) and North Carolina Department of Environmental Quality (NCDEQ)
Water Quality Certification (WQC) No. 3890 for commercial and institutional
developments.
BACKGROUND INFORMATION
Parr Construction proposes to construct a development to include commercial and retail
development as well as the construction of 352 multi -family apartment units, parking,
utilities, and stormwater management facilities, lighting, and landscaping. The site is
located south of the Union Cross Road and Kenosha Drive intersection and north of I-40,
in Kernersville, North Carolina.
S&ME visited the site to delineate the jurisdictional wetlands and waters of the U.S.
within the subject property to perform a jurisdictional delineation. S&ME conducted

Permit Modification Application for NWP 39 and WQC 3890 SWE Project No. 4305-14-228 (CO -2)
Smith Crossing Development December 22, 2016
regulatory site meetings with the USACE and NCDWR to confirm our findings on
August 29, 2013. S&ME received a copy of the USACE Notification of Preliminary
Jurisdictional Determination signed September 5, 2013. We also received NCDWR
correspondence regarding the site visit on September 4, 2013. The original impacts were
limited to the emergent herbaceous wetlands that had formed in the bottom of the drained
pond in the amount of 0.09 -acres and a USACE NWP 39 permit application for these
impacts was submitted to the USACE Raleigh Regional Office on November 3, 2014.
The proposed wetland impacts were below the written notification thresholds for
NCDWR so the application was submitted to the USACE only. The USACE issued a
General Permit Verification for the wetland impacts on November 12, 2014.
A NWP No. 39 permit modification and concurrent NCDEQ WQC No. 3890 was
requested for permanent impacts to the remaining emergent herbaceous wetlands located
in the bottom of the old pond in the amount of 2,690 square feet or 0.06-acres.Therefore,
the total cumulative impacts to jurisdictional wetlands include the previously permitted
impacts (0.099 -acres) and the new proposed impacts (0.06 -acres) for a total of 0.16 -acres.
The USACE issued a General Permit Verification for the additional wetland impacts on
April 24, 2015 and the NCDEQ issued a 401 WQC approval on June 1, 2015 and both
approvals are provided in Appendix III.
We are now requesting a permit modification for stream and riparian buffer impacts to an
unnamed tributary of Abbotts Creek, associated with the proposed Solomon Drive, a 60 -
foot right-of-way that will provide vehicular connectivity to the existing Kenosha Drive.
A site meeting was conducted with Mr. John Thomas of the USACE and Ms. Sue
Homewood of the Winston-Salem Regional Office of NCDWR on March 21, 2016 to
review the proposed road crossing area and stream. A USACE and NCDWR stream form
for Stream Feature A is included in Appendix IV and a photo log is included in
Appendix V.
The following documents are provided in support of our request:
• Appendix I: Pre -construction Notification (PCN);
• Figures: USDA-NRCS Forsyth County Soil Survey Map (Figure 1), USGS
Topographic Map (Figure 2), Color Aerial and Topographic Map (Figure 3).
• Appendix II: Stream Impact Exhibits: Smith Crossing Final Development Plan
(Exhibit 1), Smith Crossing Stream Crossing (Exhibit 2), and Smith Crossing
Stream Crossing Profile (Exhibit 3);
• Appendix III: USACE NWP No. 39 and NCDEQ WQC No. 3890 Approval
• Appendix IV: USACE and NCDWR Stream Forms
• Appendix V: Photo Log
• NCDWR Minor Water Quality Application Fee ($240)
PROPOSED PROJECT IMPACT
The proposed road construction will result in permanent stream and Town of Kernersville
Watershed Protection Riparian Buffer impacts consisting of headwall, culvert, and rip -rap
outlet pad installation. Proposed impacts included 147 linear feet of stream, 9,163 square
2

Permit Modification Application for NWP 39 and WQC 3890 SWE Project No. 4305-14-228 (CO -2)
Smith Crossing Development December 22, 2016
feet of Zone 1, and 4,855 square feet of Zone 2 of the riparian buffer. See Appendix II
for more information.
Therefore, the total cumulative impacts to jurisdictional waters include the previously
permitted impacts of 0.16 acres of wetlands and the new proposed impacts of 147 linear
feet of intermittent stream.
CLOSING
By copy of this correspondence and completed Pre -construction Notification, we are
requesting your written concurrence with this NWP No. 39 and WQC No. 3890 permit
modification application. Please contact Walter Cole if you have any questions or need
additional information.
Sincerely,
S&ME
M
Walter Cole, L.S.S., R.E.H.S
Project Manager
[phone]
[e-mail]
3

Appendix I

W A
TF9OG
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
Corps:
TO 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 39 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ® Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
t.pyes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f. Is payment into a mitigation bank or in -lieu fee ed for mitigation
of impacts? If so, attach the acceptance lett j n -lieu
fee program.
® Yes
❑ No
1g. Is the project located in any of NC's twenty oa tal count ft If )res, ar� r 1h
below. a 24 r
1 h. Is the project located within a NC DCM Ar one rn EC)?
E]Yes
❑ Yes
® No
® No
2. Project Information ES
2a. Name of project:
Smith Crossing Project
2b. County:
Forsyth
2c. Nearest municipality / town:
Kernersville
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
Parr Construction
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
Chris Parr
3d. Street address:
P.O. Box 4088
3e. City, state, zip:
Greensboro, NC 27404
3f. Telephone no.:
[phone]
3g. Fax no.:
3h. Email address:
[e-mail]
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Water Cole
5b. Business name
(if applicable):
S&ME, Inc.
5c. Street address:
3201 Spring Forest Rd.
5d. City, state, zip:
Raleigh
5e. Telephone no.:
[phone]
5f. Fax no.:
5g. Email address:
[e-mail]
Page 2 of 11

B. Project Information and Prior Project History I
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
See PCN attachment
1b. Site coordinates (in decimal degrees):
Latitude: 36.078852 Longitude: - 80.104768
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
83.46 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Fiddlers Creek
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin: map is available at
http://h2o.enr.state.nc.us/admin/maps/
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 subject property is partially developed and is bounded to the south by 1-40, to the west by Union Cross Road, and to
the Northeast by Kenosha Court. The project vicinity is primarily developed residential or commercial development.
3b. List the total estimated acreage of all existing wetlands on the property:
0.167 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1,350 linear feet
3d. Explain the purpose of the proposed project:
The purpose of development is for commercial and retail development and construction of 352 multi -family apartment
units. Associated with the project will be the required parking, utilities, and stormwater management.
3e. Describe the overall project in detail, including the type of equipment to be used:
Construction will be performed by standard commercial construction equipment. No specialized equipment not regularly
seen on commercial projects is anticipated.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
® Yes ❑ No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
Preliminary ®Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: S&ME, Inc
Name (if known): W. Cole
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
USACE Notification of Determination dated September 5, 2013, and NCDWR On-site Determination Letter dated
September 4, 2013
5. Project History
5a. Have permits or certifications been requested or obtained for
® Yes ❑ No El Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
A USACE NWP 39 was issued on 11-12-14 for 0.09 -acres of wetland impact. A USACE NWP 39 modification and
NCDWR WQC 3890 was issued on 04-24-2015 and 06-01-15 respectively for an additional 0.16 -acres of wetland impact.
6. Future Project Plans
6a. Is this a phased project?
® Yes ❑ No
6b. If yes, explain.
Phase one will consist of mixed development uses including retail and wholesale trade, business and personal services,
institutional and public uses and residential development. Phase two will include the construction of additional residential
properties and will take place at a later date.
Page 4 of 11

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ® Buffers
❑ 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 impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non-404, other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments:
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.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
Temporary (T)
intermittent
(INT)?
DWQ — non-404,
width
(linear
feet)
other)
(feet)
S1 ® P [:IT
Culvert
UT to Abbotts
❑ PER
® Corps
3
147
Creek
® INT
® DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
147
3i. Comments: Impacts are the result of culvert, headwall and rip rap outlet pad installation.
Page 5 of 11

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 indiv dually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P
02 ❑P
03 ❑P❑T
04 ❑P❑T
0. Total open water impacts
4g. Comments: There are no impacts to open waters anticipated as a result of this project.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or purpose
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
number
of pond
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments: There are no impacts to ponds or lakes anticipated as a result of this project.
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 MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar -Pamlico ®Other: Town of
Project is in which protected basin?
Kemersville Watershed Protection Riparian Buffer
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
B1 ®P [-IT
Road
crossing
UT to Fiddlers Creek
❑ Yes
® No
9,163
4,855
B2 ❑P❑T
❑Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
9,163
4,855
6i. Comments: Riparian buffer impacts are associated with the Town of Kernersville UDO — Article III, Watershed Protection
Page 6 of 11

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 site plan has been designed to minimize impacts to the jurisdictional Waters of the U.S. by incorporating a headwall
into the design. Appropriate sediment and erosion control practices equaling those outlined in the most recent version of
the "North Carolina Sediment and Erosion Control Planning and Design Manual" will be used.
b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Specific attention will be paid to ensure grading is only performed to the extent needed for the proposed project and all
grading not required will be avoided.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments:
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:
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? If Yes. You will have to fill out this entire form — please
contact the State for more information.
❑ Yes ® No
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.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation 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 11

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑ Yes ® No
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments:
El Yes El No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
29.5
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 Stormwater Management Plan is currently being finalized by the project engineer. The Stormwater Management
Plan includes four potential BMPs to mitigate the increase of runoff and provide for water quality.
® 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?
Kernersville
® Phase II
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
apply (check all that apply):
❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
4a. Which of the following state -implemented stormwater management programs apply
❑ HQW
❑ ORW
(check all that apply):
® Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ® No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ® No
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
❑ Yes ❑ No
(North Carolina) Environmental 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 NEPA or SEPA final approval
letter.)
❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
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
ED 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 you answered "no," provide a short narrative description.
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.
Wastewater will be conveyed to a municipal wastewater treatment facility.
Page 10 of 11
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
habitat?
❑ Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑ Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
El Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS website: http://www.fws.gov/raleigh, Natural Heritage Program's on-line database, GIS data of Elemental
Occurrences and Significant Natural Heritage Areas (January 2014) for the project area downloaded from the North
Carolina Center for Geographic Information and Analysis website, NC OneMap. See PCN Attachment for additional
information.
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?
The USFWS website: http://www.fws.gov/raleigh, Natural Heritage Program's on-line database, GIS data of Elemental
Occurrences and Significant Natural Heritage Areas (January 2014) for the project area downloaded from the North Carolina
Center for Geographic Information and Analysis website, NC OneMap, and the Essential Fish Habitat Mapper on the NOAA
Habitat Conservation website.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
Review of historic properties on the North Carolina State Historic Preservation Office Geographic Information Systems
(GIS) Virtual Workroom (http://gis.ncdcr.gov/hpoweb/) did not reveal any historic properties in the project area. See PCN
Attachment for additional information.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
Yess No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? Available FEMA mapping (NCFloodMap.com) and
Project Engineer
Walter Cole
r
12-22-16
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 11 of 11

A. Applicant Information/ B. Project Information and Prior Project
History
3. Owner Information/ 1. Property Identification, a. Property Identification No.
Parcel PIN Number
6874-29-9209,
6875-30-5140
6875-30-4115
6874-29-9567,
6874-39-1720,
6874-39-4747,
6874-39-6995,
6874-48-0736,
6874-49-7107,
6874-59-2195
3a. Name(s) on
I-40 Union Cross RE,
Smith Bissell, LLC
Ronald M. Smith
Recorded Deed
LLC
& Nancy F. Smith
3b. Deed Book and
Page No.
3c. Responsible Party
(for LLC if
applicable):
3d. Street address:
125 South Elm Street,
501 Simpson Street
833 Lynnhaven
Unit 500
Park Drive
3e. City, state, zip:
Greensboro, NC 27401
Greensboro, NC 27401
Winston-Salem,
NC 27107
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
The Pointe at Smith Crossing Owner:
Parr Investments, INC., ATTN: Chris Parr
P.O. Box 10888
Greensboro, NC 27404
Phone: [phone]
Fax: [phone]
Email: [e-mail]
F. Supplementary Information
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Literature Review

Protected Species
S&ME's review of potential protected species habitat included a literature review of existing
records obtained from federal and state sources. The U.S. Fish and Wildlife Service's current list
of federally protected species was consulted for a listing of protected species within Harnett
County, North Carolina. This review identified one protected plant species and two animal
species. Listed fauna and flora and their federal status are identified in Table 1. Explanations of
rankings are included at the end of the table.
Table 1: Federally Protected Flora and Fanna Cnm
Species
Federal Rank*
County Status
Habitat
FY3410
DOE
Well House
Present
Cardamine micranthera
SL
John Hastings
0.96
Small-anthered bittercress
E
Historical
No
Glyptemys muhlenbergii
SO
House
0.56
Bog turtle
T
Current
No
Picoides borealis
Red -cockaded
E
Historical
No
woodpecker
--MivauKcicu, i — inreatuneu
As part of the literature review, S&ME also consulted the North Carolina Natural Heritage
Program (NCNHP) Geographic Information Systems (GIS) Element Occurrence (EO) and
Significant Natural Heritage Areas databases for records of endangered or threatened species and
environmentally sensitive areas within or near the project site. No Elemental Occurrences were
within one mile of the project site. The closest Elemental Occurrence (EO ID: 2500) is approximately 2.5
miles from the project site.
Cultural Resources
S&ME reviewed the North Carolina Historic Preservation Office (NCSHPO) GIS web service
(http:H—ais.ncdcr.gov/hDoweb) to identify recorded historic resources in the vicinity of the project
area. No historic resources were identified within the project area. There is a site with a
Determination of Eligibility 0.03 mile of the project area, but is not within the project Boundary.
An additional eleven historical sites were found within one mile of the project area and are
described in Table 2 below.
Table 2: NC Historic Preservation Office Historic Properties
Site ID
Status*
Site Name
Distance from
Site mi
FY3410
DOE
Well House
0.03
FY0345
SL
John Hastings
0.96
FY0338
SD
-House
House (Gone)
0.79
FY0339
SO
House
0.56

FY0340
SD
L.V. Smith House (Gone)
0.28
FY0341
SD
Joe Beeson House (Gone)
0.43
FY0348
SD
House (Gone)
0.42
FY0335
SO
Bodenhamer House
0.88
FY0344
SO
Carter House
0.88
FY0346
SO
Levi P. Matthews House
0.72
FY0378
SD
Ed Crews House (Gone)
0.34
FY3295
SO
Mostinger House
0.11
'DUB: Determination of ELigibility
SL: Individual Study List Entry
SO: Surveyed only. No individual designation, but may be within a National Register, Study
List, or DOE district.
SD: Surveyed only, Gone.

pr
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REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM THE 1976 USDA -SCS SOIL SURVEY OF FORSYTH COUNTY, o
NORTH CAROLINAAND THE 2014 FORSYTH COUNTY SHAPEFILE. PLEASE NOTE THIS MAPIS FOR _ Project Site ro
a
INFORMATIONAL PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES.
THERE ARE NO GUARANTEES ABOUT ITS ACCURACY. S&ME, INC. ASSUMES NO RESPONSIBILITY FOR Proposed Road N
ANY DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. - IIF----- V)
r
U
W
SCALE: 1 �� = 500 USDA -SCS SOIL SURVEY MAP FIGURE NO. p
°ATE: 03-05-16 -_ S&ME FORSYTH COUNTY SHEETS 40, 41, 32, 33 a
0
DRAWN BY: A. STEELSSMITH CROSSING PROJECT
WWW.SMEINC.COM UNION CROSS ROAD, KERNERSVILLE
PROJECT NO: 4305-14-228
\ ENGINEERING LICENSE NO: F-0176 FORSYTH COUNTY, NORTH CAROLINA

C�
KINGS.W00D
DR
x
Feature A
,,Zook �
4{ W DR
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM THE 2013 USGS KERNERSVILLE TOPOGRAPHIC
QUADRANGLE, 1:24,000 SCALE AND THE 2014 FORSYTH COUNTY SHAPEFILE. PLEASE NOTE THIS
MAP IS FOR INFORMATIONAL PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY Q Project Site
OTHER USES. THERE ARE NO GUARANTEES ABOUT ITS ACCURACY. S&ME, INC. ASSUMES NO
RESPONSIBILITY FORANY DECISION MADE OR ANYACTIONS TAKEN BY THE USER BASED UPON THIS
INFORMATION. I Proposed Road
SCALE: 1 „ __ 600'
00 FIGURE NO.
*S&ME
USGS TOPOGRAPHIC MAP
DATE: 03-05-16 KERNERSVILLE QUADRANGLE
DRAWN BY: A. STEELS SMITH CROSSING PROJECT 2
WWW.SMEINC.COM UNION CROSS ROAD, KERNERSVILLE
PROJECT NO: 4305-14-228
ENGINEERING LICENSE NO: F-0176 FORSYTH COUNTY, NORTH CAROLINA

'
Project Site o,
r" n
0
Contours
REFERENCE: N
GIS DATA LAYERS WERE OBTAINED FROM THE 2014 NCONEMARCOM AERIAL ORTHOIMAGERY LATER, e
THE 2007 NCDOT LIDAR DATASETAND THE 2014 FORSYTH COUNTY SHAPEFILE. PLEASE NOTE THIS o
MAP IS FOR INFORMATIONAL PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY v
0
500 1,000
OTHER USES. THERE ARE NO GUARANTEES ABOUT ITS ACCURACY. SBME, INC. ASSUMES NO
'.
RESPONSIBILITY FOR ANY DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS N
TI Feet
INFORMATION. U
w
SCALE.
1 �� = 500.
FIGURE NO. 'p
COLOR AERIAL AND TOPOGRAPHIC MAP
a
DATE:
03 05-16
#S&ME
a
SMITH CROSSING PROJECT
3
DRAWN BY:
A. STEELS
WWW.SMEINC.COM
UNION CROSS ROAD, KERNERSVILLE
�Ro IEcr No:
4305-14-228
ENGINEERING LICENSE NO: F-0176
FORSYTH COUNTY, NORTH CAROLINA

Appendix II

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WINSTON-SALEM, NORTH CAROLINA 27103
1-40 UNION CROSS RE,LLC/PARR CONSTRUCTION, INC. Fwc (;)"
UNION CROSS ROADPROJECT NO.: 'mp:/ANw .alll v.com
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50' ZONE 2 STREAM BUFFER IMPACT = 4,855 SF.
Allied Design, Inc.
SMITH CROSSING CIVIL ENGINE EFRING
STREAM CROSSING 4720 KESTER MILL ROAD
WINSTON-SALEM, NORTH CAROLINA 27103
Ptmo(3W) M5 -2W
1-40 UNION CROSS RE,LLC/PARR CONSTRUCTION, INC. I= (: M) 780 -OW
UNION CROSS ROADPROJECT NO.: hV:fhvwAM9d-9fVv".=n 13-M
DATE: /16
KERNERSVILLE, NORTH CAROLINA SCALE: 11121 1"-w
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SMITH CROSSING Allied Design, Inc.
CML ENGINEERING
STREAM CROSSING PROFILE 4720KESTERMUROAD
WINSTON-SALEM, NORTH CAROLINA 27103
1-40 UNION CROSS RE,LLC/PARR CONSTRUCTION, INC. F�3W M"M
UNION CROSS ROADm0:1m'"'"'A11sd "x=
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UNION CROSS ROADm0:1m'"'"'A11sd "x=
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KERNERSVILLE, NORTH CAROLINA : 1%4o /1%4v
I SKETCH NO.: 3

Appendix III

F"
LL �F
AJ
N EMR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
June 1, 2015
Parr Construction
Attn: Chris Parr
PO Box 4088
Greensboro NC 27404
DWR # 15-0342
Forsyth County
Subject: APPROVAL OF 401 WATER QUALITY CERTIFICATION WITH ADDITIONAL CONDITIONS
Smith Crossing Mixed Use Development Project
Dear Mr. Parr:
You have our approval for the impacts listed below for the purpose described in your
application dated April 1, 2015, received by the Division of Water Resources (Division) April 7,
2015, with subsequent information on June 1, 2015. These impacts are covered by the
attached Water Quality General Certification Number 3890 and the conditions listed below.
This certification is associated with the use of Nationwide Permit Number 39 once it is issued to
you by the U.S. Army Corps of Engineers. Please note that you should get any other federal,
state or local permits before proceeding with your project, including those required by (but not
limited to) Sediment and Erosion Control, Non -Discharge, and Water Supply Watershed
regulations.
This approval requires you to follow the conditions listed in the enclosed certifications) or
general permit and the following additional conditions:
1. The following impacts are hereby approved provided that all of the other specific and
general conditions of the Certification are met. No other impacts are approved,
Including incidental impacts. (15A NCAC 02B .0506(b)(c)]
Impact Area
Temporary/Permanent
Impact Amount
404/401 Wetlands
Permanent
0.16 acres
2. This approval is for the purpose and design described in your application. The plans and
specifications for this project are incorporated by reference as part of the Certification.
If you change your project, you must notify the Division and you may be required to
submit a new application package with the appropriate fee. If the property is sold, the
Winston-Salem Regional Office
Location: 450W. Hanes Mil Rd, Suite 300. Winsron-Salem, North Carolina 27105
Phone: [phone]M FAX: 336-77$-97971 Customer Service: t-877.623.6748
Internet http:llponai.ncadenr.orgNreblwqilws
An Equal Opportunity \ Affirmadve Action Employer

Parr Construction
DWR# 15-0342
401 APPROVAL
Page 2 of 3
new owner must be given a copy of this approval letter and General
Certifications)/Permit/Authorization and is responsible for complying with all
conditions. [15A NCAC 02B .0507(d)(2)]
3. All wetlands, streams, surface waters, and riparian buffers located within 50 feet of the
construction area on the project site shall be clearly marked (example- orange fabric
fencing) prior to any land disturbing activities and must be maintained on the property
until the project phase is completed. [15A NCAC 02H .0506 (b)(2) and (c)(2) and 15A
NCAC 02H .0507 (c)]
4. Any final construction plans for this project must include or reference the application
and plans approved by the Division under this authorization letter and certification. The
applicant will also be required to evaluate all acquired permits to assure that they are
consistent and all relative impacts are accounted for and shown on the construction
plans. [15A NCAC 02H.0502 (b) and 15A NCAC 02H.0506 (4)]
5. You are required to provide one copy of the approved SMP, including plan details. on
full-sized plan sheets, with proof of the Town of Kernersville's approval. The approved
SMP shall be submitted to the DWR 401 & Buffer Permitting Unit (1617 Mail Service
Center, Raleigh, NC 27699-1617) before any impacts authorized in this certification
occur. After it is approved and submitted to the Division, the SMP may not be modified
without prior written authorization from the Town of Kernersville If the SMP is modified
in the future, then you shall provide one modified SMP with proof of approval to the
DWR 401 & Buffer Permitting Unit prior to the commencement of the modifications.
[15A NCAC 02H .0506(b)(5)]
This approval and its conditions are final and binding unless contested. [G.S. 143-215.5]
This Certification can be contested as provided in Articles 3 and 4 of General Statute 1506 by
filing a written petition for an administrative hearing to the Office of Administrative Hearings
(hereby known as OAH) within sixty (60) calendar days.
A petition form may be obtained from the OAH at http:llwww.ncoah.com/ or by calling the
OAH Clerk's Office at [phone] for information. A petition is considered filed when the
original and one (1) copy along with any applicable OAH filing fee is received in the OAH during
normal office hours (Monday through Friday between 8:00am and 5:00pm, excluding official
state holidays).
The petition may be faxed to the OAH at [phone], provided the original and one copy of
the petition along with any applicable OAH filing fee is received by the OAH within five (5)
business days following the faxed transmission.

Parr Construction
DWRii 15-0342
401 APPROVAL
Page 3 of 3
Mailing address for the OAH:
If sending via US Postal Service: If sending vio delivery service (UPS, FedEx, etc):
Office of Administrative Hearings Office of Administrative Hearings
6714 Mail Service Center 1711 New Hope Church Road
Raleigh, NC 27699-6714 Raleigh, NC 27609-6285
One (1) copy of the petition must also be served to DEN R:
John Evans, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, NC 27699-1601
This letter completes the review of the Division under section 401 of the Clean Water Act.
Please contact Sue Homewood at 336-776-9693 or [e-mail] if you have any
questions or concerns.
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Enclosures: GC 3890
cc: Walter Cole, S&ME Inc (via email)
John Thomas, USACE Raleigh Regulatory Field Office (via email)
Jeff Smith, Smith -Bissell LLC & 1-40 Union Cross LLC, PO Box 2534 Kernersville NC 27285
Nancy Smith, 833 Lynnhaven Park Dr, Winston Salem NC 27107
DWR WSRO 401 files
DWR 401 & Buffer Permitting Unit

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2013-01674 County: Forsyth U.S.G.S. Quad: NC-KERNERSVILLE
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee:
Address
Telephone Number:
Parr Construction
Chris Parr
P.O. Box 4088
Greensboro, NC, 27404
Size (acres) 84 Nearest Town Kernersville
Nearest Waterway Fiddlers Creek River Basin Upper Yadkin. Virginia North Carolina
USGS HUC 3040101 Coordinates Latitude: 36.078852
Longitude: -80.104768
Location description: Smith Crossing Mixed Use Development project located off of 1455 Union Cross Road, adjacent to Fiddlers
Creek, Kernersville, Forsyth County, North Carolina.
Description of projects area and activity: Smith Crossing proposed multi -family apartment complex project located off of Union
Cross Road adjacent to a tributary of Fiddlers Creek, south of Kernersville, in Forsyth County, North Carolina. Propose project
construction includes road access construction resulting in fill of 0.099 acre of jurisdictional wetlands of Fiddlers Creek.
Per Your request of April 7, 2015, to modify your permit to include 0.06 acre of wetland impacts associated with the
construction of a residential unit this verification is modified to include the additional 'urisdictional wetland impact to result
in a total 0.16 acre of jurisdictional impact for the current development
Special Condition: In order to compensate for impacts associated with this permit, mitigation shall be provided in
accordance with the provisions outlined on the most recent version of the attached Compensatory Mitigation
Responsibility Transfer Form. The requirements of this form, including any special conditions listed on this form
are hereby incorporated as special conditions of this permit authorization
Applicable Law: N Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number or Nationwide Permit Number: NWP 39 Commercial and Institutional
Developments.
SEE ATTACHED RGP or NWP GENERAL, REGIONAL AND SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application and attached information dated 04/24/2015. Any violation of the attached
conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration order, a Class
I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are
under construction) or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Quality (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management in Morehead City, NC, at [phone].

Aw-2413-01674
this Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
m s
program, please contact John Tho919-554-480 x25 or John.T.Thomas.MC&,usace.armv.mil.
Corps Regulatory Official: Date: 04/24/2015
Expiration Date of Verificatio /18/2017
Determination of Jurisdiction:
A. ❑ Based on preliminary information, there appear to be waters of the US including wetlands within the above described project
area. This preliminary detennination is not an appealable action under the Regulatory Program Administrative Appeal Process
( Reference 33 CFR Part 331).
B. ❑ There are Navigable Waters of the United States within the above described project area subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
C. ® There are waters of the US and/or wetlands within the above described project area subject to the permit requirements of
Section 404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published regulations,
this determination may be relied upon for a period not to exceed five years from the date of this notification.
D. ❑ The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued . Action ID: SAW -
Basis For Determination: Site has tributary o f Fiddlers Creek which is a tributary of the Yadkin River which
flows to the Pee Dee River in South Carolina and on to the Atlantice Ocean.
Remarks:
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination may not be valid for the wetland conservation provisions of the Food Security
Act of 1985. If you or your tenant are USDA Program participants, or anticipate participation in USDA programs, you should request
a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B
and C above).
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this determination you
must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1OM15
Atlanta, Georgia 30303-8801
Phone: [phone]

SAW-2013-01674
In order'for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has bee received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be ceived at the above address by
**It is not necessary to submit an RFA to the Division f ce if you don t object to the determination in this correspondence.**
Corps Regulatory Official:
ohn homas
Date of JD: 11/12/2014
Expiration Date of JD: 03/18/2017
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete our customer Satisfaction Survey online at http://re�,-ulatorv.usacesurvev.coin/.
Copy furnished:
Agent: S&ME, Inc.
Walter Cole
Address: 3201 Spring Forest Road
Raleigh, NC, 27616
Telephone Number:

Action ID Number: SAW -2013-01674 County: Forsyth
Permittee: Parr Construction
Chris Parr
Project Name: Smith Crossing Mixed Use Development
Date Verification Issued: 04/24/2015
Project Manager: John Thomas
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
Attn: John Thomas
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee
Date

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Parr Construction
Chris Parr
File Number: SAW -2013-01674
Date: 04/24/2015
Attached is: See Section below
❑ INITIAL PROFFERED PERMIT Standard Permit or Letter ofpermission)
A
❑ PROFFERED PERMIT (Standard Permit or Letter ofpermission)
B
❑ PERMIT DENIAL
C
❑ APPROVED JURISDICTIONAL DETERMINATION
D
® PRELIMINARY JURISDICTIONAL DETERMINATION
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or littp://«,�vw.usace.ariny.mil.:Missions/'Civil'forks/Re-,Julatoa.-ProEramatidPertnits.aspx
or the Corps reaulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the pen -nit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.

D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division, Attn:
Mr. Jason Steele, Administrative Appeal Review Officer
John Thomas
CESAD-PDO
U.S. Army Corps of Engineers, South Atlantic Division
60 Forsyth Street, Room 10M 15
Atlanta, Georgia 30303-8801
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the o ortunity to participate in all site investigations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: John Thomas, 69 Darlington Avenue, Wilmington, North Carolina
28403
For Permit denials, Proffered Permits and approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Administrative Appeal
Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

Appendix IV

NC Division of Water Quality -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC DWQ Stream Identification Form Version 4.11
Date: March 2, 2016
Project/Site: Smith Crossing Development
Latitude: 36.077256 N
Evaluator: Walter Cole, LSS - S&ME
county: Forsyth
Longitude: -$0.103116 W
Total Points:
Stream is at least intermittent 28,25
Stream Determination (circle one)
Intermittent
Other
e.g. Quad Name: Kernersville
if z 19 or perennial if z 30•
2. Sinuosity of channel along thalweg
0
A. Geomorphology Subtotal = 15
Absent
Weak
Moderate
Strong
18, Continuity of channel bed and bank
0
1
2 •
3
2. Sinuosity of channel along thalweg
0
1
2
3 r.
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0 O
1
2 ©
3
4. Particle size of stream substrate
0
1
2 •
3
5. Active/relict floodplain
08
1 •
2
3
6. Depositional bars or benches
0
1
2 •
3
7. Recent alluvial deposits
0
1
2 •
3
8. Headcuts
0 •
1
2
3
9. Grade control
0
0.•
1
1.5
10. Natural valley
0
0. 1
1
1.5 •
11. Second or greater order channel
No = OM I
Yes = 3
annium oncnes are not rates; see discussions in manual
B. Hvdrologv (Subtotal = 7.5 1
12. Presence of Baseflow
00
1()
2 Q
30
13. Iron oxidizing bacteria
0 •
1
2
3
14. Leaf litter
1.
1 •.
0.
0
15. Sediment on plants or debris
0
0.5
1 •.
1.5
16. Organic debris lines or piles
0
0.5 •
1
1.5
17. Soil -based evidence of high water table?
No=00
0.5
Yes = 3
0
U. t5lologv (Subtotal = 5.15
18. Fibrous roots in streambed
3
2 •
1
0
19. Rooted upland plants in streambed
3 •
2
1
0
20. Macrobenthos (note diversity and abundance)
0 •
1
2
3
21. Aquatic Mollusks
0 •
la
2
3
22. Fish
0 •
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians0
•
0.5
1
1.5
25. Algae
0 •
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.7500BL = 1.500ther = 00
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
41

1
2
3
4
5
U
'~ 6
0.i 7
8
9
10
11
12
E -r
a 13
14
F
COD 15
16
F* 17
H
18
x 19
20
21
22
a
O
pa 23
STREAM QUALITY ASSESSMENT WORKSHEET
FF.ATIIRF. A AT Rnen runcciNC-
CHARACTERISTICS
Presence of flow / persistent pools in stream
(no flow or saturation = 0; strong flow = max points)
Evidence of past human alteration
(extensive alteration = 0; no alteration = max points)
Riparian zone
(no buffer = 0; contiguous, wide buffer = max points)
Evidence of nutrient or chemical discharges
(extensive discharges = 0; no discharges = max points)
Groundwater discharge
no discharge = 0; springs, seeps, wetlands, etc. = max poir
Presence of adjacent floodplain
(no floodplain = 0; extensive floodplain = max points)
Entrenchment / floodplain access
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands
(no wetlands = 0; large adjacent wetlands = max points)
Channel sinuosity
extensive channelization = 0; natural meander = max point
Sediment input
extensive deposition= 0; little or no sediment = max point
Size & diversity of channel bed substrate
(fine, homogenous = 0; large, diverse sizes = max points)
Evidence of channel incision or widening
(deeply incised = 0; stable bed & banks = max points)
Presence of major bank failures
(severe erosion = 0; no erosion, stable banks = max points
Root depth and density on banks
(no visible roots = 0; dense roots throughout = max points
Impact by agriculture, livestock, or timber production
(substantial impact =0; no evidence = max points)
Presence of riffle-pool/ripple-pool complexes
10 riffles/ripples or pools = 0; well-developed = max point
Habitat complexity
ttle or no habitat = 0; frequent, varied habitats = max poin
Canopy coverage over streambed
io shading vegetation = 0; continuous canopy = max point!
Substrate embeddedness
(deeply embedded = 0; loose structure = max)
Presence of stream invertebrates (see page 4)
(no evidence = 0; common, numerous types = max points)
Presence of amphibians
(no evidence = 0; common, numerous types = max points)
Presence of fish
(no evidence = 0; common, numerous types = max points)
Evidence of wildlife use
(no evidence = 0; abundant evidence = max points)
Total Points Possible
ECOREGION
POINT RANGE
SCORE
Coastal
Piedmont
Mountain
0-5
0-4
0-5
4
0-6
0-5
0-5
2
0-6
0-4
0-5
3
0-5
0-4
0-4
0
0-3
0-4
0-4
1
0-4
0-4
0-2
0
0-5
0-4
0-2
2
0-6
0-4
0-2
0
0-5
0-4
0-3
4
0-5
0-4
0-4
3
NA*
0-4
0-5
2
0-5
0-4
0-5
2
0-5
0-5
0-5
4
0-3
0-4
0-5
3
0-5
0-4
0-5
3
0-3
0-5
0-6
1
0-6
0-6
0-6
3
0-5
0-5
0-5
3
NA*
0-4
0-4
2
0-4
0-5
0-5
0
0-4
0-4
0-4
p
0-4
0-4
0-4
0
0-6
0-5
0-5
2
100
100
100
TOTAL SCORE (also enter on first page)
*These characteristics are not assessed in coastal streams
44

Appendix V

Yry
a
r
t,' !
1
�iow of Stream (Feature A) where proposed road will
rss, looking upstream where NCDWR and USACE
tream Forms were recorded.
Wit
AI
tr
/iew of alluvial deposit adjacent to stream where Data
'oint was recorded. Vegetation consisted of cat tails,
uncus smilax microste ium cherry and maple saplings.
"ME Smith Crossing Mixed Use Development Project S&ME Project No. 4305-14-228
Union Cross Road, Kernersville, Forsyth County, North Carolina Taken by: W. Cole Date Taken: March 2016
1