20171439 Ver 1_401 Application_20171108

Montalvo, Sheri A
From: Montalvo, Sheri A
Sent: Thursday, November 09, 2017 11:45 AM
To: [e-mail]
Subject: Finley Ridge
Attachments: Agent Authorization Form.pdf
Importance: High
Nancy,
We have received the PCN for the above. Page 11 of 11 shows your signature and will
require a completed agent authorization form to be filled out in order for me to take the
project off hold an forward through the review process. I have attached one for your
use. Once competed please email it back to me.
Thanks
Sheri Montalvo
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.montalvoQncdenr.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.
1

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO,
STREET ADDRESS: 705 Pisgah Church Road
Greensboro, NC
Please print:
PDR Horton, Inc.
Property owner:
Property Owner:
PARCEL ID: 0092489
The undersigned, registered property owners of the above noted property, do hereby authorize
Nancy Scott
(Contractor / Agent)
of Three Oaks Engineering
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance
of this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
8001 Arrowridge Blvd, Charlotte, NC 28273
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to
the best of our knowledge.
authorized Signature Authorized Signature
Date: �� I"� Date:

EEq/NC,
NOV 0 8 2017•
N�N33N\`�
November 3, 2017
David Bailey
20171439
Three Oaks Engineering, Inc.
324 Blackwell Street, Suite 1200
Durham, NC 27701
[phone]
Jennifer Burdette
Raleigh Regulatory Field Office NC Division of Water Resources
US Army Corps of Engineers 401 & Buffer Permitting Branch
3331 Heritage Trade Drive, Suite 105 512 North Salisbury Street
Wake rorest, NC 27587 Raleigh, NC 27604
SUBJECT: Nationwide Permit 12 Application for the Construction of a Residential Development
Greensboro (PIN: 7866268536)
SAW -2017-00592. Guilford County, NC
Evans Engineering proposes the construction of a residential development in Guilford County, NC in the City of
Greensboro. The project consists of 71 townhomes on a 10.57 acre parcel. The project will require installation of a
sewer line, which will cross a stream and a wetland. Cut/fill operations will result in approximately 4.72 acres of
built upon area.
Please find enclosed a PCN form, USGS quad map, Jurisdictional Determination documents, and Survey Platt with
the proposed building footprints.
The North Carolina Natural Heritage Database was checked for records of threatened and endangered species. The
US Fish and Wildlife Service (USFWS) lists two species for Guilford County that have federal status. Small whorled
pogonia !Isotria medeoloides) is listed as threatened. The Bald eagle is protected in every county in North Carolina
under the Bald and Golden Eagle Protection Act. Suitable feeding/water sources (Philadelphia Lake and Richland
Lake) are located within one mile of the project study area, which could support Bald eagle. A review of the July
2017 North Carolina Natural Heritage Program's (NCNHP) database of rare species indicates no known occurrences
of Bald eagle are found within 1.0 mile of the project area.
Small whorled pogonia generally occurs in open, dry, deciduous woods with acid soil, according to the USFWS.
However, it is also known to occur in a variety of habitats in North Carolina, including along streams. The project
site is mostly forested, with a stream and wetland complex on the western side of the site. There are maintained
road right of ways along the northern border of the site. NCNHP records indicate no known occurrences of small
whorled pogonia are found within 1.0 mile of the project area. The USFWS was consulted regarding surveying for
the small whorled pogonia outside of the recommended survey window. Based on relatively small size and location
of the project, combined with Three Oaks personnel experience with identifying small whorled pogonia, the USFWS
agreed that such a survey could be performed. As such, a survey conducted on November 2, 2017 concluded that
no small whorled pogonia were within the project site.
A review of the HPOWEB GIS Service, a service maintained by State Historic Preservation Office (SHPO), on October
18, 2017 found no historic buildings within 1.0 mile of the subject project. There is a residential building currently
Three Oaks Engineering

located on the property site that was built in 1945. The building is not identified on the HPOWEB website as a
potential site for historic preservation, so no further coordination was done with SHPO. Tht current structure will
be removed for the construction of the residential development.
Impacts to Waters of the United States
The project area is adjacent to an unnamed tributary (UT) to Philadelphia Lake. The UT to Philadelphia Lake (DWR
WS -V; NSW) is on the USGS topographic map as a perennial stream. The proposed impact site is approximately 1.1
river mile (RM) to Philadelphia Lake. Philadelphia Lake flows approximately 2.1 RM to North Buffalo Creek, which
flows 10 RM to Buffalo Creek. Buffalo Creek flows 8.6 RM to Reedys Fork, which flows 8.4 RM to the Haw River.
Haw River meets the definition of a Traditional Navigable Water. For these reasons, we believe the unnamed
tributary to Philadelphia Lake is a Relatively Permanent Water and is under the jurisdiction of the U.S. Army Corps
of Engineers. In order to construct the project, it will be necessary to impact waters of the United States in the
Cape Fear River Basin (HUC 03030002). Specifically, Evans Engineering is requesting to temporarily impact the
stream and associated wetland to install a new sanitary sewer line. The impacts are listed in the tables below:
Existing Condition (Map ID) Proposed Condition Net Impacts
Wetland (WA) Fill Temporary: <0.01 acre
Stream (SA) Fill Temporary: 80 linear feet
Avoidance and Minimization
The proposed project is to install a new sanitary sewer line to provide service to a new residential development,
which requires the crossing of a UT to Philadelphia Lake. As the only nearby sanitary sewer available for this
property is the existing manhole located on the adjacent property to the west, these impacts cannot be avoided.
Impacts are expected to be minimal, as the crossing will be done perpendicular to the stream and at the most
narrow part of the wetland. Impacts will be temporary.
Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work
area to prevent sedimentation of downstream aquatic resources. Impacts will be minimized by through use of Best
Management Practices for the protection of surface waters, restrictions against the staging of equipment in or
adjacent to waters of the US, and coordination with appropriate agency personnel.
Permits Requested
Evans Engineering is hereby requesting authorization under Section 404 of the Clean Water Act to proceed with the
construction project outlined above. We are also requesting a 401 Water Quality Certification from the North
Carolina Department of Environment and Natural Resources (DENR), Division of Water Resources (DWR).
If you have any questions or need additional information, please contact me by mail, by email at
[e-mail], or at [phone]. Your review and consideration are greatly
appreciated.
Sincerely,
Nancy Scott
Environmental Scientist
?hm Oaks EngineerbW thieeaaksengineerinq corn

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
® Section 404 Permit ❑Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1c.
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
1e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
❑ No
2.
Project Information
2a.
Name of project:
Finley Ridge at 705 Pisgah Church Rd, Greensboro, NC
2b.
County:
Guilford
2c.
Nearest municipality / town:
Greensboro
2d.
Subdivision name:
Morehead
2e.
NCDOT only, T.I.P. or state
project no:
N/A
3.
Owner Information
3a.
Name(s) on Recorded Deed:
DR Horton, Inc
Map Book 7982, Page 471-474
3b. Deed Book and Page No.
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
8001 Arrowridge Blvd
3e.
City, state, zip:
Charlotte, NC 28273
3f.
Telephone no.:
[phone] 401 & B FF R P
I
3g.
Fax no.:
3h.
Email address:
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: Engineer
4b. Name:
Lee Bryant
4c. Business name
(if applicable):
Evans Engineering, Inc.
4d. Street address:
4609 Dundas Drive
4e. City, state, zip:
Greensboro, NC 27407
4f. Telephone no.:
[phone]
4g. Fax no.:
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
Nancy Scott
5b. Business name
(if applicable):
Three Oaks Engineering
5c. Street address:
324 Blackwell St, Suite 1200
5d. City, state, zip:
Durham, NC 27701
5e. Telephone no.:
[phone]
5f. Fax no.:
5g. Email address:
[e-mail]
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
7866268536
1 b. Site coordinates (in decimal degrees):
Latitude 36.128236 Longitude: -79.803470
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
10.57 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
UT to Philadelphia Lake
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS -V; NSW
2c. River basin:
Cape Fear River Basin (HUC 03030002)
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 project study area is comprised of hardwood forest and maintained roadway along Pisgah Church Rd and nearby
residences. In addition to the UT to Philadelphia Lake, there are two wetlands on the property.
3b. List the total estimated acreage of all existing wetlands on the property:
0.025
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
341
3d. Explain the purpose of the proposed project:
To construct a residential development.
3e. Describe the overall project in detail, including the type of equipment to be used:
The proposed project is the construction of a residential development. A sewer line will be installed under a UT to Philadelphia
Lake (noted as stream SA on plans) on the western side of the propoerty (see attached plans). Erosion and sedimentation
control measures will be implemented in accordance with state regualtions. The sewer line will be installed via an open cut.
Water will be pumped around the work area during construction by installed impervious dikes upstream of the proposed
crossing. Equipment to be used includes a track hoe, dump truck, pumps, and various hand tools.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes [I No El Unknown
project (including all prior phases) in the past?
Comments: N/A
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: Three Oaks Engineering
Name (if known): Chris Sheats, PWS
Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
March 21, 2017; SAW 2017-00592
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
N/A
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
N/A
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - 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
Fill
Headwater Forest
® Yes
❑ No
® Corps
® DWQ
<0.01
2g. Total wetland impacts
<0.01
2h. Comments: Impacts will be less than 0.01 acre of wetland.
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
intermittent
DWQ - non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ® T
Excavation
UT to Philadelphia
® PER
® Corps
3-6
20
Lake
❑ INT
I ❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total Permanent Stream and Tributary Impacts
3i. Comments: N/A
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P)
or Temporary T
01 ❑P❑T
4f. Total open water impacts
4g. Comments: There are no open water impacts.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version

5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose of
(acres)
number
pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments: There are no ponds created for 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:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P)
for
Stream name
mitigation
(square feet)
(square feet)
or Temporary T
impact
required?
B1 ❑P❑T
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments: N/A
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The only way to connect the proposed devlopment to the existing sewer utility is to cross the UT to Philadelphia Lake. The
crossing location was designed to be perpendicular to the stream and at the most narrow part of the wetland. The
devlopment was designed to leave the exsiting vegetated buffer of at least 30 feet around the UT to Philadelphia. The
proposed project is to install a new sanitary sewer line to provide service to a new residential development, which requires the
crossing of a UT to Philadelphia Lake. As the only nearby sanitary sewer available for this property is the existing manhole
located on the adjacent property to the west, these impacts can not be avoided. Impacts are expected to be minimal, as the
crossing will be done perpendicular to the stream. Impacts will be temporary.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion and sedimentation BMPs will be installed prior to construction and properly maintained in accordance with
state/federal regulations. Water will be diverted around the work area to prevent sedimentation of downstream aquatic
resources. Tree removal / vegetative disturbance will be kept to the minimum necessary to install the sewer line.
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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:
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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?
❑ 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
PCN Form —Version 1.3 December 10, 2008 Version

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
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: The project is located in the Jordan Lake protected watershed, but the
❑ Yes ® No
stream on the project does not qualify for buffer protections, as it is not on the
USGS topographic map or the soil survey map. Therefore, a diffuse flow plan is not
required.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
44.7%
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:
Plan is attached.
® 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?
Greensboro
® Phase II
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ 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
❑ HOW
4a. Which of the following state -implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the 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
❑ 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.
The construction of a residential development will not result in future impacts. The property is located in a residential
area, and most of the other properties in the vicinity have been developed. Therefore, this project is not anticipated to
result in further impact the area.
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 generated from the proposed project will be connected to existing sewer lines in the City of Greensboro.
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
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
® Yes ❑ No
impacts?
® Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville '
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NCNHP Database and field review
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?
This building construction project takes place in Guilford County which is not near any coastal or tidal habitat that would
support EFH (i.e. salt marshes, oyster reefs, etc.).
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?
A review of the NC SHPO HPOWEB GIS service on October 18, 2017 found no historic buildings within 1.0 mile of the
subject project. Therefore, it is not likely that any historic properites would be affected by this project.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements: N/A
8c. What source(s) did you use to make the floodplain determination? North Carolina Floodplain Mapping Program
Nancy Scott
11/3/17
Applicant/Agent's Signature
Applicant/Agent's Printed Name
Date
(Agent's signature is valid only if an authorization letter from the
applicant isprovided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

��j�l\lI ftu Prepared Fir
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Mr. Bill Eudy
Pisgah Church Road
Jurisdictional Waters
Assessment
Jurisdictional Features Map
Guilford County, North Carolina
Date* February 2017
Scale: 040 80 Feet
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Job No : 16-611
Drawn By:
Checked By
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Figure

����1NEEIP/y� Prepared For.
Mr. Bill Eudy
33N
Pisgah Church Road
Jurisdictional Waters Assessment
USGS 7.5 Minute
Topographic Quadrangle Map
Guilford County, North Carolina
Dace. February 2017
Scales 0 50 100 Feet
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U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2017-00592 County: Guilford U.S.G.S. Quad: NC -LAKE BRANDT
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner/Applicant: Susie Eudy Agent: Three Oaks Engineering
Address: 1348 Miles Chapel Rd. attn: Chris Sheats
Mebane, NC 27302 Address: 324 Blackwell Street, Suite 1200
Durham, NC 27701
Size (acres) 11.56 Nearest Town Greensboro
Nearest Waterway UT to Philadelphia Lake River Basin Cape Fear
USGS HUC 03030002 Coordinates 36.128411° N, -79.802774° W
Location description: The project area is located on the south side of Pisgah Church Road, approximately 0.2 mile
west of its intersection with Baylor Street at 705 Pisgah Church Road, in Greensboro, Guilford County, North
Carolina The project area boundaries are shown as the "Study Area" on the attached sketch labeled "Figure 1."
Indicate Which of the Following Apply:
A. Preliminary Determination
X There are waters, including wetlands, on the above described project area, that may be subject to Section 404 of
the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC §
403). The waters, including wetlands, have been delineated, and the delineation has been verified by the Corps to
be sufficiently accurate and reliable. Therefore this preliminary jurisdiction determination may be used in the
permit evaluation process, including determining compensatory mitigation. For purposes of computation of
impacts, compensatory mitigation requirements, and other resource protection measures, a permit decision made
on the basis of a preliminary JD will treat all waters and wetlands that would be affected in any way by the
permitted activity on the site as if they are jurisdictional waters of the U.S. This preliminary determination is not
an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part 331).
However, you may request an approved JD, which is an appealable action, by contacting the Corps district for
further instruction.
_ There are wetlands on the above described property, that may be subject to Section 404 of the Clean Water Act
(CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). However, since the
waters have not been properly delineated, this preliminary jurisdiction determination may not be. used in the permit
evaluation process. Without a verified wetland delineation, this preliminary determination is merely an effective
presumption of CWA/RHA jurisdiction over all of the waters at the project area, which is not sufficiently accurate and
reliable to support an enforceable permit decision. We recommend that you have the waters of the U.S. on your property
delineated. As the Corps may not be able to accomplish this wetland delineation in a timely manner, you may wish to
obtain a consultant to conduct a delineation that can be verified by the Corps.
B. Approved Determination
There are Navigable Waters of the United States within the above described property subject to the permit requirements of
Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act (CWA)(33 USC
§ 1344). Unless there is a change in 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.
_ There are waters of the U.S., including wetlands, on 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.
_ We recommend you have the waters of the U.S. on your property delineated. As the Corps may not be able to
accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that
can be verified by the Corps.
_ The waters of the U.S., including wetlands, on the above described project area have been delineated and the
delineation has been verified by the Corps. If you wish to have the delineation surveyed, the Corps can review and verify
the survey upon completion. Once verified, this survey will provide an accurate depiction of all areas subject to CWA
Page 1 of 2

and/or RHA jurisdiction on your property which, provided there is no change in the law or our published regulations,
may be relied upon for a period not to exceed five years.
_ The waters of the U.S., including wetlands, have been delineated and surveyed and are accurately depicted on the plat
signed by the Corps Regulatory Official identified below on . 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.
_ There are no waters of the U.S., to include wetlands, present on the above described project area which are subject to the
permit requirements of Section 404 of the Clean Water Act (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.
The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act
(CAMA). You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to
determine their requirements.
Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit
may constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material,
construction or placement of structures, or work within navigable waters of the United States without a Department of the
Army permit may constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If
you have any questions regarding this determination and/or the Corps regulatory program, please contact David Bailey at
[phone] X 30 or David.E.Bailev2()usace.army.mil.
C. Basis For Determination:
The proiect area exhibits water bodies with indicators of ordinary high water marks and wetland criteria as defined in
the applicable regional supplement to the 1987 wetland delineation manual. The water bodies on the site are listed in
the attached table. This determination is based on a field verification by David E. Bailey (USACE) on 2/14/2017.
D. Remarks:
The water bodies in the Proiect Area were flagged by Three Oaks Engineering, with changes made in the field by David
E. Bailey (USACE), and are approximated on the attached sketch labeled "Figure 1,"
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. 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 fmd 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 10M15
Atlanta, Georgia 30303-8801
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 been 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 received at the above address by N/A.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence.** Digitally signed byovern ent,o.E.1 379283736
=DoD,ou=PKI
DN: c=US, o=US. Government, ou=8373 ou=PKI.
ou=USA,cn=BAILEY.DAVID.E.1379283736
Corps Regulatory Official: Date: 2017.0321 13:27:20-04'00'
Date: March 21, 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, located online at
http://co!psmapu.usace.amly.mil/cm apex/t°p=136:4:0.
Copy furnished:
Sue Homewood, NCDEQ-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston-Salem, NC 27105

�AEE%eOA-
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Prepared For.
Mr. Bill Eudy
Pisgah Church Road
Jurisdictional Waters
Assessment
Jurisdictional Features Map
Guilford County, North Carolina
Date: February 2017
Scale: o 40 80 Feet
L— t t
Job No 16-611
Drawn By:
Checked By:
NDH
CMS
Figure

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: March 21, 2017
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Susie Eudy, 1348 Miles Chapel Road, , NC, 27302.
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, 705 Pisgah Church Road / Greensboro / Guilford
County / residential, SAW -2017-00592
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Guilford City: Greensboro
Center coordinates of site (lat/long in degree decimal format): Lat.: 36.12841130838960 Long.: -79,8027739609952°
Universal Transverse Mercator:
Name of nearest waterbody: UT to Philadelphia Lake
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
® Field Determination. Date(s): 2/14/2017
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
Number
Latitude (decimal
degrees)
Longitude
(decimal degrees)
Estimated amount of
aquatic resources in
review area (acreage
and linear feet, if
applicable
Type of aquatic
resources (i.e.,
wetland vs. non-
wetland waters)
Geographic authority to
which the aquatic resource
"may be" subject (i.e.,
Section 404 or Section
10/404
SA
36.128236
-79.803470
340.61 linear feet
Non -wetland
Section 404
WA
36.128098
—79.803479
0.05 acre
Wetland
Section 404
WB
36.128332
—79.803504
0.05 acre
wetland
Section 404

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
A.PPE
Applicant: Susie Eudy File Number: SAW -2017-00592 Date: March 21 2017
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.
Y 4 niau�ilf�rn�zt>_,�,1,� or
Additional information may be found atlltl�. ������.�� ;�,c�..rrniV.nnt �l��,iun� C �vilkko,�k, RL,2kiI.itt;i [ �ooi-a
Corps regulations 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 permit 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 11- 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
Mr. Jason Steele, Administrative Appeal Review Officer
attn: David E. Bailey
CESAD-PDO
Raleigh Regulatory Field Office
U.S. Army Corps of Engineers, South Atlantic Division
3331 Heritage Trade Drive, Suite 105
60 Forsyth Street, Room 1OM15
Wake Forest, North Carolina 27587
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 ortuni to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant oragent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, David Bailey, 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]