20181080 Ver 1_401 Application_20180818

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Corps action ID no.
DWQ project no. _
Form Version %4AC
20181080
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
Pre -Construction Notification PCN Form
A. Applicant Information
1.
Processing
1a. Type(s) of approval sought from the
Corps:
N Section 404 Permit ElSection 10 Permit
1b.
Specify Nationwide Permit (NWP) number: NWP 29 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:
❑ 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
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
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:
Drummond Place
2b.
County:
Forsyth
2c.
Nearest municipality / town:
Kernersville
2d. Subdivision name:
Drummond Place
2e.
NCDOT only, T.I.P. or state
project no:
AUU0 3 2018
3.
Owner Information 8 =4L17Y
3a.
Name(s) on Recorded Deed:
SMI Properties, LLC 77NG
3b.
Deed Book and Page No.
003357/04414
3c.
Responsible Party (for LLC if
applicable):
Mr. Brian Shugart
3d.
Street address:
221 Jonesville Road
3e. City, state, zip:
Winston Salem, NC 27104
3f.
Telephone no.:
336.765.9661
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:
Bradley S. Luckey
5b. Business name
(if applicable):
Pilot Environmental Inc.
5c. Street address:
PO Box 128
5d. City, state, zip:
Kemersville, NC 27285
5e. Telephone no.:
336.708.4997
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
1 a. Property identification no. (tax PIN or parcel ID):
6897126408
1 b. Site coordinates (in decimal degrees):
Latitude: 36.14214 Longitude: - 80.04482
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
35 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Beaver Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS -III, NSW
2c. River basin:
Cape Fear
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The site contains undeveloped wooded land and agricultural fields. Residential structures are located on portions of the
site. The site is located in a residential/rural area of Kemersville, Forysth County, North Carolina
3b. List the total estimated acreage of all existing wetlands on the property:
—1.5 Acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
—2,500 LF perennial stream
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to provide wastewater treatment and long term maintenane access to wastewater
septic systems.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project consists of development of the site with a residential sub -division. In order to provide maintenance
access and wastewater services, an access road and 3 wastewater utility line crossings are necessary. To facilitate
development of the site and construction of the proposed stream crossings, clearing and grading portions of the site are
necessary. Graders, haulers, excavators and other heavy equipment will be used during site construction.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes El No El Unknown
project (including all prior phases) in the past?
Comments: SAW -2016-01703
4b. If the Corps made the jurisdictional determination, what type
®Preliminary E] Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: Pilot Environmental, Inc.
Name (if known): Bradley Luckey/Michael Brame
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW -2016-01703=9.13.16. DWR=10.17.16
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.
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.
The project is not part of a phased project. Impacts t6streams/wetlands, outside of those proposed in this application,
are not anticipated as a result of the proposed project.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 []PST
Sewer Line
PFO
® Yes
❑ No
® Corps
® DWQ
0.026
W2 ❑ P ®T
Sewer Line
PFO
® Yes
❑ No
® Corps
® DWQ
0.036
W3 SPOT
Culvert Fill/Pump
Around
PFO
® Yes
❑ No
® Corps
®DWQ
0.062/0.046
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
0.062/0.108
2h. Comments: The road crossing will permanently impact 0.062 acres of wetlands from culvert fill and temporarily impact
0.046 acres of wetlands from de -watering pump around. Sewer line crossing #1 will temporarily impact 0.026 acres of
wetlands. Sewer line crossing #2 will temporarily impact 0.036 acres of wetlands. The sewer line crossings will include de-
watering stream pump around and open cut/backfill sewer line installation. Temporary impacts from the road/utility crossings
will be resorted to similair pre -construction grade and planted.
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
Sewer Line
Unnamed
® PER
❑ INT
® Corps
® DWQ
6
20
S2 ❑ P ® T
Sewer Line
Unnamed
® PER
❑ INT
® Corps
® DWQ
6
20
S3 ❑ P ® T
Sewer Line
Unnamed
® PER
❑ INT
® Corps
® DWQ
6
20
S4 SPOT
Culvert Fill/Rip-
Rap/Pump Around
Unnamed
® PER
❑ INT
® Corps
® DWQ
6
40/30/50
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
40/30/110
3i. Comments: Sewer line crossings #1-3 will cumulatively result in temporary impact to 60 linear feet of perennial stream
channel 20 LF/crossing). The proposed road crossing will permanently impact 40 linear feet of stream channel with culvert fill
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

and 30 linear feet with keyed in rip -rap dissipater. Additionally, the proposed road crossing will temporarily impact 50 linear
feet of stream channel with pump around. Areas of temporary impact from the sewer line and road crossings will be restored
to similair pre -construction beds/banks conditions, matted and seeded.
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.
Open water
impact number —
Permanent (P) or
Temporary
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody type
4e.
Area of impact (acres)
01 ❑ PEI T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments: Open water impacts are not proposed.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
Pond ID
number
5b.
Proposed use or purpose
of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
K Total
5g. Comments: Construction of ponds/lakes are not proposed.
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:
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 El Tar-Pamlico ®Other. Lake Jordan
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) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary
impact
re uired .
B1 ❑P
El Yes
❑ No
B2 ❑P
El Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments: Proposed buffer impacts are exempt. Therefore, the applicant is not requesting a buffer authorization
certificate from NCDEQ-DWR or delgated local municipality.
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 road crossing location was selected in an area of stream that is relatively straight with few meanders. The applicant has
further demonstrated avoidance and minimization of stream impacts by proposing to construct approximately 2.5 feet tall
culvert head/end walls and utilize 2:1 road side slopes. Furthermore, the Applicant has designed rip-rap stabilization measure
to be keyed into existing grades of beds and banks to 30 linear feet of stream channel.
The remainder of the larger residential subdivision has been designed to avoid impact to WoUS and Lake Jordan buffers.
There are approximately 2,500 linear feet of perennial stream channel and 1.5 acres of wetlands located on the site. The site
has been designed to avoid approximately 1.44 acres of wetlands and 2,430 linear feet of perennial stream.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The clearing limits will be staked and silt fence will be used. Temporary coffer dams will be installed upgradient of the
proposed culvert and sewer line trench. During construction, water will be pumped around the construction footprint.
Appropriate stream bank protection will be provided in the channel during construction and all excess excavated material will
be immediately removed from the stream bank crossing area. The top 1 foot of stream bed material will be stored in upland
areas and used to backfill the top 1 foot of the excavation trench for the sewer line crossings. Upon completion of the
culvert/utility line installation, the temporary sand bag coffer dams will be removed and flow will be diverted through the culvert
or across the sewer lines. Disturbed banks will be restored to similar pre-construction conditions, matted and seeded/live
staked.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
❑ Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
ElPayment to in-lieu fee program
project?
❑ Permittee Responsible Mitigation
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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:
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.
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 8of11
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. 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: Concentrated flow will not be discharged to the buffers. The proposed
❑ Yes ® No
road is not impervious and will sheet flow into buffers.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
Low Density %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Based on the overall development being
low density, a stormwater management plan is not requried.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ 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?
❑ 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
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the 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)
la. 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
❑ Yes ® No
letter.)
Comments: We are not aware of a NEPA or SEPA being requried.
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.
We are not aware of additional development that will impact nearby downstream water quality.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Wastewater will be treated on-site. Impacts outside of those proposed within this application are not anticipated for
wastewater treatment.
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?
E] Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS List of federally protected species for Forsyth County identifies: Bog tune (T=S/A , NLEB (T) and small-
anthered bittercress (E). Based on our site observations, suitable habitat for the bog turtle and small anthered bittercress
are not located on the site. Suitable summer roosting habitat for NLEB is located on the site. However, the site is not
located within 150' of known summer roost trees or 1/4 mi of known hibernacula. Therefore, the applicant will rely on the
final 4(d) rule for NLEB and removal of suitable summer roosting trees should not be restricted.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat. Best
management practices and the use of temporary sediment and erosion control devices will prevent sediment from entering
down -gradient waterbodies which may contain fish.
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?
NC SHPO HPO GIS Website (attached).
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM 3710689700K
Digitally signed by Bradley S. Luckey
DN: cn=Bradley S. Luckey, o=Pilot
Bradley S. Luckey
-/ — Environmental, Inc, ou,
emall=[e-mail], c=US
8.1.18
/ Date: 2018.08.01 10:1 HS -04'00'
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(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

This form authorizes PEI to act as our agent in stream/wetland matters including U.S. Army Corps
of Engineers and North Carolina Division of Water Resources field verification and permitting.
Property Address:
Applicant Information:
Name:
Address:
Telephone Number:
Fax Number:
E-mail Address:
S
Drummond Place
0 N. Main Street
Kernersville NC 27284
SMI Properties, LLC, c/o Mr. Brian Shugart
221 Jonesville Road
Winston Salem, NC 27104
336.765.9661
[e-mail]
ignature Date:

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Drawing 1 USGS Topographic Map
USGS Topographic Map _
Belews Creek & Drummond Place
Kernersville, NC Approximate 34.78 Acre Tract
"j Quadrangles Kernersville, Forsyth County, NC
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LEGEND
Site Boundary
NWI Designations
Estuarine and Marine
A
Deepwater
. '
,J Estuarine and Marine Wetland
`
Freshwater Emergent Wetland
a
Freshwater Forested/Shrub
Wetland
Freshwater Pond
g
r
Lake
F -]Other
+r
® Riverine
IW
Drawing 3
USFWS National Wetlands
Inventory Mapper
Not to Scale
a
NWI Map
Drummond Place
Approximate 34.78 Acre Tract
Kernersville, Forsyth County, NC
PEI Project 2096
�11 •

13
Drawing 4
FEMA FIRM Panel No.
3710689700K
Effective 01/02/2009
Not to Scale
LEGEND
Approximate Site Boundary
SPECIAL FLOOD HAZARD AkEAS (SFRAS) SUBJECT TO
INUNDATION BY THE 1% ANNUAL CHANCE FLOOD EVENT
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PEI Project 2096

FLAG NUMBERS/INFOLEGEND
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USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ ON SEPTEMBER 9, 2016.. THEY HAVE NOT BEEN SURVEYED OR GEOLOCATED.
Drawing 5 Wetland Map
2015 Aerial Photograph from Google Drummond Place
Earth and PEI Field Notes Approximate 34.78 Acre Tract
Scale: 1" = 400' Kernersville, Forsyth County, NC
Date: 08.24.2016 PEI Project 2096

Legend
PROPERTY LINE
PROPOSED PROPERTY LME
PROPOSED LOT LME
EXISTMG STREAM
WETLAW1>S
SFUGn4Rr MANAGEMENT, MC.
221 JONESTOWN ROAD
UANSTON SALEM, NG 21104
CONTACT: GREG GAWMETT
EMAJL: QRSCif6HUGARTMANAMIENTZOM
PHONE: [phone]
TOTAL AREA= 36.18 ACRES
TOTAL LOTS= 33 LOTS
DENSM 091 LOTS/ACRE
JURISDICTION: FORSYTH COUNTY
PARCEL ID : 6891-12-6bOOO
PARCEL ID : 6691-22-0491M
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• • P OND ESTATES 1420 DOUBLE CREEK DRIVE
HWY 150 NORTH MAIN ST LEWISVILNC 27023
FORSYTH COUNTY, NC (C) 336.57.57 7.5079

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2016-01703 County: Forsyth U.S.G.S. Quad: NC-BELEWS CREEK
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner:
Address:
Telephone Number:
Watson Heirs
Jeffery Watson
5335 Reidsville Road
Walkertown, NC, 27051
336 414-9006
Size (acres) 35
Nearest Waterway Beaver Creek
USGS HUC 03030002
Nearest Town Kernersville
River Basin Haw
Coordinates Latitude: 36.14214
L.onaitude: -80.04482
Location description: Proposed Watson Heirs development property located off of NC 150, adjacent to a tributary of Beaver
Creek, east of Kernersville, in Forsyth County, North Carolina.
Indicate Which of the Following Apply:
A. Preliminary Determination
X Based on preliminary information, there may be waters of the U.S. including wetlands on the above described project area
We strongly suggest you have this property inspected to determine the extent of Department of the Army (DA)
jurisdiction. To be considered final, a jurisdictional determination must be verified by the Corps. Phis preliminary
determination is not an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33
CFR Part 331). If you wish, you may request an approved 1D (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
1D. Please see remarks section in regard to this Jurisdictional Determination.
B. Approved Determination
_ There are Navigable Waters of the United States within the above described project area subject to the permit requirenunts
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.
_ 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 strongly suggest you have the waters of the U.S. including wetlands on your project area delineated. Due to the
size of your property andlor our present workload, the Corps may not be able to accomplish this wetland delineation in a
timely manner. For a more timely delineation, you may wish to obtain a consultant. To be considered final, any
delineation must be verified by the Corps.
_ The waters of the U.S. including wetlands on your project area have been delineated and the delineation has been
verified by the Corps. We strongly suggest you have this delineation surveyed. Upon completion, this survey should be
reviewed and verified by the Corps. Once verified, this survey will provide an accurate depiction of all areas subject to
CWA 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.
Page I of 2

_ 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 chanae in the law or our
published regulations, this determination may be relied upon for a period not to exceed five %ears 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
(LAMA). You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to
determine their requirements.
Placement of dredged or till material within waters of the US and/or wetlands without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 131 1). if you have any questions regarding this
determination and/or the Corps regulatory program, please contact John Thomas at 919-554-4884 x25 or
John T Thomas.JRna.usace.army.mil.
C. Basis For Determination: Site includes tributaries of Beaver Creek which flows to the Hary River and ort to the
Atlantic Ocean.
D. Remarks: For the purpose of development Planning, the Corps concurs with the
preliminary iurisdictional determination depicted on provided maps included in the
agent's review request received on September 12, 2016.
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean 'Vater Act jurisdiction for the
particular site identified in this request. The deIineation'determination may not be valid for the wetland conservation
provisions of the Food Security Act of 1955. Ifvou 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 N;ttural ROOLII-ces
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 find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If) ou 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 IOM 15
Atlanta, Georgia 30303-8501
In order for an RFA to be accepted by the Corps, the Corps trust determine that it is complete, that it meets the criteria fur
appeal under 33 CFR part 33 1.5, and that it has been received by the Division Office within 60 days of the date of the NAI'.
Should you decide to submit an RFA form, it must be received at the above address by 11/13/2016.
**It is not necessary to submit an -A form to the Division Office if you do not object to the determination in this
correspondence.
Corps Regulatory Official:
Date: September 13, 2016 c: MICIiael F3ratne, Pilot Environmental, 743 Park Lawn Count, Kernersville, NC 27284

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
htt}� �;'ru�tt l �tc7ry.utinc�sui � r� .�cunl.

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Jeffery �Vat,on I :I� Number: SAW-2016-01703
Date: September 13, 2016
Watson Heirs
----
See Section below
Attached is:
INITIAL PROFFERED PERMIT (Standard Permit or Letter ofpermission)
A
PROFFERED PERMIT Standard Permit or Letter of permission)
B
C
PERMIT DENIAL.,
[—] APPROVED JURISDICTIONAL DETERMINATION
E --
1 PR[ LIMINARY JURISDICTIONAL DETERMINATION
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at Iottl+�N.IfScI�Z �irmy.mil M�tsi�i�, C w_if1 �u�ks. Rc<�ulatortii'ri�tr��ma>>dNc�mits.as �x or
!L.
_Cors re ulations 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 terns and conditions therein, you may request
that the permit be modified accordingly. You must complete Section 11 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 terns 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 11 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 I I 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 - RE UEST 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.
I lowever, you may provide additional information to clarify the location of information that is already in the administrative
rvc ord.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision andlor the
If you only have questions regarding the appeal princess yuu may
appeal process you may contact:
District Engineer, Wilmington Regulatory Division,
also contact:
Mr. Jason Steele, Administrative Appeal Review Officer
Attn: John Thomas
CESAD-PDO
U.S. Army Corps of Engineers, South Atlantic Division
60 Forsyth Street, Room I OM 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 opportunity 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, John Thomas,
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 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

FLAG NUMBERS/INFO
L
LAND FLAGS = FFA' ALAM FLAGSam Flags = 103
land Flags = 76
l Flags = 179
,w
Non -jurisdictional;
Not subject to buffer
regulations
:� " . # ++
R � r
W AW 6
ANO WA 1-33
Non -Jurisdictional;
Not subject to buffer
regulations
u _U1.
At
SA 1-95
WA 34 37�.
rV
LEGEND
Site Boundary
Perennial Stream i
Wetlands iY
96 sn i -s Flag Number
oP t • Data Point
- Culvert
L :, -
i
t WAA 1-32
r
WAA 33-39
uF 2 O
SB 1-8
I
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY WERE DELINEATED BY MR.
DAVID S. BRAME AND MR. MICHAEL T. BRAME ON AUGUST 24, 2016. THEY WERE VERIFIED BY MR. JOHN THOMAS WITH THE
USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ ON SEPTEMBER 9, 2016.. THEY HAVE NOT BEEN SURVEYED OR GEOLO
Drawing 5 N Wetland Map
Drummond Place
2015 Aerial Photograph from Google
I Field Notes Approximate 34.78 Acre Tract
Earth and PEF 400' Kernersville, Forsyth County, NC
Scale: 1I
DPEI Project 2096
Date: 08.24.2016
LA -�

Water Resources
ENVIRONMENTAL OUALITY
PAT MCCRORY
Cir ver-m,r
DONALD R. VAN DER VAART
S""-1-1,
S. JAY ZIMMERMAN
LhrecMr
October 17, 2016
Mr. Mike Brame
Pilot Environmental Inc.
P.O. Box 128
Kernersville, NC 27285
Subject Property: Drummond Place Subdivision, Hwy 150, Kernersville NC, Forsyth County
On -Site Determination for Applicability to the Mitigation Rules (15A NCAC 2H .0500)
Dear Mr. Brame:
On September 9, 2016, at your request and in your attendance, Sue Homewood conducted an
on-site determination to review features located on the subject project for stream
determinations with regards to the above noted state regulations. John Thomas with the US
Army Corps of Engineers was also present during the site visit.
The Division acknowledges the areas and boundaries identified as jurisdictional wetlands by the
USACE. The attached map accurately depicts all stream determinations conducted during the
site visit.
Please note that at the time of this letter, all perennial stream channels and jurisdictional
wetlands found on the property are subject to the mitigation rules cited above. These
regulations are subject to change in the future. In addition, the Jordan Lake Buffer Rules may
apply to some streams at this location, please be sure to contact the local government for
further information regarding the Jordan Lake Buffer Rules.
The owner (or future owners) should notify the Division (and other relevant agencies) of this
decision in any future correspondences concerning this property. This on-site determination
shall expire five (5) years from the date of this letter.
450 W. Hanes Mill Road, Suite 300, Winston-Salem, North Carolina 27105
Phone: [phone] FAX: [phone] Customer Service 1-877-623-6748
Internet: www.ncdenr.gov - www.ncwater.org

Landowners or affected parties that dispute a determination made by the Division or Delegated
Local Authority that a surface water exists and that it is subject to the buffer rule may request a
determination by the Director. A request for a determination by the Director shall be referred to
the Director in writing c/o 401 & Buffer Permitting Branch, 1650 Mail Service Center, Raleigh, NC
27699-1650. Individuals that dispute a determination by the Division or Delegated Local
Authority that "exempts" surface water from the buffer rule may ask for an adjudicatory hearing.
You must act within 60 days of the date that you receive this letter. Applicants are hereby
notified that the 60 -day statutory appeal time does not start until the affected party (including
downstream and adjacent landowners) is notified of this decision. The Division recommends
that the applicant conduct this notification in order to be certain that third parry appeals are
made in a timely manner. To ask for a hearing, send a written petition, which conforms to
Chapter 1508 of the North Carolina General Statutes to the Office of Administrative Hearings,
6714 Mail Service Center, Raleigh, N.C. 27699-6714. This determination is final and binding
unless you ask for a hearing within 60 days.
This letter only addresses the applicability to the mitigation rules and the buffer rules and does
not approve any activity within Waters of the United States or Waters of the State or their
associated buffers. If you have any additional questions or require additional information please
contact me at 336-776-9693 or [e-mail].
Sincerely,
Sue Homewood
Winston-Salem Regional Office
Enclosures: USGS Topo Map
Pilot Environmental Map
cc: Watson Heirs c/o Jeffery T. Watson, [e-mail]
John Thomas, USACE Raleigh Regulatory Field Office (via email)
DWR, Winston-Salem Regional Office

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Drawing 1 USGS Topographic Map
USGS Topographic Map
Belews Creek & Drummond Place
Kernersville, NC Approximate 34.78 Acre Tract
Quadrangles Kernersville, Forsyth County, NC
.: Scale: V= 2,000' PEI Project 2096 }

I
op
WA 1-33
FLAG NUMBERS/INFO ,.
.,LLI.�.
# LEGEND
WETLAND FLAGS
Site Boundary
g
STREAM FLAGS =
Non -Jurisdictional;
e
Stream Flags = 103
• Perennial Stream
Wetland Flags = 76
Total Flags = 179
Wetlands"`
`.
regulations DP -z p
Flag Number
Data Point
I
4.
41 Non -Jurisdictional;
- culvert
46
Not subject to buffer
- ,
regulations41
r.
AIL -
;
SA 1-95
;
WA 34-37
11;
` t
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY WERE DELINEATED BY MR.
DAVID S. BRAME AND MR. MICHAEL T. BRAME ON AUGUST 24, 2016. THEY
WERE VERIFIED BY MR. JOHN THOMAS WITH THE
USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ ON SEPTEMBER 9, 2016.. THEY HAVE NOT BEEN SURVEYED OR GEOLOCATED.
A.smmmw
Drawing 5
Wetland Map
ti
2015 Aerial Photograph from Google
Drummond Place
op
WA 1-33
WAA 1-32
Non -Jurisdictional;
e
Y Not subject to buffer
WAA 33-39
regulations DP -z p
4
4.
46
r.
;
SA 1-95
;
WA 34-37
11;
` t
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY WERE DELINEATED BY MR.
DAVID S. BRAME AND MR. MICHAEL T. BRAME ON AUGUST 24, 2016. THEY
WERE VERIFIED BY MR. JOHN THOMAS WITH THE
USACE AND MS. SUE HOMEWOOD WITH THE NCDEQ ON SEPTEMBER 9, 2016.. THEY HAVE NOT BEEN SURVEYED OR GEOLOCATED.
A.smmmw
Drawing 5
Wetland Map
ti
2015 Aerial Photograph from Google
Drummond Place
Earth and PEI Field Notes
Approximate 34.78 Acre Tract
Scale: 1" = 400'
Kernersville, Forsyth County, NC
- Date: 08.24.2016
PEI Project 2096