20171156 Ver 1_PCN Mitigation Submittal_20191210

ID#* 20171156 Version* 1
Select Reviewer:*
Mac Haupt
Initial Review Completed Date 12/10/2019
Mitigation Project Submittal - 12/10/2019
Is this a Prospectus, Technical Proposal or a New Site?* r Yes r No
Type of Mitigation Project:*
V Stream r Wetlands r- Buffer r- Nutrient Offset
(Select all that apply)
Project Contact Information
Contact Name:*
Lin Xu
Project Information
...................................................................................
ID#:* 20171156
Existing IDr
Project Type:
Project Name:
County:
Email Address:*
[e-mail]
Version:
*1
Existing Version
r DMS r Mitigation Bank
Horne Creek Tributaries Mitigation Project
Surry
Document Information
Mitigation Document Type:*
Mitigation Plans
File Upload: HorneCreekTribs_MP_100026_FINAL_July2019.pdf 63.98MB
HorneCreekTrib401 COffice. pdf 50.6KB
HorneCreekTrib401 FeeMemo.pdf 45.44KB
HorneCreekTribPCN.pdf 3.21 MB
Rease upload only one RDFof the corrplete file that needs to be subrritted...
Signature
Print Name:* Lin Xu
Signature:*
vac

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TIM BAUMGARTNER
Director
NORTH CAROLINA
Environmental Quality
December 10, 2019
Mac Haupt, Acting 401 & Buffer Permitting Unit Supervisor
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
Re: Permit Application- Horne Creek Tributaries Mitigation Project, Surry County (DMS
Full Delivery Project)
Dear Mr. Haupt:
Attached for your review is 404/401 permit application package for the subject project. A memo
for the permit application fee is also included in the package. Per agreement between DMS and
DWR, the hard copy of the final mitigation plan is not included in the submittal (However, I did
submit a final mitigation plan since DMS has extra copies). In addition, the electronic copy of
the final mitigation plan along with all other electronic files have been uploaded to NC DWR's
file system. Please feel free to contact me with any questions regarding this plan (919-707-
8319).
Thank you very much for your assistance.
Sincerely
Lin Xu
Attachment: 404/401 Permit Application Package
Permit Application Fee Memo
E\\Q�
DR-Im"dE.&W— W QWIy
North Carolina Department of Environmental Quality I Division of Mitigation Services
217 W. Jones Street 1 1652 Mail Service Center I Raleigh, North Carolina 27699-1652
919.707.8976

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
11M BAUMGARTNER
Director
MEMORANDUM:
NORTH CAROLINA
Environmental Quality
TO: Debby Davis
FROM: Lin Xu 1jC
SUBJECT: Payment of Permit Fee
401 Permit Application
DATE: December 10, 2019
The Division of Mitigation Services (DMS) is implementing a mitigation project for
Horne Creek tributaries Mitigation Project in Surry County (DMS IMS # 100026). The
activities associated with this restoration project involve stream restoration related
temporary stream and wetland impact. To conduct these activities, the DMS must
submit a Pre -construction Notification (PCN) Form to the Division of Water Resources
(DWR) for review and approval. The DWR assesses a fee of $570.00 for this review.
Please transfer $570.00 from DMS Fund # 2984, Account # 535120 to DWR as
payment for this review. If you have any questions concerning this matter I can be
reached at 919-707-8319. Thanks for your assistance.
cc: Mac Haupt, DWR
North Carolina Department of Environmental Quality I Division of Mitigation Services
217 W. Jones Street 1 1652 Mail Service Center I Raleigh, North Carolina 27699-1652
919.707.8976

oe'oF wArFgQ�
f,
o
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps: ❑X Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 27 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ❑ Yes X❑ No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑x 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le. Is this notification solely for the record For the record only for DWQ
For the record only for Corps Permit:
because written approval is not required? 401 Certification:
❑ Yes © No
❑ Yes X❑ 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
❑ Yes ❑X No
or in -lieu fee program.
t
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ❑Yes ❑X No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes X❑ No
2. Project Information
2a. Name of project: Home Creek Tributaries Mitigation Project
2b. County:
Surry
2c. Nearest municipality / town:
Pilot Mountain
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state project no: I N/A
3. Owner Information
3a. Name(s) on Recorded Deed:
See Addendum
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address: f
Page 1 of 10
PCN Form —Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑X Other, specify: NC DMS ,ILF
4b. Name:
Lin Xu
4c. Business name
(if applicable):
NCDEQ Division of Mitigation Services (DMS)
217 West Jones Street
4d. Street address:
4e. City, state, zip:
Raleigh, NC, 27603
4f. Telephone no.:
919-707-8543
4g. Fax no.:
N/A
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Kayne Van Steil
5b. Business name
(if applicable):
Water & Land Solutions
5c. Street address:
7721 Six Forks Road, Suite 130
5d. City, state, zip:
Raleigh, NC, 27615
5e. Telephone no.:
919-614-5111
5f. Fax no.:
N/A
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
See Addendum
1 b. Site coordinates (in decimal degrees): I Latitude: 36.285195 Longitude:-80.503202
1 c. Property size:
11.8 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Horne Creek
2b. Water Quality Classification of nearest receiving water: Class C
2c. River basin: Yadkin River Basin 03040101
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:
A mainrity of the exintinn OrPam raarhae hava haan danradad einnifiranflu na a raenlf of hicfnrir and n..rrnnf eerie. 1fr—1 .,..d ..::..:... as.....:.......�:....-
including unrestricted cattle access, piping or culverting of the stream, and/or channelization. Portions of the project stream reaches are unstable, with
documented active headcut migration and associated localized channel widening and down -cutting. See Mitigation Plan (pg 8-21) for more detail.
3b. List the total estimated acreage of all existing wetlands on the property: 0.349
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 5,681
3d. Explain the purpose of the proposed project:
Stream Mitigation. See attached addendum at end of application.
3e. Describe the overall project in detail, including the type of equipment to be used:
See Addendum
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the ❑X Yes
Corps or State been requested or obtained for this property / Comments:
project (including all prior phases/ in the oast?
4b If the Cor d i th ' A;
1 d t ' t' h
❑ No
Ca
ps ma e e juris iona a ermina ion, w at type ❑x Preliminary
of determination was made?
❑ Unknown
❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Water & Land Solutions
Name (if known): Chris Sheats & Adam McIntyre Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
See attached Mitigation Plan Appendix 9 with JD package from William Elliott. USACE Action ID# SAW-2017-01510 dated March 26, 2019.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
6b. If yes, explain.
❑Yes ❑X No El Unknown
❑ Yes 0 No
Page 3 of 10
PCN Form —Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑X Wetlands ❑X 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 impact
Type of wetland
Forested
Type of jurisdiction
Area of
number
Corps (404,10) or
impact
Permanent (P) or
DWQ (401, other)
(acres)
Temporary T
Excavation
Floodplain Pool
Yes
Corps
WB P
0.0017
WD P
Excavation
Floodplain Pool
Yes
Corps
0.0456
-
Choose one
Choose one
Yes/No
-
-
Choose one
Choose one
Yes/No
-
- Choose one Choose one Yes/No -
- Choose one Choose one Yes/No -
2g. Total Wetland Impacts: 0.0473
2h. Comments:
The proposed stream restoration practices will provide a more natural hydrology and flow regime. The riparian buffer area will be planted with native
species woody vegetation that is more tolerant of wetter conditions. The design approach will also improve existing areas of adjacent fringe, toe of
slope or marginally functioning wetlands through higher water table conditions (elevated stream profiles) and a more frequent out of bank flooding.
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 (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 -
Choose one
See Addendum
-
-
S2 -
Choose one
-
S3 -
Choose one
-
-
S4 -
Choose one
-
-
S5 -
Choose one
-
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
3i. Comments:
See Addendum
Page 4 of 10
PCN Form —Version 1.4 January 2009

,#. vpen Yvater 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
Area of impact (acres)
Permanent (P) or
type
Temporary T
01 -
Choose one
Choose
02 -
Choose one
Choose one
Choose
Choose
03 -
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded I Filled I Excavated I Flooded I Filled I Excavated
P1 Choose one
P2 Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below_ If anv impacts renuire mitigation_ then vnu MUST fill nut Sac:tinn r) of this fnrm
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number—
Permanent (P) or
Temporary T)
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet
6g.
Zone 2
impact
(square
feet
131 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
W. Comments:14U Na""""G"` 1U°C' ""Nacw GIC GIRIUpGICU GS G MbUII of IriC p1UpUbVU SUtWil ICJlo1CLLIUn JAMAK 65. om IVOOgallon rlan Tor riparian
buffer planting strategies.
Page 5 of 10

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.
Proposed stream and wetland impacts and mitigation approaches are necessary to restore 5,344 LF and enhance 84 LF of stream of jurisdictional
streams that flow directly to the Yadkin River basin system. See Mitigation Plan section 6.8 for more details.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Sedimentation and Erosion Control measures will be implemented during the construction phase per the NCDEMLR - Land Quality S&EC Planning
and Design Manual and approved permit conditions. The stream restoration work will involve filling the degraded channels and constructing stable
design channels. The contractor will work outside the degraded stream banks and only enter the channel from specific locations designated on the
plans to minimize buffer disturbances. A pump-around/dewatering operation will be utilized to minimize sediment entering downstream.
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 ❑X 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
❑Payment to in -lieu fee program
project? I
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one 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:
Choose one
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:
S. 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 6 of 10
PCN Form —Version 1.4 January 2009

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 Yes X No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet)
I'
Zone 1 3 (2 for Catawba)
Zone 2 1.5
(square feet)
J 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 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes 0 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.
No increase in impervious surface
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 1
2b. Does this project re uire a Stormwater Management Plan? ❑ Yes ❑X No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Project site meets the criteria for Low Density development and will not increase overall percent imperviousness. Site plan is well below the
impervious surface area threshold. Stormwater/diffuse flows will be transported via stable vegetated channels and across restored stream channels
and natural floodplain topography.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which localgovernment's jurisdiction is thisproject?
❑ Phase II
❑ NSW
3b. Which of the following locally -implemented stormwater management programs
USMP❑
❑
apply (check all that apply):
Water Supply Watershed
❑ Other
3c. Has the approved Stormwater Management Plan with proof of 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 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
(North Carolina) Environmental 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.) Refer to approved Categorical Exclusion in Appendix 11 of the Mitigation Plan.
Comments:
2. Violations (DWQ Requirement)
❑R Yes ❑ No
❑X Yes ❑ No
❑X Yes ❑ No
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 ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application? ❑Yes ❑X 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 ❑X No
f 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.
NC Office of Archives and History website and NRIS database was searched. A letter was also sent to the NC Office of State and Archaeology and
the NC Historic Preservation Office. The approval letter is included in Appendix 11 of the Mitigation Plan.
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.
No wastewater will be generated from the proposed project.
Page 9 of 10
PCN Form —Version 1.4 January 2009

S. Endangered Species and Designated Critical Habitat (Corps Requirement)
So. Wail this project occur in or near an area with federally protected species or
® Yes ❑ No
habitat?
Sb. Have you checked with the USFWS concerning Endangered Species Act
Byes ❑ No
Impacts?
Sc. If yes, indicate the USFWS Field Office you have contacted.
Asheville
Sd. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NCWRC Natural Heritage and USFWS waWas. Letters were sent to USFWSINCWRC. Refer to the Categorical Exclusion in App I I of do Mitigation
Plan. Per the agency response letters, proposed project acclivities are not tdcely to adversely affect federally listed spades or their critical habitat.
S. 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?
NCWRC Natural Heritage and USFWS websites. Letters were sent to USFINS/NCWRC. Refer to the Categorical Eausion requesting Information
regarding potential species impacts. Verified that proposed action is not Akeh► to significantly/negatively Impact aquatic and terrestrial wildlife resources
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 Olfim of Archives and History websb and NRIS database was searched. A letter was also sent to the NC Office of State and Archaeology and
the NC Historic Preservation Office. The approval letter Is included in Appendbc I I of the Mitigation Plan.
8. Flood Zone Designation (Corps Requirement)
So. Will this praject occur in a FEMA-designated 100-year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
Sc. What source(s) did you use to make the floodplain determination?
North Carolina Floodmaps I Floodplain Mapping Information System and FIRM Panel 1782, 1792.
Lin Xu
Appticant/Agenfs Printed Name Applicant/Agents Signature
(Agents signature Is valid only It an authorization Date
letter from the applicant Is provided.)
Kayne Van Stell
Co -Applicant's Printed NameCo-Applicants
Date '
Sign re
Page 10 of 10

Horne Creek Tributaries Mitigation Project: PCN Addendum
DMS Project ID: #1000026
NOTE:
The following project descriptions were attached separately from the PCN document because the
interactive Adobe form would not allow for the required number of lines needed to represent the
project.
A. Application Information
3. Owner Information
(3a) Name(s)
William Franklin
Mary Ellen
Mary Ellen
on Recorded
Fulp and Debra
Smith
Smith
P. Fulp
_Deed
(3B)Deed
Book and Page
00521/1524
�00527/0589
00370/0890
No.
(3d) Street
410 Caudle
Kiger Road
Caudle Road
Address
Road
(3e) City, Pinnacle, NC Pinnacle, NC
State, Zip 27043-9464 27043-9288
B. Project Information and Prior Project History
1. Propertv Identification
la. Property identification no. (tax PIN or A)arcel ID)
Brown Farms
I Jane B.
of Surry Co
Boger
LLC
00936/0448
00945/0886
Kiger Road
363 Kiger
Road
Pinnacle, NC Pinnacle, NC Pinnacle,
27043-9464 27043-9288 NC 27043-
9288
595200774688,595200765174,595200772795,595200567091,595200733427
3d. Explain the purpose of the proposed project.
The primary purpose of the proposed project is to improve ecologic functions to impaired stream
systems that discharge directly into Horne Creek within the Yadkin River Basin. See attached Mitigation
Plan section 5 for specific goals and objectives intended to improve aquatic resource functions. The
proposed full -delivery project will provide 5,378 stream mitigation credits (SMCs) in the Yadkin River
Basin for the DMS ILF program. Approximately 11.8 acres will be placed in a conservation easement and
will be protected in perpetuity. See attached Mitigation Plan that provides detailed project descriptions,
site mapping, and design plans of the existing conditions and proposed design approach to generate
these assets, as well as the proposed credit release schedule, vegetation planting plan, and performance
monitoring plan to be implemented after construction is completed.
3e. Describe the overall gro�ect in detail. including the type of equipment to be used:
The proposed stream restoration and enhancement activities will be conducted along two unnamed
tributaries to Horne Creek. Activities will consist of filling the impaired/channelized portions of existing
stream and restoring a natural floodplain connection. Work will be conducted using track hoes
(excavators), dump trucks/track dumps, tractors w/ disk harrow or rippers, and other equipment

Horne Creek Tributaries Mitigation Project: PCN Addendum
DMS Project ID: #1000026
typically used in restoration projects for channel construction, minor floodplain grading and in -stream
structure installation. See Mitigation Plan section 6 for proposed restoration practices and design
approaches as well as common construction elements.
C. Proposed Impacts Inventory
3. Stream Impacts
3a.
3b.
3c.
3d. 3e.
3f.
3g.
Stream
Type of
Stream
Perennial Type of
Average
Impact length
impact
impact
Name
(PER) or Jurisdiction
stream
(linear feet)
number
intermittent
width
Permanent
(INT)?
(feet)
(P) or
Temporary
(T)
4.5
1,397
S1 P
Relocation
R1
PER
Corps
S2 P
Relocation
R2
INT
Corps
4.4
286
S3 P
Relocation
R3
INT
Corps
3.6
75
S4 P
Relocation
R4
PER
Corps
6.7
1,191
S5 P
Relocation
R4a
PER
Corps
4.9
124
S6 P
Relocation
R4b
PER
Corps
3.0
89
S7 P
Relocation
R5
PER
I Corps
8.2
impacts
2,519
Total stream and tributary
1 5,681 jl
3i. Comments:
Average stream widths are represented at the existing channel top of banks and not OHWM or bankfull
elevations since those features were difficult to consistently identify in the field.

Legend
Project Location Surry Co. Hydrography
TLWs Surry County
TLW: 03040101110070 0 NC Counties
LWP-2008-51 Conservation Easement
Q HUC: 03040101
HUC-12
- ,
Yadkin County
1 0 4 8
0 50 100 r
Miles
Miles ,
Project is located in
TLW HUC-14: 03040101110070
LWP: 2008-51
V�
nf�
Cott
Stokes County
Forsyth County
0
W A
J 09% M!L'fteS`'Ci'
N
Source ;Esri, HERE, DeLorme, USGS, Inte,.rmap, INCREMENT P, N� 3n,
0 0.4 0.8 Esri Japan, METI, Esri China (Hong Kong), Esri orea, Esri (Thailan
Mapmylndia, NGCC, © OpenStreetMap confibufors and the GIS U :r
i� Miles Comm; n ity
FIGURE
WATER & LAND' Horne Creek Tributaries Vicinity Map
SOLUTIONS Mitigation Project
NAD 1983 2011 State Plane
North Carolina FIPS 3200 FT US

Legend,.'"`
,Conservation Easement
I� s�
^ Catchment Area: 28 acres a
Catchment Area: 38 acres
Catchment Area: 81 acres
r '
Catchment Area: 169 acres %� f
� s tto VA
I ti: a T1
I 1�
Ir
. 4 f
N�
Pilot Mountain Quadrangle
0 500 1000 f Feet North Carolina- Surry Co.
_'� � }
Copyright:© 2013.National Geographic Society. `i-cu.. ed.
FIGURE
WATER &LAND`" Horne Creek Tributaries USGS
SOLUTIONS Mitigation Project Topographic Map
NAD 1983 2011 State Plane 2
North Carolina FIPS 3200 FT US

Legend ,.
QConservation Easement
Stream Classification
Intermittent *.+ll�►<— ra,
Perennial k `
M
0 Verified Wetlands
51
Impervious Cover: 0.5%
Dominant Land Use: Agricultural (Pasture/Hay
(46%), Row Crop (24%)), Mixed Forest (16%) ,.
R3
• r
� L
{!4, Wt r R2 C
g�
R4A� R4
pp
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11413'
_ t
w-�iJ�,
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a WA ; ' e ,-5x. r
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Fe �r Diy;laii�l�• E . Ea' h 1 g i- ,C r• s
�:, :IJSDA U 5 '- r Rd IG . an IS ser 'tag . i
FIGURE
WATER & LAND Horne Creek Tributaries Current Conditions
SOLUTIONS Mitigation Project
NAD 1983 2011 State Plane 4
North Carolina FIPS 3200 FT US

Legend �* `
Conservation Easement } W ►
Stream: Top of Bank *1 4
1 AF
Verified Wetlands =-
Wetland Impacts (0.0473 ac)
F t
. 7 �
Wetlai
i� n nni-i
L�vt�y
� R3 �.'
r �
Wetland: WC R2 `
Not Impacted
- s
r y
%•x"�y" :� Wetland: WD
A
91,*' : otit r' � 0.0456 Acres Impacted
yy •sue—} in+.
1I Wetland: WA
Not Impacted
i R5 ,
LR
I re
�BcrRtl 4
N
'+�,►
0 500 1,000
:' 5ourc, Fsn. ❑i IalGlope. �_ea; Earthstar Geographies, CNES/Arb'u
F,eet� �� x-.,
US. USDA, uSGS Aer&GRID, IGN','and the GIS User Community
FIGURE
WATER & LAND" Horne Creek Tributaries Wetland Impacts
SOLUTIONS Mitigation Project
NAD 1983 2011 State Plane
North Carolina FIPS 3200 FT US

Water & Land Solutions
Appendix 9 — WOTUS Information
Horne Creek Tributaries Mitigation Project

U.S. ARMY CORPS OF ENGINEERS
WILNU GTON DISTRICT
Action ID: SAW-2017-01510 County: Surry U.S.G.S. Quad: Siloam
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner: Edward Brown
Address: 3865 Shoals Rd
Pinnacle, NC 27043
Telephone Number: 336-325-2456
Size (acres): 121.34 Nearest Town: Pinnacle
Nearest Waterway: Horne Creels Coordinates: 36.28519,-80.50321
River Basin/ HUC: Upper Pee Dee
Location description: The site is located at 363 Kieer Rd.. Pinnacle, NC 27043
Indicate Which of the Following A 1 :
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) andlor Section 10 of the Rivets 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 aid 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
alI 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 ID, 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, ir-icluding wetlands, 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 overall of the waters, including wetlands, 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 Corns 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 the law or our published regulations, this determination may be relied upon for
a period not to exceed five years £coin the date of this notification.
There are waters of the U.S. including wetlands on the above described property 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
accomplishh this wetland delineation in a timely mariner, 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 your 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 and/or RHA
j urisdiction 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 charge 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 to determine their requirements.
Placement of dredged or fill 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 § 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 William Elliott at
828-271-7980, ext. 4225 or [e-mail].
C. Basis for Determination:
See attached preliminary jurisdictional determination form.
The site contains wetlands as determined by the 1987 Corps of Engineers Wetland Delineation Manual and the
Regional Supplement to the Corps of Engineers Wetlands Delineation Manual: Eastern Mountain and Piedmont
Region (version 2.0). These wetlands are adjacent to stream channels located on the property that exhibit indicators
of ordinary high water marks. The stream channel on the property is an unnamed tributary (UT) to" Horne Creek
which flows into the Yadkin River.
D. Remarks:
The potential waters of the U.S., at this site, were verified on -site by the Corps on 2/19l2019and are as approximately
depicted on the attached Potential Wetland/Waters Map
E. Attention USDA Program Participants
This delineation/determinatior. 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 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 fallowing address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1OM15
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 (Preliminary -JD).

**It is not necessary to submit an RFA fornj to the Division Office' ou do not 'ect to the determination in this
correspondence.**
Corps Regulatory Official: r
William Elliott
Issue Date of JD: March 26.2019 Expiration Dats: N/A Preliminary JD
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://corpsmapu.usace.armv.mil/em a gl0=136:4:0.
Copy furnished:
Adam V. Mulatyre-Water & Land Solutions, 7721 Six forks Rd. Ste 130, Raleigh; NC 27615

NO Ill ICAT[ON OF AIIMINISTRATIVE APPEAL OPTIONS AND PROCESS
R VQf f EST FOR APPEAL :O
Applicant: Edward Brown File Number: SAW-SAW-2017-01510 1 Date: March 26, 2019
Attached is: See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permissibo A
F 11 PROFFERED PERMIT (Standard Permit or Letter of permission) B
F-11 PERMIT DENIAL C
APPROVED JURISDICTIONAL DETERMINATION _ D
NJ PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I -The following identifies your r ghts and options regarding an administrative appeal of the above decisloh.
Additional information may be found at or
Corps regulations at 33 CFR Part 331.
A: YNYTYAL 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 II of this forni 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 ofyour 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
ai:d 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.
4

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 perriit 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
rovide additional information to clarify the location of information that is a.lreadv in the administrative record.
POINT OF CONTACT FOR OUESTIQNS 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: William Elliott
CESAD-PDO
151 Patton Avenue, Room 208
U.S. Army Corps of Engineers, South Atlantic Division
Asheville, North Carolina 28801-5006
60 Fors .ytIt Street, Room IOM15
828-271-7980, ext, 4232
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 covirse of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the oppoi•tu it[
to participate in all site invest ations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn.: William Elliott, 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 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

PRELIMINARY JURISDICTIONAL DETERMINATION (JD) FORM
U.S. Army Corps of Engineers
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JD: March 26, 2019
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY -JD:
Edward Brown
3865 Shoals Rd,
Pinnacle, NC 27043
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
CESAW-RG-A, SAW-2017-01510,
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
The site is located at 363 Kiger Rd., Pinnacle, NC 27043
State: NC County/parish/borough: Surry City: Pinnacle
Center coordinates of site (!at/long in degree decimal format): 36.28519,-80.50321
Universal Transverse Mercator: N/A
Name of nearestwaterbody: Horne Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
Office (Desk) Determination. Date: March 26, 2019
[� Field Determination. Date(s): 2/19i2019
Use the table below to document aquatic resources and/or aquatic resources at different sites
TABLE OF AQUATIC RESOURCES WREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION
Site
Centered Coordinates
Estimated Amount
Type of Aquatic
Geographic
Number
(decimal degrees)
of Aquatic Resource
Resources
Authority to Which
in Review Area
Aquatic Resource
Latitude Longitude
(linear feet or acre)
"May Be" Subject
See Attach List
❑ Wetland
Section 404
❑ Non -wetland Waters
❑ Section 10/404
Q Wetland
❑ Section 404
❑ Non -wetland Waters
❑ Section 101404
[� Wetland
❑ Section 404
Non -wetland Waters
Section 10/404
Q Wetland
[j Section 404
Non -wetland Waters
Q Section 10/404
❑ Wetland
❑ Section 404
L[ Non -wetland Waters
[[ Section 10/404
Q Wetland
❑ Section 404
0 Non -wetland Waters
❑ Section 10/404
E] Section 404
[] Wetland
p Non -wetland Waters
E] Section 10/404
❑ Wetland
[[ Section 404
❑ Non -wetland Waters
Q Section 10/404

1. 'IN Corps of Engineers believes that there may be jurisdictional aquatic resources in the review
area, and the requester of this PJD is hereby advised of his or her option to request and obtain an
approved JD (AID) for that review area based on an informed decision after having discussed the
various types of JDs and their characteristics and circumstances when they may be appropriate.
2. In any circumstance where a permit applicant obtains an individual permit, or a Nationwide General
Permit (NWP) or -other general permit verification requiring "pre- constructior. notification' (PCN),
or requests verification for a non -.reporting NWP or other general permit, and the permit applicant
has not requested an AJD for the activity, the permit applicant is hereby made aware that; (1) the
permit applicant has elected to seek a permit authorization based on a PJD, which does not make
an official determination of jiv isdictior3a; aquatic resources; (2) the applicant has the option to
request an AJD before accepting the terms and conditions of the permit authorization, and that
basing a permit authorization on an AJD could possibly result in less compensatory mitigation
being required or different special conditions; (3) the applicant has the right to request an individual
permit rather than accepting tee terms and conditions of the NIOR or other general permit
authorization; (4) the applicant can accept a pern•,it authorization and thereby agree to comply with
A the terms and conditions of that, permit, utcluding whatever mitigation requirements the Corps
has determined to be necessary; (5) undertaking any activity in reliance upon the subject permit
authorization without requesting- an AJD constitut s the applicant`s acceptance of the use of the
PJD; (6) accepting•a permit authorization (e.g., sinning a proffered individual permi() or
undertaking any activity in reliance on any ri rrn of Corps permit authorization based on a PJD
constitutes agreement that all aquatic resources in the review area affected in any way by that
activity will be treated as jurisdictional, and waives any challenge to such jurisdiction in any
administrative or judicial compliance or enforcement action, or in any administrative appeal or in
any Federal court; and (7) whether the applicant elects to use either an AJD or a PJD, the JD will
be processed as soon as practicable. Further, art AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively appealed
pursuant to 33 CRK Part 331. If, during an administrative appeal, it becomes appropriate to
make an official determination whether geographic jurisdiction exists over aquatic resources in the
review area, or to provide an official delineation of jurisdictional aquatic resources in the review
area, the Corps will provide an AJD to accomplish that result, as soon as is practicable. This PJD
finds that there "May be" waters of the U.S, andior that there "may lie" navigable waters of the U.S.
on the subject review area, and identifies all aquatic features in the review area that could be
affected by the proposed activity, based on the following information:

SUPPORTING DATA
Data reviewed for preliminary JD (check all that apply) - Checked items should be included in subject file.
Appropriately reference sources below where indicated for all checked items:
Maps, plans, plots or plat submitted by or on behalf of preliminary JD requester:
® Data sheets prepared/submitted by or on behalf of preliminary JD requester.
® Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rational:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
® U.S. Geological Survey (USGS) Hydrologic Atlas:
❑ USGS NHD data.
® USGS S and 12 digit HUC maps.
❑ USGS map(s). Cite scale & quad name: Siloam.
�( Natural Resources Conservation Service (MRCS) Soil Survey.
Citation: Surry County, NC
❑ National wetlands inventory (NWl) map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ Federal Emergency Management Agency (FEMA) / Flood Insurance Rate MEp (FIRM) maps:
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Applicable/supporting scientific literature:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily been verified by the Corps and
should not be relied upon for later jurisdicti0tal determrnations.
William Elliott, March 26, 2019 Edward Brown
Signature and date of Regulatory Signature and date of person requesting
staff member completing preliminary JD (REQUIRED, unless obtaining the
preliminary JD signature is impracticable)
Two copies of this Preliminary JD Form have been provider. Please sign both copies. Keep one signed copy for your record
and return a signed copy to the Asheville Regulatory Field Office by mail or a-nrait
USArtuy Corps ofEugiueers-PHImington District
Asheville Regulatory Field Office
751 Patton Avenue, Room 208
Asheville, NC 28801-5006
1 Districts may establish timefiames for requester to return signed PJD forms. If the requester does not respond within the established time
frame, the district may presume concurrence and no additional follo),v up is necessary prior to finalizing an action.

Site #
Latitude
Longitude
-80.510192
Estimated amount
of resource in
review area
(acreage and linear
ft, if applicable)
Type of aquatic
resource (i.e.
wetland vs, non-
wetland waters)
Geographic authority to
which the aquatic
resource "may be"
subject (i.e. Section 404
or Section 10/401)
WA
36.282565
0.005 ac
Wetland
Section 404/401
WB
36.2874.52
-80.50265
-80.50232
0.076 ac
Wetland
Section 404/401
WC
36.287756
0.093 ac
Wetland
Section 404/401
W❑
36.28756
-80.501849
0.175 ac
291 If
Wetland
Non -wetland
Section 404/401
Section 404/401
S1
36.289687
-80.500118
S2
36.289516
-80.501029
41 If
Non -wetland
Section 404/401
S3
36.289357
-80.500934
3,340 If
Non -wetland
Non -wetland
Non -wetland
Section 404/401
S4
S5
S6
36.287641
-80.502223
123 If
Section 404/401
36.287410
-80,502623
71 If
1,267
Section 404/401
36.282523
-80.510805
Non -wetland
Section 404/401

Legends r
QConservation Easement '
Wetlands
Streams * T
Intermittent I +
Perennial
r Irl
t`
.f
WC y'3
1 i > WB
r
� r
r .
A {I�
ei
4
•. _ t M
� 5
Horne Creek Tributaries Jurisdictional Waters FIGURE
WATER & LA N DTM Stream & wetland Map
SOLUTIONS Mitigation Project 3
Su County, North Carolina NADa9lina83 FI State Plane
� tY� North Carolina FIPS 3200 FT US

Water & Land Solutions
Appendix 11— Approved FHWA Categorical Exclusion Form
Horne Creek Tributaries Mitigation Project

Appendix A
Categorical Exclusion Form for Ecosystem Enhancement
Program Projects
Version 1.4
Note, only Appendix A should to be submitted (along with any supporting documentation) as the
environmental document.
T
vlmu r IV . 7rIVVVLV, Ulvf%7 VVIILICKAif/ 101
Pro'ect Sponsor: Water & Land Solutions, LLC
Project ContactName: William "Scott' Hunt, III, PE
Project Contact Address: 11030 Raven Rid a Road, Ste. 119, Ralei h, NC 27614
Pro'ect Contact E-mail: scoff waterlandsolutions.com
P Proiect Manacer: Matthew Reid
The Home Creek Tncularies Mir gallon Project is a full-ftivery project for the NCD=C division of :uf gation Services (CMS)
identified and contracted to provide scream r6a.-alior, credits for permitted, unavoidable Impacts in the Yadkin River Basin,
Cataloging Unit 0304G101. The project vr'll involve the restoration, enhancement, and permanent protection of seven steam
reaches (Read+es R1, R2, R3, R4, R4a, Rob, and RS), totaling approximately 5A39 linear feet of fisting streams t`aat comprise
the headwaters of Home Creek. In addition, tr:e adjacent riparian wetlands and riparan buffers will be restored, and the entire
restored corridor will be protected by a permanent conservation easement to be held by the State of Nc-th Carolina. The projecttt
site ccnssts of a degraded headwater stream and riparian wetland system that flows through active cattle pastures, Into the
headwaters of Ho.,.e Creek. The proposed restoration project not only has the potential to provide at least 5,389 steam mitigatior,
credits, but will also provide significant ecological improvements and functional uplift through habitat restoration, and through
decreasing nutrient and sediment loads from the project watershed. The project is located in SJny County approximately seven
miles souttrwest o€the Town of pilot rOmntaln.
Reviewed By:
/Zz I ir" f P
Date
Conditional Approved By:
Date
❑ Check this box if there are outstanding issues
Final Approval By:
f d
Cate
Project Manager
For Division Administrator
FHWA
For Division Administrator
FHWA
Version 1.4, 8116/05

2: All Projects
Regulation/QuestionPart
Response
Coastal Zone Mana ement Act CZMA
1. Is the project located in a CAMA county?
❑ Yes
® No
❑ Yes
2. Does the project involve ground -disturbing activities within a CAMA Area of
Environmental Concern (AEC)?
❑ No
® N/A
3. Has a CAMA permit been secured?
❑ Yes
❑ No
® N/A
4. Has NCDCM agreed that the project is consistent with the NC Coastal Management
❑ Yes
Program?
❑ No
® N/A
Comprehensive Environmental Response. Com ensation and Liabilit Act CERCLA
1 Is this a "full -delivery" project?
® Yes
❑ No
2. Has the zoning/land use of the subject property and adjacent properties ever been
❑ Yes
designated as commercial or industrial?
® No
❑ NIA
3. As a result of a limited Phase I Site Assessment, are there known or potential
❑ Yes
hazardous waste sites within or adjacent to the project area?
® No
❑ N/A
4. As a result of a Phase I Site Assessment, are there known or potential hazardous
❑ Yes
waste sites within or adjacent to the project area?
❑ No
® N/A
5. As a result of a Phase II Site Assessment, are there known or potential hazardous
❑ Yes
waste sites within the project area?
❑ No
® N/A
6. Is there an approved hazardous mitigation plan? ❑ Yes
❑ No
_ ® N/A
National Historic Preservation Act (Section 106)
1. Are there properties listed on, or eligible for listing on, the National Register of ❑ Yes
Historic Places in the project area? ® No
2. Does the project affect such properties and does the SHPO/THPO concur?
El es
❑ No
® N/A
3. If the effects are adverse, have they been resolved?
❑ Yes
❑ No
® N/A
Uniform Relocation Assistance and Real Property Acquisition Policies Act Uniform
Act
1. Is this a "full -delivery" project?
® Yes
❑ No
2. Does the project require the acquisition of real estate? ® Yes
❑ No
❑ N/A
3. Was the property acquisition completed prior to the intent to use federal funds? ❑ Yes
® No
❑ N/A
4. Has the owner of the property been informed: ® Yes
" prior to making an offer that the agency does not have condemnation authority; and ❑ No
" what the fair market value is believed to be? ❑ N/A
Version 1.4, 8/16/05

ekegi iationi1r,imesponse
American Indian Religious Freedom Act AIRFA
1. Is the project located in a county claimed as "territory" by the Eastern Band of ❑ Yes
Cherokee Indians? ® No
2. Is the site of religious importance to American Indians? ❑ Yes
❑ No
® N/A
3. Is the project listed on, or eligible for listing on, the National Register of Historic ❑ Yes
Places? ❑ No
® N/A
4. Have the effects of the project on this site been considered? ❑ Yes
❑ No
® N/A
Antiquities Act AA
1. Is the project located on Federal lands? ❑ Yes
® No
2. Will there be loss or destruction of historic or prehistoric ruins, monuments or objects
❑ Yes
of antiquity?
❑ No
® N/A
3. Will a permit from the appropriate Federal agency be required?
❑ Yes
❑ No
® N/A
4. Has a permit been obtained?
El Yes
❑ No
® N/A
Archaeolo ical Resources Protection Act ARPA
1. Is the project located on federal or Indian lands (reservation)?
Yes
® No
2. Will there be a loss or destruction of archaeological resources? ❑ Yes
❑ No
®N/A
3. Will a permit from the appropriate Federal agency be required?
❑ Yes
❑ No
® N/A
4. Has a permit been obtained?
❑ Yes
❑ No
® N/A
Endangered Species Act ESA
1. Are federal Threatened and Endangered species and/or Designated Critical Habitat
® Yes
listed for the county?
❑ No
2. Is Designated Critical Habitat or suitable habitat present for listed species?
® Yes
❑ No
❑ N/A
3. Are T&E species present or is the project being conducted in Designated Critical
❑ Yes
Habitat?
® No
❑ N/A
4. Is the project "likely to adversely affect' the specie and/or "likely to adversely modify"
❑ Yes
Designated Critical Habitat?
® No
❑ N/A
5. Does the USFWS/NOAA-Fisheries concur in the effects determination?
❑ Yes
❑ No
® N/A
6. Has the USFWS/NOAA-Fisheries rendered a "jeopardy" determination?
❑ Yes
❑ No
® N/A
Version 1.4, 8/16/05

Executive Order 13007 Indian Sacred Sites
1. Is the project located on Federal lands that are within a county claimed as "territory"
❑ Yes
by the EBCI?
® No
2. Has the EBCI indicated that Indian sacred sites may be impacted by the proposed
❑ Yes
project?
❑ No
® N/A
3. Have accommodations been made for access to and ceremonial use of Indian sacred
❑ Yes
sites?
❑ No
® N/A
Farmland Protection Policy Act FPPA
1. Will real estate be acquired?
® Yes
❑ No
2. Has NRCS determined that the project contains prime, unique, statewide or locally
® Yes
important farmland?
❑ No
❑ N/A
_
3. Has the completed Form AD-1006 been submitted to NRCS? ® Yes
❑ No
❑ N/A
ish and Wildlife Coordination Act F%
1. Will the project impound, divert, channel deepen, or otherwise control/modify any ® Yes
water body? ❑ No
2. Have the USFWS and the NCWRC been consulted? ® Yes
❑ No
❑ N/A
Land and Water Conservation Fund Act (Section 6(f))
1. Will the project require the conversion of such property to a use other than public,
❑ Yes
outdoor recreation?
® No
❑ Yes
2. Has the NPS approved of the conversion?
❑ No
®N/A
Magnuson -Stevens Fishery Conservation and Mana ement Act Essential Fish
Habitat
1. Is the project located in an estuarine system?
❑ Yes
® No
❑ Yes
_
2. Is suitable habitat present for EFH-protected species?
❑ No
® N/A
❑ Yes
3. Is sufficient design information available to make a determination of the effect of the
project on EFH?
❑ No
® N/A
4. Will the project adversely affect EFH?
❑ Yes
❑ No
® N/A
5. Has consultation with NOAA-Fisheries occurred?
❑ Yes
❑ No
® N/A
Migratory Bird Treat Act MBTA
1. Does the USFWS have any recommendations with the project relative to the MBTA?
❑ Yes
® No
2. Have the USFWS recommendations been incorporated?
❑ Yes
❑ No
® N/A
Wilderness Act
1. Is the project in a Wilderness area? ❑ Yes
® No
2. Has a special use permit and/or easement been obtained from the maintaining
❑ Yes
federal agency?
❑ No
® N/A
Version 1.4, 8/16/05

LANDOWNER A-UTHORIZATION FORM
PROPERTY LEGAL D SCRiTIO :
Deed Book: Z�.r g Page: 15- ._ county:
Parcel ID Number: 5 f1 � '� 7 �` a - v
Street Address: `} / (i
Pin me Z
Property Owner (please. print: i
Property Owner (please print):
The undersigned, registered property olvvner(s) of the above property, do hereby autholiiae
MAILc,
of ii h/a S
(ContractoriAgent/Project Manager), r`ilTame of Contractor/Agent Firrn/Ageneyf
to take all actions necessary for the evaluation of the property as a potential stream, wetland and/or
riparian buffer mitigation project, including conducting stream and/or wetland deter$ninations and
delineations, as well as issuance and acceptance of any required permit(s) or certification(s). I
agree to allow regulatory agencies, including the US Army Corps of Engineers, to visit the property
as part of these environmental reviews.
Property Owners(s) Address:
(if different from above)
Property- Owner Telephone Number: C 7 c s- - 0
Property Owner Telephone Number: -3-3to 7 6,'1` - G 3
We hereby certify the above information to, be true and accurate to the best of our knowledge.
`( V
(Prc�erty Qwner A
Signature)
(Property- Owner Authorized Signature)
1
' (Date)
I/Q ' 7
(Date)
Nan,,e of full delivery staff member or DMS project manager (design -bid -build).
''\came of company (ILIH-deliveries) or DMS (design -bid -build).

I
PROPERTY LEGAL DESCRITION;
Deed &iok: C, 0 S Z,-? Page: -A el County: 1.5,
ty
Parcel ID Number:
-I L4
Street Address:
2', nrl ck e N C
Property Owner (please print: Mc;,-v EJe,
Property Owner (please print);
The. undersigned, registered property owuer(s) of the above property do hereby authorize
(Contractor!'Agent/Project Manager)!
M (Name of Contractor/Agent Firm/Agency)2
to take all actions necessary for the evaluation of the property, as a potential stream, wetland and; or
riparian buffer mitigation project, including conducting stream and/or wetland determinations and
M V
delineations, as well as issuance and acceptance of any required permit(s) or certification(s). I
agree to allow regulatory agencies, including the US Army Corp3 of Engineers, to visit the property
as part of these environmental reviews. a�
Property Owners(s) Address: < D I
(if different from above)
Propertly Owner Telephone Number: ( 2 3 G. ) 7 6,'5- - 6 3 q 2-
Property Owner Telephone Number:( .2-Y
We Eereby certify the above information to be true and ace7irate to the best of our knowledge.
M ev, '3 't4 7 2 el -/ 2
(Property, OWner Authorized Signature) (Date)
(Property Owner Authorized Signature)
(Date)
Name of full delivery staff member (full -deliveries) or 13�IS project manager (design -bid -wild).
game of company (full -deliveries} or DMS (design -bid -build).

sr AUNMVIY N1.: IR -4h.1'1HO3\IZkT.i� _X FO�`}._
PROPERTY LEGAL: DESCPdTION:
Deed Book. TLr:> -7 o Page:. -
I R=A 1I3 X-,2 r ber:_ { g 5- Z CC, -7, 7 _� 71�1 S^
Street Address: ` 4 y d t c
Property Oti uer (please print: vi i, - F t 5, , r L,
Property Owner ;please print):.
The undersigned, registered property owner(s) of the above property, do hereby authorize
4 f&i�L w p L-t Ct of P W?
(Contractor/Agent/Project Manager)' (dame of Contractor/Agent Firm/Agency)2
to take all actions necessary for the evaluation of the property as a potential stream, wetland andlor
riparian buffer mitigation project, including conducting stream and/or wetland determinations and
delineations, as well as issuance and acceptance of any required permit(s) or certification(s). I
agree to allow regulatory agencies, including the US Army Corps of Engineers, to visit the property
as part of these environmental reviews.
Property Owners(s) Address: 3I S 1 Q ed .
(if different from above)
17yl?L++3
Property Owner Telephone Number:
Property Owner Telephone number:
We hereby certify. the above h formation to be true and accurate to the best of our knowledge.
�,q
(Property Owner Authorized Signature)
(Property- Owner Authorized Signature)
7 J e- r7
(Date')
(Date)
',Name of Full delivery staff inembex (full -deliveries) or DMS project manager (design-bid-buiid).
'-dame of cornpa.:ry (full deliveries) or DiXIS ; desigat-bid-build).

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book: _Qo a36 Page: o 6 County: S ,, r ,r
Parcel ID Number: S"J S Gcc 5'61 nej )
Street Address: 3 6 3 i s.
Property Owner (please print: f� r p
Property Owner (please print):
The undersigned, registered property owner(s) of the above property, do hereby authorize
.4hew Re c(' of p615
(Contractor/Agent/Project Manager)' (Name of Contractor/Agent Firm/Agency)-
to take all actions necessary for the evaluation of the property as a potential stream, wetland and/or
riparian buffer mitigation project, including conducting stream and/or wetland determinations and
delineations, as well as issuance and acceptance of any required permit(s) or certification(s). I
agree to allow regulatory agencies, including the US Army Corps of Engineers, to visit the property
as part of these environmental reviews.
Property Owners(s) Address: -2i
(if different from above)
Property Owner Telephone Number: ( ' b J Z `( S-
Property Owner 'Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
(Property Owner Authorized Signature)
(Property Owner Authorized Signature)
7 ,�,- X—_ /ri
(Date)
(Date)
'Name of full delivery staff member (full -deliveries) or DMS project manager ("design -bid -build).
'Name of company (full -deliveries) or DMS (desi-gn-bid-build).

North Carolina
Department of Administration
State Property Office
Roy Cooper, Governor
October 9, 2019
MEMORANDUM
TO: Scott Hunt
Water & Land Solutions
11030 Raven Ridge Rd, Suite 119
Raleigh, North Carolina 27614
FROM: Blane Rice, DMS Manager h
State Property Office (v11'e�-�'4�
SUBJECT: Authorization to Record Conservation Easement Deeds and Plats
Horne Creek Tributaries
Department of Environmental Quality Contract 6993
DMS Project ID 100026
11.872 Acres
SPO File Numbers shown below
Surry County
Grantor SPO File No.
William F. Fulp and wife Debra P. Fulp 86-BM
Mary Ellen Smith, widow 186-BN
Brown Farms of Surry County, LLC 86-BO
Jane B. Boger, unmarried 86-BP
Machelle Sanders
Secretary
Acres
2.69
3.08
6.10
0.002
Tim Walton
Director
On behalf of the State of North Carolina, the Division of Mitigation Services Review Team and I have reviewed
the preliminary plats, shape files, draft conservation easement, access easement, and applicable title
information as submitted by Water & Land Solutions. These acquisitions by conservation easement are
approved to close on behalf of the State of North Carolina with the conditions as listed as follows.
a) The name of the Project is "Horne Creek Tributaries". This name is required to be used in all references.
Please edit plat and all documents accordingly.
b) The SPO File Numbers are assigned as shown above and should be added to both the title block of the plat
and the corresponding conservation easement document at upper left, page one. All legal descriptions
should also incorporate both the DMS Site ID Number and the SPO File Number where applicable.
c) The DMS Site ID is 100026 and should be added to both the title block of the plat and the corresponding
conservation easement document at upper left, page one.
d) DMS requests surveyor to note where existing access to site is located.
State of North Carolina I State Property Office
116 West Jones Street, Suite 4055 11321 Mail Service Ctr. I Raleigh, NC 27699
919 807 4650 T I Web: http://www.ncspo.com

100026 Horne Creek Tributaries Authorization Memo Cont.
e) Plats are then approved for county review, approval, and subsequent recording.
f) Deed of Trust from William F. Fulp and wife Debra P. Fulp recorded In Book 1671, Page 828 requires
subordination for clear title. Draft of subordination agreement was submitted.
g) Any taxes due at time of closing due for the year that are applicable to the Conservation Area.
h) Any deferred agricultural taxes applicable to the Conservation Area that may be triggered.
i) Any other matters noted on the Preliminary Title Opinions and updates prior to recording required for
clear title to the Conservation Area including, but not limited to releases for any indebtedness on the
conservation easement portion of the parcel.
j) All other real property requirements as stipulated in the DEQ Contract.
cc: Paul Wiesner, Western Supervisor
Matthew Reid, Project Manager
Kristie Corson, DMS
Jeff Jurek, Procurement Manager
Jeff Horton, Properly Specialist