20191712 Ver 1_401 Application_20191213

SPANGLER
ENVIRONMENTAL, INC.
Land Planning Permitting Environmental Consulting Construction Management Expert l
LETTER OF TRANSMITTAL
Date: 12/12/2019 46i20"6iQ/4Dc
Name: NC Division of Water Resources SEC 13 20, GAR
irk 9
Company Name: NCDEQ �r�r'�De�oea
From: Maria Polizzi RE: PCN for Mohawk
WE ARE SENDING YOU:
Attached
SEI #: 20190816
Under Separate Cover via
Shop Drawings Specifications
Letters Change Order
X Reports Computer Disk
Invoices
Reproducibles
Samples
COPIES
DATE
DESCRIPTION
2
1
12/12/2019
12/12/2019
Pre Construction Notification and supporting documents
Check for $240
THESE ARE TRANSMITTED as checked below:
X For Approval Approved as Submitted
For Your Use Approved as Noted
As Requested Return for Corrections
For Review & Comment FOR BIDS DUE
;6-
Resubmit Copies for Approval
Submit Copies for Distribution
Return Corrected Prints
Other
Please email [e-mail] with questions or call 919-875-4288
SIGNED:
CC:
4338 Bland Road Raleigh, N.C. 27609 tel [phone] fax [phone]
3961-B Market Street Wilmington, N.C. 28403 tel [phone] fax [phone]-SPANGLER www.spanglerenvironmental.com

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NORTH \
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HEADWALL
76 LF OF 48"0 CLASS
IV RCP @ 0.57%
76 LF OF 18"0 CLASS—
IV RCP @ 1.30%
I REFERENCE
TOPOGRAPHIC INFORMATION BASED
UPON V354D33.DWG SURVEY
CONDUCTED BY PITTMAN
PROFESSIONAL SURVEYING ON JUNE
10, JULY 12, JULY 15, JULY 31,
AUGUST 1, AND OCTOBER 24, 2019
2. APPROXIMATE WETLANDS AND STREAMS
PROVIDED BY SPANGLER
ENVIRONMENTAL INC. ON SEPTEMBER
2019.
LEGEND
EXISTING CONTOUR
-- _ — EXISTING STREAM
EXISTING WETLANDS
EXISTING CHAIN LINK
FENCE
PROPOSED ROAD
850 PROPOSED CONTOUR
ST �iimi PROPOSED DRAINAGE
SYSTEM
�—� STREAM FLOW
VC
o SCALE IN FEET
a`O ` ROCK RIPRAP
HEADWALL 0 30 60
v
MOHAWK INDUSTRIES
UNILIN FLOORING N.V
Civil & Environmental Consultants, Inc. HAULING ROAD RELOCATION
3701 Arco Corporate Drive •Suite 400 •Charlotte, NC 28273 MOUNT GILEAD, NORTH CAROLINA
Ph: 980.237.0373 • Fax: [phone] PROPOSED STREAM IMPACT
www.cecinc.com
DRAWN BY: CTH CHECKED BY: TMG APPROVED BY: BDR EXHIBIT:
DATE: 11 /12/2019 DWG SCALE: AS NOTED PROJECT NO: 191-488 FIG 1
*HAND SIGNATURE ON FILE

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T
z0 460
j PROPOSED
W HEADWALL
J
W EXISTING STREAM —
INV ELEV. _
455.00
450
LEGEND
854. r
104' STREAM IMPACT
PROPOSED 30' NEW ROAD
— 76LF 48" 0 CLASS IV RCP
CULVERT ® 0.57%
0
LO
PROP. INV -
854.00
PROPOSE[
HEADWALL
ROCK
RIPRAP
1 +00
STREAM IMPACT FIGURE PROFILE
EXISTING GROUND PROPOSED ROAD
EXISTING STREAM STRUCTURAL FILL
PROPOSED DRAINAGE
SYSTEM
REFERENCE
TOPOGRAPHIC INFORMATION BASED
UPON V354D33.DWG SURVEY
CONDUCTED BY PITTMAN
PROFESSIONAL SURVEYING ON JUNE
10, JULY 12, JULY 15, JULY 31,
AUGUST 1, AND OCTOBER 24, 2019.
2. APPROXIMATE WETLANDS AND STREAMS
PROVIDED BY SPANGLER
ENVIRONMENTAL INC. ON SEPTEMBER
2019.
460
APPROX. EXISTING
GROUND SURFACE
INV ELEV. _
"453. 00
450
1+14
STREAM IMPACT SECTION SCALE IN FEET
SCALE H: 1 " = 20'
SCALE V: 1 " = 5' 0 20 40
AV AIFAV /
IA / /
Civil & Environmental Consultants, Inc.
3701 Arco Corporate Drive - Suite 400 • Charlotte, NC 28273
Ph: 980.237.0373 • Fax: [phone]
www,cecinc.com
MOHAWK INDUSTRIES
UNILIN FLOORING N.V
HAULING ROAD RELOCATION
MOUNT GILEAD, NORTH CAROLINA
PROPOSED STREAM IMPACT SECTION
DRAWN BY: CTH CHECKED BY: TIVIG APPROVED BY: BDR EXHIBIT:
DATE: 11 /12/2019 DWG SCALE: AS NOTED PROJECT NO: 191-488

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I REFERENCE - \
0
NORTH
a a
1. TOPOGRAPHIC INFORMATION BASED
UPON V354D33.DWG SURVEY
CONDUCTED BY PITTMAN
PROFESSIONAL SURVEYING ON JUNE
10, JULY 12, JULY 15, JULY 31,
AUGUST 1, AND OCTOBER 24, 2019.
2. APPROXIMATE WETLANDS AND STREAMS
PROVIDED BY SPANGLER
ENVIRONMENTAL INC. ON SEPTEMBER
2019.
LEGEND
— —460-- EXISTING CONTOUR
—— EXISTING STREAM
`fy EXISTING WETLANDS
• PROJECT AREA
SCALE IN FEET
0 150 300
MIA MOHAWK INDUSTRIES
UNILIN FLOORING N.V
Civil & Environmental Consultants, Inc. HAULING ROAD RELOCATION
3701 Arco Corporate Drive •Suite 400 •Charlotte, NC 28273 MOUNT GILEAD, NORTH CAROLINA
Ph: 980.237.0373 • Fax: [phone] POTENTIAL JURISDICTIONAL FEATURES MAP
www.cecinc.com
DRAWN BY: CTH CHECKED BY: TMG APPROVED BY: BDR EXHIBIT:
DATE: 11 /15/2019 DWG SCALE: AS NOTED PROJECT NO: 191-488 F I G
*HAND SIGNATURE ON FILE

ROY COOPER
Govenor
MICHAEL S. REGAN
Secretary
TIM BAUMGARTNER
Director
Christopher Greene
Mohawk Industries, Inc.
149 Homanit USA Road
Mt. Gilead, NC 27306
Project: Mohawk
w gArt 7
r.
NORTH CAROLINA
Environmental Qual ty
December 10, 2019
Expiration of Acceptance: 6/10/2020
County: Montgomery
The purpose of this letter is to notify you that the NCDEQ Division of Mitigation Services (DMS) is willing to
accept payment for compensatory mitigation for impacts associated with the above referenced project as
indicated in the table below. Please note that this decision does not assure that participation in the DMS in -
lieu fee mitigation program will be approved by the permit issuing agencies as mitigation for project impacts.
It is the responsibility of the applicant to contact permitting agencies to determine if payment to the DMS will
be approved. You must also comply with all other state, federal or local government permits, regulations or
authorizations associated with the proposed activity including G.S. § 143-214.11.
This acceptance is valid for six months from the date of this letter and is not transferable. If we have not
received a copy of the issued 404 Permit/401 Certification within this time frame, this acceptance will
expire. It is the applicant's responsibility to send copies of the permits to DMS. Once DMS receives a copy
of the permit(s) an invoice will be issued based on the required mitigation in that permit and payment must
be made prior to conducting the authorized work. The amount of the in -lieu fee to be paid by an applicant is
calculated based upon the Fee Schedule and policies listed on the DMS website.
Based on the information supplied by you in your request to use the DMS, the impacts for which you are
requesting compensatory mitigation credit are summarized in the following table. The amount of mitigation
required and assigned to DMS for this impact is determined by permitting agencies and may exceed the
impact amounts shown below. _
River Basin _ - impact Location Impact Type - Impact Quantity-
--- I (8-digit HUCj
Yadkin 03040104 Warm Stream 104
Upon receipt of payment, DMS will take responsibility for providing the compensatory mitigation. The
mitigation will be performed in accordance with the In -Lieu Fee Program instrument dated July 28, 2010 and
15A NCAC 02B .0295 as applicable. Thank you for your interest in the DMS in -lieu fee mitigation program.
If you have any questions or need additional information, please contact Kelly Williams at [phone].
cc: Jim Spangler, agent
D_E
Sincerely,
Ja ,es. Stanfill
Ass6tanagement Supervisor
North Carolina Department of Erwtronmental Qality I Division of MRtgation Services
W W. Jones Street 11652 Mail Service Cerzter I Raleigh, North Carolina 27699-1652
919.707,0976

Mohawk / Unilin MDF 69 Mohawk Stream/Wetland Map
149 Homanit Usa Rd SPANGLER
ENVIRONMENTAL, INC.
Mt. Gilead, NC 4338 Bland Road, Raleigh, North Carolina 27609
September, 2019 919-875-4288
map source:
Montgomery County GIS/nconemap.com

Jurisdictional Determination Request
US Army Corps
of Engineers.
Wln ftton DWM
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http•//www saw usace.army.miI/Missions/Re ug latoryPermitProaram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
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 also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: 419 Homanit USA
City, State:
Mount Gilead, NC
County: Montgomery County
Parcel Index Number(s) (PIN): 7504 00 97 2556,
7504 00 99 3023, 7514 00 08 1624
B. REQUESTOR INFORMATION
Name: James A. Spanqler / Maria Polizzi
Mailing Address: 4338 Bland Rd, Raleigh NC 27609
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
Select one:
I am the current property owner.
✓❑ I am an Authorized Agent or Environmental Consultant'
❑ Interested Buyer or Under Contract to Purchase
ElOther, please explain.
C. PROPERTY OWNER INFORMATION'
Name: Christopher Greene
Mailing Address: 149 Homanit USA Rd, Mt. Gilead NC
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
Must provide completed Agent Authorization Form/Letter.
' Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION' 4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. 1, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
James A. Spangler
Print Name
Capacity: ❑ Owner ✓❑ Authorized Agents
11 /26/19
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
✓❑ I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑ I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
HA Corps JD is required in order obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
s Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
❑✓ 1 am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
✓❑ Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
aSize of Property or Review Area 215.81 acres.
❑✓ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
0✓
Project Coordinates (Decimal Degrees): Latitude:
35.253355
Longitude:-79.973575
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 1 Ix17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).'
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
■ Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. httL://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Pro eram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
DCompleted appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDs• please complete an Approved Jurisdictional Determination Form'
0 Vicinity Map
Aerial Photograph
USGS Topographic Map
a Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
Other Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/re ug_latory/regdocs/JD/RGL 08-02 App A Prelim JD Form fillable.pdf
' Please see http://www.saw.usace.army.mil/Missions/Re ug latory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Quality Forest Products
December 4, 2019
To Whom It May Concern:
The letter serves to inform you that Jordan Lumber & Supply, Inc. and/or JordanTwo, LLC.
located at 1939 NC Hwy. 109 South (PO Box 98, Mt. Gilead, NC 27306 )hereby authorizes
Spangler Environmental, Inc. to act as our technical agent for the purposes of environmental
issues, including wetland and stream identification, permitting, mitigation planning and
regulatory agency coordination at the property known as Tract No. 9149 and Tract No. 9151, and
as shown in Montgomery County records as Tax Parcel Nos. 7514 00 08 1628 and 7504 00 99
3023. All site visits by regulatory personnel must be coordinated in advance with our agent,
Spangler Environmental, Inc. This letter supercedes all previous Agent -related correspondence.
The following contact persons should be copied on all correspondence:
Property Owner (or Legal Agent/Representative):
Robert B. Jordan, IV
VP/General Manager
1939 NC Hwy. 109 South, PO Box 98, Mt. Gilead, NC 27306
910-439-8119
Riordan amjordanlumber. com
Technical Agent:
James A. Spangler, CEI, A.M.ASCE
Spangler Environmental, Inc
4338 Bland Road
Raleigh, NC 27609
919-875-4288
[e-mail]
Sincerely, /n
Robert B. Jordan, IV
Jordan Lumber & Supply, Inc
VP/General Manager
Jordan Lumber & Supply, Inc. • P.O. Box 98 • Mt. Gilead, N.C. 27306 • Phone [phone] Fax [phone]

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
A. REPORT COMPLETION DATE FOR PJD: 11/26/2019
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: James A. Spangler / Maria Polizzi
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Raleigh
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Montgomery City: Mt. Gilead
Center coordinates of site (lat/long in degree decimal format):
Lat.: 35.253355 Long.:-79.973575
Universal Transverse Mercator: 17S 593375.05E 3901622.54N
Name of nearest waterbody: Big Town Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date: 11/26/19
5011 Field Determination. Date(s): 10/3/19
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH"MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, 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 10/404)
W 1
35°15-8.395" N
79°58-22.853"W
.24 acres
Wetland
Section 404 Wetland
S 1
35°15'10.621"N
79058-24.443"W
104 feet
Non -Wetland Waters
Section 10 Non -Wetland

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) 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 -
construction 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 jurisdictional 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 the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including 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 constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form 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, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. 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. and/or that there "may be" 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 PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
0 Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:
❑E Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
❑ U.S. Geological Survey map(s). Cite scale & quad name:
❑ Natural Resources Conservation Service Soil Survey. Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ 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 jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signature and date of w
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
' Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

35' 1516" N
35° 15 6" N
Custom Soil Resource Report
Soil Map
a� �
593160 593200 593240 593290 593320 593360 593400 593440 593483 593520 593560
3 3
� Map Scale: 1:2,040 fi printed on A landscape (11" x 8.5') sheet.
Meters �
f� NN 0 30 60 120 180
/V
0 50 100 200 300r Map projection: Web Mercator Comer coordinates: WGS84 ridge t�s: U1M Zone 17N WGS84
9
35° 15 W N
35° 15' 6" N

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site: Mohawk City/County: Mount Gilead/Montgomery Sampling Date: 10/3/19
Applicant/Owner: Mohawk Industries Inc. State: NC Sampling Point: WA
Investigator(s): James A. Spangler Section, Township, Range:
Landform (hillslope, terrace, etc.): Relic flood plain Local relief (concave, convex, none): Concave Slope (%): <2
Subregion (LRR or MLRA): MLRA 136 Lat: 35.253355 Long:-79.973575 Datum: NAD1983
Soil Map Unit Name: Badin-Goldston complex NWI classification: Upland/ Not Classified
Are climatic / hydrologic conditions on the site typical for this time of year? Yes _ No ✓ (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes ✓ No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ No Is the Sampled Area
Hydric Soil Present? Yes ✓ No within a Wetland? Yes No
Wetland Hydrology Present? Yes No
Remarks:
3 Week drought, 100°F.
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required; check all that aaaly)
Surface Soil Cracks (136)
Surface Water (Al)
Aquatic Fauna (613)
Sparsely Vegetated Concave Surface (138)
High Water Table (A2)
Marl Deposits (1315) (LRR U)
Drainage Patterns (1310)
Saturation (A3)
_
_ Hydrogen Sulfide Odor (Cl)
_ Moss Trim Lines (B16)
Water Marks (131)
Oxidized Rhizospheres along Living Roots (C3) Dry -Season Water Table (C2)
Sediment Deposits (B2)
_ Presence of Reduced Iron (C4)
_ Crayfish Burrows (C8)
_ Drift Deposits (B3)
Recent Iron Reduction in Tilled Soils (C6)
Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (134)
Thin Muck Surface (C7)
Geomorphic Position (D2)
_ Iron Deposits (65)
Other (Explain in Remarks)
Shallow Aquitard (D3)
_ Inundation Visible on Aerial Imagery (137)
FAC-Neutral Test (D5)
Water -Stained Leaves (139)
Sphagnum moss (D8) (LRR T, U)
Field Observations:
Surface Water Present? Yes
No Depth (inches):
Water Table Present? Yes
No Depth (inches): 5
Saturation Present? Yes
No Depth (inches): 0
Wetland Hydrology Present? Yes No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

VEGETATION (Five Strata) - Use scientific names of plants.
Sampling Point: WA
Absolute Dominant Indicator
Dominance Testworksheet:
Tree Stratum (Plot size:
) % Cover Species? Status
Number of Dominant Species
1. (Quercus sp.)
10 Yes FAC
That Are OBL, FACW, or FAC: 3 (A)
2.
Total Number of Dominant
3.
Species Across All Strata: 3 (B)
4.
Percent of Dominant Species
5.
That Are OBL, FACW, or FAC: 100 (A/B)
6.
Prevalence Index worksheet:
10 = Total Cover
50% of total cover: 5 20% of total cover: 2
Total % Cover of: Multiply by:
OBL species 0 x 1 =
Sapling Stratum (Plot size: )
1 (Quercus sp.)
10 Yes FAC
FACW species 0 x 2 =
FAC species 30 x 3 = 90
2 Sweetgum (Liquidambar styraciflua) 10 Yes FAC
3.
FACU species 0 x 4 =
4.
UPL species 0 x 5 =
5.
Column Totals: 30 (A) 90 (B)
6.
Prevalence Index = B/A = 3
20 = Total Cover
Hydrophytic Vegetation Indicators:
10 4
50% of total cover: 20% of total cover:
❑ 1 - Rapid Test for Hydrophytic Vegetation
Shrub Stratum (Plot size:
)
❑ 2 - Dominance Test is >50%
1.
❑ 3 - Prevalence Index is s3.0'
2.
ElProblematic Hydrophytic Vegetation' (Explain)
3.
4.
'Indicators of hydric soil and wetland hydrology must
5.
be present, unless disturbed or problematic.
6.
Definitions of Five Vegetation Strata:
0 = Total Cover
50% of total cover: 20% of total cover:
Tree - Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and 3 in.
Herb Stratum (Plot size:
)
(7.6 cm) or larger in diameter at breast height (DBH).
1.
Sapling - Woody plants, excluding woody vines,
2.
approximately 20 ft (6 m) or more in height and less
3
than 3 in. (7.6 cm) DBH.
4.
Shrub - Woody plants, excluding woody vines,
5.
approximately 3 to 20 ft (1 to 6 m) in height.
6.
Herb -All herbaceous (non -woody) plants, including
7.
herbaceous vines, regardless of size, and woody
$
plants, except woody vines, less than approximately
3 ft (1 m) in height.
9.
10.
Woody vine - All woody vines, regardless of height.
11.
0 = Total Cover
50% of total cover: 20% of total cover:
Woody Vine Stratum (Plot size:
)
1.
2.
3.
4.
5.
0
Hydrophytic
= Total Cover
50% of total cover: 20% of total cover:
Vegetation
Present? Yes _2L No Ll
Remarks: (If observed, list morphological adaptations below)
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0

SOIL
Sampling Point: WA
the depth needed to document the indicator or
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' ' Loc2 Texture Remarks
0-2 7.5YR 3/3 100 Silty Clay 0 Horizon
2-5 10YR 2/1 100
5+ 10YR 3/1 100
Silty Clay
Silty Clay
A Horizon
B Horizon
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.)
Indicators for Problematic Hydric Soils':
_ Histosol (Al)
Polyvalue Below Surface (S8) (LRR S, T, U) 1 cm Muck (A9) (LRR O)
_ Histic Epipedon (A2)
Thin Dark Surface (S9) (LRR S, T, U)
2 cm Muck (A10) (LRR S)
_ Black Histic (A3)
Loamy Mucky Mineral (171) (LRR O)
Reduced Vertic (F18) (outside MLRA 150A,B)
Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
Piedmont Floodplain Soils (F19) (LRR P, S, T)
_ Stratified Layers (A5)
Depleted Matrix (F3)
Anomalous Bright Loamy Soils (1720)
Organic Bodies (A6) (LRR P, T, U)
Redox Dark Surface (F6)
(MLRA 153B)
_ 5 cm Mucky Mineral (A7) (LRR P, T, U)
Depleted Dark Surface (F7)
Red Parent Material (TF2)
_ Muck Presence (A8) (LRR U)
Redox Depressions (F8)
Very Shallow Dark Surface (TF12)
1 cm Muck (A9) (LRR P, T)
Marl (F10) (LRR U)
Other (Explain in Remarks)
Depleted Below Dark Surface (Al 1)
Depleted Ochric (F11) (MLRA 151)
Thick Dark Surface (Al2)
Iron -Manganese Masses (F12) (LRR O, P, T)
3Indicators of hydrophytic vegetation and
Coast Prairie Redox (A16) (MLRA 150A)
_ Umbric Surface (F13) (LRR P, T, U)
wetland hydrology must be present,
Sandy Mucky Mineral (S1) (LRR O, S)
Delta Ochric (F17) (MLRA 151)
unless disturbed or problematic.
_ Sandy Gleyed Matrix (S4)
Reduced Vertic (F18) (MLRA 150A, 150B)
Sandy Redox (S5)
_Piedmont Floodplain Soils (F19) (MLRA 149A)
_ Stripped Matrix (S6)
Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D)
_ Dark Surface (S7) (LRR P, S, T, U)
Type:
Depth (inches):
Remarks:
Hydric Soil Present? Yesa No -a
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TIM BAUMGARTNER
Dirpaor
Christopher Greene
Mohawk Industries, Inc.
149 Homanit USA Road
Mt. Gilead, NC 27306
Project: Mohawk
NORTH CAROLINA
Environmental Quality
December 10, 2019
Expiration of Acceptance: 6/10/2020
County: Montgomery
The purpose of this letter is to notify you that the NCDEQ Division of Mitigation Services (DMS) is willing to
accept payment for compensatory mitigation for impacts associated with the above referenced project as
indicated in the table below. Please note that this decision does not assure that participation in the DMS in -
lieu fee mitigation program will be approved by the permit issuing agencies as mitigation for project impacts.
It is the responsibility of the applicant to contact permitting agencies to determine if payment to the DMS will
be approved. You must also comply with all other state, federal or local government permits, regulations or
authorizations associated with the proposed activity including G.S. § 143-214.11.
This acceptance is valid for six months from the date of this letter and is not transferable. If we have not
received a copy of the issued 404 Permit/401 Certification within this time frame, this acceptance will
expire. It is the applicant's responsibility to send copies of the permits to DMS. Once DMS receives a copy
of the permit(s) an invoice will be issued based on the required mitigation in that permit and payment must
be made prior to conducting the authorized work. The amount of the in -lieu fee to be paid by an applicant is
calculated based upon the Fee Schedule and policies listed on the DMS website.
Based on the information supplied by you in your request to use the DMS, the impacts for which you are
requesting compensatory mitigation credit are summarized in the following table. The amount of mitigation
required and assigned to DMS for this impact is determined by permitting agencies and may exceed the
impact amounts shown below.
Impact
Yadkin 03040104
Impact Type Impact Quantity
Warm Stream 104
Upon receipt of payment, DMS will take responsibility for providing the compensatory mitigation. The
mitigation will be performed in accordance with the In -Lieu Fee Program instrument dated July 28, 2010 and
15A NCAC 02B -0295 as applicable. Thank you for your interest in the DMS in -lieu fee mitigation program.
If you have any questions or need additional information, please contact Kelly Williams at [phone].
cc: Jim Spangler, agent
6 W e28MK M fwaEwgYJI O.Y/�
Sincerely, -
Ja as. Stanfill
Ass anagement Supervisor
North Carolha Department of Erw ronmentai Quality I Divlston of NO19ation Services
2r7 W.lones Street 11652 Mail Service Center I Raleig4 North Carolina 27699-1652
919.707.8976

Mohawk / Unilin MDF 6g Mohawk Stream/Wetland Map
149 Homanit Usa Rd SPANGLER
ENVIRONMENTAL. INC.
Mt. Gilead, NC 4338 Bland Road, Raleigh, North Carolina 27609 map source:
September, 2019 919-875-4288 Montgomery County GIS/nconemap.com

Jurisdictional Determination Request
US Army Corps
of Engineers.
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.army.mil/Missions/Re ug lato PererrmitProaram/Contact/CouMLocator.asl2x,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number. [phone]
Fax Number. [phone]
WILMINGTON REGULATORY FIELD OFFICE
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
US Army Corps of Engineers
69 Darlington Avenue
3331 Heritage Trade Drive, Suite 105
Wilmington, North Carolina 28403
Wake Forest, North Carolina 27587
General Number: 910-251-4633
General Number: [phone]
Fax Number. [phone]
Fax Number. [phone]
INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
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 also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

A.
B.
C.
Jurisdictional Determination Request
PARCEL INFORMATION
Street Address: 419 Homanit USA
City, State: Mount Gilead, NC
County: Montgomery County
Parcel Index Number(s) (PIN): 7504 00 97 2556,
7504 00 99 3023, 7514 00 08 1624
REQUESTOR INFORMATION
Name: James A. Spanqler / Maria Polizzi
Mailing Address: 4338 Bland Rd, Raleigh NC 27609
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
Select one:
I am the current property owner.
DI am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other, please explain.
PROPERTY OWNER INFORMATION2
Name: Christopher Greene
Mailing Address:
149 Homanit USA Rd, Mt. Gilead NC
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION','
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
James A. Spangler
Print Name
Capacity: ❑ Owner Z Authorized Agents
11 /26/19
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
✓❑ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
RI intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑A Corps JD is required in order obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
HI believe that the site may be comprised entirely of dry land.
Other:
For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
7 I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
Size of Property or Review Area 215.81 acres.
aThe property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
FProject Coordinates (Decimal Degrees): Latitude:
Longitude
35.253355
-79.973575
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 11 x 17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).'
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
■ Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
✓� Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. http://www.saw.usace.army.miI/Missions/Re ug latoty-Permit-
Proeram/Juri sdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
✓1 Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDs, please complete an Approved Jurisdictional Determination Form'
✓� Vicinity Map
0 Aerial Photograph
❑ USGS Topographic Map
❑✓ Soil Survey Map
✓❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
❑ Other Assessment Forms
' www saw usace.army.mil/Portals/59/docs/re ug latory/reg_docs/JD/RGL 08-02 App A Prelim JD Form fillable.ndf
' Please see hqp://www saw usace army mil/Missions/Re ug latoEy-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction isto be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Quality Forest Products
December 4, 2019
To Whom It May Concern:
The letter serves to inform you that Jordan Lumber & Supply, Inc. and/or JordanTwo, LLC.
located at 1939 NC Hwy. 109 South (PO Box 98, Mt. Gilead, NC 27306 )hereby authorizes
Spangler Environmental, Inc. to act as our technical agent for the purposes of environmental
issues, including wetland and stream identification, permitting, mitigation planning and
regulatory agency coordination at the property known as Tract No. 9149 and Tract No. 9151, and
as shown in Montgomery County records as Tax Parcel Nos. 7514 00 08 1628 and 7504 00 99
3023. All site visits by regulatory personnel must be coordinated in advance with our agent,
Spangler Environmental, Inc. This letter supercedes all previous Agent -related correspondence.
The following contact persons should be copied on all correspondence:
Property Owner (or Legal Agent/Representative):
Robert B. Jordan, IV
VP/General Manager
1939 NC Hwy. 109 South, PO Box 98, Mt. Gilead, NC 27306
910-439-8119
Riordan(i, iordanlumber.com
Technical Agent:
James A. Spangler, CEI, A.M.ASCE
Spangler Environmental, Inc
4338 Bland Road
Raleigh, NC 27609
919-875-4288
[e-mail]
Sincerely,
Robert B. Jordan, IV
Jordan Lumber & Supply, Inc
VP/General Manager
Jordan Lumber & Supply, Inc. - P.O. Box 98 - Mt. Gilead, N.C. 27306 - Phone [phone] Fax [phone]

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
A. REPORT COMPLETION DATE FOR PJD: 11 /26/2019
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: James A. Spangler / Maria Polizzi
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Raleigh
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Montgomery City: Mt. Gilead
Center coordinates of site (lat/long in degree decimal format):
Lat.: 35.253355 Long.:-79.973575
Universal Transverse Mercator: 17S 593375.05E 3901622.54N
Name of nearest waterbody: Big Town Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date: 11 /26/19
On Field Determination. Date(s): 10/3/19
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, 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 10/404)
W 1
35°15'8.395" N
79°58'22.853"W
.24 acres
Wetland
Section 404 Wetland
S 1
35°15'10.621 "N
79°58'24.443"W
104 feet
Non -Wetland Waters
Section 10 Non -Wetland

1)
2)
The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) 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.
In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction 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 jurisdictional 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 the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including 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 constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form 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, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. 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. and/or that there "may be" 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 PJD (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 the PJD requestor:
Map:
■❑ Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
❑ U.S. Geological Survey map(s). Cite scale & quad name:
❑ Natural Resources Conservation Service Soil Survey. Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ 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 jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
w4v&�Z 149;n1e,
Signature and date of w
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
' Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

35' 15' 16" N
35° 15 G' N
Custom Soil Resource Report
Soil Map
N
593160 580200 593240 59= 59M 553400 593440 5f0483 59352D 593560
3 3
Map Sole: 1:2,040 if printed on A landscape (11' x 8.5D street
N Mears
0 30 60 12D 18D �
Feet
0 50 100 200 l 300
Map proJ�: Web Mercator Comer 000rdi�s: WGS84 Edge bm: UiM Zone 17N WGS84
9
35' 1516" N
35° 15 6" N

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site: Mohawk City/County: Mount Gilead/Montgomery Sampling Date: 10/3/19
Applicant/Owner. Mohawk Industries Inc. State: NC Sampling Point: WA
Investigator(s): James A. Spangler Section, Township, Range:
Landform (hillslope, terrace, etc.): Relic flood plain Local relief (concave, convex, none): Concave Slope (%): <2
Subregion (LRR or MLRA): MLRA 136 Let: 35.253355 Long: -79.973575 Datum: NAD1983
Soil Map Unit Name: Badin-Goldston complex NWI classification: Upland/ Not Classified
Are climatic / hydrologic conditions on the site typical for this time of year? Yes _ No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes ✓ No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ No Is the Sampled Area
Hydric Soil Present? Yes ✓ No within a Wetland?
Wetland Hydrology Present? Yes ✓ No
3 Week drought, 100°F.
HYDROLOGY
Yes ✓ No
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two reauired)
Primary Indicators (minimum of one is
reouiredo check all that apply)
Surface Soil Cracks (136)
_ Surface Water (Al)
Aquatic Fauna (613)
Sparsely Vegetated Concave Surface (138)
✓ High Water Table (A2)
_ Marl Deposits (1315) (LRR U)
Drainage Patterns (610)
Saturation (A3)
_ Hydrogen Sulfide Odor (C1)
_ Moss Trim Lines (1316)
Water Marks (61)
Oxidized Rhizospheres along Living Roots (C3) Dry -Season Water Table (C2)
✓ Sediment Deposits (132)
_ Presence of Reduced Iron (C4)
_ Crayfish Burrows (C8)
_ Drift Deposits (133)
Recent Iron Reduction in Tilled Soils (C6)
Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (134)
Thin Muck Surface (C7)
Geomorphic Position (D2)
_ Iron Deposits (135)
Other (Explain in Remarks)
Shallow Aquitard (D3)
_ Inundation Visible on Aerial Imagery (137)
FAC-Neutral Test (D5)
_ Water -Stained Leaves (89)
Sphagnum moss (D8) (LRR T, U)
Field Observations:
Surface Water Present? Yes
No Depth (inches):
Water Table Present? Yes
No Depth (inches): 5
Saturation Present? Yes
✓ No Depth (inches): 0
Wetland Hydrology Present? Yes No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

VEGETATION (Five Strata) — Use scientific names of plants.
Sampling Point: WA
Absolute Dominant Indicator
Dominance Testworksheet:
Tree Stratum (Plot size:
) % Cover Species? Status
Number of Dominant Species
1. (Quercus sp.)
10 Yes FAC
That Are OBL, FACW, or FAC: 3 (A)
2.
Total Number of Dominant
3.
Species Across All Strata: 3 (B)
4.
Percent of Dominant Species
5.
That Are OBL, FACW, or FAC: 100 (A/13)
6.
Prevalence Index worksheet:
10 = Total Cover
50% of total cover. 5 20% of total cover. 2
Total % Cover of: Multiply by:
Sapling Stratum (Plot size:
)
OBL species 0 x 1 =
1. (Quercus sp.)
10 Yes FAC
FACW species 0 x 2 =
2. Sweetgum (Liquidambar styraciflua) 10 Yes FAC
FAC species 30 x 3 = 90
3,
FACU species 0 x 4 =
4,
UPL species 0 x 5 =
5.
Column Totals: 30 (A) 90 (B)
6.
Prevalence Index = B/A = 3
20 = Total Cover
Hydrophytic Vegetation Indicators:
50% of total cover. 10 20% of total cover. 4
❑ 1 - Rapid Test for Hydrophytic Vegetation
Shrub Stratum (Plot size:
)
❑ 2 - Dominance Test is >50%
1
❑ 3 - Prevalence Index is 53.0'
2
❑ Problematic Hydrophytic Vegetation' (Explain)
3.
4.
'Indicators of hydric soil and wetland hydrology must
5
be present, unless disturbed or problematic.
6.
Definitions of Five Vegetation Strata:
0 = Total Cover
50% of total cover. 20% of total cover:
Tree — Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and 3 in.
Herb Stratum (Plot size:
)
(7.6 cm) or larger in diameter at breast height (DBH).
1.
Sapling — Woody plants, excluding woody vines,
2.
approximately 20 ft (6 m) or more in height and less
3
than 3 in. (7.6 cm) DBH.
4.
Shrub — Woody plants, excluding woody vines,
5,
approximately 3 to 20 ft (1 to 6 m) in height.
6.
Herb —All herbaceous (non -woody) plants, including
7.
herbaceous vines, regardless of size, and woody
plants, except woody vines, less than approximately
$
3 ft (1 m) in height.
9.
10
Woody vine — All woody vines, regardless of height.
11.
0 = Total Cover
50% of total cover. 20% of total cover:
Woody Vine Stratum (Plot size:
)
1.
2.
3.
4.
5.
0 = Total Cover
Hydrophytic
Vegetation
Fv]
50% of total cover. 20% of total cover:
Present? Yes No
Remarks: (If observed, list morphological adaptations below).
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

SOIL
Sampling Point: WA
Description: (Describe to the depth needed to
or
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loci Texture Remarks
0-2 7.5YR 3/3 100 Silty Clay 0 Horizon
2-5
10YR 2/1
100
Silty Clay
A Horizon
5+
10YR 3/1
100
Silty Clay
B Horizon
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.)
Indicators for Problematic Hydric Soils':
_ Histosol (Al)
Polyvalue Below Surface (S8) (LRR S, T, U) 1 cm Muck (A9) (LRR O)
_ Histic Epipedon (A2)
Thin Dark Surface (S9) (LRR S, T, U)
2 cm Muck (A10) (LRR S)
_ Black Histic (A3)
Loamy Mucky Mineral (F1) (LRR O)
Reduced Vertic (F18) (outside MLRA 150A,B)
_ Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
Piedmont Floodplain Soils (F19) (LRR P, S, T)
_ Stratified Layers (A5)
r Depleted Matrix (F3)
Anomalous Bright Loamy Soils (F20)
_ Organic Bodies (A6) (LRR P, T, U)
Redox Dark Surface (F6)
(MLRA 1538)
_ 5 cm Mucky Mineral (A7) (LRR P, T, U)
Depleted Dark Surface (F7)
Red Parent Material (TF2)
_ Muck Presence (A8) (LRR U)
Redox Depressions (178)
Very Shallow Dark Surface (TF12)
_ 1 cm Muck (A9) (LRR P, T)
Mari (F10) (LRR U)
Dther (Explain in Remarks)
_ Depleted Below Dark Surface (A11)
Depleted Ochric (F11) (MLRA 151)
_ Thick Dark Surface (Al2)
Iron -Manganese Masses (F12) (LRR O, P, T)
3Indicators of hydrophytic vegetation and
_ Coast Prairie Redox (A16) (MLRA 150A)
_ Umbric Surface (F13) (LRR P, T, U)
wetland hydrology must be present,
_ Sandy Mucky Mineral (S1) (LRR O, S)
Delta Ochric (F17) (MLRA 151)
unless disturbed or problematic.
_ Sandy Gleyed Matrix (S4)
Reduced Vertic (F18) (MLRA 150A, 150B)
_ Sandy Redox (S5)
Piedmont Floodplain Soils (F19) (MLRA 149A)
_ Stripped Matrix (S6)
Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C,153D)
_ Dark Surface (S7) (LRR P, S, T, U)
Type:
Depth (inches):
Remarks:
Hydric Soil Present? Yes a No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

O�O� W ATF9OG
FMI0 �
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
1 a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number. 4135 - Linear Transportation
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):
❑ 401 Water Quality Certification — Regular ❑X 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 ❑X No
For the record only for Corps Permit:
❑ 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
or in -lieu fee program.
❑ Yes ❑X No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below.
❑ Yes ❑X No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes Q No
2.
Project Information
2a.
Name of project:
Mohawk
2b.
County:
Montgomery
2c.
Nearest municipality / town:
Mount Gilead
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Jordan Lumber & Supply Inc; Jordan Three LLC; Mohawk Industries Inc.
3b.
Deed Book and Page No.
Book: 338; 704; 495 Page: 621; 294; 569
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
149 Homanit Rd
3e.
City, state, zip:
Mount Gilead, NC, 27306
3f.
Telephone no.:
[phone] ext. 272
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑X Agent ❑ Other, specify: Owner of Project
4b. Name:
Christopher Greene
4c. Business name
(if applicable):
Mohawk Industries Inc.
4d. Street address:
149 Homanit USA Rd
4e. City, state, zip:
Mt. Gilead NC
4f. Telephone no.:
[phone] ext. 272
4g. Fax no.:
4h. Email address:
[e-mail]
5. AgentlConsultant Information (if applicable)
5a. Name:
James A. Spangler / Maria Polizzi
5b. Business name
(if applicable):
Spangler Environmental LLC
5c. Street address:
4338 Bland Road
5d. City, state, zip:
Raleigh, NC, 27609
5e. Telephone no.:
[phone]
5f. Fax no.:
[phone]
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):
1750400972556,751400081628,750400993023
1b. Site coordinates (in decimal degrees):
Latitude: 35.253355 Longitude:-79.973575
1c. Property size:
215.81 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Big Town Creek
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Yadkin-Peedee River Basin
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 area surrounding the project site consists of an industrial factory and lumber yard (Mohawk, Jordan Lumber), surrounded by non -developed
wooded land. The site is in the wooded area, adjacent to Mohawk and Jordan Lumber, with a small stream running through it.
3b. List the total estimated acreage of all existing wetlands on the property: 0.24
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 692
3d. Explain the purpose of the proposed project:
The purpose of this project is to create a road crossing between the Jordan Lumber yard and the Mohawk Industries facility.
3e. Describe the overall project in detail, including the type of equipment to be used:
A stream crossing and unpaved gravel road is being built. The equipment used to build this road includes, but is not limited to excavator(s), bulldozers
0
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project(including all priorphases) in thepast?
❑ Yes ® No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SEI has delineated features within the project area and a JD request form is attached to this PCN
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes © No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ 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.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 -
Choose one
Choose one
Yes/No
-
W2 -
Choose one
Choose one
Yes/No
-
W3 -
Choose one
Choose one
Yes/No
-
W4 -
Choose one
Choose one
Yes/No
-
W5 -
Choose one
Choose one
Yes/No
-
W6 -
Choose one
Choose one
Yes/No
-
2g. Total Wetland Impacts:
2h. Comments:
No Wetland impacts
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.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P
Culvert
Stream 1
PER
DWQ
3
104
S2 -
Choose one
-
-
S3 -
Choose one
-
-
S4 -
Choose one
-
-
S5 -
Choose one
-
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
104
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

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 -
Choose one
Choose
O2 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments: NIA
5. Pond or Lake Construction
If pond or lake construction proposed, the 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
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 any impacts require mitigation, then you MUST fill out Section D of this form.
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
B1 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
6i. Comments: No buffers within the Yadkin/ Pee Dee watershed
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The plans were designed in a way in which the smallest amount of stream would be impacted.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Necessary erosion control measures will be taken in order to ensure sediment from the site does not impact protected waters.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑X Yes
4b. Stream mitigation requested:
104 linear feet
4c. If using stream mitigation, stream temperature:
warm
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 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
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 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes Q 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.
The project does not occur within a protected riparian buffer.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
0 %
2b. Does this project require a Stormwater Management Plan?
❑ Yes © No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
At the end of this project, there will be 35% built -upon land. However, the roadway that is proposed is a gravel road which will not increase the amount
of impervious surface on the project site.
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?
N/A
❑ Phase II
❑ NSW
3b. Which of the following locally -implemented stormwater management programs
USMPWater
apply (check all that apply):
® 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
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PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes
❑X 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
El 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:
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
❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
El 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
El Yes
❑X No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
No Sewage required.
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PCN Form — Version 1.4 January 2009

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 []X, No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program/ Reached out to USFWS but did not receive response.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA Essential Fish Habitat Mapper
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 ❑X 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?
EDR NEPA Report
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA Floodplain Map
Maria Polizzi
12-11-2019
Applicant/Agent's Printed Name
Applicant/Agent's Sigl a
Date
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
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