20110189 Ver 1_401 Application_20110211

Q Suite 300
Kimley-Horn 201 10 1 ?7 9 4651 Charlotte Park Drive
G. and Associates Inc. Charlotte, North Carolina
, 28217
TEL [phone]
FAX [phone]
Transmittal
Date: February 23, 2011 Job Number: 015476140
Project Name: Wal-Mart Store #3036-00 (Yanceyville, NC)
To: Ian McMillan
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
We are sending these by
? U.S. Mail ® FedEx ? Hand Deliver 'Al
? Other:
We are sending you
® Attached
E] Shop Drawings
? Under separate cover via
the following items:
? Prints/Plans ? Samples E] Specifications ? Change Orders
® Other: 404/401 Permit (Nationwide 39) Application Package
Copies Date No. Description
5 2/23/11 1 404/401 Permit (Nationwide 39) Application Package
1 2/23/11 2
g'y
Fee Check $240 in.
1 2/23/11 3 CD-R (PDF Full Size Plan Set)

J a '>

L ?CA/ATFt? Zh
These are transmitted as checked below:
0 For your use ? Approved as submitted ? Resubmit F? Copies for approval
? As requested ? Approved as noted ® Submit ? Copies for distribution
® For review and comment 0 Returned for corrections ? Return ? Corrected prints
Remarks: Please feel free to contact me if you have any questions: 704-409-1802
Copy to: file Signed
Chris Tinklenberg, WP
pPP- = ?? Kimley-Horn
? = and Associates, Inc.
February 23, 2011
Mr. Andrew Williams
Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Mr. Ian McMillan
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Re:404/401 Permit (Nationwide 39) Application
Walmart Store #3036-00 (Yanceyville, NC)
Yanceyville, Caswell County, NC
Dear Mr. Williams and Mr. McMillan:
On behalf of Walmart Real Estate Business Trust, Kimley-Horn and Associates,
Inc. is submitting the enclosed joint 404/401 Preconstruction Notification
Application for authorization to construct the above referenced retail building
and associated parking lots under Nationwide Permit #39 and General 401 Water
Quality Certification number 3821. The following information is included as
part of this application submittal:
• Project Summary Sheet
• Pre-Construction Notification Form
• Agent Authorization Form
• Site Figures
o Figure 1 - Vicinity Map
o Figure 2 - USGS Topographic Map (Yanceyville Quadrangle)
o Figure 3 - USDA Soil Survey (Caswell County, 1908)
o Figure 4 - Aerial Map (NAIP 2010 Caswell Co. Aerial)
o Figure 5 - Impact Area Map (NAIP 2010 Caswell Co. Aerial)
• Construction Plan Drawing
• NCEEP In-Lieu Fee Program Acceptance Letter
• Site Data forms and Photographs
o USACE Stream Quality Assessment Worksheet
o NCDWQ Stream Identification Form
o Site Photographs
o Rapanos Jurisdictional Determination Form
¦
TEL [phone]
FAX [phone]
¦
Suite 300
4651 Chad de Park Drive
Chadotte, Nedh Carolina
28217-1911
Kimley-Horn
and Associates, Inc.
• Project Site Historical Permit Documentation
The project site is located within the town of Yanceyville, NC within Caswell
County, along US Hwy 158 South. The project site is currently an undeveloped
parcel that has been historically maintained for future development. Existing
land use in the vicinity of the project consists of single family residential
development, commercial development, and undeveloped forested land.
The 404/401 (NWP 39) application information presents site conditions
evaluated by Kimley-Horn and Associates, Inc (KHA) staff (Chris Tinklenberg,
WPIT) on January 13, 2011 and verified by the US Army Corps of Engineers
staff (Andy Williams) and the NC Division of Water Quality staff (Sue
Homewood) on February 1, 2011.
The proposed project seeks to construct a new - 14,869 square foot commercial
retail building with associated parking lots on an approximately 5.3+/- acre tract.
The proposed design also incorporates the construction of a wet detention basin
to treat runoff from the newly constructed impervious area. The project will
result in permanent impacts to 81 linear feet of a perennial RPW from the
replacement/realignment of a 48" CMP. The project requires 35 linear feet of
temporary impacts to install sand bags and a pump-around to allow work "in the
dry"
Please feel free to contact me at [phone] if you have any questions, or if
additional information is necessary.
Sincerely,
KIMLEY-HORN AND ASSOCIATES, INC.
Chris Tinklenberg, WPIT
Attachments
Cc: Steve Mitchael, Walmart Real Estate Business Trust
Austin Watts, Kimley-Horn and Associates, Inc.
? ? ? Kimley-Horn
and Associates, Inc. Project Summary Sheet
Project Name: Walmart Store #3036-00 (Yanceyyille, NC)
Applicant Name and Address: Steve Mitchael
Walmart Real Estate Business Trust
2001 SE 10th Street
Bentonville AR 72716-0550
Telephone Number: 479-273-4846
Type of Request: ® Nationwide PCN (NWP # 39) ? Individual Permit Application
? Jurisdictional Determination ? Other:
Included Attachments: ® Project Plans ® USGS Map ® NRCS Soil Survey
® Agent Authorization ® Delineation Sketch ® Delineation Survey
? Data Forms (Up & Wet) ® NCDWQ Stream Forms ® USACE Stream Forms
® NCEEP Confirmation ® Aerial Photo Site Photos
? Agency Correspondence ? Other: ? Other:
Check if applicable: ? CAMA County ? Trout County ? Isolated Waters
? Section 7, ESA ? Section 106, NHPA ? EFH
® Mitigation Proposed (® NC EEP ? On-Site ? Off-Site ? Other)
County: Caswell Nearest City/Town: Yanceyville
Waterway: UT to South Fork Rattlesnake Creek
H.U.C.: 03010104-Roanoke
River Basin: Roanoke
USGS Quad Name: Yancewille
Property Size (acres): 5.3
Site Coordinates (in decimal degrees): 36.412761 ON
Approx. Size of Jurisdiction on Site (acres): 0.035
-79.344978 °W
Project Location: The proiect site is located in the town of Yanceyyille, NC along US Highway 158 South.
Site Description: The project site is currently an undeveloped parcel that has been historically prepared for future
development. The parcel is maintained and approximately 300 linear feet of a perennial RPW and associated riparian buffer
exist on the property.
Impact Summary (if applicable): The project will result in permanent impacts to 81 linear feet of a perennial RPW from
the replacement/realianment of a 48" CMP. The project requires 35 linear feet of temporary impacts to install sand bags and
a pump-around to allow work "in the dry".
O
W
t W
tl
d Stream Channel
NWP
# pen
a
er
(acres) an
e
(acres) Intermittent and/or
Unimportant A uatic Function Perennial and/or Important Aquatic
Function
T P T P Tem Perm. Tem Perm.
emp. erm. emp. erm. if ac if ac if ac if Ac
39 35 0.004 81 0.009

Total
Total Permanent Impact to Waters of the U.S. (acres) 0.009
Kimley-Horn Contact: Chris Tinklenbere, WPIT
¦
4651 Charlotte Park Dr. Ste 300
Charlotte, North Carolina
28217
Direct Number: [phone]
¦
TEL [phone]
FAX [phone]
201 10 189
ot W AL?9
r
O Y
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the

Corps:
®Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 39 or General Permit (GP) number: 3821
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ® Yes ? No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Walmart Store #3036-00 (Yanceyville, NC) D
2b. County: Caswell
2c. Nearest municipality / town: Yanceyville
2d. Subdivision name: - l a'

2e.
project noonly, T.I.P. or state QU,
yy NR yy s all
3. Owner Information
3a. Name(s) on Recorded Deed: Wilson Properties Inc.
3b. Deed Book and Page No. Book 348 Page 82
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 133 Mountain View Dr.
3e. City, state, zip: Pilot Mountain, NC 27041
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Walmart Real Estate Business Trust
4b. Name: Steve Mitchael
4c. Business name
(if applicable): Walmart Real Estate Business Trust
4d. Street address: 2001 SE 10`h Street
4e. City, state, zip: Bentonville, AR 72716-0550
4f. Telephone no.: 479-273-4846
4g. Fax no.: 479-204-0934
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Chris Tinklenberg, WPIT
5b. Business name
(if applicable): Kimley-Horn and Associates
5c. Street address: 4651 Charlotte Park Drive Suite 300
5d. City, state, zip: Charlotte, NC 28217
5e. Telephone no.: 704-409-1802
5f. Fax no.: 704-333-0845
5g. Email address: [e-mail]
Page 2 of 11
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 899608896246
1 b. Site coordinates (in decimal degrees): Latitude: 36.412761 Longitude: -79.344978
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 5.3 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to South Fork Rattlesnake Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: Class C water
2c. River basin: Roanoke
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The project site is located within the town of Yanceyville, NC along US Hwy 158 South. The project site is currently an
undeveloped parcel that has been historically prepared for future development. The parcel is maintained. Approximately
300 linear feet of a perennial RPW and associated riparian buffer exist on the property. Existing land use in the vicinity of
the project consists of single family residential development, commercial development, and undeveloped forested land.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
--300 LF
3d. Explain the purpose of the proposed project:
The purpose of this project is to construct a new -14,869 square foot commercial retail building with associated parking
lots. Additionally, the proposed project includes the construction of a wet detention basin to treat runoff from the newly
constructed impervious area.
3e. Describe the overall project in detail, including the type of equipment to be used:
Site preparation and construction of the proposed Walmart will be performed using heavy equipment such as bulldozers
and excavators.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes ? No ? Unknown
project (including all prior phases) in the past?
Comments: JD was submitted on January 26, 2011.
4b. If the Corps made the jurisdictional determination, what type
? Preliminary Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Kimley-Horn and
Associates, Inc.
Name (if known): Chris Tinklenberg, WPIT Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
JD was submitted on January 26, 2011.
Page 3 of 11
PCN Form - Version 1.3 December 10, 2008 Version
5. Project History
5a. Have permits or certifications been requested or obtained for ® Yes ? No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
A Nationwide Permit 26 (Headwaters and Isolated Waters) was issued in 1995 permitting the impacts to .078 acres of
jurisdictional waters and wetlands located adjacent to, and above the headwaters of, the UT of South Fork Rattlesnake
Creek.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3
P F-1 T ? Yes El Corps
? ? No ? DWQ
W4
P ? T ? Yes El Corps
? ? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts NA
2h. Comments: NA
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number -
Permanent (P) or (PER) or
intermittent (Corps - 404, 10
DWQ - non-404 stream
width length
(linear
Temporary (T) (INT)? ,
other) (feet) feet)
S1-Impact 1 Replace/realign UT to South Fork ® PER ® Corps
® P [:1 T 48" CMP Rattlesnake Creek ? INT El pWQ 5 81
S1-Impact 2

? P ® T Installation of
pump around and UT to South Fork ® PER ® Corps

5

15
sand bags Rattlesnake Creek ? INT [:1 DWQ
S1-Impact 3
?
P ® T Installation of
impervious stone UT to South Fork
R ®PER ®
Corps 5 20

ring
attlesnake Creek ?
INT
?pWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 116
3i. Comments:
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
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 an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
131 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The site layout was designed to limit the amount of impacts to the stream while providing safe and effective routing for store
operations. A retaining wall has been placed at the end of the impacts to further reduce impacts to the stream. Additionally, a
wet detention basin has been designed to remove 90% of Total Suspended solids. The basin will also meet the pre-
development stormwater condition for the 1-yr, 2-yr, and 10-yr 24 hour storm events.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
An effective erosion and sedimentation control plan has been developed to minimize the impacts to the existing stream. The
plan is to reduce as much stormwater flowing to the stream during construction by way of lined diversion ditches that will flow
to sediment traps/basins. To handle the off-site flow, the area in front of the existing upstream inlet will be dammed with
sandbags. A temporary pump will be used to pump clean water around construction activity. In addition, the limited water that
will pass through the existing stream will pass through a rock check dam prior to entering the unimpacted portion of the stream
during construction.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ® Yes ? No
2b. If yes, mitigation is required by (check all that apply): ® DWQ ® Corps

2c. If yes, which mitigation option will be used for this

project? ? Mitigation bank

®Payment to in-lieu fee program

? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ® Yes
4b. Stream mitigation requested: 81 linear feet
4c. If using stream mitigation, stream temperature: ® warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments: Per our agency meeting on February 1, 2011 mitigation is required at a ratio of 1:1.
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1
Zone 2
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 30% (Approximate)
2b. Does this project require a Stormwater Management Plan? ® Yes ? No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: n/a
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Based on the impervious area increase, a wet detention basin has been designed to remove 90% of Total Suspended
solids. The basin will also meet the pre-development stormwater condition for the 1-yr, 2-yr, and 10-yr 24 hour storm
events.
2e. Who will be responsible for the review of the Stormwater Management Plan? ? Certified Local Government
? DWQ Stormwater Program
Note: The Stormwater Management Plan Express Review is in process. ® DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? n/a
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ® No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply):
? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ® Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ® Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? 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 ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Wastewater will be contained in a private sanitary sewer lateral from the building to a proposed on-site lift station. A force
main from the lift station will carry wastewater into the existing public sanitary sewer main within the Right-of-Way.
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or [] Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
El Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS Endangered and Threatened Species county list for Caswell County and the NC Natural Heritage program
database were reviewed (02/22/2011) as part of this project. There are no current or historic occurrences of threatened
or endangered species in the project corridor. In addition, suitable habitat was not observed for any species listed by
USFWS during field reconnaissance.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
The project does not occur in a coastal county.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
A review of the SHPO GIS database and the Office of State Archaeology GIS database was conducted on 02/22/2011.
No historical or archaeological resources will be impacted as a result of the proposed project
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? NC Floodplain Mapping Information System
Chris Tinklenberg, WPIT 2/22/2011
Applicant/Agent's Printed Name Applicant/Agent's Signat Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 11
PCN Form - Version 1.3 December 10, 2008 Version
AGENT AUTHORIZATION FORM
Name: Wilson Properties, Inc.
Address:
Phone:
Project Name/Description: Retail f a c i l i t
Date: January 20,_ 2011
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
Attention: Andrew Williams
Field Office Raleigh Field Office
Re: Wetland Related Consulting and Permitting
To Whom It May Concern:
I, the current property owner, hereby designate and authorize Kimley-Horn and
Associates, Inc. to act in my/our behalf as my/our agent solely for the purpose of
processing of Section 404 permits and Section 401 Water Quality Certifications
applications and to furnish upon request supplemental information in support of
applications, etc. from this day forward until successful completion of the permitting
process or revocation by the owner.
77-
Authorized this the 2
/
day of Tarvu&rr,
so r'0 T
Print Prope Owner's Name Property wner's Signature
CC: Ian McMillan,
4 N.C. Wetlands Unit
1621 Mail Service Center
Raleigh, N. C. 27699-1621
Project Site 86
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PROGRAM
February 21, 2011
Steve Mitchael
Walmart Real Estate Business Trust
2001 SE 10`s St.
Bentonville, AR 72716 Expiration of Acceptance: November 21, 2011
Project: Yanceyville Retail Facility Site County: Caswell
The purpose of this letter is to notify you that the North Carolina Ecosystem Enhancement Program (NCEEP) is willing to accept
payment for impacts associated with the above referenced project. Please note that this decision does not assure that the payment will
be approved by the permit issuing agencies as mitigation for project impacts. It is the responsibility of the applicant to contact these
agencies to determine if payment to the NCEEP will be approved. You must also coMRIY with all other state, federal or local
government vermits, reeulations or authorizations associated with the orooosed activitv including SL 2009-337: An Act to Promote
Compensatory Mitigation by Private Mitigation Banks.
This acceptance is valid for nine months from the date of this letter and is not transferable. If we have not received a copy of the
issued 404 Permit1401 Certification/CAMA permit within this time frame, this acceptance will expire. It is the applicant's
responsibility to send copies of the permits to NCEEP. Once NCEEP 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 to NCEEP by an applicant is calculated based upon the Fee Schedule and policies listed at www.nceep.net.
Based on the information supplied by you the impacts that may require compensatory mitigation are summarized in the following
table.
River
Basin CU
Location Stream (feet) Wetlands (acres) Buffer I
(Sq. Ft.) Buffer H
(Sq. Ft.)
Cold Cool Warm Riparian Non-Riparian Coastal Marsh
Impact Roanoke 03010104 0 0 81 0 0 0 0 0
Credits Roanoke 03010104 0 0 162 0 0 0 0 0
Upon receipt of payment, EEP will take responsibility for providing the compensatory mitigation. If the regulatory agencies require
mitigation credits greater than indicated above, and the applicant wants NCEEP to be responsible for the additional mitigation, the
applicant will need to submit a mitigation request to NCEEP for approval prior to permit issuance. The mitigation will be performed
in accordance with the N.C. Department of Environment and Natural Resources' Ecosystem Enhancement Program In-Lieu Fee
Instrument dated July 28, 2010.
If you have any questions or need additional information, please contact Kelly Williams at [phone].
Sincerely,
W lia D. Gilmore, PE
Dir r
cc: Ian McMillan, NCDWQ Wetlands/401 Unit
Andy Williams, USACE-Raleigh
Sue Homewood, NCDWQ-Winston-Salem
Chris Tinklenberg, agent
File
Kutoriil!j... ... Pro". Our .State
HURNRI
North Carolina Ecosystem Enhancement Program, 1652 Mail Service Center, Raleigh, NC 27699-1652 / 919-715-0476 / www.nceep.net
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name:
3. Date of evaluation: January 13, 2001
5. Name of stream: S1-UT to South Fork Rattlesnake Creek
7. Approximate drainage area:67 ac
9. Length of reach evaluated: 75ft.
11. Site coordinates (if known): prefer in decimal degrees.
2. Evaluator's name: Chris Tinklenberg, WPIT
4. Time of evaluation: 1:00 pm
6. River basin: Roanoke
8. Stream order: 1
10. County: Caswell
12. Subdivision name (if any):
Latitude (ex. 34.872312): 36.412761
Longitude (ex. -77.556611):_-79.344978
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GISOther GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location): The reach
is located west/southwest of US HWY158.
14. Proposed channel work (if any): Unknown
15. Recent weather conditions: Very cold: winter storm on the 10'h and I Ph: snow still on the >_roun?
16. Site conditions at time of visit: Sunny and clear. 35 degrees.
17. Identify any special waterway classifications known: Section 10 Tidal Waters Essential Fisheries Habitat
Trout Waters Outstanding Resource Waters Nutrient Sensitive Waters Water Supply Watershed (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES NO If yes, estimate the water surface area: 0.3 ac
19. Does channel appear on USGS quad map? YES NO 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 10 % Residential 60 % Commercial % Industrial % Agricultural
15 % Forested 15 % Cleared / Logged % Other ( )
22. Bankfull width: 4-5ft. 23. Bank height (from bed to top of bank): 4-5 ft.
24. Channel slope down center of stream: Flat (0 to 2%) _X _Gentle (2 to 4%) Moderate (4 to 10%) Steep (>10%)
25. Channel sinuosity: Straight X Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points to
each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the characteristics
identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a characteristic cannot
be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the comment section. Where
there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture into a forest), the stream
may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each reach. The total score
assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the highest quality.
Total Score (from reverse): 58 Comments:
Evaluator's
This channel evaluation form is intended to be used only as guide to assist landowners and environmental professionals in gathering
the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream quality. The total score
resulting from the completion of this form is subject to USACE approval and does not imply a particular mitigation ratio or
requirement. Form subject to change - version 06/03. To Comment, please call 919-876-8441 x 26.
Stream Quality Assessment Worksheet
# Ch
t
i
ti Eco-re ion Point Range S
arac
er
s
cs
Coastal
Piedmont
Mountain core

1 Presence of flow / persistent pools in stream
0-5
0-4
0-5
3
(no flow or saturation = 0; strong flow = max points)
2 Evidence of past human alteration 0-6 0-5 0-5 5
extensive alteration = 0; no alteration = max points)
3 Riparian zone 0-6 0-4 0-5 3
no buffer = 0; contiguous, wide buffer = max points)
4 Evidence of nutrient or chemical discharges 0-5 0-4 0-4 4
(extensive discharges = 0; no discharges = max points)
04
5 Groundwater discharge
0-3
0-4
0-4
2
U (no discharge = 0; springs, seeps, wetlands, etc. = max points)
rr
6 Presence of adjacent floodplain
0-4
0-4
0-2
3
no flood lain = 0; extensive flood lain = max points)
7 Entrenchment / floodplain access 0-5 0-4 0-2 l
a+ dee l entrenched = 0; frequent flooding = max points)
8 Presence of adjacent wetlands
j 0-6 0-4 0-2 0
no wetlands = 0; large ad
acent wetlands = max points)
9 Channel sinuosity 0-5 0-4 0-3 3
(extensive channelization = 0; natural meander = max points)
10 Sediment input 0-5 0-4 0-4 4
extensive deposition= 0; little or no sediment = max points)
I 1 Size & diversity of channel bed substrate NA* 0-4 0-5 2
fine, homogenous = 0; large, diverse sizes = max points)
12 Evidence of channel incision or widening 0-5 0-4 0-5 2
F (deeply incised = 0; stable bed & banks = max points)
E-
0-0
13 Presence of major bank failures
0-5
0-5
0-5
3
04 (severe erosion = 0; no erosion, stable banks = max points)
Q 14 Root depth and density on banks 0-3 0-4 0-5 3
F no visible roots = 0; dense roots throughout = max points)
CA r15 Impact by agriculture, livestock, or timber production 0-5 0-4 0-5 4
substantial impact =0; no evidence = max points)
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
F no riffles/ripples or pools = 0; well-developed = max points)
Q
1 Habitat complexity
0-6
0-6
0-6
3
(little or no habitat = 0; frequent, varied habitats = max points)
M
18 Canopy coverage over streambed
0-5
0-5
0-5
3
no shading vegetation = 0; continuous canopy = max points)
19 Substrate embeddedness NA* 0- 4 0- 4 3
dee l embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0-4 0-5 0-5 0
no evidence = 0; common, numerous types = max points)

21 Presence of amphibians
0-4
0-4
0-4
0
O (no evidence = 0; common, numerous types = max points)

O
22 Presence of fish
0-4
0-4
0-4
0
no evidence = 0; common, numerous types = max points)
23 Evidence of wildlife use 0-6 0-5 0-5 3
no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100 100
TOTAL SCORE (also enter on first page) 58
* These characteristics are not assessed in coastal streams.
North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/13/2011 Project/Site: Yanceyville-Retail Latitude: 36.412547
Evaluator: Chris Tinklenberg County: Caswell Longitude: -79.345542
Total Points: 34 Stream Determination (circle one) Other
Stream is at least intermittent Ephemeral Intermittent Perennial e.g. Quad Name. Yanceyvllle
if 2 19 or perennial if 2 30
A. Geomorphology Subtotal = 17.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalwe 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool, ripple-
ool sequence 0 1 2 3 2
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic flood lain 0 1 2 3 2
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or greater order channel No = 0 Yes = 3 0
artificial ditches are not rated; see discussions in manual
B. Hvdroloov Subtotal = 11.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 0.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 2
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos note diversity and abundance 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OB L = 1.5; Other = 0 0
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
c,?7,?rv?,,r???a ?. a l? t ? ,?

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View of S 1 (UT to South Fork Rattlesnake Creek). Looking upstream in eastern portion of project area.

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View of S 1 (UT to South Fork Rattlesnake Creek). Looking downstream in eastern portion of project area.
Title Site Photographs
Project Walmrt Store #3036-00 (Y
nceyville, NC)
Prepared By: Yance ille, Caswell County, North Carolina
y

M dey+bm
M and Ammles
Date
KHA Project Number
Site Photo Page
2/22/11 015476140 1
APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: NC County/parish/borough: Caswell City: Yanceyville
Center coordinates of site (lat/long in degree decimal format): Lat. 36.412761° N, Long. -79.344978° W.
Universal Transverse Mercator:
Name of nearest waterbody: South Fork Rattlesnake Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Dan River
Name of watershed or Hydrologic Unit Code (HUC): 03010104 - Rattlesnake Creek
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
? Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
? Office (Desk) Determination. Date:
® Field Determination. Date(s): January 13, 2011
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
? Waters subject to the ebb and flow of the tide.
? Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): t
? TNWs, including territorial seas
? Wetlands adjacent to TNWs
® Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
? Non-RPWs that flow directly or indirectly into TNWs
? Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
® Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
? Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
? Impoundments of jurisdictional waters
? Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non-wetland waters: 325 linear feet: 4-5 width (ft) and/or 0.037 acres.
Wetlands: 0.018 acres.
c. Limits (boundaries) of jurisdiction based on: Established by OHWM.
Elevation of established OHWM (if known):
2. Non-regulated waters/wetlands (check if applicable):3
? Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
Boxes checked below shall be supported by completing the appropriate sections in Section III below.
Z For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
3 Supporting documentation is presented in Section III.F.
SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non-navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbodya is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.C below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: Pick List
Drainage area: Pick List
Average annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
? Tributary flows directly into TNW.
? Tributary flows through Pick List tributaries before entering TNW.
Project waters are Pick List river miles from TNW.
Project waters are Pick List river miles from RPW.
Project waters are Pick List aerial (straight) miles from TNW.
Project waters are Pick List aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW5:
Tributary stream order, if known:
° Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
5 Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.
(b) General Tributary Characteristics (check all that applvl:
Tributary is: ? Natural
? Artificial (man-made). Explain:
? Manipulated (man-altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: feet
Average depth: feet
Average side slopes: Pick List.
Primary tributary substrate composition (check all that apply):
? Silts ? Sands ? Concrete
? Cobbles ? Gravel ? Muck
? Bedrock ? Vegetation. Type/% cover:
? Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain:
Presence of run/riffle/pool complexes. Explain:
Tributary geometry: Pick List
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for: Pick List
Estimate average number of flow events in review area/year: Pick List
Describe flow regime:
Other information on duration and volume:
Surface flow is: Pick List. Characteristics:
Subsurface flow: Pick List. Explain findings:
? Dye (or other) test performed:
Tributary has (check all that apply):
? Bed and banks
? OHWM6 (check all indicators that apply):
? clear, natural line impressed on the bank ?
? changes in the character of soil ?
? shelving ?
? vegetation matted down, bent, or absent ?
? leaf litter disturbed or washed away ?
? sediment deposition ?
? water staining ?
? other (list):
? Discontinuous OHWM.7 Explain:
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
? High Tide Line indicated by: ? Mean High Water Mark indicated by:
? oil or scum line along shore objects ? survey to available datum;
? fine shell or debris deposits (foreshore) ? physical markings;
? physical markings/characteristics ? vegetation lines/changes in vegetation types.
? tidal gauges
? other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality, general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
'A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.
(iv) Biological Characteristics. Channel supports (check all that apply):
? Riparian corridor. Characteristics (type, average width):
? Wetland fringe. Characteristics:
? Habitat for:
? Federally Listed species. Explain findings:
? Fish/spawn areas. Explain findings:
? Other environmentally-sensitive species. Explain findings:
? Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain:
Wetland quality. Explain:
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Pick List. Explain:
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
? Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW:
? Directly abutting
? Not directly abutting
? Discrete wetland hydrologic connection. Explain:
? Ecological connection. Explain:
? Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the Pick List floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
? Riparian buffer. Characteristics (type, average width):
? Vegetation type/percent cover. Explain:
? Habitat for:
? Federally Listed species. Explain findings:
? Fish/spawn areas. Explain findings:
? Other environmentally-sensitive species. Explain findings:
? Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.
For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D: Man-made stormwater wetlands adjacent to the RPW are separated by a rip-rap apron but overflow directly into the
RPW.
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
? TNWs: linear feet width (ft), Or, acres.
? Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
® Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: See attached NCDWQ Stream ID form.
? Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:
Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 325 linear feet 4-5width (ft).
Other non-wetland waters: acres.
Identify type(s) of waters:
Non-RPWsg that flow directly or indirectly into TNWs.
? Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
? Tributary waters: linear feet width (ft).
? Other non-wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
? Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
? Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
? Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section 111.13 and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
® Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section III.C.
Provide acreage estimates for jurisdictional wetlands in the review area: 0.018 acres.
6. Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
? Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters.
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
? Demonstrate that impoundment was created from "waters of the U.S.," or
? Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
? Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):"
? which are or could be used by interstate or foreign travelers for recreational or other purposes.
? from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
? which are or could be used for industrial purposes by industries in interstate commerce.
? Interstate isolated waters. Explain:
? Other factors. Explain:
8See Footnote # 3.
v To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.
Cct-19-98 02:43P Gary L Jones Construction 919 471 9750 P.02
State of North Carolina
Department of Eny+ronment,
Health and Natural Resources 1
Winston-Salem Regional Office
James B. Hurt, Governor DEHNR
Jonathan B. "owes, Secretary Leesha Fuller, Regional Manager
DIVISICN OF LAND RESOURCES
LAND QUALITY SECTION
April 10, 1995
LETTER OF RECEIPT
Brassfield Properties, Inc.
P. O. BOX 71666
Durham, North Carolina 27722
Dear Sir or Madam:
This office has received a soil erosion and sediment control plan
for the project listed below which was submitted as required by
the North Carolina Sedimentation Pollution Control Act (G.S.
113A-57).
Please be advised that the Act requires that all persons
disturbing an area of one or more acres of land must obtain
approval of a soil erosion control plan prior to the commencement
of said land-disturbing activity. The Act further states that
this plan must be filed a minimum of 30 days prior to the
activity and the approving authority must approve or disapprove
the submitted plan within 30 days of receipt. Failure of the
approving authority to approve or disapprove the submitted plan
within the 30-day period will be deemed approval of the plan if
the submitted plan is complete. Commencement or continuation of
a land disturbing activity under jurisdiction of this Act prior
to the approval of an erosion and sediment control plan is a
violation of the Act.
We have performed a preliminary review of your submitted plan and
have determined that additional information will be necessary
before a final review can be completed. Enclosed is a checklist
of items that must be submitted beforg we can complete the review
process. Failure to provide the additional information may
result in disapproval of your plan.
585 Woughtown Street. Winston-Salem. No^ Carolina lc7107-2241 telephone [phone] FAX [phone]
An Equa; Or4ywturity Attlrmotive ACtlon Emt;lovot 50% rscyc4d! 1096 post conwmer pap©r
0ct-19-98 02:43P Gary L Jones Construction 919 471 9750 P.03
Brassfield Properties, Inc.
Page 2
April 10, 1995
If you have questions please do not hesitate to contact this
office. Your cooperation in this matter is appreciated and we
look forward to working with you on this project.
sincerely,
Matthew E. Gantt, E.I.T.
Assistant Regional Engineer
MEG/dcl
Enclosure
PROJECT NAME: Brassfield Inn / Luna Bells
LOCATION: Caswell County
SUBMITTED BY: Allan Hill, P.E.
DATE RECEIVED BY L.Q.S.: April 5, 1995
Oct-19-98 02:44P Gary L Jones Construction 919 471 9750 P.04
State of North Caroline
Department of EnvlronrTtent,
Health and Natural R0WLffCes 4
~Or}solem Realowl Otrxm Aja
?
,Sarnas e. Hunt; Jr.. Gomm
Jonothon S. Nawtor a Nbno ? EE""
lrasho F". RegOar
EROSION AND SEDIMENTATION CONTROL LAN„ME, 1ST
To expedite the spproval process, a cursory review of your submitted Erosion Control Plan has
been made and has shown the need for sdditional Information as specified below. To meet our
review schedule, any additional Information should be received by this Regional Office no later then
Failure to meet this schedule may msuft in disapproval of your plan.
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a re e ss ?i Y 1st v o T/'+ le.-P) ? f? L N s 10,0f411 sZ W. •?.f" 4001yra? 4/-
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!aa Wa uh4 wn ft*0 AA6-- -- S I Vk. Nafh CGF0&iG 271(V 2241 TelaphW0 o1a771.OW FAX [phone]
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2.) lt/vv? li/c 1'?o sc c Q ryG/? S'Ca?iop .d ?loi? ?a s:4 *'1'
OGt-19-90 02:44P Gary L Jones Construction 919 471 9750 P.05
State of North Carolina
Department of Environment,
Health and Natural Resources
Winston-Salem Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes. Secretary
Leesho Fuller, Regional Manager
A IL ",a W
-a t?_mT.7
;k ? 2AJ
[DEHNR
DIVISION OF LAND RESOURCES
LAND QUALITY SECTION
April 21, 1995
LETTER OF APPROVAL
Brassfield Properties, Inc.
P. 0. Box 71666
Durham, North Carolina 27722
Dear Sir or Madam:
This office has reviewed the subject sedimentation and
erosion control plan. We find the plan to be acceptable and
hereby issue this letter of approval.
Be advised that Title 15 NCAC 4B.0017(a) requires that a
copy of the approved erosion control plan be on file at the job
site. Also, you should consider this letter to give the Notice
required by GS 113A-61(d) of our right of periodic inspection to
insure compliance with the approved plan.
North Carolina's Sedimentation Pollution Control Program is
performance oriented, requiring protection of the natural
resources and adjoining properties. If following commencement of
this project it is determined that the plan is inadequate to meet
the requirements of the Sedimentation and Pollution Control Act
of 1973 (North Carolina General Statute 113A-51 through 66), this
office may require revisions to the plan and its implementation
of the revisions to insure compliance with the Act.
Please note that this approval is based in part on the
accuracy of the information provided in the Financial
Responsibility Form which you have provided. You are requested
to file an amended form if there is any change in the information
included on the form. In addition, it would be helpful if you
notify this office of the proposed starting date for this
project. Please notify us if you plan to have a proconstruction
conference, we will plan to attend.
585 Waughtown Street. Winston-Salem. NrAh Carolna 2 7 107-224 1 Telephone [phone] FAX [phone]
An Eqtial Opportunity Affrmotive AcMan Employer 50% recycled/ 10% post-consumer paper
Oct-19-98 02:44P Gary L Jones construction 919 471 9750 P.06
Brassfield Properties, Inc.
Page
April 21, 1995
"The land-disturbing activity described in this plan may be
subject to the approval of other Local, State or Federal
agencies. This could include the Division of Environmental
Management under storm water or water quality regulations,
the U.S. Army Corps of Engineers under Article 404
jurisdiction, county, city or town agencies under other
local ordinances, or other approvals that may be required.
This approval cannot supersede any other permit or
approval."
Please be aware that if more than five acres are to be
disturbed by this project, you will need to submit a Notice of
Intent (NOI) for coverage under the general stormwater NPDES
Permit for construction sites prior to beginning any land
disturbing activities. Before submitting the NOI, you should
first become familiarized with all of the requirements for
compliance with the general permit. When submitting the NO2, a
copy of this letter of approval needs to be attached.
Your cooperation is appreciated and we look forward to
working with you on this project.
Sincerely,
Matthew E. Gantt, E.I.T.
Assistant Regional Engineer
MEG/dcl
Enclosure
PROJECT NAME: Brassfield Inn / Luna Sells
LOCATION: Caswell County
SUBMITTED BY: Allan. Hill, P.E.
DATE RECEIVED: April 5, 1995
Oct-19-
5P Gary L Jones Construction 919 471 9750
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Oct-19-98 02:47P Gary L Jones Construction 919 471 9750 P.08
State of North Carolina
Department of Environment,
Health and Natural Resources
Winston-Salem Regional Off,ce
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Leesho Fuller, Regiona( Manager
-=A:* A-M
E:)EHNR
DIVISION OF LAND RESOURCES
LAND QUALITY SECTION
September 15, 1995
LETTER OF APPROVAL
Brassfield Properties, Inc.
P. O. Box 71666
Durham, North Carolina 27722
Dear Sir or Madam:
This office has reviewed the subject sedimentation and
erosion control plan. We find the plan to be acceptable and
hereby issue this letter of approval.
Be advised that Title 15 NCAC 4B.0017(a) requires that a
copy of the approved erosion control plan be on file at the job
site. Also, you should consider this letter to give the Notice
required by GS 113A-61(d) of our right of periodic inspection to
insure compliance with the approved plan.
North Carolina's Sedimentation Pollution Control Program is
performance oriented, requiring protection of the natural
resources and adjoining properties, If fallowing commencement of
this project it in determined that the plan is inadequate to meet
the requirements of the Sedimentation and Pollution Control act
of 1973 (North Carolina General statute 113A-51 through 66), this
office may require revisions to the plan and its implementation
of the revisions to insure compliance with the act.
Please note that this approval is based in part on the
accuracy of the information provided in the Financial
Responsibility Form which you have provided. You are requested
to file an amended form if there is any change in the information
included on the form. In addition, it would be helpful if you
notify this office of the proposed starting date for this
project. Please notify us if you plan to have a preconstruction
conference, we will plan to attend.
586 Wctughtown Street, Winston-Salem. North Carolnc 27107-2241 Telephone [phone] FAX [phone]
An Equal Opportunity A`flrmo!Ne Action Employer 50% recycled/ ?O% post-consumer caper
Oct-19-98 02:48P Gary L Jones Construction 919 471 9750

P.09
Cauc d
NORTH CAROLINA DEPARTMENT OF ENVIRONMEY , HEALTH, AND NAT&RAL RESOURCES
LAND QUALNY SECTION: 585 Waughtown Street, Winston-Salem, NC 27107 (910)
,: L F4vjat: ?.rf atiY' :t?..?1 -'r..) -1 ..ti:, i" • 771-4600
-River Basin lJp-"- . r t
Persem Final cially ]?CCL110IIS1bIG k-t + i5? F Ct L? t t l? 1a > 1 !-Y F
t,?t?.? r.,' t'. 'ilk:t?,? li_?,....?. ,.;? •?;`tTl;..'j -
1. Project Location '',Y . 'Pictures: Yes ? No IPrints [] Slides [] Video ?
2. Weather and Soil Conditions
'
3. Is site currently under notice of violation? Yes No
4. Is the site in compliance with the S.PE.A. and rules? Yes 0 No ? If no, check violations below:
5. Violations:
a. No approved plan, G.S. 113A-57 (4) and 15A N.C.A.C. 4$.000?(c) g. Inadequate buffer zone, G.S. I I3A-57(1)
b. Failure to follow approved plan, G.S. 113A-61.1 a. Graded slopes and fills too steep,
c. F allure to submit revised plan, G.S. 113A-54.1 f,b) and G.S. i I3A-57(2) or I SA N.C.A.C. 4B.0024(d)
15A N.C.A.C. 48.0018(a) i. Unprotected exposed slopes, G.S. 113A-57(2)
[] d. Failure to provide adequate groundcover, G.S. 113A-57(3) and 8 j. Failure to maintain erosion control measures,
15A N.C.A.C. 4BD007(b) or ISA N.C.A.C 4B.0024(c) 15A N.C.A.C. 4B.0013
? e. Insufficient measures to retain sediment on site, G.S. 113A-57(3) k. Other(describe)
? f. Failure to take all reasonable measures. 15A N.C.A.C.411.0005
6. Has sedknnentation damage occurred since last inspection? Yes ? if yes, where? (check all that apply): No
Lekn/natural watercourse on the tract ? Lake/natural watercourse off the tract ? Other property ?
Description t-Ff A _.. .
Degree of damage: Slight ? Moderate ? Severe ?
7. Contact made with (Name) - Tile
Inspection Report givers ? orsenL? to Person Financially Responsible. Date given/seii?, ti?_l ?,' It's
8. Conutive actions noeded:
CArnmcn1&. i?l 1 - 4+1
Report by{ Olburs Presents
t
114
Aatc of inspat n j J c: t
_ T'me atnving on sitC (C ....M Time le:,viag site .:. _
cc:
Oct-19-98 02:48P Gary L Jones Construction 919 471 9750
State of North Carolina
Department of Environment,
Health and Natural Resources
Winston-Salem Regional Office
James S. Hunt, Jr., Governor
IDEHNR
DIVISION OF LAND RESOURCES
LAND QUALITY SECTION
October 30, 1997
Brassfield Properties, Inc.
Attention: Gary Jones
PO Box 71666
Durham; NC 27722
Proiect: Brassfield Inn / Luna Bells
Dear Mr. Jones:
Enclosed is a copy of the inspection report which was prepared following an onsite inspection
of the referenced project. This report is intended to prnvide you with infbrmation concerning the
status of the project as it relates to compliance with the North Carolina Sedimentation Pollution
Control Act of 1973.
P.10
Please review this report carefully, as it may contain corrective actions needed or comments
which will assist you in meeting the required performance standards of the Act.
It is our desire that any and all possible problems be discussed and resolved at the earliest
possible time. To facilitate this effort, please contact me or the named inspector at the address shown
on the inspection report if you have any questions.
Sincerely,

Matthew E. Gantt, P.E.
Regional Engineer
MEG/grh
Enclosure
MIS Woughtown Street, '? FAX [phone]
Winston Salem, North Carolina 27107-2241 N'V4F C An Fqud Opportunity/AMrmatlve Action Emplcysr
Velee 910-771-46W 50% recycled/ 10% post-comumer oaper
Oct-19-98 02:48P Gary L Jones Construction 919 471 9750 P.11
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Oct-19-98 02:49P Gary L Jones Construction 919 471 9750
REPLY TO
Al iWION OF
DEPARTMENT OF THE ARMY
WILM INOTON DISTRICT, CORPS Of ENOWEERS
P.O. BOX 1880
WILMINGTON, NORTH CAROLINA 26402-1890
April 17, 1995
Regulatory Branch
P.12
s0'
lrw
SUBJECT: Action ID. 199502492 and Nationwide Permit No. 26 (Headwaters and
Isolated waters)
Mr. Gary L. Jones
Gary L. Jones Construction
Post Office Box 71666
Durham, North Carolina 27722
Dear Mr. Jones:
Reference is made to your permit request received on March 24, 1995,
regarding your plans to discharge fill material into the waters and/or
wetlands of South Fork kattlesrake Creek, associated with your proposed
commercial development located off of N.C. 96, Yanceyville, Caswell County,
North Carolina. Reference is also made to the site inspection of February
9, 1995, conducted by Mr. John Thomas of the Raleigh Regulatory Field Office
Staff. The purpose of this inspection was to review your draft plans for the
proposed project, and to examine the site for waters and wetlands subject to
Lepartment of the Army permitting authority.
Review of your request and the previous site inspection indicates that
your proposed work would adversely impact 0.78 acre of jurisdictional waters
and wetlands located adjacent to, and above the headwaters of, the referenced
unnamed tributary of South Fork Rattlesnake Creek.
For the purposes of the Corps of E'ngineers' Regulatory Program, Title 33,
Code of Federal Regulations (CPR), Part 330.6, published in the Federal
Register on November 22, 1991, lists nationwide permits. Authorization was
provided, pursuant to Section 404 of the Clean Water Act, for discharges of
dredged or fill material into headwaters and isolated waters.
Your work is authorized by this nationwide permit provided its
accomplished in strict accordance with the enclosed conditions and provided
you receive a section 401 water quality certification fror the North Carolina
Division of Environmental Management (NCDEM). You should contact Mr. John
Dorney, telephone [phone], regarding water quality certification, This
nationwide permit dues not relieve you of the responsibility to obtain any
required state on lccdl approval.
Thls verification will be valid until the nationwide permit is modified,
reissued or revoked, which will occur no later than January 21, 1997. It i5
incumbent upon you to remair informed of charges to tr.e nationwide perruts,
which will be announced by public notice when they occur. If you commence, cr
are under contract to commerce, this activity before the date the nationwide
permit is modified or revoked, you will have twelve months from the date of
the modification or revocation to complete the activity under the present
terms and conditions of this nationwide permit.
Please be reminded that no excavated or fill maLetials may be placed in
any waters or wetland areas without prior Federal permit authorization.
Accordingly, you should contact this office for a determination of Department
of the Army permit requirements for any future, proposed impacts in any water
or wetland areas subject to our permitting authority.
Prntm an 0 PACYded PAM
Oct-19-98 02:49P Gary L Jones Construction 919 471 9750 P.13
-2-
Thank you for your time and cooperation. If you have any questions,
please contact Mr. Thomas, Raleigh Regulatory Field office, telephone (919)
876-8441, ext. 25.
Sincerely,
e Wrig
CLe Regulatory Branch
Enclosure
Copies Furnished (without enclosure):
Mr. John Parker
North Carolina Department of Environment,
Health, and Natural Resources
Post Office Box 27687
Raleigh, North Carolina 27611-7697
Mr. John norney
Water Quality Section
Division of Environmental :management
North Carolina Department of Environment,
Health, and Natural Resources
4401 Reedy Creek
Raleigh, North Carolina 27E07
Regional Office Manager
North Carolina Department of Environment,
Health, and Natural Resources
8025 North Point Boulevard
Suite 100
Winston-Salem, North Carolina 27106
P.14
n-t_Zg_gg 02z50P Gary L Janes construction 919 471 9750
COMM ColmrTICNS
1. yavigatian. Did activity may cause more than a minLmal inverse effect an
navigation.
2. Proper Maintenance. Any structure or fill autt9orized stall be properLy
maintained, including =jataaaace to *a=* public Wety.
3. E=iat ind Siltation Can=ls. Appropriate erasion and siltation
eaatrvls ®=t be used acd maintained in
all e nosed sail and aetberctiLLSs pmusttb!$prse?eatly?during
coastructica, and stabLLed at the earnest practicable date.
R, Aauieu Lire Nova ra. so activity may snbstantiaLLy disrupt the
aoveaent of these species of aQuatic ZL-'a ittdigeacus to tte waterbady,
i.aaLudiag those species which aorm I Ly mutate thraagt the area, unless the
act:v:yy's primary purpose is to impound water.
5. Squipmt. Heavy egmLpmsat worms La wetlacd meter be plzeed as mats or
other ; urw out be taken to miaiSU-6 SO LL disturbaacs.
6. bgiaaal and Case-by-case Conditions. The activity out fly vita say
"giaeaL conditions vb.:ch may have been added by the Division Engineer and arty
can specific conditions added by rite Carps.
T. WLd and Scenic Rivers. No activity nay occur is a mmpaaant of the
%Lr.i=%L Wtd and Scenic River Sy3r4a; or Lit a river at::ciaUy desigaatsd by
Caeg-ass as a "study rLvsr" Ear possibLe LaclusLon La Me sysC?, Where me
rLver is is as afftcL&L sc:J4y status. IafaraatLott oa WLLd wad Sranic Rivers
my be obtained tram tree National ftrk Serv ere deed tee Q.S. Farast Service.
8. tribal its. go activit7 or its aps.-atiaa map iapsir raserYed true.?
rioca, LacLcidLatp but nor- I.Laitsd to, rsservad water V4XCs ad treaty
V saint. WA butiag riots.
9. stater QU910-7 CerCifiesCian. In, certain staeas, as iodividUL state
water quia,1t7 etrtirieattam mist be obtalmed ar waived.
to. caustai tone waage r-. to aeetata seztas, an Lmdiv;.*=L state oaaseaL
=no aiaag?t aaasLstacy arse be obtained ar Wived.
t 1. Udmger" Smml . to activW Is atttwerL= d miler any W Iftie* Ls
L UMLY to repar"m me ommst eed a L"Mme of at "restai or M"ft Id
speaidr or a aptaLa lsea 420t4, as UMSU M Waft the
pedsesL mad act, oar nktjt As LUWLr to destray or aararaely
W"f? mo setCieaL habitat of amt species. tea-taeraL Mmes ML ::
aocLer em at= Let Ragiaeer if nay II std Amiss of erietral habitat Rtte
be artenrad or Li in the •Lainity at the Omleet wad *=U not begin work an
the aetivitt MOLL Mgtfted by Me CLstrLct "CLa~ Mgt - ere r**LU-"ftU ar
P.15
Oct-19-98 02:50P Gary L Jones Construction 919 471 9750
-2-
the c"adargerted Species Act have been satisfied and that the activity Ls
autharised. taformation oa the location of t;h.*eatened :ad endangered spaciea
caa be obtained from the Q.S. Fish and WUdlile Service and Mational Mritte
Fisheries Service.
12. Ststoric properties. go activity which may affact historic Properties
listed, or eligible for listzag, is the National Registar cf K!~oric Places
is au'? ar red, until the Distr Lc: Engineer has cogUed with the provisions CC
33 M, 325, ippendirC. The prospective permit zee oust nati:y the District
USiaesr Lf the autharited aotiviLq any aVpact any ttistor?e properties Listad,
der.ersiaed t.o be oUgibI, ar which the prospective p@Mi ttee Clad reason to
believe mil be *14ible"?or :Lsc:ag as the NatLotra? Rsgfscer of HiistorLc
?Licss, and shalLl aot begin the act:.v: =til nazi. ied by etas District
En:neer t?at the reguirsamts of the Yat:ertal Histcric Fr-.serration Acc save
beet satisfied Acd that the actLvit.7 Ls author:.-ed. Woraation an :he
Lacatiar. and esistefsaa of historic rssourzes can to at: Lied fmm Che State
ifistar:c Frsserntion Cf'Lce aad the YacLcna.L Regacar of :iistcr:c Placss (see
33 M 330 .a(S)).
13. Ratification.
a. Whers fragfxired by the terns of the w?, the Prospective perutt" oust
aacL07 Cho 3ist: Lr-t ?'ag_aeer as early as passible sad st a.L: oat begin the
actLvitp:
( t) untL oat;: Lod by the Distr. :cc Sagineer =a, :he sctt.r:C3r mar
omceed ceder tro MP vita =ay spec:a: congjt;.ans LXCSed by the 0 '
ot'rtsiaa Fagiaeer; or utrict or
(2) Lf aotL•Led by ttto District ar Divisics Zq`=.eer that an
LadLTt*'&L gersbc Ls t,'3gM!zft; 4e,
t3) Caress 30 daps lave pssseQ f'MM the CL :-Lc= eagfaeer's race:pt
at Me ooe:t! citt oa and t:.'u
PrmsRect:ivs peratt:,.oe floe oat rxaLvsd notice f: cm
Me Distract or Qi SUM Mater. Stusqueetely, the perUCUe's E.L;ht Co
proceed under etc SW may be ar+o41t14d, snspe"ded or re:vaiead ealy La accor3iace
wt= ttw praasdure set tarns sa 33 M 330.1(d)(2).
U. TbA oatuLa own wet be LU te~ittag &Ad iac:as?de fey 112UML 6
is ttotU iaa aced sat rogttl t, ed tw :
C 1) NNW * wd"M am UL41 r mobw of the P"Pea IVI PIMM" ;
(2) Loa u= of Me p "Gad pnj ct.
(3) 9r:af dwert;uaft of C" P-13903ed 0"loce; the dL -wc Pad Ltutirests advlrst savirarIMUC&L effects CM Pen jK?iQ3e
9750 P-10
Oct-19-98 02.51P Gary L Jones Construction 919 471
fact
-3-
Other amp(s), reSfonal general permit(s) or iadividual permit(s) used or
intended to be used to authorize any part of the proposed protect or related
activity;
(g) Where required by the terms of the NP, a deelineayion of affected
speci;L aquatic sites, including votla.ads; and
(g) A statement that the prospective pe=itrst has ccntac ad;
(a) The QW4/'aWS regarding tbo presence of any Eederall y Listed
(or proposed for Listing) erdaagereed or Welteaed species or critical habitat
is the. perz.t area, tthc may 'be affected by the proposed project; and any
availible information provided by these agencies. ('4ae prospecttve perait`ree
nay ==t Corps District Off Lcts for WXAINM agracy contacts and List o..
ar f'=4 COL habitat.)
(b) The SM regardiag Me pram as of say historic properties jr.
tie ¢emit area that may be of=acted by the proposed protect; 'sad the
aaxi:,aMlee iaforratton, i.' any Pravided by that agency.
14. Water Supply IataMs. No discharge of dredged or fill mX*riai nay omm
to =* prosizity of a public water supply intake except wturee the discharge Ls
repal.- al the pubZ:a vaster supply iatake struccuru or adjaaene 5aft
11. She' I Lsh l roduatLon. go discharge of dredged or fiLL aster taL sly oc=
La arms of concentrated. Mteuli & ¢rz=dtJ=" IM I SS the dLsc"m is
d:teeeetp related to a she.:3,tLstt h&-test activity aarharizft by miamUee
Permit.
id. duttstrle MatertaL. No discharge of dmwgeed ar hill matertaL nap aoasist
of unsmitable m eariaL (e.g., craltc, debris, ur badiem, etc.) sad materisL
d:sc mrztd not be tree from taxis polLataazs is taxio U=CS.
17. Mitiptim. Disdurgees of dredge or r= ie twt L Lato wgters Of the
Qaited States out be siaLMLzed or avoided to t" fttiAa wMag peacti=ble
at me Project site (i.e., on-seta)' Mess the 3Lstrice Ingfnew boa approved
a =MOMCLM OLUC PUm A= for me speef fLC !`tVIUft yett".
IL Sdw ' Arses. O in =awl ar+w dewtq I3ag aeaaeoe:m
Omm be &VGU ea to ON aesla m amens prsatLaY1L 0
_? • O"O vaUm of 9:0 fu". ?o Elie aaiiaeea OMM? peeeCtc'alfle, -.-
A4.2
i I I Weise: ant pecoaentz y e+estrLCC or LOP*" ft eta I KO flaws or asw the reLacaciaa or tams wmw (oaf ? ?7
PC" of Vie rill is to Lapmaad graters) .
P.17
Oct-19-98 02:52P Gary L Jones Construction 919 471 9750
bm=Owg CmI=ws
a. -me discs.-qa does not cause he lass of Mora t:aa to acras of wave-s
of the G.S. ror the pu-7034 of this eat==v'do po=i.c, the &="Se of loss of
Tatars a: cha ?. S . irel ud&s the filled ay as plus waters o the Q. $ . tic are
adveasely affacted by flood:ag, "=vat:L=, or d.--aiaage as a result of the
pr* j ect.
b. A 3a-day rotiticatiam to the Dist. et 2g'`.-seer (DE. Is r*gLi:ad i~
rthm. discbi-'4e wauld cm, a the loss o: racer o? the G.3. g=sacer thaw =8 acs.
?or disc?" 3es is speeal aquatic sites, l cludiag wat'..s-I , t :a moti!; cacfca
ruse iscluda a drlismar.41 t of awfacted special aquatic sitas ae:.udim
v atla ws .
C. 'l:..a 3ischaMe, liad- ? alL ac"andant faith-sts, back tm*o=rj and
gent;;.'i.s gaz% of i ?le and eompleta project.
STS CSi3tSZS'I: ww. =IDLTtm
a. ALl Li:: material authcired by =S pa.-MiC susz be obw=ed fx"c"m as
ce?rl.aa,d saes.-es .
b. Gss of this M&t:oatrid+e pesmi= for .as=a dispose:. facO I mi.as is =c
sas.bort zed. ;
C. 2: ehs pzapos+ed activity is within the 10orth Carolina Coastal Area
sad tea sew-j r+.ty will teseL.e is the Lass of waters of tbs *=%ad states
greseer tbia 113 of as seta, ebee appliaaz mist receive wrirtaa cx??r:vacs
:.ore ehe Norm Caaoliaa Cfvissaa of Coastal Management == Lug the
&z=v=_c-j is eoasistat vi.rh tba atom Ca-caLiza Coastal Nocagaamr. V=T-m.
d. ShouLd alt or part of a proposed &Ctivzcy be Located wimh-4a an A--"
of !svitzoemeesr l Cows= {.1=C1 as des:gaaced by the camLiaa Wawa:
lamaz am G.aaiasfaa, a *=&U.= Arse massgrwat Aat tCmw gars.:C fs
I--= this NOVIA CLVGL4= Divtsi.aa of Goasw Managamaat GV=GKI . MlouLd as
atria-eIy wir.Wa Or poeaatiLty iffect=q as AEC his proposed by a jlgd&=.
agency, a musi sesurr decas?i114a4 ;VmIUAt rn u CM 220 our. be provided ca
cm V=Cl at Laise $a days betas. the onset of Cho proposed wtei v+-ry.
GERML Clz :7.1" %V-C3 C=Z%P:=
a. reassaZ UX-L- 3eaciaa is daested for fails greaeer than ame area is
SA. =ut. WK, am, sin-t and =-= wourshads. Geaaral aer'..t.:tMr..'am is
issued =as 4" arks= %UCara for fills of wr- more than, Zb aces and is those
%ftC=3h"& sgedfi ad aboA faze =14 of sae more the : me an~s.
is. fell or ? modi,iesti as of gresCat cbm add-c"I ft
a,j as sees of smeh useemm Ina' ad muclaads. sag=i.-as a +.r:.ttm -- WCONIUM
frees as ?Msresz Css+altas viv sfaa of I +?will rsL
a. ?Ca?t3afrd ltme a" me:meiAu aaatx-ot yramteaa .4.U be ari "sed
m pewee VtOLALtAmm 49 as a0psvpzissa V=b3df My rases Qesility st>mdae (sQ
=,a i& !tile" at 90"1 dot am add, as Graaf macars by the lpgu
*A%LUA UvLsias of May{ ¦' Miatsa?e¦areC (==) . 2S sm, s is ALL
saLrwiear CUSSA D and alas Lakes and tssaY"Mi= sad Ld VMS JA ="%a Warm").
4LT-2s
nct-19-98 02:52P Gary L Jones Construction 919 471 9750 P.18
-2-
d. MGU=es shall be, Cakaa Co Pr%v%Mt IIva or f"esh 0==ete 9=m caaistg
iAC* ==4C. vi Mh waters of the stita uat:1. th& caa=ata has ba.Ated.
t. J1dUef?aaal sits-specitic c=dltLoms neat' be add+ad to tb"
C#-tt:iestioa is ardar to SCUM" C=VUaort vicis a,LL appU=f%l-0 water ; a ty
aad effluent sr"' 'xd'-
-0 . G?acat-: aaca t:oa the Dtasth Car UMS 13i vi ssaa of Sc rf .-= AzaL
cKaasgeasa.C (D l? Chet this Gereift=CiaA M9 1i" to as lydiw+.dUL pro?sae
$tGiZ wqi..* th=ve gain L-ad the date of the =ver Letter ft -mm DtmLk.

Oct-19-98 02:53P Gary L Jones Construction 919 471 9750 P.19
e+' s
.4%
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JA MEs B. HUNT JR. DIVISION OF HIGHWAYS
Q.)VEPNOR
P. c >. 1-lox 2513
Reidsville. NC 27323-2513
'vlarch 31. 1995
CASNVELL COUNTY
Nir. Gary L. Jones, Pres.
Brassfield Properties, Inc.
P. U. Box 71666
Durham, NC 27722
R. SAMUEL HUNT Ill
StckfrARr
SG`l3JL (71': Dcivewav Permit for firass-EcId Motel on NC 86:: VS 158 in Yance)Nilc.
Dear Mr. Jones:
Attached, please find the subject driveway permit which has been approved by this office.
Please take note of any comments or recommendations on the back of the permit form.
This permit is valid for ninety (90) da-,,s from the date of approval and a written request is
required for a time extension.
Please adviw this office when constrwtion has started and when winplc:ted so that an
inspection can N made.
If you have any questions, pleas; do not hesitate to contact me at 910-634-5644.
Sincerely.
5. P. Ivey, PE
DIS"IMCT ENCH'-NEL1Z
SPI dph
i2
P.20
Oct-19-98 02:53P Gary L Jones Construction 919 471 9750
APPROVALS
APPROVAL BY: Gouemmntal AMMMIy (when nD PW)
_.
Z/ ?
- TIRE OATS
APPLICATION RECEIVED BY 06TFbCT ENGINE APPLICATION APPROVED BY DISTRICT ENGINEER
,:?& / - :3
J,
l
TsmaTurs OAST N OAT!

COMMENTS:
SHOW:
1. LOCATION OF DRIVEWAYS PROPOSED PLANS
DRAW OR SKETCH BELOW. OR ATTACK
INCLUDING PIPES
DETAILS OF WORK
2 CONSTRUCTION PLANS FOR STREETS
,
.
3. EXISTING BUILDING. WALL, ETC. OR DRIVEWAYS.
4. PROPOSED BUILDING. WALL, ETC.
5. HIGHWAY FEATURES INDICATE
NORTH
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