20140164 Ver 1_401 Application_20140214

Suite 440
Kimley -Horn 2000 South Boulevard
❑ ❑ and Associates, Inc. 20 1 4 0 1 6 4 28z 3 tte, North Carolina
TEL [phone]
FAX [phone]
Transmittal
Date: February 17, 2014 Job Number: 015476255
Project Name: Walmart Store 47315 -00 Hickory (W), NC
To: Karen Hi2p-ins
NC DWR, 401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, North Carolina 27699 -1650 r''T�
We are sending these by
U.S. Mail ® FedEx ❑ Hand Deliver
Other:
We are sending you
® Attached Under separate cover via the following items:
❑ Shop Drawings ❑ Prints /Plans ❑ Samples ❑ Specifications E] Change Orders
® Other: 404/401 Pre- Construction Notification Package (NWP #39)
Copies Date No. Description
5
2/17/2014
1
404/401 Pre - Construction Notification Package (NWP 439)
1
2/17/2014
2
PCN Application Fee Check
2
2/17/2014
3
Full -Size Plan Sheets
3
2/17/2014
4
Half -Size Plan Sheets
1
2/17/2014
5
CD -R Full -Size Plan Sheets
These are transmitted as checked below:
® For your use ❑ Approved as submitted ❑ Resubmit 0 Copies for approval
E] As requested E] Approved as noted ® Submit Copies for distribution
For review and comment ❑ Returned for corrections ❑ Return Correc
A)I
Remarks:
If you have any questions, please feel free to contact me at 704 - 409 -1802
Copy to: File
Page 1
Signed
E3 x l
�
Chris Tinklenberg,WPIT

Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name: Walmart Store #7315 -00 Hickok (W) NC
2. Name of Property Owner /Applicant: LNBC. LLC
3. Name of Consultant /Agent: Kimley -Horn & Associates, Inc.
*Agent authorization needs to be attached
4. Related /Previous Action ID number(s): N/A
5. Site Address: 483 US Highway 70 SW
7. City: Hickory
8. County: Catawba
9. Lat: 35.719585 Long: - 81.347764 (Decimal Degrees Please)
10. Quadrangle Name: Hickory
11. Waterway: Unnamed Tributary to Geitner Branch
12.
13. Requested Action:
X Nationwide Permit # 39
General Permit #
X Jurisdictional Determination Request
Pre - Application Request (Mitigation Proposal)
The following information will be completed by the Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose:
Site /Waters Name:
Keywords:

® Kimley -Horn
b and Associates, Inc.
February 17, 2014
Ms. Karen Higgins
NC DWQ, Wetlands, Buffers,
Stormwater Compliance and Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
Re: 404/401 Permit (Nationwide 39; GC 3890) Application
Walmart Store #7315 -00 Hickory (W), NC
Hickory, Catawba County, NC
Dear Ms. McCormick and Ms. Higgins,
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,
fuel center and associated parking lots under Nationwide Permit #39 and General
401 Water Quality Certification number 3890. The following information is
included as part of this application submittal:
• Project Summary Sheet
• Agent Authorization Form
• Pre - Construction Notification Form
• Site Figures
• Figure l — Vicinity
• Figure 2 — USGS Topographic Map (Hickory 7.5' Quadrangle)
• Figure 3 — SSURGO Soils (Catawba County)
• Figure 4 — Jurisdictional Features (2010 ESRI World Imagery)
• Figure 5 — Impact Area (2010 ESRI World Imagery)
• Site Data forms and Photographs
• USACE Stream Quality Assessment Worksheet
• NCDWQ Stream Identification Form
• Site Photographs
• Construction Plan Drawing
• Jurisdictional Determination Request Documentation
■
TEL [phone]
FAX 704 333 OB45
■
Ms. Tasha McCormick
Suite 440
2000 South Boulevard
Asheville Regulatory Field Office
Charlotte, North Carolina
US Army Corps of Engineers
28203
151 Patton Avenue, Room 208
Asheville, NC 28801 -5006
Ms. Karen Higgins
NC DWQ, Wetlands, Buffers,
Stormwater Compliance and Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
Re: 404/401 Permit (Nationwide 39; GC 3890) Application
Walmart Store #7315 -00 Hickory (W), NC
Hickory, Catawba County, NC
Dear Ms. McCormick and Ms. Higgins,
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,
fuel center and associated parking lots under Nationwide Permit #39 and General
401 Water Quality Certification number 3890. The following information is
included as part of this application submittal:
• Project Summary Sheet
• Agent Authorization Form
• Pre - Construction Notification Form
• Site Figures
• Figure l — Vicinity
• Figure 2 — USGS Topographic Map (Hickory 7.5' Quadrangle)
• Figure 3 — SSURGO Soils (Catawba County)
• Figure 4 — Jurisdictional Features (2010 ESRI World Imagery)
• Figure 5 — Impact Area (2010 ESRI World Imagery)
• Site Data forms and Photographs
• USACE Stream Quality Assessment Worksheet
• NCDWQ Stream Identification Form
• Site Photographs
• Construction Plan Drawing
• Jurisdictional Determination Request Documentation
■
TEL [phone]
FAX 704 333 OB45

/ =FJ Kimley -Horn
► = and Associates, Inc.
The project site is located in the town of Hickory, Catawba County, NC along US
Hwy 70 South The majority of project site has been historically developed,
however, recently the structures were demolished and only former parking lots
remain A smaller portion of the project site ( -2 acres) is currently undeveloped
forested land Existing land use in the vicinity of the project consists of
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 November 4, 2013 The stream delineation was performed by utilizing
sub -meter global positioning system (GPS) equipment
The proposed project seeks to construct a new 45,064 square foot commercial
retail building, fuel center and associated parking lots on an approximately
6 35 +/- acre tract The proposed design also incorporates the construction of a
wet detention basin to treat runoff from the newly constructed impervious area
133 linear feet of a jurisdictional seasonal relatively permanent water (RPW) was
identified within the project boundary The stream begins at a large eroded pool
caused by a highly degraded 24" reinforced concrete pipe (RCP) outfall and
flows southwest to a 48" RCP and offsite The stream is likely influenced
predominately by stormwater drainage, however, the channel has excessively
down -cut and soil -based observations of connectivity of the stream bed to the
water table were observed The proposed project will result in permanent
impacts to 35 linear feet of a seasonal RPW from the installation of a new 48"
RCP, outlet structure, and rip -rap apron The proposed project will require 10
linear feet of temporary impacts to install a temporary stone ring
Please feel free to contact me at (704) 409 -1802 if you have any questions, or if
additional information is necessary
Sincerely,
KIMLEY -HORN AND ASSOCIATES, INC
Chris Tmklenberg, WPIT
Environmental Analyst
Attachments
Cc Michael Thomas, Walmart Real Estate Business Trust
Austin Watts, Kimley -Horn and Associates, Inc

Kimley -Horn
C'M _ and Associates, Inc Project Summary Sheet
Project Name: Walmart Store #7315 -00 Hickory (W), NC
Applicant Name and Address: Michael Thomas
Sam Walton Development Complex
2001 SE 10th Street
Bentonville, AR 72716 -0550
Telephone Number: 479 - 204 -2186
Type of Request: ® Nationwide PCN (NWP # L9) ❑ 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: Catawba Nearest City/Town: Hickory
Waterway: UT to Geitner Branch
H.U.C.:03050102
Property Size (acres): 6.35
Site Coordinates (in decimal degrees): 35.719585 ON
River Basin: Catawba: NCDWQ 03 -08 -35
USGS Quad Name: Hickory
Approx. Size of Jurisdiction on Site (acres): 0.015
- 81.347764 °W
Project Location: The proiect site is located in the town of Hickory, NC along US Highway 70 SW.
Site Description: The ma)ority of eroiect site has been historically developed: however, recently the structures were
demolished and only former parking lots remain. A smaller portion of the project site (-2 acres) is currently undeveloped
forested land.
Impact Summary (if applicable): The proiect will result in permanent impacts to 35 linear feet of a seasonal relatively
permanent water (RPW) from the installation of a 48" reinforced concrete pipe (RCP) outlet structure and rip rap apron
The proposed project will require 10 linear feet of temporary impacts to install a temporary stone ring.
NWP
Open Water
(acres)
Wetland
(acres)
Stream Channel
Intermittent and /or Unimportant
Aquatic Function
Perennial and /or Important
Aquatic Function
#
Temp.
Perm.
Temp.
Perm.
Tem
Perm.
Tem
Perm.
If
ac
If
ac
If
ac
If
Ac
39
10
0.001
35
0.003
Total
10
0.001
1 35
0.004
Total Permanent Impact to Waters of the U.S. (acres)
0.003
Kimley -Horn Contact: Chris Tinklenberg, WPIT
■
2000 South Boulevard Ste 440
Charlotte, North Carolina
28203
Direct Number: (704)409 -1802
Email: chris .tinklenberg@kimley=horn.com
■
TEL [phone]
FAX [phone]

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 370214341990: 370214341725
STREET ADDRESS: 483 U.S. 70. Hickory, NC 28602
Please print:
Property Owner: LNBC LLC Attn: Mr. Benny Yount
The undersigned, registered property owners of the above noted property, do hereby authorize
Chris Tinklenberg, WPIT , of Kimley -Hom and Associates. Inc.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: [phone] x220
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: �Z C� h 414�

o�OF W A TF9OG
o =�
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
Pre - Construction Notification PCN Form
A. Applicant Information
1.
Processing
1a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
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
1d.
Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Walmart Store #7315 -00 Hickory (W), NC
2b.
County:
Catawba
2c.
Nearest municipality / town:
Hickory
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
LNBC, LLC
3b.
Deed Book and Page No.
Book 3145 Page 949
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
PO Box 3447
3e.
City, state, zip:
Hickory, NC 28603
3f.
Telephone no.:
828- 449 - 1420 x2205
3g.
Fax no.:
3h.
Email address:
djordan @parmountauto.com
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
Michael Thomas
4c
Business name
(if applicable)
Walmart Real Estate Business Trust
4d
Street address
2001 SE 10`" Street
4e
City, state, zip
Bentonville, AR 72716 -0550
4f
Telephone no
479 - 204 -2186
4g
Fax no
4h
Email address
mthom49 @wal -mart com
5
Agent/Consultant Information (if applicable)
5a
Name
Chris Tinklenberg, WPIT
5b
Business name
(if applicable)
Kimley -Horn and Associates
5c
Street address
2000 South Boulevard Suite 440
5d
City, state, zip
Charlotte, NC 28203
5e
Telephone no
704 -409 -1802
5f
Fax no
5g
Email address
chris tinklenberg @kimley -horn com
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)
370214341990, 370214341725
lb Site coordinates (in decimal degrees)
Latitude 35 719585 Longitude -81 347764
(DD DDDDDD) ( -DD DDDDDD)
1c Property size
6 35 acres
2 Surface Waters
2a Name of nearest body of water (stream, river, etc) to
Unnamed Tributary to Geitner Branch
proposed project
2b Water Quality Classification of nearest receiving water
Class C water
2c River basin
Catawba
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 in the town of Hickory, Catawba County, NC along US Hwy 70 South The majority of project
site has been historically developed, however, recently the structures were demolished and only former parking lots
remain A smaller portion of the project site ( -2 acres) is currently undeveloped forested land Existing land use in the
vicinity of the project consists of 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
—133 LF
3d Explain the purpose of the proposed project
The purpose of this project is to construct a new 42,000 square foot commercial retail budding and fuel center 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 /
project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
Comments Approved JD documents are included with this
PCN
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
Name (if known)
Other
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b If yes, explain in detail according to "help file" instructions
Page 3 of 11
PCN Form — Version 1 3 December 10, 2008 Version

r
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
Type of jurisdiction
impact number
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
— Permanent
(if known)
DWQ — non -404, other)
(acres)
(P) or
Temporary T)
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
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 -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P)
intermittent
DWQ — non -404,
width
(linear
or Temporary
(INT)?
other)
(feet)
feet)
(T)
S1- Impact 1
SPOT
Installation of
48" RCP, outlet structure
UT to Geitner
Branch
❑ PER
® INT
® Corps
❑ DWQ
5
35
and rip -rap apron
S1- Impact 2
Installation of temporary
❑ PER
® Corps
5
10
❑ P ® T
stone ring
® INT
[:1 DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
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
45
31 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
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
number —
Permanent
(P) or
Temporary T
01 ❑P FIT
02 ❑P ❑T
03 ❑P FIT
04 ❑P ❑T
4f. Total open water impacts
4g Comments
5. Pond or Lake Construction
If pond or lake construction proposed, then com lete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose of
(acres)
number
pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g Comments
5h Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
Page 6 of 11
PCN Form — Version 1 3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below If yes, then individually list all buffer impacts
below If any impacts require mitigation, then you MUST fill out Section D of this form
6a.
❑ Neuse El Tar-Pamlico El Other
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number —
Reason for
Buffer
Zone 1 impact
Zone 2 impact
Permanent
impact
Stream name
mitigation
(square feet)
(square feet)
(P) or
required?
Temporary T
B1 ❑P ❑T
El Yes
❑ No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
61 Comments
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 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
Erosion control measures in the form of silt fence, diversion ditches with check dams, and a sediment basin are proposed to
reduce erosion and route sediment away from the stream Offsite flow will be routed around construction disturbance to
maintain flow without increasing sediment discharge Construction will be phased with the stream in mind to reduce the
required impacts
2 Compensatory Mitigation for Impacts to Waters of the U.S or Waters of the State
2a Does the project require Compensatory Mitigation for
❑ Yes ® No
impacts to Waters of the U S or Waters of the State?
2b If yes, mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
❑ Mitigation bank
2c If yes, which mitigation option will be used for this project?
❑ 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
Page 7 of 11
PCN Form — Version 1 3 December 10, 2008 Version

3c Comments
4. Complete if Making a Payment to In -lieu Fee Program
4a Approval letter from in -lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation, stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non - riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
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. Stonnwater 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
lb 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?
75% (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
❑ 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
El USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a Which of the following state - implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 -246
❑ Other
4b Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
5. DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements?
® Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
® Yes ❑ No
Page 9 of 11
PCN Form — Version 1 3 December 10, 2008 Version

F. Supplementary Information
1 Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes ® No
use of public (federal /state) land?
1 b If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c 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 budding 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
❑ Yes ® No
or 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 Catawba County and the NC Natural Heritage program
database were reviewed (12/26/2013) as part of this project There are no current or historic occurrences of threatened
or endangered species in the project comdor 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
❑ Yes ® No
habitat?
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Geographic Information Systems
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 NCSHPO HPOWEB GIS Service database was conducted on 12/26/2013 No historical or
archaeological resources were identified within the vicinity of the proposed project area
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
2/17/2014
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the
applicant is provided
Page 1 1 of 11
PCN Form — Version 1 3 December 10, 2008 Version

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STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: Walmart Stores, Inc. 2. Evaluator's name: ChrisTinklenberg, WPIT
3. Date of evaluation: 11/4/2013 4. Time of evaluation: 10:00 am
5. Name of stream: Unnamed Tributary to Geitner Branch 6. River basin: Catawba
7. Approximate drainage area: 10 acres
9. Length of reach evaluated: 50 ft.
11. Site coordinates (if known): prefer in decimal degrees.
8. Stream order:
10. County: Catawba
12. Subdivision name (if any):
Latitude (ex. 34.872312): 35.718854 Longitude (ex. - 77.556611): - 81.34821
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/61S Other GI Othe Survey /GIS
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location): The project
area is located along US Hwy 70 SW in Hickory. NC. The reach was evaluated beginning at the degraded 24" RCP and downstream
approximately 50'.
14. Proposed channel work (if any): Installation of a new 48" RCP and rip -rap apron.
15. Recent weather conditions: Sunny, 50 degrees. Dry
16. Site conditions at time of visit: 50 degrees and mostly sunny
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:
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: % Residential 100 % Commercial % Industrial % Agricultural
Forested % Cleared / Logged % Other ( )
22. Bankfull width: 5ft. 23. Bank height (from bed to top of bank): 4 -5ft.
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): 45 Comments:
Evaluator's Signature Date 1 1/4/2013
This channel evaluation form is intended to be used only as a 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
* These characteristics are not assessed in coastal streams
#
Characteristics
Eco-region Point Range
Score
Coastal
Piedmont
Mountain
I
Presence of flow / persistent pools in stream
0 - 5
0-4
0 - 5
4
(no flow or saturation = 0, strong flow = max points)
2
Evidence of past human alteration
0-6
0-5
0-5
1
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
3
extensive discharges = 0, no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
2
(no discharge = 0, springs, seeps, wetlands, etc = max points)
V
U
6
Presence of adjacent floodplam
0-4
0-4
0-2
]
no flood lam = 0, extensive flood lam = max points)
7
Entrenchment / floodplam access
0-5
0-4
0-2
1
a+
(deeply entrenched = 0, frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
no wetlands = 0, large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
1
(extensive channelization = 0, natural meander = max points)
10
Sediment input
0-5
0-4
0-4
3
extensive deposition= 0, little or no sediment = max points)
I I
Size & diversity of channel bed substrate
NA*
0-4
0 - 5
3
fine, homogenous = 0, large, diverse sizes = max points)
1 2
Evidence of channel incision or widening
0 - 5
0-4
0 - 5
1
(deeply incised = 0, stable bed & banks = max points)
,�•
1 3
Presence of major bank failures
0 - 5
0-5
0 - 5
2
(severe erosion = 0, no erosion, stable banks = max points)
Q
14
Root depth and density on banks
0 - 3
0-4
0 - 5
3
no visible roots = 0, dense roots throughout = max points)
CO)
1 5
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
2
H
no riffles/ripples or pools = 0, well-developed = max points)
Q
1
Habitat complexity
0-6
0 - 6
0-6
2
M
little or no habitat = 0, frequent, varied habitats = max points)
Q18
Canopy coverage over streambed
0-5
0-5
0-5
4
no shading vegetation = 0, continuous canopy = max points)
x
19
Substrate embeddedness
NA*
0-4
0-4
3
(deeply 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
0
(no evidence = 0, common, numerous types = max points)
Q
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
2
no evidence = 0, abundant evidence = max points)
Total Points Possible
100
100
100
100
TOTAL SCORE (also enter on first page)
45
* These characteristics are not assessed in coastal streams

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 11/4/2013
Pro ect/Slte: UT to Geitner/
1 Stream 1
Latitude: 35.718854
Evaluator: Chris Tinklenberg, WPIT
County: Catawba
Longitude: - 81.34821
Total Points: 26.5
Stream Dete circle one)
Other
Stream is at least intermittent
Ephemer Intermittent Perennial
e.g. Quad Name: Hickory
if? 19 or perennial if? 30
0
1
A. Geomorphology Subtotal = 12.5
Absent
Weak
Moderate
Strong
Score
1a. Continuity of channel bed and bank
0
1
2
3
1 „\
2. Sinuosity of channel along thalweg
0
1
2
3
",{3 s`•
3. In- channel structure: ex. riffle -pool, step -pool, ripple-
ool se uence
0
0
1
2
3
`�1
�v
4. Particle size of stream substrate
0
1
2
3
5. Active /relic flood lain
0
1
2
3
IT ,•, `,"
6. De ositional bars or benches
0
1
2
3"
7. Recent alluvial deposits
0
1
2
1 3
11,10,15' `l1~
8. Headcuts
0
1
2
3
IM`.
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No = 0
Yes= 3
t
artificial ditches are not rated, see discussions in manual
R Hvdrolnav Suhtotal =
12. Presence of Baseflow
0
1
2
3
.,
13. Iron oxidizing bacteria
0
1
2
3
14. Leaf litter
1.5
1
0.5
0
",{3 s`•
15. Sediment on plants or debris
0
0.5
1
1.5
'
16. Organic debris lines or piles
0
0.5
1
1.5
17. Soil -based evidence of high water tableT-1
No = 0
1 Yes = 3
1
C. Biology Subtotal =
18. Fibrous roots in streambed
3
2
1
0
.,
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos note diversity and abundance)
0
1
2
3
",{3 s`•
21. Aquatic Mollusks
0
1
2
3�t:
..
22. Fish
0
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
0"
24. Amphibians
0
0.5
1
1.5.
25. Algae
0
0.5
1
1.5:,,_p,_;
26. Wetland plants in streambed
FACW = 0.75; OBL
= 1.5; Other = 0
7"
`perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
S1 begins at a large eroded gully /wash caused by a highly degraded 24" reinforced concrete pipe (RCP) outfall
and flows southwest to a 48" RCP and offsite. The stream is likely influenced predominately by stormwater
drainage; however, the channel has excessively down -cut and soil -based observations of connectivity of the
stream bed to the water table were observed.

View of S1 (UT to Geitner Branch). From the head of the stream looking upslope at the
eroded /degraded 24" RCP.
zt 1
View of S1 (UT to Geitner Branch). From the head of the stream looking downstream.
Notice vertical banks and strong baseflow.
Title I Site Photographs
Project Walm rt Store #7315 -00 Hickory (W), NC
Prepared BY: Hickor , Catawba County, North Carolina
ConKenleyHom
endpssmates,lne. Date KHA Project Number Site Photo Page
2/17/14 015476255 1

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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 North Carolina County/parish/borough Catawba City Hickory
Center coordinates of site ([at/long in degree decimal format) Lat 35 719585° N Long 81 347764° W
Universal Transverse Mercator 1983
Name of nearest waterbody UT to Geitner Branch
Name of nearest Traditional Navigable Water (TNW) Into which the aquatic resource flows Lake Norman
Name of watershed or Hydrologic Unit Code (HUC) 03050102
® 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)
SECTION II SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There %re 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 maybe susceptible for use to transport interstate or foreign commerce
Explain
B CWA SECTION 404 DETERMINATION OF JURISDICTION
There FA—re "waters of the US" 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) i
❑ TNWs, including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent watersZ (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 133 linear feet 5 width (ft) and/or 0 015 acres
Wetlands acres
c Limits (boundaries) of jurisdiction based on Estabbshed b_ y 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 TN W and that typically flows year -round or has continuous flow at least "seasonally"
(e g , typically 3 months)
Supporting documentation is presented in Section 111 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 HI.A.1 and Section I LD I 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 n/a
Summarize rationale supporting determination
2 Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent" n/a
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 waterbody4 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 HI.B.1 for
the tributary, Section HI B 2 for any onsite wetlands, and Section 11I.113 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 10 acres
Drainage area 10laeres
Average annual rainfall 43 inches
Average annual snowfall inches
(u) Physical Characteristics
(a) Relationship with TNW
❑ Tributary flows directly into TNW
® Tributary flows through 3 tributaries before entering TNW
Project waters are 30_(or more) river miles from TNW
Project waters are 11, (or,less) river miles from RPW
Project waters are 30 (o "r,;mor@ aerial (straight) miles from TNW
Project waters are 11(or less), aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TNW` UT to Geitner Branch flows to Henry Fork, which flows to South Fork Catawba River,
which flows to the Catawba River (TNW)
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West
' 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

Tributary stream order, if known
(b) General Tributary Characteristics (check all that apply)
Tributary is ❑ Natural
❑ Artificial (man -made) Explain
® Manipulated (man- altered) Explain UT to Geitner Branch has been been significantly
influenced by point source discharge of stormwater
Tributary properties with respect to top of bank (estimate)
Average width 5 feet
Average depth 5 feet
Average side slopes l ertical (1:1 or less)
Primary tributary substrate composition (check all that apply)
N Silts N Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ❑ Vegetation Type /% cover
❑ Other Explain
Tributary condition/stability [e g, highly eroding, sloughing banks] Explain Highly eroding, Incised in most areas
Presence of run/nffle /pool complexes Explam Not present
Tributary geometry Relatively straight
Tributary gradient (approximate average slope) 4 -5 %
(c) Flow
Tributary provides for Seasonal flow
Estimate average number of flow events in review area/year 2-5
Describe flow regime
Other information on duration and volume
Surface flow is Discrete and confined Characteristics
Subsurface flow Unknown Explain findings
❑ Dye (or other) test performed
Tributary has (check all that apply)
N Bed and banks
N OHWM6 (check all indicators that apply)
N clear, natural line impressed on the bank
N
❑ changes in the character of sot
❑
❑ shelving
❑
❑ vegetation matted down, bent, or absent
❑
❑ leaf litter disturbed or washed away
N
N 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.junsdiction (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 to vegetation types
❑ tidal gauges
❑ other (list)
(in) Chemical Characteristics
Characterize tributary (e g, water color is clear, discolored, oily film, water quality, general watershed characteristics, etc )
Explain Water is generally clear Water quality is likely low /moderate Tributary watershed are generally commercically
developed and covered by impervious pavement
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
'[bid

(w) Biological Characteristics Channel supports (check all that apply):
® Riparian corridor Characteristics (type, average width) Generally the riparian corridor is Bottomland Hardwood Forest
and is approximately 100' on either side
❑ 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 P_iek List
Characteristics
Subsurface flow Pick List Explain findings Wetland is located at the toe of slope
❑ 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/barner Explain
(d) Proximity (Relationship) to TNW
Project wetlands are Peek 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 floodplam
(n) 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) _T
All wetland(s) being considered in the cumulative analysis Pick-Lis`t
Approximately ( ) acres in total are being considered in the cumulative analysis

For each wetland, specify the following
Directly abuts9 (Y/N) Size (in acres) Directly abuts9 (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 floodplam 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 TNW9
• 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 TNW9
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs9
• 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
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
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
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 NC DWQ Stream iD forms

Provide estimates for.junsdictional waters in the review area (check all that apply)
® Tributary waters 133 linear feet 5 width (ft)
_❑_ Other non - wetland waters acres
identify type(s) of waters
Non -RPWss 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 111 C
Provide estimates for Iunsdictional 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 III B 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 14 5 acres
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs
El 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 acres
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,junsdictional wetlands in the review area acres
Impoundments of, jurisdictional waters .9
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),
❑ Demonstrate that water is isolated with a nexus to commerce (see E below)
ISOLATED [INTERSTATE OR INTRA- STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WA7 ERS (CHECK ALL THAT APPLV)•10
❑ 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
Identify water body and summarize rationale supporting determination
"See Footnote # 3
v To complete the analysis refer to the key in Section 111 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

Provide estimates for jurisdictional waters in the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non - wetland waters acres
Identify type(s) of waters
❑ Wetlands acres
F. NON - JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
❑ if potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements
❑_ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR)
❑ Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction Explain
❑ Other (explain, if not covered above)
Provide acreage estimates for non - jurisdictional waters in the review area, where the sole potential basis of.junsdiction is the MBR
factors (i e, presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
Judgment (check all that apply)
❑ Non - wetland waters (i e, rivers, streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non - wetland waters acres List type of aquatic resource
❑ Wetlands acres
Provide acreage estimates for non - jurisdictional waters in the review area that do not meet the "Significant Nexus' standard, where such
a finding is required for Jurisdiction (check all that apply)
❑ Non - wetland waters (i e , rivers, streams) linear feet, width (ft)
❑ Lakes /ponds acres
❑ Other non - wetland waters acres List type of aquatic resource
❑ Wetlands acres
SECTION IV DATA SOURCES
A. SUPPORTING DATA Data reviewed for JD (check all that apply - checked items shall be included in case file and, where checked
and requested, appropriately reference sources below)
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant Kimley -Horn and Assoc, Inc
® Data sheets prepared /submitted by or on behalf of the applicant/consultant
❑ Office concurs with data sheets /delineation report
❑ Office does not concur with data sheets /delineation report
❑ 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 1 24,000 Hickory Quad (1993)
® USDA Natural Resources Conservation Service Soil Survey Citation Catawba County SSURGO Soils
❑ National wetlands inventory map(s) Cite name
❑ State /Local wetland inventory map(s)
❑ FEMA/FiRM maps
❑ 100 -year Floodplam Elevation is (National Geodecthc Vertical Datum of 1929)
® Photographs ® Aerial (Name & Date) 2010 ESRI World Imagery
or ® Other (Name & Date) Site Photographs, November 4, 2013
❑ Previous determination(s) File no and date of response letter
❑ Applicable /supporting case law
❑ Applicable /supporting scientific literature
❑ Other information (please specify)
B ADDITIONAL COMMENTS TO SUPPORT JD.

Jurisdictional Determination Request
0
US Army Corps
of Engineers
Wilmington Distrid
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
to the appropriate Corps Field Office (or project manager, if known) via mail, electronic mail, or
facsimile. A current list of County assignments by Field Office and project manager can be
found on -line at: http: / /www.saw.usace.army.miI /Missions /RegglatoaPermitPro Try, am.aspx , by
telephoning: 910 -251 -4633, or by contacting any of the field offices listed below:
ASHEVILLE REGULATORY FIELD OFFICE
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801 -5006
General Number: (828) 271 -7980
Fax Number: (828) 281 -8120
RALEIGH REGULATORY FI ELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: (919) 5544884
Fax Number: (919) 562 -0421
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: (910) 251 -4610
Fax Number: (252) 975 -1399
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910 - 2514633
Fax Number: (910) 251 -4025
Version: December 2013 Page 1

Jurisdictional Determination Request
INSTRUCTIONS
All requestors must complete Parts A, B, C, D, E and F
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 G
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION Please-be aware that all JD
request s 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 to be considered a complete request
NOTE ON PART D - INCDOT 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 als_d request a certified wetland determination from the local office of the Natural
Resources Conservation Service, prior to starting work
Version December 2013 Page 2

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address 483 U S 70
City, State! Hickory, NC
County Catawba
Directions From Interstate 40 West take Exit 123B to merge onto US -321 N, Take Exit 44
to merge onto US -321 B /US -70 E, The project site is 0 8 mile on the right
Parcel Index Number(s) (PIN ) 370214341990,
370214341725
B. REQUESTOR INFORMATION
Name
Mailing Address
Telephone Number
Electronic Mail Address
Chris Tmklenberg
2000 South Boulevard, Ste 440
(704) 409 -1802
chns tinklenberg @kimley -horn com
Select one
❑ 1 jam the current property owner
❑✓ 1 am an Authorized Agent or Environmental Consultant
❑✓ Interested Buyer or Under Contract to Purchase
❑ Other, please explain
C. PROPERTY OWNER INFORMATION
Name LNBC, LLC Attn Mr Benny Yount
Mailing Address Post Office Box 3447
Hickory, NC 28603 -3447
jTelephone Number 828 - 449-1420 x2205 (Danny Jordan for Mr Yount)
Electronic Mail Address 3F dtordan @parmountauto com
❑✓ Proof of Ownership Attached (e g a copy of Deed, County GIS/Parcel /Tax Record data)
' If available
2 Must attach completed Agent Authorization Form
3 If available
Version December 2013 Page 3

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION'
I, the undersigned, a duly authorized owner of record of the property /properties identified herein,
do 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
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Mr. Benny Yount
(please print)
Property Owner Sig at re
E. JURISDICT AL DETERMINATION TYPE
Select One:
January 20, 2014
Date
ElI am requesting that the Corps provide a Preliminary JD for the property identified herein.
This request does include a delineation.
F] I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUS5 and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
F] I am requesting that the Corps delineate the boundaries of all WoUS on a property /project
area and provide an approved JD (this may or may not include a survey plat).
I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property /project area and provide an approved JD (may or may not
include a survey plat).
For NCDOT requests following the current NCDOT /USACE protocols, skip to Part E.
s Waters of the United States
Version: December 2013 Page 4

Jurisdictional Determination Request
F. ALL REQUESTS
❑ Map of Property or Project Area (attached)[ This Map must clearly depict the boundaries
of the area of evaluation
0
Size of Property or Project Area 6 3
acres
II[[ verify that the property (or project) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable
G. JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests
❑ Completed and signed Preliminary Jurisdictional Determination Foim6
❑ Project Coordinates Latitude Longitude
Maps (no larger than 11x17) with Project Boundary Overlay
❑ [Large and small scale maps that depict, at minimum streets, intersections, towns
❑ Aerial Photography Of the project area
❑ 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)
6 See Appendix A of this Form From Regulatory Guidance Letter No 08 -02, dated June 26, 2008
Version December 2013 Page 5

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
Wetland Data Sheet§§
Tributaries:
❑ USACE Assessment forms
Upland Data Sheets Other Assessment Form§
(when appropriate)
F] Landscape Photos, if taken
Field Sketch overlain on legible Map that includes:
■ All aquatic resources (for sites with multiple resources, label and identify)
■ Locations of wetland data points and /or tributary assessment reaches
■ Locations of photo stations
■ Approximate acreage/linear footage of aquatic resources
(2) Approved JDs including Verification of a Delineation:
FVJ Project Coordinates: 35.719585 Latitude - 81.347764 Longitude
Maps (no larger than 1 Ix 17) with Project Boundary Overlay:
❑✓ Large and small scale maps that depict, at minimum: streets, intersections, towns
❑✓ Aerial Photography of the project area
❑✓ USGS Topographic Map
❑✓ Soil Survey Map
❑✓ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
1987 Manual Regional Supplements and Data forms can be found at:
http: / /www.usace.army.miI/ Missions/ CiviIWorks/ ReguIatoryProgramandPermits /reg suvo.asox
Wetland and Stream Assessment Methodologies can be found at:
http: / /Portal.ncdenr.org /c /document library /get file ?uuid= 76f3c58b -dab8- 4960- ba43- 45b7faf06f4c &groupld =38364 and,
http: / /www.saw.usace.army.mil/ Portals /59 /docs /regulatory /publicnotices /2013 /NCSAM Draft User Manual 130318.pdf
8 Delineation information must include, at minimum, one wetland data sheet for each wetland /community type.
Version: December 2013 Page 6

Jurisdictional Determination Request
Delineation_Information (when applicable)
Wetlands
Wetland Data Sheets
Tributaries ❑
USACE Assessment Forms
❑ Upland Data Sheets Fv—(1 Other Assessment Forms
(when appropriate)
❑✓ Landscape Photos, if taken
❑✓ Field Sketch overlain on legible Map, that includesi
• All aquatic resources (for sites with multi lie resources, label and identify)
• Locattons_oflwetland_datal points and /or tributary assessment reaches
• Locations of photo stations
• Approximate acreage /linear footage of aquatic resources
Supporting Jurisdictional Information (for Approved JDs only)
✓❑ Approved Jurisdictional Determination Form(s) (also known as "Rapanos
Form(s)")
❑ Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc to navigable waters
9 Delineation information must include, at minimum, one wetland data sheet for each wetland /community type
Version December 2013 Page 7

J
Hickory Development Site
200 2
00
Co
A,
C,
h
H
W- yo;
20U.:
421.00
1;
43.21 11
174.00
x.29 59
6B
53
Parcel IDs:
370214341990
370214341725
See attached report for ownership details.
I
[-A

Parcel Summary Report
6 records
Parcel ID / LRK: 370214341725 / 604373
Owner: LNBC LLC
Building Value: $0
Deed Book /Page: 3145/0952
Parcel ID / LRK: 370214341990 / 29548
Owner: LNBC LLC
Building Value: $0
Deed Book/Page: 3145/0949
Parcel ID / LRK: 370214341990 / 29548
Owner: LNBC LLC
Building Value: $0
Deed Book /Page: 3145/0949
Parcel ID / LRK: 370214341990 / 29548
Owner: LNBC LLC
Building Value: $0
Deed Book /Page: 3145/0949
Parcel ID / LRK: 370214341990 / 29548
Owner: LNBC LLC
Building Value: $0
Deed Book /Page: 3145/0949
Parcel ID / LRK: 370214341990 / 29548
Owner: LNBC LLC
Building Value: $0
Deed Book /Page: 3145/0949
Selected Parcels Catawba County NC
jExcel
Parcel Address: 1120 4TH ST DR SW, HICKORY 28602
Owner Address: PO BOX 3447, HICKORY NC 28603 -3447
Land Value: $98,200 Total Value: $98,200
Subdivision: Lot Number: 2
Parcel Address: 483 HWY 70 SW, HICKORY 28602
Owner Address: PO BOX 3447, HICKORY NC 28603 -3447
Land Value: $601,800 Total Value: $601,800
Subdivision: Lot Number: PT 1
Parcel Address: 483 HWY 70 SW, HICKORY 28602
Owner Address: PO BOX 3447, HICKORY NC 28603 -3447
Land Value: $601,800 Total Value: $601,800
Subdivision: Lot Number: PT 1
Parcel Address: 483 HWY 70 SW, HICKORY 28602
Owner Address: PO BOX 3447, HICKORY NC 28603 -3447
Land Value: $601,800 Total Value: $601,800
Subdivision: Lot Number: PT 1
Parcel Address: 483 HWY 70 SW, HICKORY 28602
Owner Address: PO BOX 3447, HICKORY NC 28603 -3447
Land Value: $601,800 Total Value: $601,800
Subdivision: Lot Number: PT 1
Parcel Address: 483 HWY 70 SW, HICKORY 28602
Owner Address: PO BOX 3447, HICKORY NC 28603 -3447
Land Value: $601,800 Total Value: $601,800
Subdivision: Lot Number: PT 1
Page 1 of I
This map /report product was prepared from the Catawba County, NC Geospabal Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling
information contained on this map or data on this report. Catawba County promotes and recommends the independent verification of any data contained on this map /report product by the user. The
County of Catawba, Its employees, agents, and personnel, disclaim, and shall not be held liable for any and all damages, loss cr liability, whether direct, indirect or consequential which arises or may
arse from this map /report product or the use thereof by any person or entity.
© 2014, Catawba County Government, North Carolina. All rights reserved.
http:// gis. catawbacountync .gov /nomap /multi_report.php? key =2 +Selected %20Parcels &typ... 1/20/2014

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