20141179 Ver 1_401 Application_20141114

CLearWaLer 2 ° , °' , ' a
ClearWater Environmental Consultants, Inc
www.cwenv.com
November 10, 2014
Mr. William Elliott
US Army Corps of Engineers
Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, North Carolina 28801 -2638
Ms. Karen Higgins
NC DWR, 401 & Buffer Permitting Unit
512 N. Salisbury Street, 9s' Floor
Raleigh, NC 27604
RE: Snowball Lane Pump Station ( +/ -034 Acres)
Henderson County, North Carolina
Mr. Elliott and Ms. Higgins,
PAID
The attached Pre - Construction Notification (PCN) is being submitted on behalf of Henderson
County Cane Creek Sewer District represented by Mr. Marcus Jones. The proposed sewer pump
relocation is located off Fanning Bridge Road in Fletcher, Henderson County, North Carolina.
Henderson County is seeking a Nationwide Permit 12 for the installation of a new sewer pump
station located on higher ground. Also attached is our request for a Jurisdictional Determination.
A copy of this package has been sent to Mr. Doug Besler of the NC Wildlife Resources
Commission and Mr. Bryan Tompkins of the US Fish and Wildlife Service for review. A
courtesy copy of this application has also been submitted to Mr. Tim Fox of the NC Division of
Water Resources, Asheville Regional Office. Please do not hesitate to contact me at 828 -698-
9800 if you have any questions or comments.
Respectfully,
Kevin Mitchell
Biologist
Copy Furnished:
NC Division of Water Resources, Asheville — Tim Fox
NC Wildlife Resources Commission — Doug Besler
US Fish and Wildlife Service — Bryan Tompkins
224 South Grove Street, Suite F
Hendersonville, NC 28792
828 -698 -9800 Tel
828- 698 -9003 Fax
t
R. Clement Riddle, P.W.S
Principal

Corps Submittal Cover Sheet
Please provide the following info:
1 Project Name: Snowball Lane
I Name of Property Owner /Applicant: Henderson County — Cane Creek Sewer
District
3. Name of Consultant/Agent: C1earWater Environmental Consultants, Inc.
*Agent authorization needs to be attached.
4. Related/previous Action ID numbers(s): none
5. Site Address: 639 Fanning Bridge Road
6. Subdivision Name: N/A
7. City: Fletcher
8. County: Henderson
9. Lat: 35.432352N Long: - 82.516007W (Decimal Degrees Please
10. Quadrangle Name: Skyland
11. Waterway: Kimsey Creek
12. Watershed: Upper French Broad 06010105
13. Requested Action:
X Nationwide Permit # 12
General Permit #
Jurisdictional Determination Request
Pre - Application Request
following information will be completed by the Corps office:
Ma
File.Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Description/Nature of Activity/Project Purpose:
aters Name:

CLearWaLer
Depdrtment of the Army NCDENR
Wilmington District, Corps of Engineers NC DWR, Wcbscape Unit
Attn Scott McLendon, Chief Regulatory Division Attn: Karen Higgins
PO Box 1890 512 North Salisbury Street
Wiliiiington, NC 28402 -1890 Raleigh, North Carolina 27604
I, the current landowner /managing partner of the property identified below, hereby
authorize ClearWater Environmental Consultants, Inc. (CEC) to act on my behalf as my
agent during the processing of jurisdictional determination requests and permits to impact
Wetlands and Water of the US subject to Federal jurisdiction under Section 404 of the
Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. CEC is
authorized to provide supplemental information as needed at the request of the USACE
or DWR.
Additionally, 1 authorize representatives of the Wilmington District, US Army Corps of
Engineers to enter upon the property herein described for the purposes of conducting on-
site investigations and issuing a determination associated with Wetlands and Waters of
the US subject to Federal jurisdiction under Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act of 1899.
ty Owner of Record: Newc Lar atiA t.GNC O! wk —�G1d' DhX
ty Owner of Address: Fti S r1['. &x b0 _ 41eff—, 500
4,cAdmc2N d . N 22fnwo
j [o'l ' pr(Number: W 0
iy,Location: Fie-kber, NG
/Managing Partner Ke-rctz I Name: S PC; EAlff�&r
/Managing Partner Signature:
October 8, 2014
224 South Grove Sireet, Suite F
Hendersonville, -NC 28792
Phone: [phone]
www.cwenv.com

August V
Joyce Lan
P. 0. Box
Fletcher,
Subject:
Dear Ms.
Please fir
446939.
Lane Lift
Henderson County Engineering
1 Historic Courthouse Square, Suite.6
Hendersonville, North Carolina 28792
(828) 694 -6526 1 www.hendersoncountync.org
,2014
:e and all
.116
1C 28732
Compensation for Lift Station Easement
Snowball Lane Lift Station Relocation Project
Cane Creek Water and Sewer District
Lance,
the subject payment enclosed fdr $5,000 (five thousand dollars), check number
us payment is per the easement agreement to relocate the District's Snowball
ation on the quarry property owned by yourself, William Lance and APAC,
Thank you for your patience and understand with our project Please do not hesitate to
contact me should you have any questions.
Marcus A. Jones, P.E.
Directori of Engineering
cc: Greg Davis, APAC
Russ Burrell, County Attorney
Greg Wiggins, Operations,Manager
Will Buie, WGLA Engineering
To provide a strong value to the Citizens of Henderson County with emphasis on
Safety, Customer Service and the Environment

HEND RSON_COUNTY '
119 NORTH MAIN STREET
HENDERSONVILLE, NO 28702
FIRST- _CITIZENS BANK w l F 88= 3015.41
HENDERSONVILLE; NC 4 4 6 9 3 9 ss1,
CHECK N0.
VOID AFTER 90 DAYS
t'
446939
29472 08/14/2014 $5,000.,00
• - PROVO MR THE PAYMENT OF T49 04ECK JOR ORAFq !!A!, EN MADE
BV AN APPROPRIAMOMMILY.MWE Pmlt A n to TffkLOf.AL OOVERIUMM
PAY' -,** ** * *'5, 000 DOLLARS, LAND NO CBNTS,r BMErANOMAICONTROLAOr," ;v,-
-_ A i; I (rTO
THE' JOYCE R. LANCS AND ALL r t �, f rF�NANCe oFR'
'ir,.t ORDER ,
�} 1
CHAIRMAN OF THE BOARD

HE_NDER90N COUNTY
,i,D'r 010E!AIUMBER
08/11/14 2905715 SN
LIFT STA EASEMBN 1 5,000.00
446939
94263
f

GRANT OF NON - EXCLUSIVE UTILITY EASEMENT
KNOW ALL I EN BY THESE PRESENTS that Joyce Lance, Bill Lance and APAC - Atlantic, Inc. d /b /a Harrison
Construction company as successor and assign from Oldcastle Industrial Minerals, Inc., for themselves,
their heirs, successors and assigns, (collectively referred to as "Grantor") for and in consideration of the
sum of five thousand Dollars ($5000.00), and other good and valuable consideration, the receipt and
adequacy o I which is hereby acknowledged, do hereby grant, convey and confirm unto Henderson
County Engineering, whose address is 1 Historic Courthouse Square, Suite 6, Hendersonville, NC 28792,
its successors and assigns ( "Grantee "), a non - exclusive easement to construct, inspect,, operate and
maintain a sewer pump station and required appurtenances, for the service of Snowball Lane, Fletcher,
N.C. (the "Facilities ") upon and under a portion of the property located at 639 Fanning Bridge Road in
the County of Henderson, State of North Carolina, more particularly described at Exhibit A hereto
The dimensions of the easement shall be a thirty six (36) foot by fifty (50), foot area as depicted at
Exhibit A beginning in the Eastern corner of Kimsey Creek and Lime Kiln Creek, and running Northerly
contiguous to the stock pile area as illustrated (the "Easement ").
This Easement is subject to any and all other easements, rights -of -way, variances, memorandums
and /or agreements currently of record
Grantee
Grantee,
the event t
exercise of
its original
Grantee hei
directors, al
claims, actu
way related
with the Eas
I promptly repair any dar6age to the Easement, or any other property not owned by
sed by Grantee exercising its rights under this Easement including without limitation,
ground cover, planting, roadways, driveways, sidewalks, parking areas and structures In
it Grantee, its employees, agents or contractors cause damage to the Easement in the
ie privilege granted herein, Grantee agrees to restore the Easement parcel so damaged to
ndition and grade as may be requested by Grantor.
V agrees that it will indemnify and hold harmless Grantor and its officers, shareholders,
ts, affiliates, insurers and employees from any and all injuries to person or property,
judgments, expenses, losses, damages, costs and'attorneys' fees arising out of or in any
the negligence of Grantee or Its agents, employees, licensees, or invitees In connection
lent, its activities on the Easement or other properties of Grantor, the presence of the
Facilities or any breach of this Easement.
This Easement shall continue for so long as the Facilities continue in operation such sewer pump station
and necessary appurtenances Grantee and Grantee employees, that perform work at the above
reference easement parcel, shall sign in at the scale house during normal operating hours In the event
that the Grantee arrives at the easement Lparcel after normal business hours, the Grantee shall contact
Oldcastle Industrial Minerals Fletcher plant management.
Grantee acknowledges that some or all of Grantor's property is an active mining operation. Grantee
warrants that all persons entering Grantor's property shall be properly trained as required by the Mine
Safety and Health Act and all applicable federal, state and local laws. Grantee acknowledges that all

persons entering the property shall be fully capable of identifying and addressing any risk associated
with the operations of Grantor or its property and accepts all risk of injury to person or property
associated with presence on or at Grantor's property.
Grantee further warrants Grantor's activities and uses do not and will not endanger, harm or impair the
Facilities. Grantee further represents and warrants that all activities allowed hereunder, including
ingress and egress, shall be conducted in strict compliance with all applicable laws and regulations and
that all construction, design, installation, inspection, maintenance, renewal, repair, removal,
replacement and operation of the Facilities are solely the responsibility of Grantee
IN WITNESS WHEREOF, Grantor has hereunto set its hand this /ay of 7'Y1 20/�
GRANTOR: Oldcastle Ind
NUAAteals, Inc. Harrison Construction Company, Joyce Lance and Bill
Lance
By'
Its,
ACKNOWLEDGMENT
STATE OF NORTH CAROLINA §
COUNTY OFI §
This instrument was acknowledged before me on f 3— 20%� by — C �V . Oci�-m
the V. P. of APAC- Atlantic, Inc., on behalf of said corporation.
WITNESS my hand,and official seal.
*IX
Name 4m" l-'vN r Notary Public,'State oftm
My commission expires• -Y1ov. a ao I g
i

W q w �J Q AADYI �cf p7l�e
Iq M"t 2oc�
1 h15 i � S�ur►�en-�, LU
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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 El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number. 12 or General Permit (GP) number.
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
le. 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
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
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:
Snowball Lane
2b. County:
Henderson
2c. Nearest municipality / town:
Fletcher
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state
project no:
N/A
3. Owner Information
3a. Name(s) on Recorded Deed:
Joyce R. Lance
3b. Deed Book and Page No.
515/193
.7 Lso
3c. Responsible Party (for LLC if
applicable):
N/A NOV 1
2 2014
3d. Street address:
639 Fanning Bridge Road
Fletcher 401 8 BUFFER VVAIERIRESOURCLt$ $
Information Unavailable
3e. City, state, zip:
3f. Telephone no.:
39. Fax no.:
N/A
3h. Email address:
Information Unavailable
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant le
❑ Agent ® Other, specify. Applicant holds sewer easement
4b Name
Henderson County -Cane Creek Sewer Distract
4c Business name
(if applicable):
N/A
4d. Street address:
1 Historic Courthouse Square, Suite 6
4e City, state, zap:
Hendersonville, NC 28792'
41'. Telephone no
828 - 694-6560
4g. Fax no.
N/A
4h Email address:
Information Unavailable
5. Agent/Consultant Information (if applicable)
5a. Name,
R. Clement Riddle
5b. Business name
(if applicable)
ClearWater Environmental Consultants, Inc
5c. Street address
224 S. Groves Street, Suite f
5dY City, state, zip:
Hendersonville, NC 28792
5e. Telephone no..
828 - 698 -9800
5f. Fax no.
WA
5g: Email address
clement@cwenv corn
Page 2 of 12
PCN Form — Version 1 3 December 10, 2068 Version

B. Project Information and Prior Project History
1. Property Identification
1a Property identification no. (tax PIN or parcel ID):
9662292964
lb Site coordinates (In decimal degrees):
Latitude- 35.432352 N Longitude- - 62.516007 W
(DD DDDDDD) ( -DD DDDDDD)
1c. Property size.
Project Area is approximately 0 34 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc ) to
Kimsey Creek
proposed project.
2b. Water Duality Classification of nearest receiving water
C
2c River basin.
Upper French Broad 06010105
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:
Kimsey Creek Is adjacent to a residential,neighborhood to the northwest and a quarry to the south and east. Land use in
the vicinity is residential, commercial, and forested.
3b. List the total estimated acreage of all existing wetlands on the property-
Approximately 0.01 acres In the project area.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Approximately 54 linear feet in the project area.
3d. Explain the purpose of the proposed project.
Henderson County's Snowball Lane sewer pump station is being relocated outside of the regulatory flood hazard area to
higher ground In order to prevent flooding of the pump station and future sanitary sewer overflows.
3e Describe the overall project in detail, Including the type of equipment to be used-
The project will include the installation of a new sewer pump station on the Joyce Lance property The proposed pipe line
will need to cross Kimsey Creek in order to-do the upgrades. The crossing will be installed using the trench -cut method
The trench-cut method Involves dewatering the work area and excavating a trench In which the sewer line is laid. The
line Is then covered with the native materials removed from the trench and the contours are returned to pre- exlsting
conditions. In this method, stream Impacts are temporary. Typical details for stream crossings are included for review
(Figure 3.1 & 3.2).
4. Jurisdictional Determinations
4a Have Jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property I
El Yes [__1 No E9 Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
❑Preliminary El 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 [I 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 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a Is this a phased, project' ❑ Yes ® No
6b. If yes, explain
Page 4 of 12
PCN Form - Version 1.3 December 16, 2608 Version

C Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply)*
❑ Wetlands ❑ Streams - tnbutanes ❑ 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)
DWO — non -404, other)
(acres)
Tem ora T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWO
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWO
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑No
❑DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
[-I No
❑DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWO
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWO
2g. Total wetland Impacts
2h. Comments.
3. Stream Impacts
If there are perennial or intermittent stream Impacts (including temporary Impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a
3b.
3c.
3d.
3e.
3f.
3g
Stream Impact
Type of impact
Stream name
Perennial
Type of Jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ® T
Utility Crossing
Kimsey Creek
® PER
❑ INT
® Corps
® DWO
8
25
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWO
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWO
S4 [_-]POT
❑ PER
❑ Corps
❑ INT
❑ DWO
S5 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWO
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWO
3h. Total stream and
tributary impacts
25
31. Comments:
Page 5 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributanes, 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
01 ❑P ❑T
02 ❑P [IT
03 ❑P ❑T
04, ❑P ❑T
4f. Total open water impacts
4g Comments
S. Pond or Lake-Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
6d.
Se.
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
02
S! Total
5g. Comments:
Sh Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
51. Expected pond surface area (acres) -
5j Size of pond watershed (acres)
5k Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST Q out Section D of this form.
ea.
❑ 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?
B1 ❑ P ❑ T
❑ Yes
❑ No
B2 ❑P
❑Yes
❑ No
B3 ❑PST
El
[] ❑ No
6h Total buffer impacts
6i. Comments,
Page 6 of 12
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 sewer line will be placed beneath Kimsey Creek. The line will be trenched in and stream contours will be returned to
preexisting conditions. Rock will be placed in the channel for stabilization at,the crossing, however, the finished top elevation
of the nprap will not exceed that of the original stream bed. Stream impacts are limited to the amount necessary to Install the
line (25 Linear feet)
1 b Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques
Construction equipment will be operated from high ground during construction. Silt fencing will be Installed along the entire
length of the stream and wetland The installation of the proposed sewer line crossing should take less than one day to install.
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 Mitgabon
3. Complete U 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 -Ileu 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:
S. Complete if Using, a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 12
PCN Form — Version 13 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
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation Is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permdtee responsible riparian buffer restoration, payment into an approved in -lieu fee fund)
6h. Comments:
Page 8 of 12
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a Does the project Include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
Within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes El No
Comments.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
<2 %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c If this project DOES NOT require a Stormwater Management Plan, explain why: This project includes the installation of a
new sewer pump station. Less than 2% impervious surface area will be added as a result of this project
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e Who will be responsible for the review of the Stormwater Management Plan?
❑ DWO § tormwater Pro gram
❑ DWO 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's junsdiebon is this project?
❑ Phase II
3b. Which of the following locally4mplemented 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
4a. Which of the following state - implemented stormwater management programs apply
El HOW
[I HO HOW
(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 12
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/statellocal) funds or the
® Yes ❑ No
use of public (federal /state) land?
1b. 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
letter )
❑ Yes ❑ No
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 26.0200)?
2b. Is this an after - the -fact permit application?
❑ Yes ® No
26 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.
The project will relocate the existing sewer pump station out of the regulatory floodplaln onto higher ground in order to prevent
future sewer'overflows.
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

S. 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?
❑ 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?
FWS county data and Natural Heritage Program GIS data
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?
South Atlantic Habitat and Ecosystem IMS. Impact will not occur in a marine system.
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?
National Register of Historic Places records maintained by the NC State Historic Preservation Office (SHPO) and
available on SHPO's HPOWEB GIS service There are six historic sites within two miles of the site. The Rugby Grange
(HPO Site ID HN0042) Is located 0 8 miles from the site. The Youngblood General Store (HPO Site ID HN1073),
Cunningham - Poteat Bagwell House (HPO Site ID HN1074), Meadows House (HPO Site ID HN0004), Calvary Episcopal
Church and Rectory (HPO Site ID HN1059), and Oak Park Historic District (HPO Site ID BN2467) are all within 1.2 miles
of the site. It is the opinion of CEC, that the proposed activity is not likely to threaten the Integrity of these sites.
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA- designated 100 -year hoodptain?
®Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: Installation of the sewer line will occur insid&of the 100 year
floodplain. The utility line will be sub - surface and upon completion of construction, contours will be returned to pre-
existing conditions throughout the length of the floodplain. The purpose of the project is to relocate the existing sewer
pump station out of the regulatory floodplain onto higher ground
8c. What source(s) did you use to make the floodpiain determination? FEMA Map Service Center, 37009653OW (effective
116/2010).
RA:
Ilcah�A ent's Printed Name
PP 9
' Q-
Applicant/Agent's Signature
Date
(Agent's signature Is valid only if an authorization letter from the applicant
Is provided
Page 11 of 12
PCN Form — Version 1.3 December 10, 2008 Version

Page 12 of 12
PCN Form — Version 1 3 December 10, 2008 Version

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Snowball Lane ( +/- 0.34 AC)

Snowball Lane ( +/- 0.34 AC)
Jurisdictional wetlands and waters identified on this map have been located withn subtmeler accuracy
utilizing a Trimble mapping grade Global Positioning System (GPS) and the subsequent ddlererWal
mrrechon of that data GPS points may demonstrate uncorreCtable errs due to topography, vegetable
cover, anftr mulbpam signal error.
Note The llustrated welland and stream locations are approximate. These areas nave been flagged in the
held, however, they have not been surveyed. Although ClearWaler Environmental Consultants, Inc. (CEC)
is confident In our assessment, the US Army Corps of Esgmeers (Corps) is the only agency that can make
final decisions regarding jurisdictional wetland and welers of the US debneetions Therefore, a9 preliminary
determinations are sub)ed to change until written verification Is obtained CEC strongly recommends that
wNten verification be obtained from the Corps prior to closing on the property, beginning any site work, or
making any legal reliance on this determination
This map was prepared try CEC using the best information available to CEC at the time of production. This
map Is for Informational purposes only and should not be used to determine preose boundaries, roadways,
property boundary Ines, nor legal detimptions. This map shah not be construed to be an official survey of
any dale depicted.
Source Data, WGLA Engineering PLLC, Mrrrtdarson County, and Field Collected Data
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� Delineated October 16, 2014
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224 South Grove Street, Suite F
Hendersonville, North Carolina 29792

Jurisdictional Determination Request

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This forth should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION 1: 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: Henderson City: Fletcher
Center coordinates of site (lat/long in degree decimal format) Lat 35 432352 Long. - 82.5160070 VW-.
Universal Transverse Mercator
Name of nearest waterbody: Kimsey Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows French Broad River
Name of watershed or Hydrologic Unit Code (HUC): Upper French Broad 06010105
® Check if map/diagram of review area and/or potential Jurisdictional area 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):
0 Office (Desk) Determination Date
® Field Determination Date(s):
SECTION 11: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There �re 56 "navigable waters ojthe US" within Rivers and Harbors Act (RHA) Jurisdiction (as defined by 33 CFR part 329) in the
review area. [RequlrrA
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 9mm "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. Intricate presence of waters of U.S. in review area (check all that apply): 2
® TNWs, including territorial seas
Wetlands adjacent to TNWs
Relatively permanent wateri2 (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,mto TNWs
A Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
Impoundments of Jurisdictional waters
a Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the US. In the review area:
Non - wetland waters. 256 linear feet: 8 width (ft) and/or 0.047 acres
Wetlands. 0.02 acres
a Limits (boundaries) of jurisdiction based on. IMINNURFID .
Elevation of established OHWM (if known)•
2. Non - regulated waters/wetiands (check If applicable):3
® Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional
Explain-
1 Boxes chocked below shall be supported by completing the appropriate sections in Section 111 below
2 For purposes of this form, an RPW is defined as a tributary that is not a TIM 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 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 II1.A.1 and Section III.D.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 IBM below
1. TNW
Identify TNW
Summarize rationale supporting determination
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 (1F 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 (egg 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) (low, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.DA.
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 nevus 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 fiuding Is not required as a matter of low.
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 wetlonds, complete Section HLB.1 for
the tributary, Section IIIA2 for any onsite wetlands, and Section III.B3 for all wetlands adjacent to that tributary, both onsite
and onsite. The determination whether a significant nexus exists Is determined in Section III.0 below.
1. Characteristics of non -TNWs that flow directly or indirectly Into TNW
(i) General Area Conditions:
Watershed size
Drainage area- MEN
Average annual rainfall. inches
Average annual snowfall. inches
(11) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
❑ Tributary flows through tributaries before entering TNW
Project waters are EMU 2 river miles fiom TNW
Project waters ere M'aefial river miles from RPW.
Project waters,are aerial (stratght) miles from TNW
Project waters are (straight) miles from RPW
Project waters cross or serve as state boundaries. Explain.
Identify flow route to TNW°:
Tributary stream order, if known
Note that the Instructional Guidebook c_ ontams additional information regardmg'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

(b) General Tributary Characteristics (check all that apply)
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 PMIK
Primary tributary substrate con osihon (check all that apply):
❑ Silts [3 Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ❑ Vegetation Type/% cover
❑ Other Explain
Tributary condition/stability [e g, highly eroding, sloughing banks] Explain
Presence of run/n I complexes. Explain:
Tributary geometry.
Tributary gradient (approximate average slope) %
(c) Flow:
Tributary provides for.
Estimate average number of flow events to review area/year.�c�k _Lir
Describe flow regime,
Other information on duration and volume-
Surface flow is . Characteristics
Subsurface flow: Explain findings.
❑ Dye (or other) test performed:
Tributary has (check all that apply):
❑ Bed and banks
❑ OHWM' (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.' Explain•
If factors other than the OHWM were used to deter
® High Tide Line indicated by. ffil
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical marlkings/characteristics
❑ tidal gauges
❑ other (list):
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
ine lateral extent ofCWA jurisdiction (check all that_apply)-
Mean High Water Mark indicated by
❑ survey to available datum;
❑ physical markings,
❑ vegetation lines/changes in vegetation types
(iiQ 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:
6A natural or man -made discontinuity in the OHWM does not necessarily sevajunsdhctimi (e g., where the sucam temporarily flows underground, or where
the OHWM has been removed by development or agncultuml pmcnces) 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):
❑ Ripanan 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
(1) 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. t+ Explain
Surface flow is:
Characteristics:
Subsurface flow: Explain findings-
El Dye (or other) test performed-
(c) Wetland Adiacencv Determination with Nan -TNW
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain.
❑ Ecological connection Explain
❑ Separated by benm/bamer. Explain
(d) Proximity (Relationship) to TNW
Project wetlands ere jWTIM river miles from TNW.
Project waters are iM aerial (straight) miles from TNW.
Flow is fiom•
Estimate approximate location of wetland as within the tloodplam
(1l) 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- sensnnve species Explain findings
❑ Aquade/wildlife diversity. Explain findings
3. Characteristics of all wetlands adjacent to the tributary (if an
All wetlands) being considered in the cumulative analysis:
Approximately ( j acres in total are being considered in the cumulative analysis.

For each wetland, specify the followmg.
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, fn 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 significetit 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.
a TNWs: linear feet - (ft), Or, acres.
is Wetlands adjacent to TNs acres
RPWs that now 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. Defined bed and bank and strong flow, delineated as a blue line stream on USGS map
® 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 256 linear feet 8 width (ft)
IN Other non - wetland waters. acres.
Identify type(s) of waters
Non -RPWss that flow directly or indirectly Into TNWs.
91 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 junsdictional Data supporting this conclusion is provided at Section 111 C
Provide estimates for jurisdictional waters within the review area (check all that apply):
® Tributary waters linear feet width (it)
Other non - wetland waters: acres
Identify type(s) of waters
4. 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: Wetland discharges directly Into stream channel.
® Wetlands directly abutting an RPW where tributaries typically flow "seasonally " Provide data indicating that tributary is
seasonal in Section 111 B and rationale in Section III D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW.
Provide acreage estimates for junsdictional wetlands in the review area 0.02 acres
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or Indirectly into TNWs.
IM 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 junsidictional Data supporting this
conclusion is provided at Section iii.0
Provide acreage estimates for jurisdictional wetlands in the review area acres
6. Wetlands adjacent to non -RPWs that flow directly or indirectly Into TNWa
® 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.0
Provide estimates for jurisdictional wetlands in the review area acres
7. 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
Q Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
IN Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED (INTERSTATE OR INTRA- STATE] WATERS, iINCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHiCH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):io
tt 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
u Interstate irolat4 waters. Explain.
n Other factors Explain-
Identify water body and summarize rationale supporting determination:
'See Footnote 93
To complete the analysis refer to the key !n Section IILD 6 of the instructional Owdebook.
w 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 Memoranduur Regarding CWA Act:kA gedon Following Rnpanos

Provide estimates for-jurisdictional waters in the review area (check all that apply)
ff] Tributary waters: linear feet width (R)
® Other non - wetland waters acres
Identify type(s) of waters
10 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.
IN Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prio`r 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:
IN Other (explain, if not covered above)
Provide acreage estimates for non- lunsdtctional waters to the review area, where the sole potential basis of Junsdictton is the MBR
factors (i e , presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
udg_ment (check all that apply) -
Non - wetland waters (i.e., rivers, streams) linear feet width (11)
® Lakes/ponds. acres
❑� Other non - wetland waters acres List type of aquatic resource:
® Wetlands- acres
Provide acreage estimates for nonyunsdtctional 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)
❑a Non- wedand waters (i.e., rivers, streams) linear feet, width (ft)
IN 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.
® 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/delmeation report.
© Data sheets prepared by the Corps.
s+ 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: l -24K Skyland
USDA Natural Resources Conservation Service Soil Survey Citation.
® National wetlands inventory map(s). Cite name:
State/Local wetland inventory map(s)
a FEMA/FIRM maps:
® 106 -year Flooi lain Elevation is: (National Geodectic Vertical Datum of 1929)
® Pho'tographs. I@ Aerial (Name & Date):NCCGIA 2010.
ov C1 Other (Name & Date):
Previous determination(s). File no. and date of response letter.
Applicable/supporting cage law:
® Applicable/supporting scientific literature:
Other information (please specify)
B. ADDITIONAL COMMENTS TO SUPPORT JD: JD applies to all streams and wetlands within the property boundary.

WETLAND DETERMINATION DATA FORM - Eastem Mountains and Piedmont Region
Project/She &Q-1%L11 I.&M CkWcounry: Sampling Date. 10/I41 y
APpilcandOwner Stale a L Sampling Point « 1-hg
Investigator(s) _ I"�I +e: ell /�,ddl(, Section. Township. Range.
Landform (hillslope. terrace, etc.) 1 rr '&uL Local relief (concave, convex, none). Co --r- Slope (%): L
Subregion (LRR or MLRA) LRR^7 L.al. $5.412 ;31 Long - ti8 51b obb Datum N AO
Soil Map Unit Name: Co Ayws (v..... NWI classification 1A
Are climatic I hydrologic conditions on the she typical foi this time of year? Yes X No (If no, explain M Remarks )
Are Vegetation . Sod or Hydrology significantly disturbed? Are 'Normal Circumstances' present? Yes X No
Are Vegetation _ . Soil . or Hydrology naturally problematic? (11 needed, explain any answers In Remarks )
SUMMARY OF FINDINGS - Attach site map showing sampling point locations. transects. important features_ etc_
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes X No within a Weiland? Yes No
Wetland Hydrology Present? Yes X No
Remarks
r11f umiLOGY
Wetland Hydrology Indicators:
5eeandam Indicators hwmum of two reoutrem
Primary indteatms (minimum Of -one Is mmdmd:
check all that a0o(q)
_ Surface Soil Cracks (BB)
2L Surface Water (Al)
_ True Aquatic Plants (B14)
SperseVVegelated Concave Surface (BB)
_ High Water Table (A2)
_ Hydrogen Sulfide Odor (C7)
_ Drainage Patterns (870)
Saturation (A3)
_ Oxidized Rhizospheras on Living Roots (C3)
_ Moss THm Lines (916)
_ Water Marks (81)
_ Presence of Reduced Iron (C4)
_ Dry- Season Water Table (C2)
_ Sediment Deposits (B2)
_ Recent Iron ReduWon In Ttiled Soils (C6)
_ Crayfish Burrows (CB)
_
_ Thin Muck Surface (C7)
_ Saturation Visible on Aerial Imagery (C9)
Algal Mat or rust
_ Algal Mai or Crust (B4)
_ Other (Explain In Remarks)
_ Stunted or Stressed Plants (D1)
_ Iron Deposits (BS!
_Geomorphic Position (D2)
Position
_ Inundation Visible on Aerial Imagery (B7)
_ Shadow Aqt (Dn
_ Water - Stained Leaves (89)
_ MS opographk R�lef (04)
_ Aquatic Fauna (013)
_ FAC- Netmal Test (D5)
Field Observations:
Surface Water Present? Yes X NO
Depth (Inches) i 1
Water Table Present? Yes x No
Depth (intiaQ O - b
S_ awratkm Present? Yes t No
(Includes capillary 111rinite)
Depth (inches)- 0 -t2
Wetland Hydrology Present? Yes X _ Na
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), If available.
Remarks-
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2 0

VEGETATION (Four Strata) - Use scientific names of plants.
SamD6na Point: CG I'll
Tree Stratum (Plot size
Cover a s� Status
Number of Dominant Species
1'
That Are OBL, FACW, or FAC, (A)
2
3
Total Number of Dominant
Species Across All Strata
4
5
Percent of Dominant Species
Thal Are OBL, FACW, or FAC. 1O0 (AIB)
6
7
Prevalence Index worksheet:
= Total Cover
Total % Cover of: MuNply btr
50% of total cover
20% of total cover
OBL species x 1 0
SaoOnolShrub Stratum (Plot size l
FACW species x 2 =
1. SAI',V nAra
2 cg pf_
FAC species x3-
2 6e*4, n:srq
FkW
FACU Species x 4 e
3.
UPL species x5.
4
Column Totals- (A) (B)
5.
6.
Prevalence Index - B/A -
7
Hydrophydc Vegetatkm Ind t:atas:
8.
_ 1 - Rapid Test for Hyrbophydc Vegetation
8
.Z 2 - Dominance Test Is xSo%
=Total Cover
_ 3 - Prevalence Index is 9 0'
5096 of total cover.
_
20 of t
96 otal cover
_ 4 - Morphological Adaptations' (Provide supporting
Herb Stratum (Plot size )
date In Remarks or an a separate street)
1 _ J1,n(y% eq-4u%
60 `Jas FAtrJ
— Problematic Hydrophytic Vegetation' (Explain)
2 CrrcK ff
_ *6 cv-J
P.ly�n�= �c.,+,jr.���,.,-
3 �
�e� must
4
be present�unles disturbed or
5
Definitions of Fair Vagetedon Strata:
6
Tree - Woody plans, excluding OHM 3 in: (7.8 cm) or
7
more In diameter at brut height (DBH), regardless of
height
a
g
Saplingl5hrub - Woody plants, excluding vines, less
than 3 la DBH and greater than or equal to 3.26 it (1
10
m) tall.
11
9l. Total Cover
Herb - AD herbaceous (norwwody) plants, regardless
of size, and woody plants less than 3.28 It tall.
50% of coral cover.
20% of total cover
Woody woe Stratton (Plot size )
Woody vine - All woody vines greater than 3 28 ft M
1
2
3
4.
5.
Hydrophytic
Vegetauon
= Total Cover
Present? Yes X No
50% of total cover
20% of total cover;
Remarks- (Include photo numbers here or on a separate sheeL)
(hean06 3 5`7
US Army Corps of Engineers Ea stem Mountains and Piedmont - Version 2 0

SOIL
Sampling Point: « 1-)
Profile Description. (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redpx Features
finches) Color (moist) % Color (moisil Type Texture Remarks
Q-A loya1112. 1 00 SS I
n OEM
&14 AyAer ctfrv.�l
Hydric Soo Indicators:
Indicators for Problematic Hydric Soils :
_ Hislosol (A7)
_ Dark Surface (S7)
_ 2 cm Muck (A10) QNLRA 147)
_ Hlslic Epipedon (A2)
_ Polyvalue Below Surface (Se) QNLRA 147,148)
_ Coast Prabie Redox (A16)
_ Black Hisllc 03)
_ Thin Dark Surface (S9) (FNLRA 147,148)
QdLRA 147,148)
_ Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Solis (F19)
_ Stratified Layers (AS)
Depleted Matrix (173)
(PALRA 138,147)
_ 2 cm Muck (AID) (LRR N)
_ Redox Dark Surface (F6)
_ Very Shallow Dark Surface (TF12)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
_ Other (Explaln In Remarks)
_ Thick Dark Surface (All 2)
_ Redox Depressions (F8)
_ Sandy Mucky Mineral (S1) (LRR N.
_ tron-Mmnganese Masses (F121(LRR N,
MLRA 147,148)
MLRA 130
_ Sandy Gleyed Mat* (S4)
_ Umbric Surface (F13) (MLRA 136,122)
rhrdicators of hydrophytic vegetation and
_ Sandy Redox (SS)
_ Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present.
Stripped Matrix (S6)
_ Red Parent Material (F21) (PALRA 127,147)
unless disturbed or problematic.
Type
Depth (indnes)-
Hydric SoB Present? Yes x No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2 0