20150755 Ver 1_401 Application_20150715

r
C1earWater Environmental Consultants, Inc.
www.cwenv.com
July 27, 2015
Mr. William Elliott
US Army Corps of Engineers
Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, North Carolina 28801 -2638
CAI®
Ms. Karen Higgins
NC DWR, 401 & Buffer Permitting Unit
512 North Salisbury Street, 9`h Floor
Raleigh, North Carolina 27604
RE: Painters Gap Road Water Line ( +/4.9 miles)
Nationwide Permit 12 Application
Rutherford County, North Carolina
Dear Mr. Elliott and Ms. Higgins,
2 0 1 50 755
The attached Pre - Construction Notification (PCN) is being submitted on behalf of Rutherford
County represented by Mr. Steve Garrison. The project site is located along Painters Gap Road
between Nix Road and Queens Gap Road in Rutherford County, North Carolina.
Please do not hesitate to contact me at 828 - 698 -9800 if you have any questions or comments
regarding the enclosed PCN. A copy of this package has been sent to Ms. Andrea Leslie of the
NC Wildlife Resources Commission and Mr. Bryan Tompkins of the US Fish and Wildlife
Service for review. A copy of this application has also been submitted to Mr. Ed Williams of the
NC Division of Water Resources, Asheville Regional Office.
Respectfully,
C
Kevin Mitchell R. Clem Riddle, W.S
Biologist Principal
Copy Furnished:
NC Division of Water Resources, Asheville — Ed Williams
NC Wildlife Resources Commission — Andrea Leslie D 3
US Fish and Wildlife Service — Bryan Tompkins
.D
224 South Grove Street, Suite F JUL 2 9 2015
Hendersonville, NC 28792
828 - 698 -9800 Tel o0N8 BUFFER RESOURCES
828 - 698 -9003 Fax ER PERM] CE

Preliminary ORM Data Entry Fields for New Actions
SAW — 201 -
BEGIN DATE [Received Date]:
Prepare file folder F1 Assign Action ID Number in ORM
1. Project Name [PCN Form A2a]: Painters Gap Road Water Line
2. Work Type: Private R Institutional 11 Government ❑� Commercial El
3. Project Description / Purpose [PCN Form B3d and 133e]:
The purpose of the project is to provide a water line that will serve the Queens Gap residential
development.
4. Property Owner / Applicant [PCN Form A3 or A4]:
Rutherford County: Mr. Steve Garrison
5. Agent / Consultant [PCN Form AS — or ORM Consultant ID Number]: ClearWater Environmental Consultants
6. Related Action ID Number(s) [PCN Form 85b]: N/A
7. Project Location - Coordinates, Street Address, and /or Location Description [PCN Form Blb]:
35.492831 N Long: - 82.027860 W
8. Project Location -Tax Parcel ID [PCN Form Bla]: The proposed water line is within the NCDOT easement
9. Project Location —County [PCN Form A2b]: Rutherford
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Union Mills
11. Project Information — Nearest Waterbody [PCN Form Val: Mill Creek and UTs; UTs Chalk Creek
12. Watershed / 8 -Digit Hydrologic Unit Code [PCN Form 132c]: Broad River 03050105
Authorization: Section 10 El Section 404 E] Section 10 & 404
Regulatory Action Type:
Standard Permit Pre - Application Request
✓ Nationwide Permit # 12 Unauthorized Activity
_ Regional General Permit # Compliance
Jurisdictional Determination Request No Permit Required
Revised 20150602

Cwa.r aber
Department of the Army NCDENR
Wilmington District, Corps of Engineers NC DWR, Webscape Unit
Attn: Scott McLendon, Chief Regulatory Division Attn: Karen Higgins
PO Box 1890 512 North Salisbury Street
Wilmington, NC 28402 -1890 Raleigh, North Carolina 27604
I, the current landowner /managing partner of the property identified below, hereby
authorize C1earWater 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 for permitting of the Queens Gap Waterline.
Additionally, I 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.
Property Owner of Record
Property Owner of Address:
Phone Number:
Property Location:
Owner/Managing Partner
Printed Name:
Owner/Managing Partner Signature:
Date:
2,29 ZQ-7, 1,g&D
�.:
1
t, f -
7/111aq s
224 South Grove Street, Suite F
Hendersonville, NC 28792
Phone: 828 - 698 -9800
www.cwenv.com

Easement Information

STATE OF NORTH CAROLINA
DEPART1VIh,NT OF TRANSPORTATION
PAT MCCRORY
GOVERNOR February 25, 2015
COUNTY: Rutherford
SUBJECT: RIGHT OF WAY ENCROACHMENT — SR 1328 (3 -Party)
Rutherford County Broad River Water Authoirty
289 N. Main Street & 138 Duke Street
Rutherfordton, NC 27605 Spindale, NC 28160
ANTHONY J. TATA
SECRETARY
Attached is an executed Encroachment Agreement relative to the installation of 22,000 linear feet of 8
inch DIP & C900 DR 14 water line, as shown on the attached sheets. The agreement is approved
subject to the attached Special Provisions.
• No above ground utilities (manholes, valves, fire hydrants, or any other associated
appurtenance) are to be placed within the ditch line or shoulder that will impede future
maintenance.
• The waterline is to be placed under or around all existing NCDOT storm drainage pipes.
• Approval of this encroachment is subject to the Second Party posting a PerfoTmance and
Indemnity Bond with the District Engineer's office in the amount of twentMousand
dollars (SWYprior to beginning construction.
#257 0.'m
All work is to be done in strict compliance with the Agreement, which requires that the North Carolina
Department of Transportation be advised before work is started. Please call our District Office at (828)
652 -3344 for this purpose.
When all work is completed, please advise this office by letter. Please send a copy to the District
Engineer, 3931 NC 226 South, Marion, NC 28752.
Sincerely,
le
J. J. wain, Jr., P.E.
Division Engineer
District I Office 3391 NC 226 South
Phone: [phone]
ww w. ncdot- gov /doh/operations /divisionl3
Marion, NC 28752
Fax: [phone]

SPECIAL PROVISIONS
RUTHERFORD COUNTY & BRWA
SR 1328
R/W 16.6
1. Notify the District Engineer's Office (828-652 -3344) prior to construction and upon completion of
the encroachment.
2. Proper traffic control devices, signs, etc. shall be installed to ensure public safety in accordance
with the latest edition of the Manual on Uniform Traffic Control Devices and any supplements
thereto and NCDOT Roadway Standard Drawings.
3. All disturbed areas to be seeded, and covered with straw mulch. Tack shall be applied at a rate
adequate to hold straw in place.
4. Materials and workmanship conform to the North Carolina Department of Transportation
Standards and Specifications.
5. All roadway sections, ditch lines, and shoulders affected by this operation shall be restored to the
satisfaction of the District Engineer.
6. Backfrll material shall be placed in 6 inch layers and compacted using a mechanical tamp, to a
minimum of 95% standard density, as determined by AASHTO Method T-99.
7. Contact the appropriate Utility Company(ies) involved and make satisfactory arrangements to
adjust the utilities in conflict with the proposed work prior to construction.
S. Any drainage structure disturbed or damaged by this installation, shall be restored to its original
condition as directed by the District Engineer.
9. Proper temporary and permanent measures shall be used to control erosion and sedimentation in
accordance with local, state, and federal regulations. The parry of the Second Part must provide a
copy of the erosion control approval letter, or a statement that one is not required for the project.
0. Strict compliance with the Policies and Procedures for Accommodatina Utilities on Hikhwav Rip-ht
of Wav Manual, shall be required
11. All manholes and/or vaults shall be of pre - approved design. If any proposed structure is not of a
design pre - approved by NCDOT, the Company shall submit details and design calculations signed
and sealed by a Professional Engineer for approval prior to construction.
12. A D.O.T. inspector, the cost of which shall be borne by the party of the second part, shall be
assigned to this project if deemed necessary by the District Engineer.
13. The restoration process shall be kept current; work shall not be performed when weather conditions
prevent proper compaction and restoration.
14. Trenching bore pits, and/or other excavations shall not be left unsafe overnight. Trenches or pits
within 8 feet of the edge of pavement left open over night shall be plated in accordance with
AASHTO (HS20) concerning highway loads.

SPECIAL PROVISIONS
RUTHERFORD COUNTY & BRWA
SR 1328
R/W 16.6
15. Underground utilities shall be placed not closer than three feet from the edge of pavement in all
locations where shoulder width will permit. A one- to-one slope ratio from the edge of pavement to
the bottom of the trench, shall be maintained where it is not prevented by shoulder width
constraints. All necessary actions shall be taken to maintain the integrity of the roadway at all
times, and assure its stability upon completion of the installation. Open Cuts shall not exceed 10
feet in death. The encroachine party must obtain the annroval of the State Desist► Service Engineer
for anv excention to this reauirement.
16. Department of Transportation personnel will instruct the contractor or owner to stop any operation
found to be in violation of OSHA regulations.
17. All signs removed during construction shall be replaced as soon as possible, and must be replaced
the same day. If necessary a flag person will be placed at the sign location during its absence to
perform the function of the sign, (i.e. Stop signs, Yield signs, etc.).
18. The encroaching party shall comply with all applicable federal, state, and local environmental
regulations, and shall obtain all necessary federal, state, and local environmental permits, including
but not limited to, those related to sediment control, storm water, wetlands, streams, endangered
species, and historical sites.
19. Excavation within 500 feet of a signalized intersection will require notification by the party of the
second part to the Division Traffic Services at telephone number (828) 298 -0094. All Traffic signal
or detection cables must be located prior to excavation.
20. Random density testing by an independent body shall be implemented if deemed necessary by the
District Engineer.
21. The DOT does not guarantee the right -of -way on this road, nor will be responsible for any claim for
damages brought by any property owner by reason of the installation.
22. No aboveground utilities (fire hydrates, valves or any other associated appurtenance) are to be
placed within the ditch line or shoulder that will impede futtue maintenance.
23. The waterline is to be placed under or around all existing NC DOT storm drainage pipes.
24. On all projects over 1000 feet in length the contractor is required to have a mechanical broom on
site.
25. Approval of this encroachment is subject to the second party posting a Performance and Indemnity
Bond with the District Engineers Office in the amount of twenty five thousand dollars ($25,000.00)
prior to beginning construction.

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
EUGENE A. CONn, JR.
SECRETARY
Directional drilling methods have not been given statewide approval for use on NCDOT
right of way. Under no condition shall jetting alone or wet boring with water of utility
pipelines be allowed. Directional boring using jetting with a Bentonite (or equivalent
material) slurry is approved at a minimum depth of ten (10) feet below the pavement
surface (fifteen (15) feet below the surface of partial and/or full control of access roads)
and five (5) feet below any ditch line. Any parallel installation utilizing the directional
boring method shall be made at a minimum depth of three (3) feet (cover) below the
ground surface except where the parallel installation crosses a paved roadway. The tip of
the drill string shall have a cutter head. Detection wire shall be installed with non - ferrous
material. Any changes shall be submitted to the district Engineer for approval prior to
construction. For multiple conduit installations, install conduits with five (5) feet
minimum horizontal separation between each conduit or install multiple conduits within a
single duct An overbore shall not be more than two (2) inches greater than the
diameter of the pipe, encasement, or duct An overbore exceeding two (2) itches
greater than the diameter of the pipe, encasement, or dud will be considered if the
encroachment agreement includes a statement signed and sealed by a North Carolina
Registered Professional Engineer indicating that an overbore in excess of two (2)
inches of the diameter of the pine. encasement or dud will arch and no damage will be
done to the pavement or sub - grade. HDPE Pipe installed be directional boring shall not
be connected to existing pipe or fittings for one week from the time of installation to
allow tensional stresses to relax.
3931 NC 226 South, Marion, NC 28752
Phone [phone] Fax 828 - 652 -8391

STATE OF NORTH CAROLINA
ROUTE SR -1328 PROJECT Oueen's Gap Water COUNTY OF Rutherford
DEPARTMENT OF TRANSPORTATION THREE PARTY RIGHT OF WAY
-AND -
Rutherford County
289 N. Main Street. Rutherfordlon. NC 28139
-AND -
Broad River Water Authority
138 Duke Street. Spirhdele, NC 28160
ENCROACHMENT AGREEMENT ON
PRIMARY AND SECONDARY SYSTEM
Z T
THIS AGREEMENT, made and entered Into this the VW day 20 by and between the Department
of Transportation, party of the first part; and Rutherford County, NC
party of the second part; and Broad River Water Authority,
party of the third part,
WITNESSETH
THAT WHEREAS, the party of the second part desires to encroach on the right of way of the public road designated as
RetAe(s) SR -1328. Painters Gap Road , located At Pinnacle Elementary School traveling north
To avoroximateiv the entrance of Welcome Home Church
with the construction and/or erection 22,ODO LF. of 8' DIP and PVC Water Line
of:
WHEREAS, it is to the material advantage of the party of the second part to effect this enemachmenl, and the party of
the first pall In the exercise of authority conferred upon it by statute, is willing to permit the encroachment within the limits of the
right of way as indicated, subject to the conditions of this agreement;
NOW, THEREFORE, IT IS AGREED that the party- of the first part hereby grants to the party of the second pert the right
and privilege to make this encroachment as shown on attached plan sheel(s), specifications and special provisions which are
made a part hereof upon the following conditions. to wit:
That the Installation, operation. and maintenance of the above described fadl y will be accomplished In accordanoe with the party of
the Pori parfe heart POLICIES AND PROCEDURES FOR ACCOMMODATING LMLITIFS ON HIGHWAY RIGHTS-OF-WAY. end such
revisions and amendrnertls thereto as may be vh etkA at the date of thm agreernertl Infonnaton as to these polices and procedures may
be obtakied from the Division Engineer or Stale Lhiay Agent of the party of the"pwL
Tea live said party of the aeoond pat binds and obligates hkrdeff to Inputs and nwirain the encroaching fayley In such sale and proper
condttion Net h wul not hnertae with or endangertravel upon said highway, corobstruc nor Interfere with the proper maintenance thereof.
to mimburm the party of the first pan for the cart incurred for any "raw maintenance to is roadways and suuct res necessary due to
installation and existence of the facilities of the party of the second pan, and t at any time the perry of One fret pat shall require the
removal of at changes M the beabon of the said Willes, that the said party Of the second pan binds himself, his suaaseon and assigns
to prompity remove or lher the said fac>bdes, In order to cordam to the said requitement, without any cost to the parry d the fiat part.
That the party of the second pen agrees to provide during consWclmt and any subsequent mebdenence proper signs. signal lights.
ragman and other warning devices far the protection of traffic In conlamertw with the hest Marne 2n LIntaan Tralde Crlritrni Qn!ms for
MOWS and 14d wave and AmbhCments w Supplemema tereto. 1 lortnatim at to the above mks and regulations be abta4vd from
the Division Engineer d are party of the fowl �Y
Thal the party of the second pad hereby agrees to inde nniy and save hamkss the party of the first pan tram all damages and claims
for damage drat may arise by mason of the I le ion and maknenance at this enawdhmern .
That the parry of the second pen agrees to lesions all areas disturbed during installation and makdanance to the $"action or the
DMslon Engineer of the party al the Ifrsi part The perry of era second pen agrees to emrdm every reasonable prawton during
mnsuuanon and maintenance to pievertl eroding of sot, siding or pollution of dvers. streams, IakeL reservoirs. clever wader Impoundments,
grouts wrfam er other property; er podkilon of the ax. These Nvet be compares with applicable rules and regulations of the Noah
Caroline Dniimil of Enwrmmerdal Managernent, North Carolina SeMfienwOn control COnanprMn. and with Ordienoes and regulations
of various counties, mtnicipeltiss and other otMisi agendas Mining to pollution prevenbtin and control. won any Inatelle ton or
Ins eodenOWhermse raestabtnh Die�grau cover to meal me satbtaakn of me 0 llson n theseoo�Pan agrees
th ri remove and replace
Engineer, pent' Of its fee pant
That the parry of the second pan agrees to assume the actual cost of any inspection of the work amoodered to be necessary by the
Divisron Engineer m the perry cl the first part.
That the party of the second pan agrees to he" available at the eonstruc on she. at all @nes duvg can struCwh, a copy of this
agreement showing evidence of approval try the party Of the first pal. The party of the feat pan reserves the night 10 stop at wank unless
evidence of approval can be damn.
Provided the work contained in this egnsernard a being perfumed on a completed ttiphwray, open to traffic; to party of the second part
agrees to give written notice to the Divuiah Engineer of the party of the irk part wean all work comalned herein has been campkted.
Unitas epecKcaly requested by the party of the fist pan, wit en notes of completion of work On highway prolecu under construction vria
flat be required
That in the case of naneompiance with the terms of this agroemen! by the pally of the second pan, the party or the fret pan reserves
the nghl to stop all work until the fatty, has been bn xgId into compliance or rerrOved from the right of way at r o cost to the party of the
r,m pat
That it is agreed by both paNes that this agreement shat become Vold t acuW mnssucion of the work contemplated herein is rot
begun within one (t) year from the date of suN melion by the party of the fast pan udw wnten waiver is secured by the parry or the
swono pan from the parry of the Post pan.
FORM R/W 16.6
Rev. July 1. 1077

During the performance perfoance of this contract, the second parry, for nselt, its asshpnees and successom In Interest (hemnaher referred to as
n
the 'contracti , agrees as follows,
a. Compliance with Regulations- The contractor "I comply win the Regulations relative to nondiscrinnation in Federally
assisted programs of the U.S. Department of Transponahon. Title 49, Code of Federal Regulations. Pan 21, as they may be
amended from time to time, (1lefennaher referred to as the Regulations), which are herein mcapoi led by reference and
ma0e a part of this contract
b. Nondiscriminallon• The contractor, with regard to the work performed by it during the contrail, shall not discriminate on the
prounds of rare, cola, or national origin In the selection and retention of Subcontractors. Including procurements of materials
and leases of equipment The contractor shag not participate eider directly or indirectly In the discrimination prohlbned by
Section 21.5 of the Regulations, including employment practices when the contract coven a program Set forth in Appendix e
of the Regulations.
c Sd9dlahons for Subcontracts. including Procurements of Mmenals and Eduipment. In an sohchations ehhar by competitive
bidding or negotiation made by the contractor for work to be performed under a subcontract, Including procurements of
materiels or leases of equipment, each potential subcontractor or supplier shall be notified by the contractor of the
contractors obligations under this contract and the Regulations relative to nondiscrimination on the grounds of race, color, or
national origin,
d Information and Reports. The cortretsor shall provme all Information and reports requlre0 by the Regulations• or directives
issued pursuant thereto, and then permit access to its books, records, accounts, other sources of Infomathon, and its facilities
as may be determined by the Department of Transportation or the Federal Highway Administration to be pertment to ascertain
compliance with such Regulations or directives. VShere any information requited of a bond or is In the exckrshm
possession of another who fats a refuses to tumhh this information. the contractor shall so certify to the Department of
Transportation, or the Federal Highway Administration as appropriate, and shag sit forth what efforts it has made to obtain
me infomution
e In the evert of the co arach is noncompliance with the nondiscrimination provisions of this
contract, the Department of Transportation shall Impose such contract sanctions as it or tine Federal! Highway Administration
may determine to be appropriate. Including. but not limited to,
(1) witnholoing of payments to the contractor under the contra until the contractor complies. andlor
(2) Cancellation, larmnallon or suspension of the contract. In whole or In part
I. Ineorooretidn of Ptevisioris. The contractor 001 Include the provisions of paragraphs '2* through Y M every subcontract,
including procurements of materials and leases of equipment, unless exempt by the Regulations, or clmdhes issued
pursuant thereto. The contractor shotI take such action with respect to any subcontract or procurement as the DepeMnent of
Transportation or the Federal Highway Administration may dired as a means of antorcing such provisions Indudthg sanctions
for noncompliance: Provided, however, that, in the event a own= becomes Involved in, or Is threatened wthh, litigation
with a subcontractor or supplier as a result or such direction. the contractor may request the Department of Transportation to
enter into such litigation to protect the interests of the State, aid, In addition, the contractor may request She United States to
enter Imo such litigation to protect the intervals of pro United Slates
Thai when title to the subject that constitutes the aforesaid encroachment passes from the party of the second part
and vests in the party of the third part, the party of the third part agrees to assume all responsibilities and rights and to
perform all obligations as agreed to herein by the party of the second part.
R/W (166) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
R/W (166) incorporating all revisions to date.
IN WITNESS WHEREOF, each of the parties to this agreement has caused the some to be executed the day and
year first above written.
WITNESS: ,
WITNESS:
& f3uL 37, "7;/WU—k- Ili
DEPAR ORTA
BY: at* .
DIVISION ENGINIIER
Carl Classen, County Manager
Rutherford County
211". Main Street Rutherfordlon, NC 28139
.4 ,/J
;- Second Party
Maria Hunnicutt. Mansoer
Broad River Water Authority
138 Dpka Street. S 'ndale. NC 2816% ,
AO
Third Party

OF W ATF9
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? I ❑ Yes
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
►,/
le. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑ Yes ® No ❑ Yes ® No
1f. Is payment into a mitigation bank or in41eu fee program proposed for mitigation ❑ Yes ® No
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes ® No
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ® No
2. Project Information
2a. Name of project: Painters Gap Road Water Line
2b. County: Rutherford County
2c. Nearest municipality / town: Rutherfordton
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state N/A
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: Water Line is within the NC Department of Transportation Easement
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if See attached right -of -way encroachment agreement.
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page I of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: I ❑ Agent ® Other, specify: Rutherford County; utility easement holder
4b. Name: I Steve Garrison
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
Rutherford County, NC
289 N. Main Street
Rutherfordton, NC 28139
828 - 287 -6060
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: I R. Clement Riddle
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
ClearWater Environmental Consultants, Inc
32 Clayton Street
Asheville, North Carolina 28801
828 -698 -9800
n/a
clement @cwenv.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):
1b. Site coordinates (in decimal degrees):
1c. Property size:
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
3. Project Description
Water line is within the NCDOT Easement
Latitude: 35.492831 N Longitude: - 82.027860 W
(DD.DDDDDD) (- DD.DDDDDD)
+/- 4.9 miles
Mill Creek and Unnamed Tributaries; Unnamed
Tributaries to Chalk Creek
WS -V, C;Tr
Broad 03050105
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:
Residential dwellings, agricultural fields, and forested areas are included in the vicinity of the proposed water line.
3b. List the total estimated acreage of all existing wetlands on the property:
Approximately 0.003 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Approximately 226 linear feet
3d. Explain the purpose of the proposed project:
The purpose of the project is to provide a water line that will serve the Queens Gap residential development.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project includes the installation of a new water line paralleling Painters Gap Road. Typical construction and earth
moving equipment will be used (i.e. backhoe). The project will Include six temporary stream crossings, one permanent
stream crossing, and one temporay wetland crossing.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / El Yes ® No El Unknown
project (including all prior phases) in the past?
Comments:
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
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
6b. if yes, explain.
❑ Yes
►M/ •
iR •
❑ Unknown
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non -404, other) (acres)
Temporary (T)
W1 ❑ PET Utility Crossing Herbaceous ❑ Yes ® Corps I 0.003
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version
® No
® DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
I
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
I
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
I
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
I
❑ No
❑ DWQ
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 — non404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ®T Utility Crossing
UT Chalk Creek
® PER
❑INT
® Corps
® DWQ
I 4
15
S2 ❑ P ® T
Utility Crossing
UT Mill Creek
® PER
❑ INT
® Corps
® DWQ
4
15
S3 ❑ P ®T
Utility Crossing
UT Mill Creek
® PER
❑ INT
® Corps
I ® DWQ
4
15
S4 ❑ P ®T
Utility Crossing
UT Mill Creek
® PER
❑ INT
® Corps
I ® DWQ
4
15
S5 ❑ P ®T
Utility Crossing
UT Mill Creek
® PER
❑ INT
® Corps
I ® DWQ
4
15
S6 ❑ P ®T
Utility Crossing
UT Mill Creek
® PER
❑ INT
® Corps
I ® DWQ
4
15
S7 ®P [:IT
Utility Crossing
Mill Creek
® PER
❑ INT
® Corps
I ® DWQ
8
15
3h. Total stream and tributary impacts
( 105
31. Comments: Impact S7 is considered a
permanent impact because rip rap will be required as specified on the major-stream
crossing detail.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds,
the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b.
4c.
4d. 4e.
Open water Name of waterbody
impact number - (if applicable)
Type of impact
Waterbody type Area of impact (acres)
Permanent (P) or
Temporary (T)
01 ❑ PEI T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f. Total open water Impacts
4g. Comments:
l
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b.
5c.
5d. 5e.
Wedand Impacts (acres)
Stream Impacts (feet) Upland
Pond ID Proposed use or purpose
(acres)
number of pond
Flooded Filled Excavated
Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
J
5h. Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
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
❑ 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
I
El Yes
❑ No
B2 ❑ PEI T
El Yes
❑ No
B3 ❑P ❑T
❑Yes
I
❑ No
6h. Total buffer impacts
16i. Comments:
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The water line will be placed beneath the streams and wetlands. The line will be trenched in and contours will be returned to
preexisting conditions. Impacts are limited to the amount necessary to install the line.
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. The water line will be placed beneath the
streams and wetlands. The line will be trenched in and contours will be returned to preexisting conditions. Impacts are limited
to the amount necessary to install the line (15 Linear feet at each crossing). The installation of the proposed water line
crossing should take less than one day to install at each crossing.
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?
2b. If yes, mitigation is required by (check all that apply):
2c. If yes, which mitigation option will be used for this
project?
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from In -lieu fee program is attached.
4b. Stream mitigation requested:
4c. If using stream mitigation, stream temperature:
4d. Buffer mitigation requested (DW(3 only):
4e. Riparian wetland mitigation requested:
4f. Non - riparian wetland mitigation requested:
4g. Coastal (tidal) wetland mitigation requested:
4h. Comments:
❑ Yes ® No
❑ DWO ❑ Corps
❑ Mitigation bank
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
Type
❑ Yes
Quantity
linear feet
❑ warm ❑ cool
square feet
acres
5. Complete if Using a Permittee Responsible Mitigation Plan
acres
acres
❑cold
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires I El Yes ® No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c.
Zone Reason for impact
Zone 1
Zone 2
6d.
Total impact Multiplier
(square feet)
3 (2 for Catawba)
1.5
6f. Total buffer mitigation required:
6e.
Required mitigation
(square feet)
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 11
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 I El Yes No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes El No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 10%
2b. Does this project require a Stormwater Management Plan? I ❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The project includes the installation of a
water line and will not increase impervious surface area at the site.
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? ❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version
❑ Phase II
3b. Which of the following locally- implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
I
4. DWO Stormwater Program Review
❑ Coastal counties
❑ HQW
4a. Which of the following state- implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006 -246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
I ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
I ❑ Yes ❑ No
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. 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
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), DWO Surface Water or Wetland Standards, ❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200) ?=
2b. Is this an after -the -fact permit application? I ❑ 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 I ❑ 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.
The water line will serve the existing residents along NC Hwy. 9. Additional development in the surrounding area is
independent of the project. The project will not result in additional development that could impact downstream water
quality.
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 not be generated as a result of this project.
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or Yes ❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act Yes No
impacts? El Yes
5c. If yes, indicate the USFWS Field Office you have contacted. El Raleigh
❑ 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. NHP data indicates an occurrence of the white irisette within
two miles of the project area; however, suitable habitat for this species does not exist within the project limits.
Suitable summer habitat for the Northern long -eared bat does exist within the proposed site. The FWS recommends
avoiding tree cutting from May 15 to August 15 if suitable habitat exists on the property. If tree cutting is completed
outside of the moratorium, then consultation with FWS should not be necessary. It is the opinion of CEC that if tree
cutting is done outside of the moratorium, the project is not likely to adversely affect the Northern long -eared bat.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? I ❑ 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. The William Monteith House (HPO Site ID RF0444) is located
approximately 2.01 miles southeast of the proposed water line. It is the opinion of CEC that the proposed project will not
threaten the integrity of this site.
S. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain? I ❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA Map Service Center. Map Panel 3710069400J,
37100069500J, 3710160400J, & 3720160300J (Effective date July 2, 2008).
R. Clement Riddle /� �
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature Is valid only if an authorization letter from the applicant
Is provided.)
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

This Page Intentionally Left Blank
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

Painters Gap Road Water Line ( +/- 4.9 miles)
Project Boundary
a
a •
Union U
Mills a
rl onn ey l°y,n >id v /oM o
R
t
0
7
,.d9nll Pd i
S
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Rutherfordton : ° /, R °L N
Legend a
d :
Piedmont
am VNe ne t, Rd 1108" ulherfordton 0 0.5 1 2
UnIm by: RKM INA5; CEC Pr*CW 685 Atdl*, Ra � � Miles
CL�r� V V � /�.� Site Vicinity Map
Rutherford County, ie
North Carolina Figure 1
32 Clayton Street
Ashevillc. North Cuohm 28801

Painters Gap Road Water Line ( +/- 4.9 miles)
= i f -
-
.� o4o�'. Project Boundary I _�
'b {
Y 1 L
0
r
,W .,r�,� - tl� '� l •l , -`.- � C ►fir!
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Olt
Legend
Waterline r 0 0.25 0.5 1
Dnawn b: •• Project# 685 1 rd ..�. -' ,� J Mile
CLearWater USGS Topographic Map
Rutherford County, Shingle Hollow &
North Carolina Sugar Hill Quads
32 Clayton Street
Asheville, North Carolina 28801 Figure 2

Figure 3
Impact Maps /Site Plans

F
9�0
a
Painters Gap Road Water Line ( +/- 4.9 miles)
L�
1 ?
S2
s �
S3
f' at
Legend
ti Sheet
�e
Culvert
Q
Stream
'Y
Wetland
Ly Project Boundary
Drawn by: � M 7.7.15; GEC Project# 665
A
Rutherford County,
North Carolina
J
17s,
` u
i
J
ry
P111eY
Knob Rd
CLearWaEer
224 South Grove Street, Suite F
Hendersonville, North Carolina 28792
C41 44".
ch Rd
a
w
l�
rDF
N
Q
1 0 0.25 0.5 1
Miles
Impact Map
Overview
Figure 3

Painters Gap Road Water Line 4.9 miles)
-I TV'r,
7
4,
w
4-
Legend
Culvert
Stream
Welland
Project Boundary
OYA U16M i.r.ti0: t;w I rMM
Rutherford County,
North Carolina
+
0 62.5 125 250
I
Feet ,E
Impact Map
Figure 3a
CLwW, aLer
224 South Grove Street, Suite F
Hendersonville, North Caroline 28792

I
Painters Gap Road Water Line + /- 4.9 mile_ s)
Rutherford County,
Ci earvAer Impact Map
North Carolina Figure 3b
224 South Grove Street, Suite f
Hendcrsonville, North Carolina 29792

Painters Gap Road Water Line ( +/- 4.9 miles)
F \ \
Legend
�- Culvert
Stream
Wetland
1101161110044 fti
Impact S3
15 LF
I
Project Boundary I0 62.5 125 250
Draw &T. RIW 7.7.15; N5 F I I Feet
Rth f dC
CLearWaEer Impact Map
u er or ount %7
North Carolina Figure 3c
224 South Grove Street, Suite F
Hendersonville, North Carolina 28792

Painters Gap Road Water Line (+/- 4.9 miles)
250
OMM09
Feetl
Map
- 3d
I

Painters
Gap
Road Water Line
( +/-
4.9
miles)
rs .t 7`/.w•: # . ` i
Ak
j
�.\
,�\
.. + t ! . � t i C !•
' ♦
4
' t. . E... � -
Sri.
Legend
-�— Culvert
Stream
Wetland
Project Boundary
Oawli Ott 01 1
Rutherford County,
North Carolina
,,.rMter
Impact S5 I
15 LF
x .
N
0 62.5 125 250
Feet
Impact Map
224 South Grove Street, Suite F
I lendersonvilk, North Caroline 28792
Figure 3e

Painters Gap Road
Water Line
( +/-
4.9 miles)
1
Pk
Legend
Culvert
Stream
Wetland
r I Project Boundary
Drawn br. RIOA 7.7.1 b; 885
Rutherford County,
North Carolina
\ Impact S6
15 LF i
\,\ ,, \,•\ � }. .eft 3 t' �'j. ' � .atY.
Impact S7
.003 AC
,LearWater
\ N
0 62.5 125 250
Feetl_
Impact Map
224 South Grove Street, Suite F
Hendersonville, North Carolina 28792
Figure 3f

Painters Gap Road Water Line ( +/- 4.9 miles)
IF Ak
x 2
Legend
Drawn br RKM 7.7.16; CEC Project#
Rutherford County,
North Carolina
a
r .t
LLearmter
H
I0 62.5 125 250
Feet
_ Impact Map - --
224 South Grove Srrcct, Suilc IF Figure 3g
licndcrsonvillc, North Carolina 28792
Culvert
Stream
Wetland
Project Boundary
Drawn br RKM 7.7.16; CEC Project#
Rutherford County,
North Carolina
a
r .t
LLearmter
H
I0 62.5 125 250
Feet
_ Impact Map - --
224 South Grove Srrcct, Suilc IF Figure 3g
licndcrsonvillc, North Carolina 28792

NOTE: ALL STREAMBANK RESTORATION AND
STABILIZATION SHALL RESULT IN A FINISH
GRADE TO ORIGINAL CONTOURS, UNLESS
SPECIFIED OR DIRECTED OTHERWISE
BY THE ENGINEER IN WRITING - INSTALL ANCHORS IN
ACCORDANCE WITH
MANUFACTURERS
RECOMMENDATIONS
PLACE CLASS I RIP —RAP TO
VERTICAL DISTANCE ABOVE
STREAMBED AS SPECIFIED ON
THE DRAWINGS —\
BACKFILL
STREAMBED
WITH NATIVE
MATERIALS
PLACE EXCELSIOR
ABOVE RIP —RAP
EXTEND TWO FEET
BEYOND TOP OF BANK
TOE IN 12 INCHES
` EXIST. GRADE
i A
f L.r1. 12„
12"
18"
MIN.
LTER FABRIC
! ~, °• _ ✓ . f + I� OVERLAP 6"
1 MINIMUM
CONCRETE ENCASEMENT
AS SPECIFIED
STREAMBANK RESTORATION DETAIL
NOT TO SCALE
STANDARD DETAIL
Metropolitan Sewerage District
of
Buncombe County, North Carolina
STREAMBANK PROTECTION III
IAPPROVED: FEBRUARY 25. 2010 1 1.18 -03
MAJOR STREAM CROSSING DETAIL
A NOTE: MATTING SHALL BE COIR FIBER, 750
GRAM PER SO. METER MATH NOMINAL 0.50 IN.
OPENING SIZE.
n
0
n
ANCHOR MATTING
IN 8" TRENCH V MIN.
E I F�1
II_
E
e
�9
mSM00TH SURFACE, REMOVE ALL —
cDEBRIS AND SEED /MULCH BEFORE
gPLACING MATTING
9�
5
To be used for minor stream
crossing locations
MATTING PLACED FLUSH WITH BANK SURFACE,
LAP OVER DOWNSTREAM/DOWN SLOPE SEAMS
12" WOOD STAKE PLACED IN
3' O.C. DIAMOND PATTERN
MATTING ANCHORED —
1' BELOW STREAM BED
4
C
C
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0
c
0
:n
U)
LL
BED
EEgXTEND MATTING A MIN. OF
DEPTH�VARIES BELOW STREAM BED.
PROPOSED UTILITY
PIPE LINE
Preliminary
Not for Construction
MINOR STREAM CROSSING DETAIL
E
PROF ESSIOPIAL MIME RING
CERTIFICATION
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DATE July 10. 2015
PROJECT- O-W, Gap WE
l PAGE 1 Of 1

Rd
0
9�
P
1
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tl
1
V
i
ley
Painters Gap Road Water Line ( +/- 4.9 miles)
GbFGbF
Project Boundary
,W f EvD N
EvE Ev0 9
1. 1 0
Evo `�rtdln
EWF ,—. R
q
EWF
Legend
Delineation Boundary
Soils
ApB; ApC Appling Sandy Loam
CaB2 Cecil Sandy Clay
CeB2 Cecil urban
ChA Chewada
EvD; EvE; EwF Evard -Cowee
GbF Greenlee -Tate
PaC2; PaO2 - Pacolet Sandy Clay
P5132-1 PsC2; PsD2 Pacolet -Saw
w
.M Tate-Greenlee
W Water
Dram by: RKM 7.9.15; CEC PMJKW 085
Rutherford County,
North Carolina
Piney Knob F
32 Claylon street
Asheville, North Carolina 28901
o�
Rd
4?
:2
tiez
J
G�
R
e
0
Flack
4
r
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�b
tyy} A
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Miles
USDA Soils Map
Figure 4
I

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Legend
to ♦
41"0,0
SO
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I
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" - A ,

Jurisdictional Determination Information

Painters Gap Road Water Line ( +/- 4.9 miles)
Junsdictlonal wetlands and walers rd9nlead on this map have been braced vnihn sub -rrelef accuracy ubhnng
a Tremble mapping gratle Global positioning System (GPS) and the subsequent differential mnecl on or mat
date GPS points may demonstrate unconedable errors due to topography, vegetative cover, andlor mtilipaah
These areas have been flagged in the
tveomeatat Consultants, Inc (CEC) is
I Is me only agency that can make final
shneaWns Therefore, al! prelim nary
pned CEC strongly recommends that
s properly. beginning any site work. or
to CEC at the lime of prJdUCWP This
,tennine precise boundanec, roadways .
construed to be an orGdal survey o1 any
-11
Wetland
Project Boundary
Drawn by: r 71.15; CEC Projectill 685
Rutherford County,
North Carolina
Pl"y Knob Rd
[LearW&er
224 South Grove Street, Suite F
Flendersonville, North Carolina 28792
Jurisdictional Water
Vetland (AC) Streams (LF)
W1 D 003 Sl 57
S2 29
S3 26
54 34
S5 23
S6 29
S7 29
Total 0.003 Total 226
ch
4f
cch Rd
a
l�0
N
0 0.25 0.5 1 n
Miles
Stream & Wetland
Delineation Map
Delineated July 2, 2015
Figure 6

Painters Gap Road Water Line ( +/- 4.9 miles)
Jurisdictional Water
Junsdtdional wetlands and waters identdied on 1n s map have been located within sub -meter acwracy utilizing
Welland (AC Streams (LF)
a Trimble mapping grade Global Positioning System (GPS) and the subsequent differential correction of that
Wl d.� Sl 57
data GPS points may demonstrate unoorrectable en-crs due to topography, vegetative cover, and/or multi path
signal error
S2 29
S3 26
Note The Illustrated welland and stream locations are approximate These areas have been flagged in the
54 34
field, however, they have not been surveyed. Although ClearWaler Envronmenlal Consultants, Inc (CEC) is
confident in our assessment, the US Army Corps of Engineers (Corps) is the only agency that ran make final
S5 23
decisions regarding jurisdictional welland and waters of the US delineations Therefore, all preliminary
S6 29
are subject to change until written verification is obtained CEC strongly recommends that
$7 28
written verification be obtained from the Corps prior to closing on the properly, beginning any site work or
making any legal reliance on this determination
Total 0,007 Total 226
This map was prepared by CEC using the best information available Io CEC al the time of production This
map is for informational purposes only and should not be used to determine prease boundaries, roadways,
Progeny bound" kites. nor legal descriptions This map shall riot be construed to be an official survey of any
data depic.
Source oata Rutherford County and Watermark Engineering, PA
I
3 l - 01
Legend
I
I t
al
r
It'll
�.
-- Culvert �• - � � ^
Stream `
Wetlands
iV
Project Boundary
Rutherford County,
North Carolina
rl nn
,,.rWater
224 South Grove Street, Suite F
Hendersonville, North Caroline 28792
;
.i
'4
i
ON-
0 62.5 125 250
F
Stream & Wetland
Delineation Map
Delineated July 2, 2015
Figure 6a

Painters Gap Road Water Line ( +/- 4.9 miles)
Jurisdictional Water
Wellae7 (AC) Streams af)
All 0 o03 S1 57
52 29
S3 26
SAI 34
S5 23
S6 29
S7 29
Total 0.003 Total
I�
ti
l
Legend
- Culvert
Stream
Wetland
Project I
.,nrrrfl ry: ,dii Y,:el,l�_�
226
Junsdiclional wetlands and waters identified on this map have been located wnthn sub-meler accuracy utilizing
a Trimble mapping grade Global Possronng System (GPS) and the subsequent differential correction of that
data. GPS points may demonstrate uncmrreclable arras due to topography, vegetative Cover, andfor mulapath
signal error
Note The illustrated wetland and stream locations are approximate These areas have been nagged in the
field, however, they have not been surveyed Although ClearWsler Environmental Consultants, Inc. (CEC) is
Confident in our assessment, the US Army Corps of Engineers (Corps) is the only agency that can make final
decisions regarding jurisdictional wetland and waters of the US dehneat,ons Therefore, all preliminary
are subject to Change unlit written verification is obtained CEC stnxigly recommends that
written verification be obtained from the Corps prior to dos" on the property, beginning any site work, or
making any legal reliance on this delerrnlnation
This map was prepared by CEC using the best information available to CEC al the time of production This
map Is for informational purposes only and should not be used to determine precise boundaries, roadways,
property boundary lines, nor legal descriptions This map shall not be construed to be an metal survey of any
data depicted
Rutherford County,
North Carolina
UJIUuMbber
224 South Grove Street, Suite F
Hendersonville, North Carolina 28792
Stream & Wetland
Delineation Map
Delineated July 2, 2015
Figure 6b

Painters Gap Road Water Line ( +/- 4.9 miles)
JtsrfadlWonal Water
Welland (AC Streams (I<F)
Wt dL S1 57
S2 29
S3 25
S4 34
55 23
S6 29
S7 26
Total 0.0133 Total
226
Jurisdictional wetlands and waters Identified on this map have been located within Sub-Meier accuracy utilizing
a Trimble mapping grade Global PosNion ig System (GPS) and the subsequent differential correction of that
data G P S points may demonstrate uncorrectab a errors due to topography, vegetative cover, and/or mulbpeth
signal error
Note The illustrated wetland and stream locations are approximate These areas have been flagged in the
held, however, they have not been surveyed Although Clear Water Environmental Corsullanls, Inc. (CEC) is
confident in our assessment, the US Army Corps of Engineers (Corps) Is the only agency trial can make final
decisions regarding jurisdictional wetland and waters of the US delineations Therefore, all preliminary
determinations are sub)ect to change until whiten verification is obtained. CEC strongly recorarends that
written verifcabon be obtained from the Corps prof to closing an the property, beginning any site work, or
making any legal rehance on this determination
This map was prepared by CEC using the best information available to CEC at the tlme of production This
map Is for Informational purposes only and should not be used to determine prease boundaries, roadways,
property boundary fines, nor legal descriptions This map shall not be construed to be an official survey of any
data depicted
Source Data Rutherford County and Watermark Engineering, PA
Legend
Culvert
Stream
Wetland
r-
�� _« ! Project Boundary
raven by: 7.7.16; CEC RiFed I
Rutherford County,
North Carolina
W
CLearWater
224 South Grove Street, Suite F
Hendersonville, North Carolirm 28792
N
0 62.5 125 250
Feet
Stream & Wetland
Delineation Map
Delineated July 2, 2015
Figure 6c

Painters Gap Road Water Line ( +/- 4.9 miles)
Jurisdictional We
Welland (At Alreame (LF)
Jurisdictional wetlands and waters identified on This map have been located within sub -meter acaracy uelizing
a Tnmble mapping grade Global Pbsrbonng System (GPS) and We subsequent differential con ion of that
�� GPS demonstrate
W1 d 3
St
57
points may unmmeCable errors due to topography. vegetative cover, and/or multipath
signal error
. s 9 ,
+° '+
S2
29
_
S3
26
Note The IWslialed wetland and stream locations are approumale. These areas have been flagged in the
S,
34
Auld, however, they have not been surveyed Although ClearWaler Envvoremenial Consultants, Inc (CEC) Is
confident in our assessment, the US Army Corps of Ergineen (Corps) is the only agency that can make final
S5
23
decisions regarding jurisdictional wetland and wafers of the US delineations Therefore, all preliminary
y
S6
29
are subject to change until written verification Is obtained. CEC strongly recommends that
14
S7
20
mitten verificaton be obtained from the Corps pnor to closing on the property, beginning any site work, or
making any legal rel ante on this determination
�Total 0.003
Total
226
This map was prepared by CEC using the best information available to CEC at the rime of production This
�.\ \
map is for informational purposes only and should not be used to determine precise boundaries, roadways,
••\ ,•\
property boundary lines, nor legal descriptions This map shah not be construed to be an official survey of any
data depicted
Source Data Rutherford County and Watermark Engineering, PA
I t
Legend
Culvert
Stream
Wetland
Lr_ ! Project Boundary
Dnnvn by: *A 7.7.15; CEC Pm*M!
Rutherford County,
North Carolina
I
.4 v,' ,a
[LWAAer
N
0 62.5 125 250
Feet
+ � I
Stream & Wetland
Delineation Map
Delineated July 2 2015
224 South Grove Street, Suite F
Hendersonvillc, North Carolina 29792 Figure 6d

Painters Gap Road Water Line ( +/- 4.9 miles)
\ `
Juritllctkmal Water
Weiland (AC) Streams (LF)
W1 0.003 S1 57
S2 29
S3 26
S4 34
S5 23
56 29
57 26
Total 0.003 Total
Legend
I -- — Culvert
Stream
Jurisdictional wetlands and waters identified on this map have been located within sub -meter accuracy utiLZing
a Trimble nuppirg grade Global Postionng Syslem (GPS) and the subsequent differential correction of that
data GPS points may demonstrate unrmrreclable errors due to topography, vegetative cover, and /or mullipath
signal error.
Note. The illustrated wetland and stream locations are apprommate These areas have been flagged in the
fiet4 however. they have not been surveyed. Aknough ClearWaler Environmental Consultants, Inc. (CEC) is
confidant In our assessment, the US Army Corps of Engineers (Corps) Is the only agency that can make final
decisions regarding jurisdictional wetland and waters of the US delineations Therefore preliminary
determinations are subject to Change until written verification is obtained. CEC strongly recommends that
written verification be obtained from the Corps prior to closing on the property, beginning any site work, or
making any legal reliance on this determination.
1
226 This map was prepared by 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 precise boundaries, roadways,
�\ property boundary lines, nor legal descriptions This map shall not be construed to be an official survey of any
�•\ data depicted.
Source Data Rutherford County and Watermark Engineering, PA
N\ \
I Wettand
!Project Boundary
Drawn by: RKM 7.7.11
Rutherford County,
North Carolina
�1 c:
N
1
0 62.5
125 250
Fe
[LearMter
Stream & wetland
Delineation Map
224 South Grove Street, Suite F
Delineated July 2, 2015
1Icndcrsonville, North Carolina 28792
Figure 6e
1

Painters Gap Road Water Line ( +/- 4.9 miles)
,
Jurfadlctfonal Water
Wetland (AC Streams (LF)
w1 0� St 57
S2 29
S3 26
S4 34
S5 23
S6 29
S7 28
f Tota1 0.003 Total 226
j4.
fir �
I
Legend
Culvert
Jurisdictional wetlands and waters identified on this map have been located within sub -meter accuracy uatiang
a Trimble mapping g•ade Global Positioning System (GPS) and the subsequent d'111 , ntal rxrtedion of that
data GPS points may demonstrate uncmaectable errors due to topography, vegetative cover, and/or mtltlpath
signal error
Note The illustrated welland and stream locetions are approwmate These areas have been flagged in the
fold, however, they have not been surveyed A'though Clear Water Environmental Consultants, Inc (CEC) Is
confident in our assessment, the US Army Corps of Engineers (Corps) is the only agency [hat can make final
decisions regarding jurisdictional wetland and waters of the US delineebcns Therefore, all preliminary
determinations ate sub)ed to change unit written verification is obtained CEC strongly recommends that
written verdcaeon be obtained from the Corps prior to closing on the property, beginning any site work, or
U making any legal reliance on this determination
• 1 This map was prepared by CEC using [he best information available to CEC at the time of production. This
map is for informational purposes only and should not be used to determine precise boundaries, roadways,
properly boundary Ines, nor legal descriptions This map shall not be construed to be an official survey of any
data depicted
Source Data Rutherford County and Watermark Engineering, PA
�t
�1
,
Stream
Wetland `
Project Boundary
.4110011 1p: i d lr t 1V :'n' s: 19 9c; n8B5
Rutherford County,
North Carolina
CLear\01:er
224 South Grove Street, Suite F
V... ,. " le, North Carolina 29792
Az I
r.
qa
••� * 1'0. .at � i r`��
Ir Jr 7011"
0 62.5 125 250
Feet
Stream & Wetland
Delineation Map
Delineated July 2, 2015
Figure 6f
Y

Painters Gap Road Water Line ( +/- 4.9 miles)
huisdictlonal Water Jurisdictional wetlands and walont identified on bas map have been located within sub -molar accuracy ukizing
Wetland (AC) Streams (LF; a Trimble mapping grade Global positioning System (GPS) and the subsequent differential carectron of Thal
W1 0.003 S1 57 gala GPS points may demonstrate uncorrectable errors due to topography, vegetative covl and/or muklpath
"not error
52 29
S3 26 Note. The illustrated wetland and stream locations are approximate These areas hove been gagged in the
$4 34 field, however, they have not been surveyed Although ClearWaler Environmental Consultants, Inc (CEC) Is
confident to our assessment, the US Army Corps of Engineers (Corps) is the only agency that can make final
S5 23 decisions regarding Jurisdictional wetland and waters of the US delineations. Therefore, all preliminary
S6 20 determinations are sub)ect to change until written verification is obtained. CEC strongly recommends that
S7 28 written venficabon be obtained from the Corps prior to closing on One property, beginning any site work, or
making any legal reliance on [his determination
Total 0.003 Total 226 Tb;s map was prepared by CEC using the best information available to CEC at the time of producion This
map is for informational purposes only and should not be used to determine precise boundaries, roadways,
property boundary lines, nor legal descriptions. This map $half not be construed to be an cfficial survey of any
data depicted
do
Source Data Rutherford County and Watermark Engineering, PA
I
I II 1
Ili l
r
t
t r
/Legend
3 Culvert
Stream
Wetland (
Project Boundary
by .7.15; m
Rutherford County,
North Carolina
��earWater
224 South Grove Street, Suite F
Hendcrsonvillc, North Carolina 28792
N
0 62.5 125 250
Feet
Stream & Wetland
Delineation Map
Delineated July 2, 2015
Figure 6g

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 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: Rutherford City: Rutherfordton
Center coordinates of site (lat/long in degree decimal format): Lat. 35.492831 ° N, Long. - 82.027860 ° W.
Universal Transverse Mercator: NAD 83
Name of nearest waterbody: Unnamed Tributaries to Chalk Creek; Mill Creek and Unnamed tributaries
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows:
Name of watershed or Hydrologic Unit Code (HUC): Broad River 03050105
® Check if map /diagram of review area and/or potential jurisdictional areas is /are available upon request.
ID 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):
Q Office (Desk) Determination. Date:
Q Field Determination. Date(s):
SECTION I1: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required)
® Waters subject to the ebb and flow of the tide.
® Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There PI— ¢k,11, t "tvaters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): t
® TNWs, including territorial seas
® Wetlands adjacent to TNWs
® Relatively permanent waters'- (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: 226 linear feet: 4 width (ft) and /or acres.
Wetlands: .003 acres.
c. Limits (boundaries) of jurisdiction based on: EatiIM -01bq" OHWM:
Elevation of established OHWM (if known):
2. Non - regulated waters /wetlands (check if applicable):3
t: Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
Boxes checked below shall be supponed by completing the appropriate sections in Section III below.
Z For purposes of this forth, an RPW is defined as a tributary that is not a TNW and that typically flows year -round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
3 Supporting documentation is presented in Section HIT.

SECTION Ill: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section IILD.1.; otherwise, see Section HLB 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 (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 III.B.I for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined In Section 1I1.0 below.
1. Characteristics of non -TNWs that now directly or indirectly into TNW
(f) General Area Conditions:
Watershed size: OWE t
Drainage area: ��`It
Average.annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationshin with TNW:
❑ Tributary flows directly into TNW.
❑ Tributary flows through k�I tributaries before entering TNW.
Project waters are Pitkaiile°t river miles from TNW.
Project waters are §IEW)ZIM EM river miles from RPW.
Project waters are aerial (straight) miles from TNW.
Project waters are Piek aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
identify Flow route to TNW5:
Tributary stream order, if known:
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
' Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to now into tributary b, which then flows into TNW.

(b) General Tributary Characteristics (check all that aonlv):
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: �'IdckLlst.
Primary tributary substrate composition (check all that apply):
❑ Silts ❑ Sands
❑ Cobbles ❑ Gravel
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
❑ Concrete
❑ Muck
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain:
Presence of run/riffle /pool complexes. Explain:
Tributary geometry: I�:lc�I:let
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for.I, t
Estimate average number of flow events in review area/year: Pia Lid
Describe flow regime:
Other information on duration and volume:
Surface flow is: AN —W f. Characteristics:
Subsurface flow:. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
❑ Bed and banks
❑ OHWM6 (check all indicators that apply):
❑ clear, natural line impressed on the bank
❑
❑ changes in the character of soil
❑
❑ shelving
❑
❑ vegetation matted down, bent, or absent
❑
❑ leaf litter disturbed or washed away
❑
❑ sediment deposition
❑
❑ water staining
❑
❑ other (list):
❑ Discontinuous OHWM .7 Explain:
If factors other than the OHWM were used to determ
tx High Tide Line indicated by: 19
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings/charactcristics
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
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 of CWA jurisdiction (check all that apply):
Mean High Water Mark indicated by:
13' survey to available datum;
❑ physical markings;
❑ vegetation lines/changes in vegetation types.
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
"A natural or man -made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g,, where the stream temporarily flows underground, or where
the OFIWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
❑ Riparian corridor. Characteristics (type, average width):
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish /spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aquatic /wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non -TNW that flow directly or indirectly into TNW
(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 Relationshin with Non -TNW:
Flow is: PIekI . Explain:
Surface flow is: kIER
Characteristics:
Subsurface flow: WLlat. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adiacencv Determination with Non -TNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands arEc.M. @01M river miles from TNW.
Project waters are Acrk"� aerial (straight) miles from TNW.
Flow is from: +AM.
Estimate approximate location of wetland as within the M LEfet floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. Explain:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish /spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: p EMS!
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (YIN) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain Is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood "waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note :, the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
I. 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:
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):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
® TNWs: linear feet width (ft), Or, acres.
ED 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 have contirious flow, strong bed and bank, and substrate diversity.
® 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 1111.13. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 226 linear feet 4 width (ft).
Q Other non - wetland waters: acres.
Identify type(s) of waters:
3. 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 jurisdictional waters within the review area (check all that apply):
® Tributary waters: linear feet width (ft).
El 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 IIl.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW: Wetland discharges directly into tributary.
Q Wetlands directly abutting an RPW where tributaries typically now "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: .003 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 jurisdictional wetlands in the review area: acres.
Impoundments of jurisdictional waters!
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
tt Demonstrate that impoundment was created from "waters of the U.S.," or
Demonstrate that water meets the criteria for one of the categories presented above (1 -6), or
Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA- STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):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:
❑ OtherTactors. Explain:
Identify water body and summarize rationale supporting determination:
8See Footnote # 3.
9 To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CN'A Act Jurisdiction Following Rapanos.

Provide estimates for jurisdictional waters in the review area (check all that apply):
Q Tributary waters: linear feet width (ft).
51 Other non - wetland waters: acres.
Identify type(s) of waters:
Wetlands: acres.
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:
t7 Other: (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction 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):
Q Non - wetland waters (i.e., rivers, streams): linear feet width W.
Q 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):
01 Non - wetland waters (i.e., rivers, streams): linear feet, width (ft).
® Lakes /ponds: acres.
® Other non - wetland waters:
Q Wetlands: acres.
SECTION 1V: DATA SOURCES.
acres. List type of aquatic resource:
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/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:Sugar Hill & Shingle Hollow 1:24K.
USDA Natural Resources Conservation Service Soil Survey. Citation:
® National wetlands inventory map(s). Cite name:
Q State/Local weiland inventory map(s):
FEMA/FIRM maps:
Q 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date):ESR] 2014.
or ❑ Other (Name & Date):
Previous determination(s). File no. and date of response letter:
O
Applicabletsupporting case law:
Applicable /supporting scientific literature:
Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD: This JD form applies to all streams and wetlands within the delineation boundary.

Wetland Data Forms

WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Region
Project/Site: 685 /Queen's Gap Waterline City /County: Rutherford County Sampling Date: 07/02/2015
Applicant/Owner. Rutherford County State: NC Sampling Point: W1
Investigator(s): KM, KY Section, Township, Range:
Landform (hillslope, terrace, etc.): Topographic Draw Local relief: Concave Slope ( %): <1
Subregion: LRR N Lat.: 35.49341 Long.: - 62.028177 Datum: NAD83
Soil Map Unit Name: Chewacla NWI Classification:
Are climatic/hydrologic conditions of the site typical for this time of the year? Y (If no, explain in remarks)
Are vegetation soil or hydrology significantly disturbed? Are "normal
Are vegetation soil or hydrology naturally problematic? circumstances" present? Yes
(If needed, explain any answers in remarks)
SUMMARY OF FINDINGS
Hydrophytic vegetation present? Y Is the sampled area within a wetland? Y
Hydric soil present? Y
Wetland hydrology present? Y If yes, optional wetland site ID: Wetland 1
Remarks: (Explain alternative procedures here or in a separate report.)
HYDROLOGY
Primary Indicators (minimum of one is required; check all that apply)
X Surface Water (A1) _True Aquatic plants
X High Water Table (A2) —Hydrogen Sulfide Odor (Cl)
X Saturation (A3) Oxidized Rhizospheres on Living
—Water Marks (B1) —Roots (C3)
—Sediment Deposits (B2) —Presence of Reduced Iron (C4)
_ Drift Deposits (63) Recent Iron Reduction in Tilled
Algal Mat or Crust (B4) _ Soils (C6)
_Iron Deposits (B5) _Thin Muck Surface (C7)
Inundation Visible on Aerial _Other (Explain in Remarks)
_ Imagery (67)
_ Water- Stained Leaves (B9)
_Aquatic Fauna (1313)
Field Observations:
Surface water present? Yes X No Depth (inches): 0 -1
Water table present? Yes X No Depth (inches): 2
Saturation present? Yes X No Depth (inches): 1
(includes capillary fringe)
Secondary Indicators (minimum of two
_Surface Soil Cracks (B6)
_Sparsely Vegetated Concave Surface(138)
—Drainage Patterns (1310)
_Moss Trim Lines (B16)
_ Dry- Season Water Table (C2)
_Crayfish Burrows (C8)
_ Saturation Visible on Aerial Imagery (C9)
_Stunted or Stressed Plants (D1)
X Geomorphic Position (132)
_ Shallow Aquitard (133)
_ Microtopographic Relief (D4)
X FAC-Neutral Test (D5)
Wetland
hydrology
present? Y
Descrive recorded data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont Region

VEGETATION - Use scientific names of plants
Sampling Point: W1
50120 Thresholds
Tree Stratum Plot Size (
30 )
Absolute
Dominant
Indicator
20% 50%
% Cover
Species
Slaus
Tree Stratum 0 0
1
Sapling /Shrub Stratum 0 0
2
Herb Stratum 11 28
3
Woody Vine Stratum 0 0
4
5
Dominance Test Worksheet
6
Number of Dominant
7
Species that are OBL,
8
FACW, or FAC: 2 (A)
9
Total Number of Dominant
10
Species Across all Strata: 2 (8)
0
= Total Cover
Percent of Dominant
Species that are OBL,
Sapling / Shuub Plot Size (
15 )
Absolute
Dominant
Indicator
FACW, or FAC: 100.00% (A/B)
Stratum
% Cover
Species
Staus
1
Prevalence Index Worksheet
2
Total % Cover of:
3
OBL species 25 x 1 = 25
4
FACW species 25 x2= 50
5
FAC species 0 x 3= 0
6
FACU species 0 x4= 0
7
UPL species 0 X5= 0
8
Column totals 50 (A) 75 (B)
9
Prevalence Index = B1A = 1.50
10
0
= Total Cover
Hydrophytic Vegetation Indicators:
Herb Stratum Plot Size (
5 )
Absolute
Dominant
Indicator
Rapid test for hydrophytic vegetation
% Cover
Species
Staus
X Dominance test Is >50%
1 Juncus effusus
25
Y
FACW
X Prevalence index is 53.0'
2 Carex ludda
15
Y
OBL
Morphoglcal adaptations' (provide
3 Leersie oryzoides
10
N
OBL
supporting data in Remarks or on a
4 Solidago spp.
5
N
sheet)
5
—separate
Problematic hydrophytic vegetation'
8
7
—(explain)
'Indicators of hydric soil and wetiand hydrology must be
8
present, unless disturbed or problematic
9
10
Definitions of Vegetation Strata:
11
12
Tree - Woody plants 3 in. (7.6 cm) or more in diameter at
13
breast height (DBH), regardless of height.
14
se u
p ngfshrub • Woody plants less than 3 in. OBH and
15
greater then 3.28 ft (1 m) tell
55
= Total Cover
Herb - All herbaceous (non - woody) plants, regardless of
Woody Vine
Absolute
Dominant
Indicator
a
se, and woody plants less than 3.28 If tall
Strat Plot Size (
um
30 )
% Cover
Species
P
Staus
vines -All woody vines greaser then 328 H in
1
Woody
2
3
4
Hydrophytic
5
vegetation
0
= Total Cover
present? Y
Remarks: (Include photo numbers here or on a separate sheet)
US Army Corps of Engineers Eastern Mountains and Piedmont Region

SOIL Sampling Point: W1
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features Texture Remarks
(Inches) Color (moist) % Color (moist) % Type` Lac ""
0 -12 10YR412 95 10YR5/6 5 C M Silt loam
*Type: C= Concentration, D= Depletion, RM= Reduced Matrix, CS= Covered or Coated Sand Grains
"Location: PL =Pore Lining, M =Matrix
Hydric Soil Indicators:
Indicators"for Problematic Hydric Soils:
Histisol (Al)
Thin Dark Surface (S9) (MLRA
_2 cm Muck (A10) (LRR K, L, MLRA 1498
r_ Histic Epipedon (A2)
147, 148)
_ Coast Prairie Redox (A16) (LRR K, L, R)
Black Histic'(A3)
_
Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Soils (F19) (MLRA 1498)
_
Hydrogen Sulfide (A4)
—
X Depleted Matrix (F3)
—Very Shallow Dark Surface (TF12)
_
Stratified Layers (A5)
— Redox Dark Surface (F6)
`Other (Explain in Remarks)
—2 cm Muck (A10) (LRR N)
_Depleted Dark Surface (F7)
Depleted Below Dark Suface (Al )_Redox
Depressions (F8)
_
Thick Dark Surface (Al2)
_ Iron- Manganese Masses (1712)
_
Sandy Mucky Mineral
_(LRR N, MLRA 136)
N, MLRA 147,148)
Umbric Surface (F13) (MLRA
_(S1)(LRR
Sandy Gleyed Matrix (S4)
136, 122)
_
Sandy Redox (S5)
Piedmont Floodplain Soils
+—Stripped Matrix (S6)
_(F19) (MLRA 148)
Surface (S7)
Red Parent Material (F21)
_Dark
Polyvalue Below Surface (S8)
_(MLRA 127, 147)
(MLRA 147, 148)
*Indicators of hydrophytic vegetation and weltand hydrology must be present, unless disturbed or problematic
Restrictive Layer (if observed):
Type: Rock Hydric soil present? Y
Depth (inches): 12
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont Region