20170133 Ver 1_401 Application_20170117

Preliminary ORM Data Entry Fields for New Actions
SAW — 2017 -
BEGIN DATE [Received Date]:
Prepare file folder ❑ Assign Action ID Number in ORMFI
1. Project Name [PCN Form A2a]: Countryside BBQ Driveway Improvements
2. Work Type: Private ❑ Institutional ❑ Government ❑ Commercial ❑-
3. Project Description / Purpose [PCN Form 63d and 63e]:
The Project will create connectivity between two parcels to facilitate coordinated business
operations including a barbecue catering operation and needed outflow parking.
4. Property Owner / Applicant [PCN Form A3 or A41: Larrabe, LLC - Todd Miller
5. Agent / Consultant [PCN Form A5 — or ORM Consultant ID Number]: McGill Associates, P.A. - John C. Vilas
6. Related Action ID Number(s) [PCN Form 65b]:
7. Project Location - Coordinates, Street Address, and/or Location Description [PCN Form 61b]:
35.667 N. -81.981 W. Off Rutherford Rd (old US 221).
8. Project Location -Tax Parcel ID [PCN Form 131a]: 1711-40-4911 and 1711-40-6757
9. Project Location — County [PCN Form A2b]: McDowell
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Marion
11. Project Information — Nearest Waterbody [PCN Form 62a]: Youngs Fork
12. Watershed / 8 -Digit Hydrologic Unit Code [PCN Form 62c]: Catawba - 030501 II
I .i yN 2011 f
Authorization: Section 10 ❑ Section 404 W71 Section 10 & 404
Regulatory Action Type:
Standard Permit
✓ Nationwide Permit # 39
❑ Regional General Permit #
❑ Jurisdictional Determination Request
Pre -Application Request
Unauthorized Activity
Compliance
❑ No Permit Required
Revised 20150602

McGill
A S S O C I A T E S
January 25, 2017
William Elliot
US Army Corps of Engineers
Asheville Regulatory Field Office
151 Patton Ave., Room 208
Asheville, NC 28801-5006
RE: Countryside BBQ Driveway
Improvements
McDowell County, North Carolina
Dear Mr. Elliot:
Please find enclosed a PCN application for a Nationwide Permit on the US
Countryside BBQ Driveway Improvements Project in McDowell County, North
Carolina. The PCN application is requesting approval on a NWP #39 for permanent fill
impacts to UT -Youngs Fork. Included with the PCN application is a Rapanos form and
project supporting figures. Copies of the application are being provided to North Carolina
Department of Environmental Quality — Division of Water Resources along with a check
for $240, US Fish and Wildlife and NC Wildlife Resources Commission. Please let me
know if you have any questions or comments.
Sincerely,
MCGILL ASSOCIATES, P.A.
John C. Vilas
Program Services Manager — Environmental
Enclosures
cc: NCDEQ, DWR — Main Office
Byron Hamstead, USFWS
Andrea Leslie, NCWRC
Todd Miller, GEM Constructors, Inc.
Y:\Seagate Dashboard 2.0UV-15'\SM-Backup 122016Trojects'46.05307 —Marion BBQ'.CL USAGE
468 New Market Blvd. Ste. B ph. 828.386.1920
Boone, NC 28607 f 828.386.1923 www.mcgillengineers.coni

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
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 39 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
[:1401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ® No
2. Project Information
2a. Name of project:
Countryside BBQ Driveway Improvements
2b. County:
McDowell
2c. Nearest municipality / town:
Marion
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
Larrabe, LLC R&M Equipment Company, LLC
3b. Deed Book and Page No.
1115/0807 and 0407/0211 0407/0211
3c. Responsible Party (for LLC if
applicable):
Todd Miller Rob Noyes
3d. Street address:
2024 Nix Creek Rd 104 Mull Street
3e. City, state, zip:
Marion, NC 28752 Morganton, NC28655
3f. Telephone no.:
[phone] [phone]
3g. Fax no.:
3h. Email address:
[e-mail]
Countryside BBQ Driveway Improvements
January 2017
Page 1 of 14
NWP #39

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: Responsible party
4b. Name:
Todd Miller
4c. Business name
(if applicable):
GEM Constructors
4d. Street address:
2024 Nix Creek Rd
4e. City, state, zip:
Marion, NC 28752
4f. Telephone no.:
828) 652-3767
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
John C. Vilas
5b. Business name
(if applicable):
McGill Associates, P.A.
5c. Street address:
468 New Market Blvd., Ste. B
5d. City, state, zip:
Boone, NC 28607
5e. Telephone no.:
[phone]
5f. Fax no.:
[phone]
5g. Email address:
[e-mail]
Countryside BBQ Driveway Improvements
January 2017
Page 2 of 14
NWP #39

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
R&M Eauioment Company. LLC (Countryside
BBQ property): 1711-40-4911
Larrabe. LLC property: 1711-40-6757
1 b. Site coordinates (in decimal degrees):
Latitude: 35.667 Longitude: - 81.981
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
R&M Eauipment Company. LLC (Countryside
BBQ property): 2.0-ac.
Larrabe. LLC property: 0.848-ac.
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to proposed project:
Young's Fork
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin: map is available at
hftp://h2o.enr.state.nc.us/adMin/maps/
Catawba
Countryside BBQ Driveway Improvements
January 2017
Page 3 of 14
NWP #39

3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The Proiect is located alona Rutherford Road (Business 221) outside the Marion city limits in McDowell County. The
Project Site consists of a 300 -ft. section on UT-Youna's Fork that flows between two developed properties On the
northern side of UT-YounaIs Fork is a 2 -acre property owned by R&M Equipment Company LLC (dba Countryside
BBQ), and on the southern side of UT -Young's Fork is a parcel owned by Larrabe LLC The Countryside BBQ property
contains a restaurant building, paved parking areas and two entrances to Rutherford Road The Larrabe LLC property
contains two buildinas a small shed paved parking areas and one entrance to Rutherford Road There are two adjacent
properties owned by Larrabe. LLC. The first adjacent property is an undeveloped parcel to the west and the second
adiacent property is currently being developed for a new funeral home to the east UT Young's Fork is a tributary that
flows northeast between the two properties and is conveyed beneath Rutherford Road through a 4' x 5' box culvert
before flowing into Young's Fork.
Areas surrounding the Project Site include commercial and industrial properties
3b. List the total estimated acreage of all existing wetlands on the property:
No wetlands were delineated within the Proiect Site.
3c. List the total estimated linear feet of all existing streams (intermittent and intermittent) on the property:
Approximately 300 -linear feet of intermittent tributary to Young's Fork
3d. Explain the purpose of the proposed project:
The Project will create connectivity between two parcels to facilitate coordinated business operations including a
barbecue catering operation and needed outflow parking
Countryside BBQ Driveway Improvements
January 2017
Page 4 of 14
NWP #39

3e. Describe the overall project in detail, including the type of equipment to be used:
Larrabe. LLC agrees to lease a 0.848 -acre developed property to Countryside BBQ and allow Countryside BBQ to
renovate and use the existing structures for caterina services The Driveway Improvements Site Plan (see attached)
proposes two new access drives to cross UT -Young's Fork between the Countryside BBQ and the Larrabe LLC
property. The first drive is 12 -ft. wide and will cross from the Countryside BBQ's southeastern property corner• the
second drive is 20 -ft. wide and will cross from the Countryside BBQ's northeastern property comer. The Site Plan shows
the 12 -ft. wide drive crossing UT -Young's Fork and entering an existing buildina on the western comer of the Larrabe
LLC property The desian is to allow caterina trucks to pull directly into the building where caterina food and equipment
can be loaded and unloaded The second drive would allow caterina trucks to exit the caterina site through the
Countryside BBQ parking and entrance. The second drive also will provide access to additional parkin areas for
Countryside BBQ customers on the Larrabe LLC property.
As noted on the Site Plan, existing paved areas will be removed during site preparation to reduce the site's overall
impervious area (see section E. 2c Stormwater Manaaement Plan). Removed paved sections will be converted to
pervious areas and planted with grass and landscape materials The existing entrance on the Larrabe LLC property will
be removed. A new entrance will be built along the property's eastern corner: the new entrance will be shared with the
new funeral home development to the east and provide access to the western adjacent property.
The Site Plan includes two stream crossinas on UT -Young's Fork:
• Crossing One: 72" x 40' CMP used in the construction of a new 12 -foot wide drive The catering access drive
will be routed from the back of the Countryside BBQ restaurant across UT-Youna's Fork 10 -linear feet of
temporary stream impacts (S-1) will occur for flow diversion measures durina pipe installation 40 linear feet of
permanent stream impacts (S-2) will occur as a result of the new pipe
• Crossing Two: 72" x 50' CMP used in the construction of a new 20 -foot wide drive The customer access drive
will be routed from the northeastern portion of the Countryside BBQ parking lot across UT -Young's Fork 10 -
linear feet of temporary stream impacts (S-3) will occur for flow diversion measures durina pipe installation 50 -
linear feet of permanent stream impacts (S-4) will occur as a result of the new pipe
Both new pipes will be countersunk 1 -ft. below streambed height to allow for aquatic life movement Rip -rap will be used
to armor new fill slopes from the edges of the access roads to new pipe inletsloutlets No rip -rap will be placed in the
stream channel. Rip -rap will be keyed in to ensure a stable slope. Disturbed stream banks and riparian areas will be
stabilized using biodearadable erosion control blankets and temporary erosion control seed mix Herbaceous vegetation
will be established following work along disturbed streambanks with the application of a native riparian seed mix (ERNST
seed mix ERNMX-308 or eauivalent).
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the Corps or
State been requested or obtained for this property / project (including
all prior phases) in the past?
❑ Yes ® No ❑ Unknown
Comments: JD Forms completed by McGill Associates are attached.
4b. If the Corps made the jurisdictional determination, what type of
Preliminary El Final
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.
Countryside BBQ Driveway Improvements
January 2017
Page 5 of 14
NW P #39

5. Project History
5a. Have permits or certifications been requested or obtained for this
project (including all prior phases) in the past?
El Yes ®No El Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Countryside BBQ Driveway Improvements
January 2017
Page 6 of 14
NW P #39

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are intermittent 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
Intermittent
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ®T
Fill
UT -Young's Fork
❑ PER
® INT
® Corps
❑ DWQ
6
10
S2 ®P ❑ T
Fill
UT -Young's Fork
❑ PER
® INT
® Corps
❑ DWQ
6
40
S3 ❑ P ®T
Fill
UT -Young's Fork
❑ PER
® INT
® Corps
❑ DWQ
6
10
S4 ®P ❑ T
Fill
UT -Young's Fork
❑ PER
® INT
® Corps
❑ DWQ
6
50
3h. Total stream and tributary impacts
110
3i. Comments: S-1 and S-3 are temporary impacts associated with flow diversion measures: S-2 and S-4 and permanent
impacts associated with new pipe installation Total permanent stream impacts will amount to 90 -If.
Countryside BBQ Driveway Improvements
January 2017
Page 7 of 14
NW P #39

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other -open water of
the U.S. then individually list all open water impacts below.
4a.
Open water
impact number —
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody type
4e.
Area of impact (acres)
01 ❑P❑T
02 ❑P❑T
03 ❑ PEI T
04 [1 POT
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
Pond ID
number
5b.
Proposed use or purpose
of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Countryside BBQ Driveway Improvements
January 2017
Page 8 of 14
NW P #39

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below.
If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then
you MUST fill out Section D
of this form.
6a.
❑ Neuse
❑ Tar-Pamlico ❑ Other:
Project is in which protected basin?
❑ Catawba
❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number—
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
131 ❑P❑T
❑Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
63 ❑P❑T
❑Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Countryside BBQ Driveway Improvements
January 2017
Page 9 of 14
NWP #39

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 12 -ft. wide access drive was narrowed to the maximum extent Practical to reduce nine length Rip -rap is proposed
to be used to stabilize slopes from the outer edges on both new drives to the Pipes' inlets/outlet Rip -rap will support a
stable 2.1 slope resulting in shortened pipe lengths compared to proposing a flatter slope with vegetated cover. Both
pipes will be countersunk for aquatic life passage Existing paved areas will be removed resulting in a net reduction in
site impervious area. Removed paved areas will be converted to pervious landscaped areas
b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion control measures will be employed to Prevent sediment runoff into UT -Young's Fork during site construction
Temporary flow diversion measures will be employed during Pipe installation to allow work to be performed in the dry.
Temporary fill will be removed from the channel after the completion of work. Disturbed streambanks and riparian areas
will be stabilized following work and seeded with a native riparian herbaceous plant mix.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
Countryside BBQ Driveway Improvements
January 2017
Page 10 of 14
NWP #39

3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? If yes, you will have to fill out this entire form — Please
contact the State for more information.
El Yes No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Countryside BBQ Driveway Improvements
January 2017
Page 11 of 14
NWP #39

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected
riparian buffers identified within one of the NC Riparian
❑ Yes ® No
Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain
why.
❑ Yes ❑ No
Comments:
2. Stormwater Management Plan
Combined properties imperviousness is 60%. Combined
properties area is 2.848 -acres: total existina impervious
2a. What is the overall percent imperviousness of this project,
area is 1.71 -acres. Project will result in a net reduction of
impervious area by 57-sf.
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
This project involves the construction of two drives and two crossings over UT-Youna's Fork to provide connectivity
between two existing developed parcels. These drives are needed to facilitate joint and coordinated business operations
between the existina developed parcels: no additional new development is proposed Total new impervious area to be
added through the construction of the two drives will be 2,776 so -ft: to compensate for this new impervious area 2,833
so -ft of existing impervious surface will be demolished and replanted with grass and landscapina plants As a result of
this project, there will be a net reduction of 57 so -ft of impervious cover between the two parcels For this reason no
Stormwater Management Plan is proposed.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater
❑ Certified Local Government
Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
McDowell County
❑ Phase II
3b. Which of the following locally -implemented stormwater
❑ NSW
❑ USMP
management programs apply (check all that apply):
❑ Water Supply Watershed
® Other: None
3c. Has the approved Stormwater Management Plan with proof
❑ Yes ❑ No
of approval been attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a. Which of the following state -implemented stormwater
❑ ORW
management programs apply (check all that apply): NA
❑ Session Law 2006-246
® Other: None
Countryside BBQ Driveway Improvements
January 2017
Page 12 of 14
NWP #39

4b. Has the approved Stormwater Management Plan with proof
of approval been attached?
❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the
appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
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)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.)
❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑ Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
El 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.
Single and complete project with no chanae from the original or intended use
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.
Proiect site is served by county sewer.
Countryside BBQ Driveway Improvements
January 2017
Page 13 of 14
NWP #39

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat?
®Yes ❑ No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
El Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
https://www.fws.gov/raleigh/species/Cntylist/mcdowell.html Forested areas within the vicinity of the Project Site contain
potential habitat for the Northern Lona -eared Bat (Myotis sententrionalis)The Droiect may involve the cutting of trees
greater than 4" in diameter. If trees will be cut as part of site preparation then trees will be cut outside of the moratorium
period. Supporting habitat and species occurrences were not observed on the Project Site for the following federally
listed species: Bald Eagle Bog turtle Carolina northern flying souirret Gray bat Rusty -patched bumble bee Mountain
golden heather, and small whorled Dogonia The North Carolina Natural Heritage Program species occurrence database
was aueried for the Prolect Site: no records for rare species Important natural communities natural areas or
conservation/managed areas within the proposed project boundaryor within one -mile radius of the project boundary
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
http://ccma.nos.noaa.00v/products/biogeography/sa-efh/
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
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
❑ Yes ® No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
http://gis.ncdcr.gov/ht)oweb/ Proiect site is approximately is over a mile from the downtown Marion Main Street Historic
District.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? httr):Mris nc gov/fds/Home aspx?ST=NC
John C. VilaS
Agent's Printed Name
Z4? /��,
Jan. 25, 2017
Date
Agent's Signature
(Agent's signature' valid only if an authorization letter from the applicant is
rovided.
Countryside BBQ Driveway Improvements
January 2017
Page 14 of 14
NWP #39

McGill
A S S O C I A T E S
AGENT AUTHORIZATION FORM
PROJECT NAME: Creekside 13130 Driveway Improvements
PROJECT COUNTY: McDowell
PROPERTY PIN: 1711-40-4911
PROPERTY OWNER: R M EQUIPMENT CO LLC
PROPERTY OWNER ADDRESS: 104 MULL STREET
MORRGANTON VC 28655
PROPERTY OWNER'S REPRESENTATIVE: I '-;1'
The undersigned, registered property owner(s) of the above noted property, do hereby authorize
John C. Vilas of McGill Associates P.A.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's/Representative's Address (if different than property above):
l6A (14 Ix 1 '�-+
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge. i
Authorized Signature:
Date: m-' I i
Environmental PIannin21 t 1~ i n a n c e
llrGi/l,ISrn idte <, P..1. • 46'Y 1 rnA Afill' A, I R/i 1. Slee. B. B(wne, Aorih Car,. limit _',SITU-
0/1,,, o-Mj 1R0- 1920 • Fax -(1-'Sj 4'N6-14 j

McGill
A S S O C I A T E S
AGENT AUTHORIZATION FORM
PROJECT NAME:
PROJECT COUNTY:
PROPERTY PIN:
PROPERTY OWNER:
PROPERTY OWNER ADDRESS
PROPERTY OWNER'S REPRESENTATIVE
Creekside BBQ Driveway Improvements
McDowell
1711-40-6757
LARRABE LLC
2024 NIX CREEK RD
MARION, NC 28752
The undersigned, registered property owner(s) of the above noted property, do hereby authorize
John C. Vilas of McGill Associates P.A.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's/Representative's Address (if different than property above):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature:
Date: ! 3 f I
E11V1ronnlentaI f Planning Finat1CC
th Gill, I","X i'Nrs. P.A. • 46N lron _Varlt t Blvd Rte', B. 6nu�n, 1t rtl; (cn nlnrn _'A'A1�'

r
N
Sources: Esri, HERE, DeLorme, USGS, Intermap. increment P Corp.,
1.5 0.75 0 1.5 Miles NRCAN, Esri Japan, METI. Esri China (Hong Kong), Esri (Thailand),
TomTom, Mapmylndia. © OpenStreetMap contributors, and the GIS User
Community
o re0'7 n o COUNTRYSIDE BBQ DES GNE- v DRIVEWAY IMPROVEMENTS LOCATION uoo e. xx„m MAP °E»'�raE"` TOWN OF MARION T„E...OMcGm
FiiE NRME
°"'° — A S S O C I A T L S
MCDOWELL COUNTY, NORTH CAROLINA ENGINEERIKG PLANNING -FINANCE

o eEoo? p
COUNTRYSIDE BBQ
=
TOPOGRAPHIC
oEscrtoe. "
X%11
DRIVEWAY IMPROVEMENTS
RMcGiff
m
MAP
l)Eb cb A
" -
�`'
TOWN OF MARION
A S S O C I A T E S
MCDOWELL COUNTY, NORTH CAROLINA
ENGINEERING PLANNING FINANCE
,WFfl bLtti. Sfb BaOyE.bC ixYP

35" 491" N
35" 39' SB" N
a Soil Map—McDowell County, North Carolina
e
(Countryside BBQ)
�iiv7v 4u1w 41113u 4111Lu 411130 411140 411150 411160 411170 411180 411190 411200 411210 411220
3
3
Map Scale: 1:673 Nprinted on A landscape (11" x 8.5") sheet
o Meters
N 0 5 10 20 30
0 30 60 120 180
Map projection: Web Mercator Comer coordinates: WGS84 Edge bcs: UTM Zone 17N WGS84
USDA Natural Resources Web Soil Survey 10/12/2016
Conservation Service National Cooperative Soil Survey Page 1 of 3
35° 39 S8" N

MAP LEGEND
Area of Interest (AOI)
Area of Interest (AOI)
Soils
Soil Map Unit Polygons
• r Soil Map Unit Lines
13
Soil Map Unit Points
Special
Point Features
v
Blowout
Warning: Soil Map may not be valid at this scale.
Borrow Pit
Very Stony Spot
Clay Spot
�i
Closed Depression
rX
Gravel Pit
„
Gravelly Spot
Other
Landfill
Q.
Lava Flow
ti
Marsh or swamp
soils that could have been shown at a more detailed scale.
Mine or Quarry
Special Line Features
Miscellaneous Water
Perennial Water
^;r
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
<' Slide or Slip
Sodic Spot
Soil Map—McDowell County, North Carolina
(Countryside BBQ)
MAP INFORMATION
Water Features
Streams and Canals
Transportation
+44 Rails
Interstate Highways
US Routes
Major Roads
Local Roads
Background
Aerial Photography
Please rely on the bar scale on each map sheet for map
measurements.
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL: http:/twebsoilsurvey.nres.usda.gov
Coordinate System: Web Mercator (EPSG:3857)
Maps from the Web Soil Survey are based on the Web Mercator
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Albers equal-area conic projection, should be used if more accurate
calculations of distance or area are required.
This product is generated from the USDA-NRCS certified data as of
the version date(s) listed below.
Soil Survey Area: McDowell County, North Carolina
Survey Area Data: Version 16, Sep 15, 2015
Soil map units are labeled (as space allows) for map scales 1:50,000
or larger.
Date(s) aerial images were photographed: Oct 22, 2010—Apr 30,
2011
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor shifting
of map unit boundaries may be evident.
USDA Natural Resources Web Soil Survey 10/12/2016
Conservation Service National Cooperative Soil Survey Page 2 of 3
Spoil Area
The soil surveys that comprise your AOI were mapped at 1:24,000.
Stony Spot
Warning: Soil Map may not be valid at this scale.
Very Stony Spot
Enlargement of maps beyond the scale of ma
9 P Y Aping can cause
Wet Spot
misunderstanding of the detail of mapping and accuracy of soil line
Other
placement. The maps do not show the small areas of contrasting
G
soils that could have been shown at a more detailed scale.
.•
Special Line Features
Water Features
Streams and Canals
Transportation
+44 Rails
Interstate Highways
US Routes
Major Roads
Local Roads
Background
Aerial Photography
Please rely on the bar scale on each map sheet for map
measurements.
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL: http:/twebsoilsurvey.nres.usda.gov
Coordinate System: Web Mercator (EPSG:3857)
Maps from the Web Soil Survey are based on the Web Mercator
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Albers equal-area conic projection, should be used if more accurate
calculations of distance or area are required.
This product is generated from the USDA-NRCS certified data as of
the version date(s) listed below.
Soil Survey Area: McDowell County, North Carolina
Survey Area Data: Version 16, Sep 15, 2015
Soil map units are labeled (as space allows) for map scales 1:50,000
or larger.
Date(s) aerial images were photographed: Oct 22, 2010—Apr 30,
2011
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor shifting
of map unit boundaries may be evident.
USDA Natural Resources Web Soil Survey 10/12/2016
Conservation Service National Cooperative Soil Survey Page 2 of 3

Soil Map—McDowell County, North Carolina
Map Unit Legend
Countryside BBQ
McDowell County, North Carolina (NCI 11)
Map Unit Symbol
Map Unit Name
Acres In AOI
Percent of AOI
DdB
Dillard loam, 1 to 4 percent
slopes, rarely flooded
0.4
61.9%
EwE
Evard-Cowee complex, 25 to 60
percent slopes
0.3
38.1%
Totals for Area of Interest
0.7
100.0%
USDA Natural Resources Web Soil Survey 10/12/2016
Conservation Service National Cooperative Soil Survey Page 3 of 3

Photo One: View of the backside of the Larrabe, LLC
property currently unoccupied. UT -Young's Fork
flows along the left side of the large metal building in
the foreground.
Photo Two: View of the Countryside BBQ property.
UT -Young's Fork is out of frame along the right side
of the photo.
Photo Three: View of UT -Young's Fork looking Photo Four: View of UT -Young's Fork looking
upstream. The proposed 20 -ft. wide drive would be downstream. The proposed 12 -ft. wide drive would
located in the immediate foreground of photo. be located in the immediate foreground of photo.
PHOTO SHEET
JANUARY 2017
COUNTRYSIDE BBQ
DRIVEWAY IMPROVEMENTS
MCDOWELL COUNTY, NORTH CAROLINA
McGill
A S S O C I A T E S
ENGINEERING PLANNING FINANCE
-NEN-M>RKP Hl VDSTPN HOON'P. IC2-17 Pli.

P rl
;4 4
-Al
-----------

D
z v
C D
D C)
x --j
< Z
N) D
v
IMPACT TABLE
S-1: 10 -LF TEMPORARY STREAM
S-2: 40 -LF PERMANENT STREAM
S-3: 10 -LF TEMPORARY STREAM
S-4: 50 -LF PERMANENT STREAM
\ 50 0 25 50
\ FEET
)IN
\S 4 S-4
R & M EQUIPMENT COMPANY, LLC \ \'� c,
D.B. 887, PG. 687 S-3
PIN 1711-40-4911 r `�
o �
o
j ?B
f m O
r 'Cc'! �\
r D
{BUFFER
S-2
Z �.
00 S-1
m oo
z Z
(n
i 'T1
LARRABE, LLC
D.B. 1168, PG. 0420
n \ \\\ PIN 1711-40-7586

0
m0
m
n
\
O
C
C
z
\
p
<
D
m
D
m
M
o
z
0
D
R & M EQUIPMENT COMPANY, LLC
D.B. 887, PG. 687
PIN 1711-40-4911
300 -SF to be Removed
\ \ 50 0 25 50
�s FEET
1r� 03 N
1 - •, is s \
;z
i
Srn
AD IMPERVIOUS AREAS
• EXISTING IMPERVIOUS AREA: 1.71 -AC
b (BOTH PROPERTIES COMBINED)
TOTAL PROPERTY SIZE: 2.848 -AC (BOTH
n PROPERTIES COMBINED)
3 `"^ NEW IMPERVIOUS AREA: 2,776 -SF
�> 1 REMOVED IMPERVIOUS AREA:2,833-SF
"� • NET REDUCTION OF IMPERVIOUS AREA:
7 rn 57 -SF
ems
2,241 -SF
to be Removed
N
LARRABE, LLC
r~ \ D.B. 1168, PG. 0420
\ �\ PIN 1711-40-7586

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: NC County/parish/borough: McDowell City: Marion
Center coordinates of site (lat/long in degree decimal format): Lat. 35.66680 eN, Long. -81.98140W,.
Universal Transverse Mercator:
Name of nearest waterbody: Youngs Fork (Classification: C)
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Catawba River
Name of watershed or Hydrologic Unit Code (HUC): 03050101
Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
Office (Desk) Determination. Date:
Field Determination. Date(s):
SECTION H: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There �T*`jo "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
Waters subject to the ebb and flow of the tide.
Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There [kre "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): t
TNWs, including territorial seas
Wetlands adjacent to TNWs
Relatively permanent waterS2 (RPWs) that flow directly or indirectly into TNWs
Non-RPWs that flow directly or indirectly into TNWs
Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
Impoundments of jurisdictional waters
Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non -wetland waters: 320 linear feet: 6 width (ft) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: lEstoblishedty OEN M.
Elevation of established OHWM (if known):
Z. Non-regulated waters/wetlands (check if applicable):3
E Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
' Boxes checked below shall be supported by completing the appropriate sections in Section III below.
2 For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
3 Supporting documentation is presented in Section III.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections I LA.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent':
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rspanos 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 IILD.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.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section HLB.3 for all wetlands adjacent to that tributary, both onsite
and onsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 3.9 Aftis
Drainage area: 236es
Average annual rainfall: 52.3 inches
Average annual snowfall: 8 inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
® Tributary flows through 2 tributaries before entering TNW.
Project waters are 1045 ever miles from TNW.
Project waters are(ii>r,ss) river miles from RPW.
Project waters are 0, t5 aerial (straight) miles from TNW.
Project waters are(itiless) aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW5: Youngs Fork; Muddy Creek; Catawba River.
Tributary stream order, if known: 1 st.
4 Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
5 Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

(b) General Tributary Characteristics (check all that apply):
Tributary is: ❑ Natural
❑ Artificial (man-made). Explain:
® Manipulated (man -altered). Explain: Tributary channel has been relocated from past
development activities for Hwy. 221; channel bank have ben altered from past development activity.
Tributary properties with respect to top of bank (estimate):
Average width: 8 feet
Average depth: 2 feet
Average side slopes: �pl.
Primary tributary substrate composition (check all that apply):
® Silts ® Sands ❑ Concrete
® Cobbles ® Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain: Mostly stable; evidence of runoff from
adjacent development causing some erosion along banks; several places banks are undercut.
Presence of run/riffle/pool complexes. Explain: riffle/pool sequences present throughout.
Tributary geometry: kdaelytsttt
Tributary gradient (approximate average slope): 5 %
(c) Flow:
Tributaryprovides for: t
P �ermittent baf;eot seasonal'floiv
Estimate average number of flow events in review area/year: 0=5
Describe flow regime: Drier conditions during the summer months; flow increases during the winter months.
Other information on duration and volume:
Surface flow is: ,adiingl. Characteristics:
Subsurface flow: 0e. 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
ED
❑ leaf litter disturbed or washed away
❑
❑ sediment deposition
❑
❑ water staining
❑
❑ other (list):
❑ Discontinuous OHWM.' Explain:
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
High Tide Line indicated by: E] Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
'A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average width): mostly grassed; some native herbaceous; mostly dominated by
Kudzu.
❑ 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: Amphibians; macrobenthics.
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(I) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain: .
Wetland quality. Explain:.
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Pick List. Explain:
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the k4ck M floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. Explain: .
❑ Habitat for.
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings: .
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section IIID:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
TNWs: linear feet width (ft), Or, acres.
Wetlands adjacent to TNWs: acres.
RPWs that flow directly or indirectly into TNWs.
19 Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: UT -Youngs Fork has a well defined OHWM, moderate baseflow, evidence of numerous high flow
events, well sorted bed material, continuous bed and bank, development of bankfull benches or inner berms, and well
developed pool/riffle morphology.
El Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
Tributary waters: 320 linear feet 6 width (ft).
Other non -wetland waters: acres.
Identify type(s) of waters:
3. Non-RPWs' that flow directly or indirectly into TNWs.
El Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
Tributary waters: linear feet width (ft).
Other non -wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section 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: acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
0 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.
6. Wetlands adjacent to non-RPWs that flow directly or indirectly Into TNWs.
ED Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters.'
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
�] Demonstrate that impoundment was created from "waters of the U.S.," or
p Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
Q 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.
BInterstate isolated waters. Explain:
Other factors. Explain:
'See Footnote # 3.
'To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
"Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
Tributary waters: linear feet width (ft).
Other non -wetland waters: acres.
Identify type(s) of waters:
[] Wetlands: acres.
F. NON -JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
�] If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
Q 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:
p 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
'uugment t(check all that apply):
Non -wetland waters (i.e., rivers, streams): linear feet width (ft).
Lakes/ponds: acres.
Other non -wetland waters: acres. List type of aquatic resource:
i1 Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a fording is required for jurisdiction (check all that apply):
Non -wetland waters (i.e., rivers, streams): linear feet, width (ft).
Lakes/ponds: acres.
Other non -wetland waters: acres. List type of aquatic resource:
Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall be included in case file and, where checked
and requested, appropriately reference sources below):
MMaps, 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: Marion East, NC 1:24,000 (attached Topo Map).
USDA Natural Resources Conservation Service Soil Survey. Citation:
National wetlands inventory map(s). Cite name:
State/Local wetland inventory map(s):
FEMA/FIRM maps:
100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
Photographs: ® Aerial (Name & Date): 2014 -NC ONE.
or ® Other (Name & Date): 2016 -field inspection photos.
Previous determination(s). File no. and date of response letter:
a Applicable/supporting case law:
Applicable/supporting scientific literature:
[] Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD:

Nr DWO Rtream identification Form Version 4.11
Date: a , 26 -L(,,,
ProjectlSite: COL4 �Ve lji- "2�
Latitude:
Evaluator: '��
County: u'` ,rj0L tj
Longitude:
Total Points:
Stream is at least intermittent�J
Stream Detep3liqUon4rcle one)
Other UT-cy'-v Favi-
if 19 or rennial If 2 30• RJ
Ephemera Intermittent erennial
e.g. Quad Na
A. Geomorphology ( (Subtotal= v
Absent
Weak
Moderate
Strong
1°- Continuity of channel bed and bank
0
1
2
1.5 1
2. Sinuosity of channel along thalweg
0
15. Sediment on plants or debris
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1/,Y
(J
3
4. Particle size of stream substrate
0
1'M
1
3
5. Active/relict floodplain
6>
1
2
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0
1
2
3
8. Headcuts
ct>
1
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0 1
0.5
1.5
11. Second or greater order channel
No:(O')
Yes = 3
artificial ditches are not rated; see discussions In manual
B. Hvdroloav (Subtotal = q . S )
12. Presence of Beseflow
0 1
2
3
13. Iron oxidizing bacteria
1
2
3
14. Leaf litter
1.5 1
0.5
0
15. Sediment on plants or debris
0
1
1.5
16. Organic debris lines or piles
0 10.
1 1
1.5
17. Soil -based evidence of high water table?
No(O')
Yes = 3
1
C. Bloloav (Subtotal =
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
0
CD
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0. i
1.5
25. Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5 Other?'07
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch: