20181349 Ver 1_Categorical Exclusion Form_20181220

Categorical Exclusion Form for Division of
Mitigation Services Projects
Version 1.4
Note: Only Appendix A should to be submitted (along with any supporting documentation) as the
environmental document.
Version 1.4, 8/18/05
-
Part
Name.,
I
General Project Information
I Mill Dam Creek Restoration Site
-County Name:
Yadkin County, NC
DMS Number:
97136
Project Sponsor:
KCI Technologies, Inc.
Project Contact Name:
Tim Morris
Project Contact Address:
4601 Six Forks Rd, Suite 220, Raleigh, NC 27609
Project Contact E-mail:
tim.morris kci.com
EEP Project Mana er:
Matthew Reid
Project Description
For Official Use Only
Reviewed By:
Date
DMS Project Manager
Conditional Approved By:
Date
For Division Administrator
FHWA
❑ Check this box if there are
outstanding issues
FinalApproval By:
Date
For Division Administrator
FHWA
Version 1.4, 8/18/05

Version 1.4, 8/18/05
Part 2: All Projects
Regulation/Question..
Coastal Zone Management Act (CZMA)
1. Is the project located in a CAMA county?
❑ Yes
❑ No
2. Does the project involve ground -disturbing activities within a CAMA Area of
❑ Yes
Environmental Concern (AEC)?
❑ No
❑ N/A
3. Has a CAMA permit been secured?
❑ Yes
❑ No
® N/A
4. Has NCDCM agreed that the project is consistent with the NC Coastal Management
❑ Yes
Program?
❑ No
® N/A
Comprehensive Environmental Response, Compensation and Liability Act (CERCLA)
1. Is this a "full -delivery" project?
❑ Yes
❑ No
2. Has the zoning/land use of the subject property and adjacent properties ever been
❑ Yes
designated as commercial or industrial?
® No
❑ N/A
3. As a result of a limited Phase I Site Assessment, are there known or potential
❑ Yes
hazardous waste sites within or adjacent to the project area?
® No
❑ N/A
4. As a result of a Phase I Site Assessment, are there known or potential hazardous
❑ Yes
waste sites within or adjacent to the project area?
❑ No
® N/A
5. As a result of a Phase II Site Assessment, are there known or potential hazardous
❑ Yes
waste sites within the project area?
❑ No
❑ N/A
6. Is there an approved hazardous mitigation plan?
❑ Yes
❑ No
® N/A
National Historic Preservation Act (Section 106)
1. Are there properties listed on, or eligible for listing on, the National Register of
❑ Yes
Historic Places in the project area?
® No
2. Does the project affect such properties and does the SHPO/THPO concur?
❑ Yes
❑ No
® N/A
3. If the effects are adverse, have they been resolved?
❑ Yes
❑ No
® N/A
Uniform Relocation Assistance and Real Property Acquisition Policies Act (Uniform Act)
1. Is this a "full -delivery" project?
® Yes
❑ No
2. Does the project require the acquisition of real estate?
® Yes
❑ No
❑ N/A
3. Was the property acquisition completed prior to the intent to use federal funds?
❑ Yes
® No
❑ N/A
4. Has the owner of the property been informed:
® Yes
* prior to making an offer that the agency does not have condemnation authority; and
❑ No
* what the fair market value is believed to be?
❑ N/A
Version 1.4, 8/18/05

Part 3: Ground -Disturbing Activities
Regulation/Question ..
American Indian Reliqious Freedom Act (AIRFA)
1. Is the project located in a county claimed as "territory' by the Eastern Band of ❑ Yes
Cherokee Indians? ® No
2. Is the site of religious importance to American Indians?
❑ Yes
❑ No
® N/A
3. Is the project listed on, or eligible for listing on, the National Register of Historic
❑ Yes
Places?
❑ No
® N/A
4. Have the effects of the project on this site been considered?
❑ Yes
❑ No
❑ N/A
Antiquities Act (AA)
1. Is the project located on Federal lands?
❑ Yes
® No
2. Will there be loss or destruction of historic or prehistoric ruins, monuments or objects
❑ Yes
of antiquity?
❑ No
® N/A
3. Will a permit from the appropriate Federal agency be required?
❑ Yes
❑ No
® N/A
4. Has a permit been obtained?
❑ Yes
❑ No
® N/A
Archaeological Resources Protection Act (ARPA)
1. Is the project located on federal or Indian lands (reservation)?
❑ Yes
® No
2. Will there be a loss or destruction of archaeological resources?
❑ Yes
❑ No
® N/A
3. Will a permit from the appropriate Federal agency be required?
❑ Yes
❑ No
® N/A
4. Has a permit been obtained?
❑ Yes
❑ No
® N/A
Endangered Species Act (ESA)
1. Are federal Threatened and Endangered species and/or Designated Critical Habitat
® Yes
listed for the county?
❑ No
2. Is Designated Critical Habitat or suitable habitat present for listed species?
❑ Yes
® No
❑ N/A
3. Are T&E species present or is the project being conducted in Designated Critical
❑ Yes
Habitat?
❑ No
® N/A
4. Is the project "likely to adversely affect' the specie and/or "likely to adversely modify"
❑ Yes
Designated Critical Habitat?
❑ No
® N/A
5. Does the USFWS/NOAA-Fisheries concur in the effects determination?
❑ Yes
(By virtue of no -response)
❑ No
® N/A
6. Has the USFWS/NOAA-Fisheries rendered a "jeopardy' determination?
❑ Yes
❑ No
® N/A
Version 1.4, 8/18/05

Executive Order 13007 (Indian Sacred Sites)
1. Is the project located on Federal lands that are within a county claimed as "territory"
❑ Yes
by the EBCI?
® No
2. Has the EBCI indicated that Indian sacred sites may be impacted by the proposed
❑ Yes
project?
❑ No
® N/A
3. Have accommodations been made for access to and ceremonial use of Indian sacred
❑ Yes
sites?
❑ No
® N/A
Farmland Protection Policy Act (FPPA)
1. Will real estate be acquired?
® Yes
❑ No
2. Has NRCS determined that the project contains prime, unique, statewide or local
® Yes
important farmland?
❑ No
❑ N/A
3. Has the completed Form AD -1006 been submitted to NRCS?
❑ Yes
❑ No
❑ N/A
Fish and Wildlife Coordination Act (FWCA)
1. Will the project impound, divert, channel deepen, or otherwise control/modify any
® Yes
water body?
❑ No
2. Have the USFWS and the NCWRC been consulted?
❑ Yes
❑ No
❑ N/A
Land and Water Conservation Fund Act (Section 6(f))
1. Will the project require the conversion of such property to a use other than public,
❑ Yes
outdoor recreation?
® No
2. Has the NPS approved of the conversion?
❑ Yes
❑ No
❑ N/A
Magnuson -Stevens Fishery Conservation and Manaqement Act (Essential Fish Habitat)
1. Is the project located in an estuarine system?
❑ Yes
® No
2. Is suitable habitat present for EFH-protected species?
❑ Yes
❑ No
® N/A
3. Is sufficient design information available to make a determination of the effect of the
❑ Yes
project on EFH?
❑ No
® N/A
4. Will the project adversely affect EFH?
❑ Yes
❑ No
® N/A
5. Has consultation with NOAA-Fisheries occurred?
❑ Yes
❑ No
® N/A
Migratory Bird Treaty Act (MBTA)
1. Does the USFWS have any recommendations with the project relative to the MBTA?
❑ Yes
® No
2. Have the USFWS recommendations been incorporated?
❑ Yes
❑ No
® N/A
Wilderness Act
1. Is the project in a Wilderness area?
❑ Yes
® No
2. Has a special use permit and/or easement been obtained from the maintaining
❑ Yes
federal agency?
❑ No
® N/A
Version 1.4, 8/18/05

Appendix
Supporting Documentation for
Categorical Exclusion Form for NC DENR Division of Mitigation
Services (DMS) Projects
Contents
Limited Phase I ESA — EDR Report
Radius Report
Sanborn Map
Agency Letters
State Historic Preservation Office Letter
United States Fish and Wildlife Service Letter with RTE Report
N RCS Letter
NC Wildlife Resources Commission Letter
NC Natural Heritage Program Letter
Uniform Act Letters
Letter References
Figure 1 — Vicinity Map
Figure 2 — Project Watershed
Figure 3 — Watershed Land Use
Figure 4 — Project Area
Agency Response
State Historic Preservation Office
United States Fish and Wildlife Service
Farmland Conversion Form (AD -1006)
NC Wildlife Resources Commission
NC Natural Heritage Program Letter
Affidavit of Public Notice

Limited Phase I ESA
1. Radius Report
2. Sanborn Map
3. Historic Topography

Mill Dam Creek
4508 Shady Grove Church Road
East Bend, NC 27018
Inquiry Number: 4651799.2s
June 20, 2016
6 Armstrong Road, 4th floor
Shelton, CT 06484
(rEDR�. Toll Free: 800.352.0050
www.edrnet.com
FORM-LBD-CCA

TABLE OF CONTENTS
SECTION
PAGE
Executive Summary
ES1
OverviewMap-----------------------------------------------------------
2
DetailMap--------------------------------------------------------------
3
Map Findings Summary
4
MapFindings------------------------------------------------------------
8
Orphan Summary---------------------------------------------------------
9
Government Records Searched/Data Currency Tracking- - - - - - - - - - - - - -
- - - - - - - - - - - - GRA
GEOCHECK ADDENDUM
Physical Setting Source Addendum
A-1
Physical Setting Source Summary
A-2
Physical Setting Source Map------------------------------------------------
A-8
Physical Setting Source Map Findings----------------------------------------
A-9
Physical Setting Source Records Searched
PSGR-1
Thank you for your business.
Please contact EDR at 1-800-352-0050
with any questions or comments.
Disclaimer - Copyright and Trademark Notice
This Report contains certain information obtained from a variety of public and other sources reasonably available to Environmental Data
Resources, Inc. It cannot be concluded from this Report that coverage information for the target and surrounding properties does not exist from
other sources. NO WARRANTY EXPRESSED OR IMPLIED, IS MADE WHATSOEVER IN CONNECTION WITH THIS REPORT. ENVIRONMENTAL
DATA RESOURCES, INC. SPECIFICALLY DISCLAIMS THE MAKING OF ANY SUCH WARRANTIES, INCLUDING WITHOUT LIMITATION,
MERCHANTABILITY OR FITNESS FOR A PARTICULAR USE OR PURPOSE. ALL RISK IS ASSUMED BY THE USER. IN NO EVENT SHALL
ENVIRONMENTAL DATA RESOURCES, INC. BE LIABLE TO ANYONE, WHETHER ARISING OUT OF ERRORS OR OMISSIONS, NEGLIGENCE,
ACCIDENT OR ANY OTHER CAUSE, FOR ANY LOSS OF DAMAGE, INCLUDING, WITHOUT LIMITATION, SPECIAL, INCIDENTAL,
CONSEQUENTIAL, OR EXEMPLARY DAMAGES. ANY LIABILITY ON THE PART OF ENVIRONMENTAL DATA RESOURCES, INC. IS STRICTLY
LIMITED TO A REFUND OF THE AMOUNT PAID FOR THIS REPORT. Purchaser accepts this Report "AS IS". Any analyses, estimates, ratings,
environmental risk levels or risk codes provided in this Report are provided for illustrative purposes only, and are not intended to provide, nor
should they be interpreted as providing any facts regarding, or prediction or forecast of, any environmental risk for any property. Only a Phase I
Environmental Site Assessment performed by an environmental professional can provide information regarding the environmental risk for any
property. Additionally, the information provided in this Report is not to be construed as legal advice.
Copyright 2016 by Environmental Data Resources, Inc. All rights reserved. Reproduction in any media or format, in whole
or in part, of any report or map of Environmental Data Resources, Inc., or its affiliates, is prohibited without prior written permission.
EDR and its logos (including Sanborn and Sanborn Map) are trademarks of Environmental Data Resources, Inc. or its affiliates. All other
trademarks used herein are the property of their respective owners.
TC4651799.2s Page 1

EXECUTIVE SUMMARY
A search of available environmental records was conducted by Environmental Data Resources, Inc (EDR).
The report was designed to assist parties seeking to meet the search requirements of EPA's Standards
and Practices for All Appropriate Inquiries (40 CFR Part 312), the ASTM Standard Practice for
Environmental Site Assessments (E 1527-13) or custom requirements developed for the evaluation of
environmental risk associated with a parcel of real estate.
TARGET PROPERTY INFORMATION
ADDRESS
4508 SHADY GROVE CHURCH ROAD
EAST BEND, NC 27018
COORDINATES
Latitude (North):
Longitude (West):
Universal Tranverse Mercator:
UTM X (Meters):
UTM Y (Meters):
Elevation:
36.2368300 - 36° 14' 12.58"
80.5193500 - 80° 31'9.66"
Zone 17
543191.1
4010122.8
946 ft. above sea level
USGS TOPOGRAPHIC MAP ASSOCIATED WITH TARGET PROPERTY
Target Property Map:
Version Date:
Northeast Map:
Version Date:
Southeast Map:
Version Date:
Northwest Map:
Version Date:
AERIAL PHOTOGRAPHY IN THIS REPORT
5947707 EAST BEND, NC
2013
5947729 PINNACLE, NC
2013
5947767 VIENNA, NC
2013
5947737 SILOAM, NC
2013
Portions of Photo from: 20140524
Source: USDA
TC4651799.2s EXECUTIVE SUMMARY 1

Target Property Address:
4508 SHADY GROVE CHURCH ROAD
EAST BEND, NC 27018
Click on Map ID to see full detail.
MAP
ID SITE NAME ADDRESS
NO MAPPED SITES FOUND
MAPPED SITES SUMMARY
DATABASE ACRONYMS
RELATIVE DIST (ft. & mi.)
ELEVATION DIRECTION
4651799.2s Page 2

EXECUTIVE SUMMARY
TARGET PROPERTY SEARCH RESULTS
The target property was not listed in any of the databases searched by EDR.
DATABASES WITH NO MAPPED SITES
No mapped sites were found in EDR's search of available ("reasonably ascertainable ") government
records either on the target property or within the search radius around the target property for the
following databases:
STANDARD ENVIRONMENTAL RECORDS
Federal NPL site list
NPL National Priority List
Proposed NPL---------------- Proposed National Priority List Sites
NPL LIENS Federal Superfund Liens
Federal Delisted NPL site list
Delisted NPL National Priority List Deletions
Federal CERCLIS list
FEDERAL FACILITY---------. Federal Facility Site Information listing
SEMS Superfund Enterprise Management System
Federal CERCLIS NFRAP site list
SEMS -ARCHIVE Superfund Enterprise Management System Archive
Federal RCRA CORRACTS facilities list
CORRACTS------------------ Corrective Action Report
Federal RCRA non-CORRACTS TSD facilities list
RCRA-TSDF RCRA - Treatment, Storage and Disposal
Federal RCRA generators list
RCRA-LQG RCRA - Large Quantity Generators
RCRA-SQG------------------ RCRA - Small Quantity Generators
RCRA-CESQG RCRA - Conditionally Exempt Small Quantity Generator
Federal institutional controls / engineering controls registries
LUCIS Land Use Control Information System
US ENG CONTROLS--------. Engineering Controls Sites List
TC4651799.2s EXECUTIVE SUMMARY 3

EXECUTIVE SUMMARY
US INST CONTROL_ _ _ _ _ _ _ _ _ _ Sites with Institutional Controls
Federal ERNS list
ERNS Emergency Response Notification System
State- and tribal - equivalent NPL
NC HSDS Hazardous Substance Disposal Site
State- and tribal - equivalent CERCLIS
SHWS------------------------ Inactive Hazardous Sites Inventory
State and tribal landfill and/or solid waste disposal site lists
SWF/LF List of Solid Waste Facilities
OLI Old Landfill Inventory
State and tribal leaking storage tank lists
LAST_________________________ Leaking Aboveground Storage Tanks
LUST Regional UST Database
INDIAN LUST Leaking Underground Storage Tanks on Indian Land
LUST TRUST ----------------- State Trust Fund Database
State and tribal registered storage tank lists
FEMA UST Underground Storage Tank Listing
UST Petroleum Underground Storage Tank Database
AST__________________________ AST Database
INDIAN UST Underground Storage Tanks on Indian Land
State and tribal institutional control/ engineering control registries
INST CONTROL No Further Action Sites With Land Use Restrictions Monitoring
State and tribal voluntary cleanup sites
INDIAN VCP ------------------ Voluntary Cleanup Priority Listing
VCP Responsible Party Voluntary Action Sites
State and tribal Brownfields sites
BROWNFIELDS Brownfields Projects Inventory
ADDITIONAL ENVIRONMENTAL RECORDS
Local Brownfield lists
US BROWNFIELDS---------- A Listing of Brownfields Sites
Local Lists of Landfill/ Solid Waste Disposal Sites
HIST LF Solid Waste Facility Listing
TC4651799.2s EXECUTIVE SUMMARY 4

EXECUTIVE SUMMARY
SWRCY---------------------- Recycling Center Listing
INDIAN ODI Report on the Status of Open Dumps on Indian Lands
ODI Open Dump Inventory
DEBRIS REGION 9 ----------- Torres Martinez Reservation Illegal Dump Site Locations
Local Lists of Hazardous waste / Contaminated Sites
US HIST CDL Delisted National Clandestine Laboratory Register
US CDL National Clandestine Laboratory Register
Local Land Records
LIENS 2---------------------- CERCLA Lien Information
Records of Emergency Release Reports
HMIRS
Hazardous Materials Information Reporting System
SPILLS
Spills Incident Listing
IMD--------------------------
Incident Management Database
SPILLS 90
SPILLS 90 data from FirstSearch
SPILLS 80 --------------------
SPILLS 80 data from FirstSearch
Other Ascertainable Records
RCRA NonGen / NLR--------.
RCRA - Non Generators / No Longer Regulated
FUDS
Formerly Used Defense Sites
DOD
Department of Defense Sites
SCRD DRYCLEANERS------.
State Coalition for Remediation of Drycleaners Listing
US FIN ASSUR
Financial Assurance Information
EPA WATCH LIST
EPA WATCH LIST
2020 COR ACTION----------.
2020 Corrective Action Program List
TSCA
Toxic Substances Control Act
TRIS
Toxic Chemical Release Inventory System
SSTS------------------------.
Section 7 Tracking Systems
ROD
Records Of Decision
RMP
Risk Management Plans
RAATS-----------------------
RCRA Administrative Action Tracking System
PRP
Potentially Responsible Parties
PADS
PCB Activity Database System
ICIS--------------------------
Integrated Compliance Information System
FTTS
FIFRA/ TSCA Tracking System - FIFRA (Federal Insecticide, Fungicide, & Rodenticide
Act)/TSCA (Toxic Substances Control Act)
MLTS------------------------
Material Licensing Tracking System
COAL ASH DOE
Steam -Electric Plant Operation Data
COAL ASH EPA
Coal Combustion Residues Surface Impoundments List
PCB TRANSFORMER-------_
PCB Transformer Registration Database
RADINFO
Radiation Information Database
HIST FTTS
FIFRA/TSCA Tracking System Administrative Case Listing
DOT OPS--------------------
Incident and Accident Data
CONSENT
Superfund (CERCLA) Consent Decrees
INDIAN RESERV
Indian Reservations
FUSRAP---------------------
Formerly Utilized Sites Remedial Action Program
UMTRA
Uranium Mill Tailings Sites
LEAD SMELTERS
Lead Smelter Sites
US AIRS---------------------
Aerometric Information Retrieval System Facility Subsystem
TC4651799.2s EXECUTIVE SUMMARY 5

EXECUTIVE SUMMARY
US MINES --------------------
Mines Master Index File
FINDS
Facility Index System/Facility Registry System
UXO
Unexploded Ordnance Sites
DOCKET HWC---------------
Hazardous Waste Compliance Docket Listing
COAL ASH
Coal Ash Disposal Sites
DRYCLEANERS
Drycleaning Sites
Financial Assurance_ _ _ _ _
_ _ _ _ _ Financial Assurance Information Listing
NPDES
NPDES Facility Location Listing
UIC
Underground Injection Wells Listing
FUELS PROGRAM-----------
EPA Fuels Program Registered Listing
ECHO
Enforcement & Compliance History Information
EDR HIGH RISK HISTORICAL RECORDS
EDR Exclusive Records
EDR MGP EDR Proprietary Manufactured Gas Plants
EDR Hist Auto________________ EDR Exclusive Historic Gas Stations
EDR Hist Cleaner EDR Exclusive Historic Dry Cleaners
EDR RECOVERED GOVERNMENT ARCHIVES
Exclusive Recovered Govt. Archives
RGA HWS Recovered Government Archive State Hazardous Waste Facilities List
RGA LF_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Recovered Government Archive Solid Waste Facilities List
RGA LUST Recovered Government Archive Leaking Underground Storage Tank
SURROUNDING SITES: SEARCH RESULTS
Surrounding sites were not identified.
Unmappable (orphan) sites are not considered in the foregoing analysis.
TC4651799.2s EXECUTIVE SUMMARY 6

EXECUTIVE SUMMARY
There were no unmapped sites in this report.
TC4651799.2s EXECUTIVE SUMMARY 7

OVERVIEW MAP - 4651799.2S
This report includes Interactive Map Layers to
display and/or hide map information. The
legend includes only those icons for the
default map view.
SITE NAME: Mill Dam Creek CLIENT: KCI Technologies, Inc.
ADDRESS: 4508 Shady Grove Church Road CONTACT: Tim Morris
East Bend NC 27018 INQUIRY #: 4651799.2s
LAT/LONG: 36.23683/80.51935 DATE: June 20, 2016 12:43 pm
Copyright m 2016 EDR, Inc. (c) 2015 TornTom Rel. 2015.
Target Property
o Iia 1@ 1 ones
Sites at elevations higher than
or equal to the target property
Indian Reservations BIA Hazardous Substance
�
Sites at elevations lower than
F/ -q
Disposal Sites
100 -year flood zone
the target property
500 -year flood zone
A
Manufactured Gas Plants
0
National Wetland Inventory
National Priority List Sites
Dept. Defense Sites
0
State Wetlands
This report includes Interactive Map Layers to
display and/or hide map information. The
legend includes only those icons for the
default map view.
SITE NAME: Mill Dam Creek CLIENT: KCI Technologies, Inc.
ADDRESS: 4508 Shady Grove Church Road CONTACT: Tim Morris
East Bend NC 27018 INQUIRY #: 4651799.2s
LAT/LONG: 36.23683/80.51935 DATE: June 20, 2016 12:43 pm
Copyright m 2016 EDR, Inc. (c) 2015 TornTom Rel. 2015.

DETAIL MAP - 4651799.2S
0 1/16 1/9 114 Mlles
0 Indian Reservations BIA Hazardous Substance
100 -year flood zone Disposal Sites
500 -year flood zone
National Wetland Inventory
0 State Wetlands
This report includes Interactive Map Layers to
display and/or hide map information. The
legend includes only those icons for the
default map view.
SITE NAME: Mill Dam Creek CLIENT: KCI Technologies, Inc.
ADDRESS: 4508 Shady Grove Church Road CONTACT: Tim Morris
East Bend NC 27018 INQUIRY #: 4651799.2s
LAT/LONG: 36.23683/80.51935 DATE: June 20, 2016 12:44 pm
Copyright m 2016 EDR, Inc. (c) 2015 TornTom Rel. 2015.
Target Property
Sites at elevations higher than
or equal to the target property
Sites at elevations lower than
the target property
A
Manufactured Gas Plants
r
Sensitive Receptors
National Priority List Sites
Dept. Defense Sites
0 1/16 1/9 114 Mlles
0 Indian Reservations BIA Hazardous Substance
100 -year flood zone Disposal Sites
500 -year flood zone
National Wetland Inventory
0 State Wetlands
This report includes Interactive Map Layers to
display and/or hide map information. The
legend includes only those icons for the
default map view.
SITE NAME: Mill Dam Creek CLIENT: KCI Technologies, Inc.
ADDRESS: 4508 Shady Grove Church Road CONTACT: Tim Morris
East Bend NC 27018 INQUIRY #: 4651799.2s
LAT/LONG: 36.23683/80.51935 DATE: June 20, 2016 12:44 pm
Copyright m 2016 EDR, Inc. (c) 2015 TornTom Rel. 2015.

MAP FINDINGS SUMMARY
Search
Distance Target
Total
Database (Miles) Property
< 1/8
1/8-1/4
1/4-1/2
1/2 - 1
> 1
Plotted
STANDARD ENVIRONMENTAL RECORDS
Federal NPL site list
NPL 1.000
0
0
0
0
NR
0
Proposed NPL 1.000
0
0
0
0
NR
0
NPL LIENS TP
NR
NR
NR
NR
NR
0
Federal Delisted NPL site list
Delisted NPL 1.000
0
0
0
0
NR
0
Federal CERCLIS list
FEDERAL FACILITY 0.500
0
0
0
NR
NR
0
SEMS 0.500
0
0
0
NR
NR
0
Federal CERCLIS NFRAP site list
SEMS -ARCHIVE 0.500
0
0
0
NR
NR
0
Federal RCRA CORRACTS facilities list
CORRACTS 1.000
0
0
0
0
NR
0
Federal RCRA non-CORRACTS TSD facilities list
RCRA-TSDF 0.500
0
0
0
NR
NR
0
Federal RCRA generators list
RCRA-LQG 0.250
0
0
NR
NR
NR
0
RCRA-SQG 0.250
0
0
NR
NR
NR
0
RCRA-CESQG 0.250
0
0
NR
NR
NR
0
Federal institutional controls /
engineering controls registries
LUCIS 0.500
0
0
0
NR
NR
0
US ENG CONTROLS 0.500
0
0
0
NR
NR
0
US INST CONTROL 0.500
0
0
0
NR
NR
0
Federal ERNS list
ERNS TP
NR
NR
NR
NR
NR
0
State- and tribal - equivalent NPL
NC HSDS 1.000
0
0
0
0
NR
0
State- and tribal - equivalent CERCLIS
SHWS 1.000
0
0
0
0
NR
0
State and tribal landfill and/or
solid waste disposal site lists
SWF/LF 0.500
0
0
0
NR
NR
0
OLI 0.500
0
0
0
NR
NR
0
State and tribal leaking storage tank lists
LAST 0.500
0
0
0
NR
NR
0
TC4651799.2s Page 4

Database
MAP FINDINGS SUMMARY
Search
Distance Target Total
(Miles) Property < 1/8 1/8-1/4 1/4-1/2 1/2 - 1 > 1 Plotted
LUST 0.500
0
0
0
NR
NR
0
INDIAN LUST 0.500
0
0
0
NR
NR
0
LUST TRUST 0.500
0
0
0
NR
NR
0
State and tribal registered storage tank lists
US CDL
TP
Local Land Records
0
LIENS 2
TP
FEMA UST 0.250
0
0
NR
NR
NR
0
UST 0.250
0
0
NR
NR
NR
0
AST 0.250
0
0
NR
NR
NR
0
INDIAN UST 0.250
0
0
NR
NR
NR
0
State and tribal institutional
control / engineering control registries
INST CONTROL 0.500
State and tribal voluntary cleanup sites
INDIAN VCP 0.500
VCP 0.500
State and tribal Brownfields sites
BROWNFIELDS 0.500
ADDITIONAL ENVIRONMENTAL RECORDS
Local Brownfield lists
0
US BROWNFIELDS
0.500
Local Lists of Landfill / Solid
Waste Disposal Sites
NR
HIST LF
0.500
SWRCY
0.500
INDIAN ODI
0.500
ODI
0.500
DEBRIS REGION 9
0.500
Local Lists of Hazardous waste /
Contaminated Sites
NR 0
US HIST CDL
TP
US CDL
TP
Local Land Records
0
LIENS 2
TP
Records of Emergency Release Reports
HMIRS
TP
SPILLS
TP
IMD
0.500
SPILLS 90
TP
SPILLS 80
TP
Other Ascertainable Records
NR
RCRA NonGen / NLR
0.250
0 0
0
NR
NR 0
0 0
0
NR
NR 0
0 0
0
NR
NR 0
0 0
0
NR
NR 0
0
0
0
NR
NR 0
0
0
0
NR
NR 0
0
0
0
NR
NR 0
0
0
0
NR
NR 0
0
0
0
NR
NR 0
0
0
0
NR
NR 0
NR
NR
NR
NR
NR 0
NR
NR
NR
NR
NR 0
NR
NR
NR
NR
NR 0
NR
NR
NR
NR
NR 0
NR
NR
NR
NR
NR 0
0
0
0
NR
NR 0
NR
NR
NR
NR
NR 0
NR
NR
NR
NR
NR 0
0
0
NR
NR
NR 0
TC4651799.2s Page 5

MAP FINDINGS SUMMARY
EDR HIGH RISK HISTORICAL RECORDS
EDR Exclusive Records
EDR MGP 1.000
Search
0
0
0
NR
0
EDR Hist Auto 0.125
0
Distance Target
NR
NR
NR
0
EDR Hist Cleaner 0.125
Total
Database
(Miles) Property
< 1/8
1/8 - 1/4
1/4-1/2
1/2 - 1
> 1
Plotted
FUDS
1.000
0
0
0
0
NR
0
DOD
1.000
0
0
0
0
NR
0
SCRD DRYCLEANERS
0.500
0
0
0
NR
NR
0
US FIN ASSUR
TP
NR
NR
NR
NR
NR
0
EPA WATCH LIST
TP
NR
NR
NR
NR
NR
0
2020 COR ACTION
0.250
0
0
NR
NR
NR
0
TSCA
TP
NR
NR
NR
NR
NR
0
TRIS
TP
NR
NR
NR
NR
NR
0
SSTS
TP
NR
NR
NR
NR
NR
0
ROD
1.000
0
0
0
0
NR
0
RMP
TP
NR
NR
NR
NR
NR
0
RAATS
TP
NR
NR
NR
NR
NR
0
PRP
TP
NR
NR
NR
NR
NR
0
PADS
TP
NR
NR
NR
NR
NR
0
ICIS
TP
NR
NR
NR
NR
NR
0
FTTS
TP
NR
NR
NR
NR
NR
0
MLTS
TP
NR
NR
NR
NR
NR
0
COAL ASH DOE
TP
NR
NR
NR
NR
NR
0
COAL ASH EPA
0.500
0
0
0
NR
NR
0
PCB TRANSFORMER
TP
NR
NR
NR
NR
NR
0
RADINFO
TP
NR
NR
NR
NR
NR
0
HIST FTTS
TP
NR
NR
NR
NR
NR
0
DOT OPS
TP
NR
NR
NR
NR
NR
0
CONSENT
1.000
0
0
0
0
NR
0
INDIAN RESERV
1.000
0
0
0
0
NR
0
FUSRAP
1.000
0
0
0
0
NR
0
UMTRA
0.500
0
0
0
NR
NR
0
LEAD SMELTERS
TP
NR
NR
NR
NR
NR
0
US AIRS
TP
NR
NR
NR
NR
NR
0
US MINES
0.250
0
0
NR
NR
NR
0
FINDS
TP
NR
NR
NR
NR
NR
0
UXO
1.000
0
0
0
0
NR
0
DOCKET HWC
TP
NR
NR
NR
NR
NR
0
COAL ASH
0.500
0
0
0
NR
NR
0
DRYCLEANERS
0.250
0
0
NR
NR
NR
0
Financial Assurance
TP
NR
NR
NR
NR
NR
0
NPDES
TP
NR
NR
NR
NR
NR
0
UIC
TP
NR
NR
NR
NR
NR
0
FUELS PROGRAM
0.250
0
0
NR
NR
NR
0
ECHO
TP
NR
NR
NR
NR
NR
0
EDR HIGH RISK HISTORICAL RECORDS
EDR Exclusive Records
EDR MGP 1.000
0
0
0
0
NR
0
EDR Hist Auto 0.125
0
NR
NR
NR
NR
0
EDR Hist Cleaner 0.125
0
NR
NR
NR
NR
0
EDR RECOVERED GOVERNMENT ARCHIVES
Exclusive Recovered Govt. Archives
RGA HWS TP
NR
NR
NR
NR
NR
0
TC4651799.2s Page 6

Database
RGA LF
RGA LUST
- Totals --
MAP FINDINGS SUMMARY
Search
Distance Target
(Miles) Property
TP
TP
0
NOTES:
TP = Target Property
NR = Not Requested at this Search Distance
Sites may be listed in more than one database
TC4651799.2s Page 7
Total
< 1/8
1/8-1/4
1/4-1/2 1/2-1 > 1
Plotted
NR
NR
NR NR NR
0
NR
NR
NR NR NR
0
0
0
0 0 0
0
TC4651799.2s Page 7

Mill Dam Creek
4508 Shady Grove Church Road
East Bend, NC 27018
Inquiry Number: 4651799.3
June 20, 2016
6 Armstrong Road, 4th floor
Shelton, CT 06484
(rEDR Toll Free: 800.352.0050
www.edrnet.com

Certified Sanborn® Maa Resort 06/20/16
Site Name:
Mill Dam Creek
4508 Shady Grove Church Ro,
East Bend, NC 27018
EDR Inquiry # 4651799.3
Client Name:
KCI Technologies, Inc.
4601 Six Forks Road
Raleigh, NC 27609
Contact: Tim Morris
The Sanborn Library has been searched by EDR and maps covering the target property location as provided by KCI Technologies, Inc.
were identified for the years listed below. The Sanborn Library is the largest, most complete collection of fire insurance maps. The collection
includes maps from Sanborn, Bromley, Perris & Browne, Hopkins, Barlow, and others. Only Environmental Data Resources Inc. (EDR) is
authorized to grant rights for commercial reproduction of maps by the Sanborn Library LLC, the copyright holder for the collection. Results
can be authenticated by visiting www.edrnet.com/sanborn.
The Sanborn Library is continually enhanced with newly identified map archives. This report accesses all maps in the collection as of the
day this report was generated.
Certified Sanborn Results:
Certification # ODF4-4CC3-8667
Po # 161601703
Project Mill Dam Creek FDP
UNMAPPED PROPERTY
This report certifies that the complete holdings of the Sanborn Library,
LLC collection have been searched based on client supplied target
property information, and fire insurance maps covering the target property
were not found.
Limited Permission To Make Copies
Sanborn® Library search results
Certification #: ODF4-4CC3-8667
The Sanborn Library includes more than 1.2 million
fire insurance maps from Sanborn, Bromley, Perris &
Browne, Hopkins, Barlow and others which track
historical property usage in approximately 12,000
American cities and towns. Collections searched:
*1111, Library of Congress
FVJ' University Publications of America
F� EDR Private Collection
The Sanborn Library LLC Since 1866 -
KCI Technologies, Inc. (the client) is permitted to make up to FIVE photocopies of this Sanborn Map transmittal and each fire insurance map accompanying this
report solely for the limited use of its customer. No one other than the client is authorized to make copies. Upon request made directly to an EDR Account Executive,
the client may be permitted to make a limited number of additional photocopies. This permission is conditioned upon compliance by the client, its customer and their
agents with EDR's copyright policy; a copy of which is available upon request.
Disclaimer - Copyright and Trademark Notice
This Report contains certain information obtained from a variety of public and other sources reasonably available to Environmental Data Resources, Inc. It cannot
be concluded from this Report that coverage information for the target and surrounding properties does not exist from other sources. NO WARRANTY
EXPRESSED OR IMPLIED, IS MADE WHATSOEVER IN CONNECTION WITH THIS REPORT. ENVIRONMENTAL DATA RESOURCES, INC. SPECIFICALLY
DISCLAIMS THE MAKING OF ANY SUCH WARRANTIES, INCLUDING WITHOUT LIMITATION, MERCHANTABILITY OR FITNESS FOR A PARTICULAR USE
OR PURPOSE. ALL RISK IS ASSUMED BY THE USER. IN NO EVENT SHALL ENVIRONMENTAL DATA RESOURCES, INC. BE LIABLE TO ANYONE,
WHETHER ARISING OUT OF ERRORS OR OMISSIONS, NEGLIGENCE, ACCIDENT OR ANY OTHER CAUSE, FOR ANY LOSS OF DAMAGE, INCLUDING,
WITHOUT LIMITATION, SPECIAL, INCIDENTAL, CONSEQUENTIAL, OR EXEMPLARY DAMAGES. ANY LIABILITY ON THE PART OF ENVIRONMENTAL
DATA RESOURCES, INC. IS STRICTLY LIMITED TO A REFUND OF THE AMOUNT PAID FOR THIS REPORT. Purchaser accepts this Report "AS IS". Any
analyses, estimates, ratings, environmental risk levels or risk codes provided in this Report are provided for illustrative purposes only, and are not intended to
provide, nor should they be interpreted as providing any facts regarding, or prediction or forecast of, any environmental risk for any property. Only a Phase I
Environmental Site Assessment performed by an environmental professional can provide information regarding the environmental risk for any property.
Additionally, the information provided in this Report is not to be construed as legal advice.
Copyright 2016 by Environmental Data Resources, Inc. All rights reserved. Reproduction in any media or format, in whole or in part, of any report or map of
Environmental Data Resources, Inc., or its affiliates, is prohibited without prior written permission.
EDR and its logos (including Sanborn and Sanborn Map) are trademarks of Environmental Data Resources, Inc. or its affiliates. All other trademarks used herein
are the property of their respective owners.
4651799 - 3 page 2

Agency Letters

KCI
TECHNOLOGIES
August 25, 2016
ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
Landmark Center IL Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
Ms. Renee Gledhill -Earley
Environmental Review Coordinator
State Historic Preservation Office
4617 Mail Service Center
Raleigh, NC 27699-4617
Subject: Cultural Resources Review
Mill Dam Creek Restoration Project
KCI Job # 161601703
Dear Mrs. Gledhill -Earley:
On behalf of our client, the North Carolina Division of Mitigation Services (DMS), KCI Technologies, Inc.
requests review and comment on any possible issues that might emerge with respect to archaeological or cultural
resources associated with a potential stream restoration project on the above referenced site. The subject site is
located approximately 0.5 miles north of the Town of East Bend, North Carolina in the northeastern portion of
Yadkin County (Figure 1). Specifically, the site is 0.2 miles north on Shady Grove Church Road (SR -1538) from its
intersection with Shoals Road (SR -1546). The site is within the 03040101 Watershed Cataloging Unit (8 -digit
HUC) of the Yadkin River Basin and the 14 -digit HUC 03040101110070 (Figure 2). Land use in the watershed is
primarily agricultural or forest land (Figure 3). Please accept the attached information as a submittal for cultural
resources review by the State Historic Preservation Office and the Office of State Archaeology.
The planned stream restoration work aims to restore the hydrology and vegetation components to this stream
system by realigning and remeandering the existing stream and stabilizing the site with native vegetation. There
will not be any impacts to existing structures (buildings, barns, etc.) on the subject property. No architectural
structures or archeological artifacts have been observed or noted during preliminary surveys of the site for
restoration purposes. In addition, the majority of the site has historically been disturbed due to agricultural purposes
such as row cropping, clearing, and stream channelization. Proposed mitigation actions are shown on Figure 4.
Please feel free to contact me at 919-278-2511, should you have any questions or require any further information
concerning the extent of site disturbance associated with this project. Thank you in advance for your assistance.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI TECHNOLOGIES
www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
June 22, 2016
Ms. Marella Buncick
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Raleigh, NC 27636
Subject: Endangered Species Act, Fish and Wildlife Coordination Act, Migratory Bird Treaty Act
Mill Dam Creek Restoration Site
KCI Job # 161601703
Dear Ms. Buncick:
Please accept this information pertaining to the proposed Mill Dam Creek stream restoration site for
natural area and rare species review by the US Fish and Wildlife Service. The subject site is located
approximately 0.5 miles north of the Town of East Bend, North Carolina in the northeastern portion of
Yadkin County (Figure 1). Specifically, the site is 0.2 miles north on Shady Grove Church Road (SR -
1538) from its intersection with Shoals Road (SR -1546). The site is within the 03040101 Watershed
Cataloging Unit (8 -digit HUC) of the Yadkin River Basin and the 14 -digit HUC 03040101110070 (Figure
2). Land use in the watershed is primarily agricultural or forest land (Figure 3).
A portion of the site (Figure 4) is currently under investigation as a stream restoration project for the
North Carolina Department of Environmental Quality Division of Mitigation Services (DMS). The
funding for this project comes from the USDOT Federal Highway Administration through the North
Carolina Department of Transportation. The planned restoration aims to restore the hydrology and
vegetation components to this stream system by realigning and remeandering the existing stream,
reducing the impacts of adjacent agricultural practices, and stabilizing the site with native vegetation. All
of the stream restoration actions will focus on reconnecting the restoration areas to its floodplain and the
forested corridor along Mill Dam Creek. Besides expanding and enhancing the riparian corridor, it will
also increase the buffering capacity before runoff reaches Mill Dam Creek. There will not be any impacts
to existing structures (buildings, barns, etc.) on the subject property. As part of the environmental
documentation process (Categorical Exclusion), coordination with the NCWRC and the USFWS is
required for compliance with the Fish and Wildlife Coordination Act and the Endangered Species Act.
We have already obtained an updated species list for Yadkin County from your web site. The rare,
threatened and endangered species for this county are included in Attachment 1. We are requesting that
you please provide any known information for any additional species, if any, in the county that we should
be aware of in the development of this project. The USFWS will be contacted if additional studies find
suitable habitat for any listed species or if we determine that the project may affect one or more federally
listed species or designated critical habitat. Please provide comments on any possible issues that might
emerge with respect to endangered species, migratory birds or other trust resources from the construction
of a stream and wetland restoration project on the subject property.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

If we have not heard from you in 30 days we will assume that our species list is correct, that you do not
have any comments regarding associated laws, and that you do not have any information relevant to this
project at the current time.
We thank you in advance for your timely response and cooperation. Please feel free to contact us with
any questions that you may have concerning the extent of site disturbance associated with this project.
My phone number is 919-278-2511 and my email address is tim.morris(&kci.com
Sincerely,
Timothy J. Morris
Project Manager
Enclosures
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

Endangered Species Review for Mill Dam Creek Restoration Site
Yadkin County, North Carolina
A review of the United States Fish and Wildlife Service's (USFWS) listing of federally
endangered species, threatened species, species of concern and candidate species revealed
three federal species of concern, and one threatened species in Yadkin County (Table 1).
Table 1. Species in Yadkin County, North Carolina listed under the federal Endangered
Species Act.
Common Name
Scientific name
Federal
Record Status
Status
Vertebrate:
Allegheny woodrat
Neotoma magister
FSC
Current
Northern long-eared bat
Myotis septentrionalis
T
Probable/Potential
Robust redhorse
Moxostoma robustum
FSC
Historic
Bald eagle
Haliaeetus leucocephalus BGPA
Current
Invertebrate:
Brook floater
Alasmidonta varicosa
FSC
Current

Bald and Golden Eagle Protection Act (BGPA)
The Bald and Golden Eagle Protection Act (BGPA) prohibits the killing, selling or
otherwise harming of eagles, their nests and their eggs. The bald eagle was delisted as
endangered in 1995 and as threatened in 2007. The BGPA continues to protect the
species regardless of its delisted status. Bald eagles have been documented in Johnston
County.
Bald Eagle (Haliaeetus leucocephalus)
Bald eagles like lakes and other large bodies of water. During the summer, they can be
seen soaring above lakes and in the nearby trees. They prefer lakes and reservoirs with
lots of fish and surrounding forests. In the winter, bald eagles can be seen around
unfrozen lakes and hunting along coastlines, reservoirs and rivers. During the migration,
bald eagles are seen near all types of water habitats. The bald eagle is an opportunistic
feeder which subsists mainly on fish, which it swoops down and snatches from the water
with its talons. It builds the largest nest of any North American bird and the largest tree
nests ever recorded for any animal species, up to 4 m (13 ft) deep, 2.5 m (8.2 ft) wide,
and 1 metric ton (1.1 short tons) in weight. Sexual maturity is attained at the age of four
to five years. The bald eagle typically requires old-growth and mature stands of
coniferous or hardwood trees for perching, roosting, and nesting. Tree species reportedly
is less important to the eagle pair than the tree's height, composition and location.
Perhaps of paramount importance for this species is an abundance of comparatively large
trees surrounding the body of water. Selected trees must have good visibility, be over
20 m (66 ft) tall, an open structure, and proximity to prey.
Potential Habitat at the Mill Dam Creek Stream Restoration Site
Habitat for Bald Eagle (Haliaeetus leucocephalus)
Bald Eagles live near rivers, lakes, and marshes where they can find fish, their staple
food. Bald Eagles will also feed on waterfowl, turtles, rabbits, snakes, and other small
animals and carrion. Bald Eagles require a good food base, perching areas, and nesting
sites. Their habitat includes estuaries, large lakes, reservoirs, rivers, and some seacoasts.
In winter, the birds congregate near open water in tall trees for spotting prey and night
roosts for sheltering.
The project lies within the headwaters of the Mill Dam Creek drainage and there are no
large bodies of water near the project to provide preferred forage for the bald eagle.
Biological Conclusion: No effect
Potential Habitat for Northern Long -Eared Bat (Myotis septentrionalis)
The northern long-eared bat is one of the species of bats most impacted by the disease
white -nose syndrome. Due to declines caused by white -nose syndrome and continued

spread of the disease, the northern long-eared bat was listed as threatened under the
Endangered Species Act on April 2, 2015. The USFWS also developed a final 4(d),
which published in the Federal Register on January 14, 2016. The 4(d) rule specifically
defines the "take" prohibitions. USFWS has determined that designating critical habitat
for the northern long-eared bat is not prudent. Northern long-eared bat summer habitat is
not limited or in short supply and summer habitat loss is not a range -wide threat to the
species. Designating critical habitat in the areas where it summers would not benefit the
northern long-eared bat, and therefore, would not be prudent. Winter habitat does have
specific physical and biological features that are essential to the conservation of the
species, and, therefore, meets the definition of critical habitat. However, information
became available demonstrating that designating critical habitat would likely increase
vandalism, disturbance, and, potentially, the spread of white -nose syndrome in the caves
and mines where northern long-eared bats hibernate. Therefore, USFWS determined that
it is not prudent to designate winter habitat as critical habitat.
The Mill Dam Creek site is located within the White -Nosed Syndrome Zone per the 4(d)
rule however it is not within a County with WNS/Pd Infected Hibernacula, nor does the
Natural Heritage database show occurrence of the Northern Long Eared Bat within a one -
mile radius of the site.
Biological Conclusion: See attached Consultation Form

Reference:
NCDEQ, Wildlife Resources Commission. 2016. Carolina Wildlife Profiles.
http://www.newildlife. org/fs_index_07_conservation.htm
NCDEQ, Natural Heritage Program. 2016. Natural Heritage Data Explorer.
https://ncnhde.natureserve.org/
United States Fish and Wildlife Service. 2016. North Carolina's Threatened and
Endangered Species. http://www.fws.gov/southeast/.

Northern Lone -Eared Bat 4(d) Rule Streamlined Consultation Form
Federal agencies should use this form for the optional streamlined consultation framework for the northern long-
eared bat (NLEB). This framework allows federal agencies to rely upon the U.S. Fish and Wildlife Service's
(USFWS) January 5, 2016, intra -Service Programmatic Biological Opinion (BO) on the final 4(d) rule for the
NLEB for section 7(a)(2) compliance by: (1) notifying the USFWS that an action agency will use the streamlined
framework; (2) describing the project with sufficient detail to support the required determination; and (3) enabling
the USFWS to track effects and determine if reinitiation of consultation is required per 50 CFR 402.16.
This form is not necessary if an agency determines that a proposed action will have no effect to the NLEB or if
the USFWS has concurred in writing with an agency's determination that a proposed action may affect, but is not
likely to adversely affect the NLEB (i.e., the standard informal consultation process). Actions that may cause
prohibited incidental take require separate formal consultation. Providing this information does not address
section 7(a)(2) compliance for any other listed species.
Information to Determine 4(d) Rule Compliance:
YES NO
1. Does the project occur wholly outside of the WNS Zone'?
❑
2. Have you contacted the appropriate agency2 to determine if your project is near
❑x
❑
known hibernacula or maternity roost trees?
3. Could the project disturb hibernating NLEBs in a known hibernaculum?
❑
N
4. Could the project alter the entrance or interior environment of a known
❑
N
hibernaculum?
5. Does the project remove any trees within 0.25 miles of a known hibernaculum at
❑
any time of ear?
6. Would the project cut or destroy known occupied maternity roost trees, or any
❑
N
other trees within a 150 -foot radius from the maternity roost tree from June 1
through July 31.
You are eligible to use this form if you have answered yes to question #1 or yes to question #2 and no to
questions 3, 4, 5 and 6. The remainder of the form will be used by the USFWS to track our assumptions in the
BO.
Agency and Applicant3 Donnie Brew, FHWA, Donnie.brew(adot.gov. 919-747-7017 and KCI
Technologies, Inc., tim.morris(akci.com 919-278-2511
Project Name: Mill Dam Creek Stream Restoration Site
Project Location: The site is located approximately 0.5 miles north of East Bend, North Carolina.
Specifically, the site is 0.2 mile north on Shady Grove Church Road (SR -1538) from its intersection
with Shoals Road (SR -1546). The center of the site is at approximately 3 6.23 90 N and —80.5201 W in
the East Bend USGS Quadrangle.
Basic Project Description (provide narrative below or attach additional information): The Mill Dam
Creek Restoration Site (MDCRS) is a candidate site for stream restoration in the Yadkin River Basin in
Yadkin County, North Carolina. As evidenced by historic aerial photos and site investigations, the streams
1 http://www.fws.gov/midwest/endangered/mammals/nleb/pdf/WNSZone.pdf
z See http://www.fvvs.gov/midwest/endangered/mammals/nleb/nhisites.html
3 If applicable - only needed for federal actions with applicants (e.g., for a permit, etc.) who are party to the consultation.

at this site have been substantially modified from relocation and straightening, impacted from cattle and
other anthropogenic impacts. Restoring these streams will not only return these tributaries to a stable
stream ecosystem with a functional riparian buffer and floodplain access, but will also lower the supply
of sediment entering Hall Creek and reduce incoming nutrients from livestock.
The project goals for MDCRS are in line with the following basin goals:
- Managing stormwater runoff.
- Reducing fecal coliform inputs.
- Improving/restoring riparian buffers.
- Reducing sediment loading.
- Improving stream stability.
- Reducing nutrient loading.
- Excluding livestock and implementing other agricultural BMPs.
Project -specific goals for the site will include:
- Restore channelized and livestock -impacted streams to more natural planforms within the
landscape.
- Buffer nutrient and sediment impacts to the Yadkin River and its tributaries from adjacent grazing
and farming practices.
- Improve and expand habitat for a variety of aquatic species.
General Project Information
YES NO
Does the project occur within 0.25 miles of a known hibernaculum?
❑
❑X
Does the project occur within 150 feet of a known maternity roost tree?
❑
❑X
Does the project include forest conversion'? (if yes, report acreage below)
❑X
❑
Estimated total acres of forest conversion
2.0
If known, estimated acres5 of forest conversion from April 1 to October 31
2.0
If known, estimated acres of forest conversion from June 1 to July 316
0.0
Does the project include timber harvest? (if yes, report acreage below)
❑ ❑X
Estimated total acres of timber harvest
If known, estimated acres of timber harvest from April 1 to October 31
If known, estimated acres of timber harvest from June 1 to July 31
Does the project include prescribed fire? (if yes, report acreage below)
❑
❑X
Estimated total acres of prescribed fire
If known, estimated acres of prescribed fire from April 1 to October 31
If known, estimated acres of prescribed fire from June 1 to July 31
Does the project install new wind turbines? (if yes, report capacity in MW below)
❑
❑X
Estimated wind capacity (MW)
4 Any activity that temporarily or permanently removes suitable forested habitat, including, but not limited to, tree removal
from development, energy production and transmission, mining, agriculture, etc. (see page 48 of the BO).
s If the project removes less than 10 trees and the acreage is unknown, report the acreage as less than 0.1 acre.
6 If the activity includes tree clearing in June and July, also include those acreage in April to October.

Agency Determination:
By signing this form, the action agency determines that this project may affect the NLEB, but that any
resulting incidental take of the NLEB is not prohibited by the final 4(d) rule.
If the USFWS does not respond within 30 days from submittal of this form, the action agency may
presume that its determination is informed by the best available information and that its project
responsibilities under 7(a)(2) with respect to the NLEB are fulfilled through the USFWS January 5,
2016, Programmatic BO. The action agency will update this determination annually for multi-year
activities.
The action agency understands that the USFWS presumes that all activities are implemented as
described herein. The action agency will promptly report any departures from the described activities to
the appropriate USFWS Field Office. The action agency will provide the appropriate USFWS Field
Office with the results of any surveys conducted for the NLEB. Involved parties will promptly notify the
appropriate USFWS Field Office upon finding a dead, injured, or sick NLEB.
Signature: Date Submitted:

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Milton Cortes
Assistant State Soil Scientist
USDA Natural Resource Conservation Service
4407 Bland Rd., Suite 117
Raleigh, NC 27609
Subject: Farmland Conversion Impact Rating
Mill Dam Creek Restoration Project
KCI Job Number - 161601703
Dear Mr. Cortes:
The purpose of this letter is to inform NRCS of our contractual intent to complete a stream restoration project on the
several properties in Yadkin County. This work is expected to occur over the course of the next year. The subject
site, known as the Mill Dam Creek restoration site is located approximately 0.5 miles north of the Town of East
Bend, North Carolina in the northeastern portion of Yadkin County (Figure 1). Specifically, the site is 0.2 miles
north on Shady Grove Church Road (SR -1538) from its intersection with Shoals Road (SR -1546). The site is within
the 03040101 Watershed Cataloging Unit (8 -digit HUC) of the Yadkin River Basin and the 14 -digit HUC
03040101110070 (Figure 2). Land use in the watershed is primarily agricultural or forest land (Figure 3).
The site is currently under investigation as a stream restoration project for the North Carolina Division of Mitigation
Services. The funding for this project comes from the USDOT and Federal Highway Administration. The planned
restoration work aims to restore the hydrology and vegetation components to this stream system by realigning and
remeandering the existing stream and stabilizing the site with native vegetation (Figure 4).
Following the review of the included documentation, please provide a determination regarding any potential impacts
from farmland conversion associated with this project. Included is the Farmland Conversion Impact Rating Form
(AD -1006) and a soil map (Figure 5) with the breakdown of soil type and acreage; please complete Parts II, IV and
V. Feel free to contact me at tim.morris(&kci.com, or 919-278-2511, should you have any questions or require any
further information concerning the extent of site disturbance associated with this project. Thank you in advance for
your assistance.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
I Landmark Center H, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Ms. Shannon Deaton
Habitat Conservation Program Manager
NC Wildlife Resources Commission, Division of Inland Fisheries
1721 Mail Service Center
Raleigh, NC 27699-1721
Subject: Fish and Wildlife Coordination Act
Mill Dam Creek Restoration Project
KCI Project Number - 161601703
Dear Ms. Deaton:
The purpose of this letter is to request review and comment from the NC Wildlife Resources Commission with
respect to potential fish and wildlife impacts associated with the above referenced project. The subject site is
located approximately 0.5 miles north of the Town of East Bend, North Carolina in the northeastern portion of
Yadkin County (Figure 1). Specifically, the site is 0.2 miles north on Shady Grove Church Road (SR -1538) from its
intersection with Shoals Road (SR -1546). The site is within the 03040101 Watershed Cataloging Unit (8 -digit RUC)
of the Yadkin River Basin and the 14 -digit HUC 03040101110070 (Figure 2). Land use in the watershed is
primarily agricultural or forest land (Figure 3).
A portion of the site (Figure 4) is currently under investigation as a stream restoration project for the North Carolina
Division of Mitigation Services. The funding for this project comes from the USDOT Federal Highway
Administration through the North Carolina Department of Transportation. Land use at this site is primarily
pastureland and agriculture. The planned restoration work aims to restore the hydrology and vegetation components
to this stream system by realigning and remeandering the existing stream and stabilizing the site with native
vegetation. As part of the environmental documentation process (Categorical Exclusion), coordination with the
NCWRC and the USFWS is required for compliance with the Fish and Wildlife Coordination Act.
Following the review of the included documentation, please provide a determination of the potential effects to
wildlife associated with this project. Please feel free to contact me at tim.morris(iDkci.com, or 919-278-2511, should
you have any questions or require any further information concerning the extent of site disturbance associated with
this project. Thank you in advance for your assistance.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

January 2016 4
SURRY
O
X
m
CO)
r -
X
52
m
Cn
O
�S
�,S,
`ver
Prarat
IREDELL DAVIE
cy
G,p
ny
67
EAST BEND
i
QCounty Boundary
Project Site Location
Major Roads
Minor Roads
Major Rivers
Cities and Towns
FIGURE 1. VICINITY MAP
N
0 0.75 1.5
Miles
MILL
DAM CREEK RESTORATION SITE
YADKIN COUNTY, NC
January 2016 4

� :.
00 r
`I ��---elk
•� C s `7 � rt � i"r.
�„ � 1 � ���' � � � ` �;, x t� fay r .-� , , �J• ��-._.. J— �
--
L �� I
_•may`
ry
���.�r � - � �� `\/ r 1r It ~ �� {�/' � � r�..r � � rr � � r tiv � 'k} � � ,•
�� ` `' �� �'•. -L_ � Gil ^`_rte � ' ` �„ ". _`L
Proposed Easement \` +, 2 I
�!
Q Project Watershed _ �_- ' _ � J
r
Project Streams r �J al•1� •�t� i f�• •`i1��a - - �r
r
Q 14 Digit HUC Boundary +tom % �•- vA_ fi 1
FIGURE 2. USGS TOPOGRAPHIC MAP N
0 1,000 2,000 MILL DAM CREEK RESTORATION SITE Source: USGS DRG,
Feet
YADKIN COUNTY, NC ^ East Bend Quad.

I
4� v
". .v
0 250
TO
T yb
Ec
410* VlWIkB
JS
NRCS Soil Survey (Columbus County)
Project Parcel
Project Easement Soils (64.6 ac)
Foreston Loamy Fine Sand (Fo) - 0.95 ac
Itor $0 Ec Johnston Loam, Frequently Flooded (Js) - 22.76
Leon Sand, 1 To 4 Percent Slopes (LnB) - 1.92 ac
Stallings Sandy Loam (St) - 3.23 ac
Mu Torhunta Fine Sandy Loam (To) - 17.67 ac
NRCS SOIL SURVEY N
500 ROUGH HORN SWAMP RESTORATION SITE source: NRCS SSURGO Data,
Feet COLUMBUS COUNTY, NC NC OneMap Imagery, 2013

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Ms. Janice Baity
4341 Shady Grove Church Road
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Ms. Baity,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Bryce Smitherman
Post Office Box 167
Sea Level NC 28577
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Smitherman,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Ms. Sara Wood
4236 Shady Grove Church Road
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Ms. Wood,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Santos Pozo
3046 Shoals Road
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Pozo,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Jose Samuel Pozo
3064 Aztec Drive
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Pozo,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Roy Russell
1670 Jordan Drive
Winston Salem NC 27105
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Russell,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Donald Mathis
Post Office Box 671
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Mathis,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. James Smitherman
3633 Shoals Road
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Smitherman,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Joel Dinkins
1121 Pecan Ridge Drive
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Dinkins,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

KCT ENGINEERS • SCIENTISTS • SURVEYORS • CONSTRUCTION MANAGERS
1 Landmark Center II, Suite 220 4601 Six Forks Road Raleigh, NC 27609 [phone] [phone] Fax
TECHNOLOGIES
August 25, 2016
Mr. Charles Smitherman
4508 Shady Grove Church Road
East Bend, NC 27018
Subject: Notification of Uniform Act Provisions
KCI Job Number — 161601703
Dear Mr. Smitherman,
As part of the environmental documentation process in preparation for the stream restoration project on your
property, this letter is to inform you of provisions in the Federal Highway Administration Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended, referred to as the Uniform Act.
The Uniform Act was developed to provide for uniform and equitable treatment of persons displaced from their
homes, businesses, non-profit associations, or farms by federal and federally -assisted programs, and establishes
uniform and equitable land acquisition policies. The Act assures that such persons are treated fairly, consistently,
and equitably, and so that they will not suffer disproportionate injuries.
This act applies to any project which utilizes federal funds for the purchase of any interest in real property, including
conservation easements. A portion of the funding for this project is ultimately provided by the US Department of
Transportation, through the NC Department of Transportation for in-kind mitigation to offset impacts from
transportation projects in the area, and therefore we are required to inform you of the following provisions.
The provisions of this act require that we inform you in writing that this conservation easement transaction is
voluntary and that the project is being developed by KCI for the North Carolina Division of Mitigation Services
(NCDMS), and as a result, KCI or NCDMS does not have the authority to acquire the property by eminent domain
in the event negotiations fail to reach an amicable agreement. In addition, the Act requires that we indicate the
agreed purchase price of $20,000 per acre.
This letter is for your information, and no response is necessary. Please feel free to contact me at 919-278-2511,
should you have any questions or require any further information.
Sincerely,
Timothy J. Morris
Senior Environmental Scientist
KCI Technologies, Inc.
KCI TECHNOLOGIES www.kci.com
Employee -Owned Since 1988

Agency Responses

North Carolina Department of Natural and Cultural Resources
State Historic Preservation Office
Ramona M. Bartos, Administrator
Governor Pat McCrory
Secretary Susan Kluttz
September 29, 2016
Timothy Morris
KCI Technologies
Landmark Center II, Suite 220
4601 Six Forks Road
Raleigh, NC 27609
Office of Archives and History
Deputy Secretary Kevin Cherry
Re: Mill Dam Creek Restoration, East Bend, KCI 161601703, Yadkin County, ER 16-1563
Dear Mr. Morris:
Thank you for your letter of August 25, 2016, concerning the above project.
We have conducted a review of the project and are aware of no historic resources which would be affected
by the project. Therefore, we have no comment on the project as proposed.
The above comments are made pursuant to Section 106 of the National Historic Preservation Act and the
Advisory Council on Historic Preservation's Regulations for Compliance with Section 106 codified at 36
CFR Part 800.
Thank you for your cooperation and consideration. If you have questions concerning the above comment,
contact Renee Gledhill -Earley, environmental review coordinator, at 919-807-6579 or
environmental.reviewgncdcr.gov. In all future communication concerning this project, please cite the
above referenced tracking number.
Sincerely,
Ramona M. Bartos
Location: 109 East Jones Street, Raleigh NC 27601 Mailing Address: 4617 Mail Service Center, Raleigh NC 27699-4617 Telephone/Fax: [phone]-6599

USDA
Natural Resources August 26, 2016
Conservation Service
North Carolina
Timothy J. Morris
State Office
Senior Environmental Scientist
4407 Bland Road
KCI Technologies, Inc.
Suite 117
Landmark Center II, Suite 220
Raleigh, NC 27609
4601 Six Forks Road
Voice 919-873-2171
Fax [phone] Raleigh, NC 27609
Dear Mr Morris:
Thank you for your letter dated August 25, 2016, Subject: Request for
Comments — Farmland Conversion Impact Rating, Mill Dam Creek Restoration
Project, KCI Job Number— 161601703, Yadkin Co., NC. The following
guidance is provided for your information.
Projects are subject to the Farmland Protection Policy Act (FPPA) requirements
if they may irreversibly convert farmland (directly or indirectly) to non-
agricultural use and are completed by a federal agency or with assistance from a
federal agency. Farmland means prime or unique farmlands as defined in section
1540(c)(1) of the FPPA or farmland that is determined by the appropriate state or
unit of local government agency or agencies with concurrence of the Secretary of
Agriculture to be farmland of statewide local importance.
For the purpose of FPPA, farmland includes prime farmland, unique farmland,
and land of statewide or local importance. Farmland subject to FPPA
requirements does not have to be currently used for cropland. It can be
forestland, pastureland, cropland, or other land, but not water or urban built-up
land.
Farmland does not include land already in or committed to urban development
or water storage. Farmland already in urban development or water storage
includes all such land with a density of 30 structures per 40 -acre area. Farmland
already in urban development also includes lands identified as urbanized area
(UA) on the Census Bureau Map, or as urban area mapped with a tint overprint
on the United States Geological Survey (USGS) topographical maps, or as
urban -built-up on the United States Department of Agriculture (USDA)
Important Farmland Maps.
The area in question meets one or more of the above criteria for Farmland.
Farmland area will be affected or converted. Enclosed is the Farmland
Conversion Impact Rating form AD 1006 with PARTS II, IV and V completed by
NRCS. The corresponding agency will need to complete the evaluation,
according to the Code of Federal Regulation 7CFR 658, Farmland Protection
Policy Act.
The Natural Resources Conservation Service
is an agency of the Department of Agriculture's
Natural Resources mission.
An Equal Opportunity Provider and Employer

Mr. Morris
Page 2
If you have any questions, please contact Milton Cortes, Assistant State Soil Scientist at
919-873-2171 or by email: milton.cortesgnc.usda.gov.
Again, thank you for inquiry. If we can be of further assistance, please do not hesitate to
contact us.
Sincerely,
Digitally signed 1, MILTON CORTES
MILTON CORTES Agriculture, —MILTON 'OR20010.... Q 78 —Department of
Date: 2016.08.2617:28:45 -04'00'
Milton Cortes
Assistant State Soil Scientist
cc:
Kent Clary, State Soil Scientist, NRCS, Raleigh, NC

U.S. Department of Agriculture
FARMLAND CONVERSION IMPACT RATING
PART I (To be completed by Federal Agency)
Date Of Land Evaluation Request 8-25-16
Name of Project MITI Dam Creek Stream Restoration
Federal Agency Involved FHWA
Proposed Land Use Stream Restoration
County and State Yadkin County, NC
PART II (To be completed by NRCS)
Date Request Received By
NRCS /25/2016
ng F r
Pe , on Cc pletiRA
Pe 6oRes CS NC
Does the site contain Prime, Unique, Statewide or Local Important Farmland?
(If no, the FPPA does not apply - do not complete additional parts of this form)
YES NO
Z✓ ❑
Acres Irrigated
none
Average Farm Size
106 acres
Major Crop(s)
CORN
Farmable Land In Govt. Jurisdiction
Acres: 80.51 °/% 174, 015 acres
Amount of Farmland As Defined in FPPA
Acres: 71.1%% 153, 764 acres
Name of Land Evaluation System Used
Yadkin Co. NC LESA
Name of State or Local Site Assessment System
N/A
Date Land Evaluation Returned by NRCS
August 26, 2016 by email
PART III (To be completed by Federal Agency)
Alternative Site Rating
Site A Site B Site C
I Site D
A. Total Acres To Be Converted Directly
36.92
B. Total Acres To Be Converted Indirectly
0
C. Total Acres In Site
39.8
PART IV (To be completed by NRCS) Land Evaluation Information
A. Total Acres Prime And Unique Farmland
5.35
B. Total Acres Statewide Important or Local Important Farmland
17.36
C. Percentage Of Farmland in County Or Local Govt. Unit To Be Converted
0.0148
D. Percentage Of Farmland in Govt. Jurisdiction With Same Or Higher Relative Value
71 %
PART V (To be completed by NRCS) Land Evaluation Criterion
Relative Value of Farmland To Be Converted Scale of 0 to 100 Points
46
PART VI (To be completed by Federal Agency) Site Assessment Criteria Maximum
Criteria are explained in 7 CFR 658.5 b. For Corridorproject use form NRCS-CPA-106 Points
Site A Site B Site C
Site D
1. Area In Non-urban Use (15)
15
2. Perimeter In Non-urban Use (10)
10
3. Percent Of Site Being Farmed (20)
20
4. Protection Provided By State and Local Government (20)
0
5. Distance From Urban Built-up Area (15)
9
6. Distance To Urban Support Services (15)
10
7. Size Of Present Farm Unit Compared To Average (10)
5
8. Creation Of Non-farmable Farmland (10)
0
9. Availability Of Farm Support Services (5)
4
10. On-Farm Investments (20)
15
11. Effects Of Conversion On Farm Support Services (10)
0
12. Compatibility With Existing Agricultural Use (10)
0
TOTAL SITE ASSESSMENT POINTS 160
88 0 0
0
PART VII (To be completed by Federal Agency)
Relative Value Of Farmland (From Part V) 100
46 0 0
0
Total Site Assessment (From Part VI above or local site assessment) 160
88 0 0
0
TOTAL POINTS (Total of above 2 lines) 260
134 0 0
0
Site Selected:
Date Of Selection
Was A Local Site Assessment Used?
YES NO
Reason For Selection:
Name of Federal agency representative completing this form: FHWA Date: 10-5-16
(See Instructions on reverse side) Form AD -1006 (03-02)

K� North Carolina Wildlife Resources Commission 9
Gordon Myers, Executive Director
September 14, 2016
Timothy Morris
KCI Technologies
4601 Six Forks Road
Raleigh, NC 27609
SUBJECT: Mill Dam Creek Restoration Project
Yadkin County
Dear Mr. Morris:
Biologists with the North Carolina Wildlife Resources Commission (NCWRC) received your
August 25, 2016 letter regarding plans for a stream restoration project on unnamed tributaries to
Hall Creek in Yadkin County. You requested information concerning potential effects to
wildlife associated with this project. Our comments on this project are offered for your
consideration under provisions of the Clean Water Act of 1977 (33 U.S.C. 466 et. seq.) and Fish
and Wildlife Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d).
The site is being evaluated as a possible stream restoration project for the NC Division of
Mitigation Services. The project involves channel realignment and riparian buffer establishment;
no details on project design or linear footage are provided.
This project will not impact wild trout resources. We do not have any records of rare or listed
species within the project footprint. However, approximately 2.5 miles downstream, there are
two state listed mussels—the Creeper (Strophitus undulatus, NC Threatened) and Brook Floater
(Alasmidonta varicosa'US Federal Species of Concern, NC Endangered) in the Yadkin River.
This reach of the Yadkin River is known as the Yadkin River Aquatic Habitat, a natural area
designated by the NC Natural Heritage Program due to the richness of rare species it contains.
We recommend that riparian buffers that are to be reestablished be as wide as possible, given site
constraints and landowner needs. NCWRC generally recommends a woody buffer of 100 feet on
perennial streams in order to maximize the benefits of buffers, including bank stability, stream
shading, treatment of overland runoff, and wildlife habitat. In addition, sediment and erosion
control is particularly important at this site in order to minimize sediment loss and impacts to
downstream aquatic resources.
Mailing Address: Habitat Conservation • 1721 Mail Service Center • Raleigh, NC 27699-1721
Telephone: [phone] • Fax: [phone]

Mill Dam Creek Restoration Project Page 2 September 25, 2016
UTs to Hall Cr, Yadkin County
Thank you for the opportunity to review and comment on this project. Please contact me at
[phone] if you have any questions about these comments.
Sincerely,
Andrea Leslie
Mountain Region Coordinator
Habitat Conservation Program

NORTH CAROLINA DEPARTMENT OF NATURAL AND CULTURAL RESOURCES
Pat McCrory Bryan Gossage Susan Kluttz
Governor Executive Director Secretary
Clean Water Management Trust Fund
NCNHDE-1518
April 20, 2016
Thomas Seelinger
KCI Technologies, Inc.
4601 Six Forks Road
Raleigh, NC 27609
[e-mail]
RE: Mill Dam Creek Stream Restoration Project
Dear Thomas Seelinger:
The North Carolina Natural Heritage Program (NCNHP) appreciates the opportunity to provide information
about natural heritage resources from our database that have been compiled for the project referenced
above.
A query of the NCNHP database, based on the project area mapped with your request, indicates that there
are no records for rare species, important natural communities, natural areas, or conservation/managed
areas within the proposed project boundary. Please note that although there may be no documentation of
natural heritage elements within the project boundary, it does not imply or confirm their absence; the area
may not have been surveyed. The results of this query should not be substituted for site-specific surveys
where suitable habitat exists. In the event that rare species are found within the project area, please contact
the NCNHP so that we may update our records.
The attached `Potential Occurrences' table summarizes rare species and natural communities that have
been documented within a one -mile radius of the property boundary. The proximity of these records
suggests that these natural heritage elements may potentially be present in the project area if suitable
habitat exists and is included for reference.
Tables of natural areas and conservation/managed area within a one -mile radius of the project area, if any,
are also included in this report. The location of the natural areas and conservation/managed areas can be
viewed online on the Natural Heritage Data Explorer found at: https://ncnhde.natureserve.or_ /.
Please note that natural heritage element data are maintained for the purposes of conservation planning,
project review, and scientific research, and are not intended for use as the primary criteria for regulatory
decisions. Information provided by the NCNHP database may not be published without prior written
notification to the NCNHP, and the NCNHP must be credited as an information source in these publications.
Maps of NCNHP data may not be redistributed without permission.
The NC Natural Heritage Program may follow this letter with additional correspondence if a Dedicated Nature
Preserve (DNP), Registered Heritage Area (RHA), or Federally -listed species are documented near the
project area.
If you have questions regarding the information provided in this letter or need additional assistance, please
contact John Finnegan at [e-mail] or 919.707.8630.
Sincerely,
NC Natural Heritage Program
Page 1 of 4

Natural Heritage Element Occurrences, Natural Areas, and Managed Areas Within a One -mile Radius of the Project Area
Mill Dam Creek Stream Restoration Project
April 20, 2016
NCNHDE-1518
Element Occurrences Documented Within a One -mile Radius of the Project Area
Taxonomic
EO ID
Scientific Name
Common Name
Last
Element
Group
Status
Rank
Rank
Observation
Occurrence
Special
G5
S2S3
Date
Status
Amphibian
15531
Ambystoma talpoideum
Mole Salamander
2014-02-26
Current
Amphibian
31683
Ambystoma talpoideum
Mole Salamander
2012-08
Current
Amphibian
18054
Hemidactylium scutatum
Four -toed Salamander
2007-04-18
Current
Butterfly
404
Erynnis martialis
Mottled Duskywing
2002-04-20
Current
Freshwater
21772
Alasmidonta varicosa
Brook Floater
2000-08-22
Current
Bivalve
3 -Medium
Species of
Endangered
G3
Freshwater
2961
Strophitus undulatus
Creeper
2000-08-22
Current
Bivalve
---
Threatened
G5
S3
2 -High
Natural
3966
Floodplain Pool
---
1991-05
Current
Community
G3G4
S4
3 -Medium
---
---
Natural
19957
Mesic Mixed Hardwood
---
2002-04-20
Current
Community
4 -Low
Forest (Piedmont
Significantly
G4?
S1
Subtype)
3 -Medium
Natural
5707
Piedmont Cliff (Acidic
---
2002-04-20
Current
Community
Subtype)
Vulnerable
Natural
7725
Piedmont Levee Forest
---
2002-04-20
Current
Community
(Typic Subtype)
Vascular Plant
35170
Heuchera pubescens
Downy Alumroot
2009-04-11
Current
Vascular Plant
27699
Silphium connatum
Virginia Cup -plant
2009-07-05
Current
Page 2 of 4
Accuracy
Federal
State
Global
State
Status
Status
Rank
Rank
4 -Low
---
Special
G5
S2S3
Concern
2 -High
---
Special
G5
S2S3
Concern
4 -Low
---
Special
G5
S3
Concern
3 -Medium
---
Significantly
G3
S2
Rare
3 -Medium
Species of
Endangered
G3
S2
Concern
3 -Medium
---
Threatened
G5
S3
2 -High
---
---
G3
S2
3 -Medium
---
---
G3G4
S4
3 -Medium
---
---
G2?
S2
3 -Medium
---
---
G3G4
S3S4
4 -Low
---
Significantly
G4?
S1
Rare Peripheral
3 -Medium
---
Special
G3G4Q
S2
Concern
Vulnerable

Natural Areas Documented Within a One -mile Radius of the Project Area
Site Name Representational Rating Collective Rating
Yadkin Islands Forest R3 (High) C4 (Moderate)
YAD/Yadkin River Aquatic Habitat n/a (Not Applicable) C4 (Moderate)
Managed Areas Documented Within a One -mile Radius of the Project Area
Managed Area Name Owner Owner Type
Pilot Mountain State Park NC DNCR, Division of Parks and Recreation State
Definitions and an explanation of status designations and codes can be found at https://ncnhde.natureserve.org/contenVhelp. Data query generated on April 20, 2016; source: NCNHP, Q4 October 2015. Please resubmit your
information request if more than one year elapses before project initiation as new information is continually added to the NCNHP database.
Page 3 of 4

NCNHDE-1518: Mill Dam Creek Stream Restoration Project
April 20, 2016 1:29,574
El Project Boundary E] Managed Area [MAREA] 0 0-25 0.5 1 mi
Suffered Project Boundary 9 0A 0.8 1.6 km
Sources: Esri, HERE, QeLorme. Intermap, increment P Corp, GEBCO.
NHP Natural Area (NFiNA)
11SGS. FAD, NPS, NRCAK Ge Base, IGN, Kadaster NL. Ord mme Survey,
Page 4 of 4

Affidavit of Public Notice

NORTH CAROLINA
YADKIN COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified and authorized by law to administer oaths,
personally appeared Ferris W. Simpson who being first duly
sworn, deposes and says: that he (she) is Circulation Manager
(Publisher or other officer or employee authorized to make affidavit) of
Civitas Media, LLC, engaged in the publication of a newspaper known as
THE YADKIN RIPPLE, published, issued, and entered as periodicals
class mail in the town of Yadkinville in said County and State; that he
(she) is authorized to make this affidavit and sworn statement; that the
notice or other legal advertisement, a true copy of which is attached
hereto, was published in THE YADKIN RIPPLE on the following dates:
and that the said newspaper in which such notice, paper, document or
legal advertisement was published was, at the time of each and every
such publication, a newspaper meeting all of the requirements and
qualifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of
the General Statutes of North Carolina.
Signature of person
Sworn to and subscribed before me, this day of
ZP44-t' j� , 2016
V qL� —
NotarV#ublic
My Commission expires: January 15, 2018
E
=HENDERSONERSONLICtynanuary 15, 2018
Mill Dam Creek Stream
Restoration Project
KCI Technologies, Inc. pro-
poses to purchase conserva-
tion easement rights on ap-
proximately 39 acres of exist-
ing farm and woodland in East
Bend, Yadkin County, NC. The
site is located on several prop-
erties between Shady Grove
Church Road and Shoals
Road. The purpose of acquir-
ing the easement rights is to
provide mitigation for impacts
to streams that have, or will,
result from existing or future
development in this area.
Anyone desiring that an in-
formational public meeting be
held for this proposed action
may make a request by re-
gistered letter to KCI Technolo-
Rles, Inc. at 4601 Six Forks
Road, Suite 220, Raleigh NC
27609. Requests must be
postmarked by October 1,
2016. If additional information
Is required, please contact Tim
Moms at 919-278-2511.
The project is being com-
pleted for the North Carolina
Department of Environmental
Quality, Division of Mitigation
Services (DMS). DMS re-
serves the right to determine If
a public meeting will be held.
Publish September 1, 2016