20190903 Ver 1_401 Application_20190708

Version 1.4
January 9, 2009
401 &Buffer Permitting PCN Submittal Checklist 2 0 1 9 0 9
03
j� The alication fee (Checks may be made out to "N.C. Division of Water Resources"
240. for 401 Water Quality Certification with minor impacts
- $570.00 for 401 Water Quality Certification with major impacts
- Express Review Fee (Amount requested on Acceptance Letter)
© Four (4) complete and collated copies of the PCN Application and supporting �\
documentation (instead of providing 4 copies of the full size plans you may provide two
copies of full size plans along with two copies of 11 X 17 plans)
❑ Stormwater Management Plan (if applicable — see PCN Form Help File Section E)
1) Please provide three (3) copies of the stormwater management plans along with all
supporting information pertaining to this project including the following:
a. Entire site development/layout plans delineating all drainage areas;
b. Design calculation sheets for all proposed BMP(s) sized for both on-site and
off-site drainage;
c. BMP supplements for each proposed BMP and Required Items Check List
(http://portal.ncdenr.org/web/Ir/bmp-manual) along with all required items;
d. A Notarized Operation & Maintenance Agreement for each stormwater
management facility;
e. Detailed construction drawing sheets shall include 7D
(i) Erosion and sediment control plans; L
(ii) Installation and planting schedules for the proposed BMPs;
(iii) Appropriately scaled plan views and cross sectional details of all 17
BMPs and associated components — inlet and outlet structures, /
forebay, respective zones and pertinent elevations.
❑ If your project is located within a State implemented Riparian Buffer Rule Area, submit the
following along with site plans and PCN form:
1) Three (3) copies of the details for on-site diffuse flow provisions, (refer to
http://portal.ncdenr.org/web/Ir/bmp-manual).
[]� DWR St am Determination Forms for streams on property and DWR determination
letter for wetlands or streams(i applicable).
The following is the most critical of all the information that you must provide. The quality and
detail of the information will often determine the expeditiousness of the review. The following is
a checklist of the types of pertinent information required at a minimum:
Maps and Plans:
The most recent version of the 1:24,000 USGS Topographic Map - Please -cleanly draw or
delineate the site boundaries on the topographic map.
The most recent version of the bound and published County NRCS Soil Survey Map -
(required for projects within the Neuse River Basin, Tar -Pamlico River Basin, Randleman
Lake Watershed and the Catawba River Basin, also recommended for all projects) -
Please clearly delineate the site boundaries, etc. on the map. If the delineation obscures
any of the features, it is recommended that a clean copy be provided. Copies of the

Version 1.4
January 9, 2009
current soil survey and/or soil survey map sheets can be obtained from the local NRCS
County Office (http://www.nc.nres.usda.gov/). GIS soil layers are not acceptable.
[Vicinity map - Please clearly mark the location and approximate boundaries of the property
and project on the map. Please indicate north arrow and scale. Please include applicable
road names or State Road numbers.
[(The Site Plan - The most critical map to be provided is the site plan. You must provide full
sized plans. The following is the minimum list of plans that are typically needed.
[Pre-construction/Pre-existing conditions - This sheet (or sheets) must include:
• All jurisdictional and non -jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Topographic contours with elevations
• Any existing structures and impervious areas
• Existing utility lines and easements
• Existing roads, culverts, and other pertinent features
• North arrow and the scale (1":50' scale is recommended).
Proposed conditions - This sheet (or sheets) must include:
• All jurisdictional and non -jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Lot layout (if a subdivision or commercial development is proposed) - lots must be
developable without further impacts to jurisdictional and non -jurisdictional wetlands,
streams, water features, and State regulated buffers. Building envelopes must be
provided when streams, wetlands, riparian buffers, or water features exist on a lot
• All built -out structures and impervious cover
• Final grading contours with elevations
• All utilities and easements (including septic fields on all lots within 100 feet of stream,
wetland, or water features - if applicable)
• Impacted areas — these should correspond with the Impact numbers listed on your PCN
form.
❑ Drainage Plans - Final drainage plans must include the following:
• Locations and pertinent elevations and sizes of the stormwater collection system and
drainage ways
• All inlets and outlets must also be shown with pertinent elevations (All outlets to
wetlands must be at a non-erosive velocity, generally less than 2 ft/sec during the peak
flow from the 10 -yr storm)
• Scaled stormwater BMPs must also be indicated as required by DWR rules and policies
• In certain cases (see Section E of PCN form), final stormwater management plans must
also be provided (see Stormwater Management Plan Checklist)
2(proposed Impacts - All impacts to jurisdictional and non -jurisdictional wetland, stream,
water features, and State regulated buffers must be shown and labeled on the site plans at
a scale no smaller than 1" = 50'. All excavation, fill, flooding, stabilization, and other impacts
that will be conducted in or near jurisdictional and non -jurisdictional wetland, stream, water
features, and State regulated buffers must be indicated. Please provide cross sectional
details showing the provisions for aquatic life passage (burial of culvert 20% for culverts s 48
inches, and 1 -foot for culverts > 48 inches).

Version 1.4
January 9, 2009
Wetland Impacts:
❑ Precise grading and final elevation contours must be provided. Existing
vegetation and any clearing must be specified.
❑ All subsurface utility lines must indicate the location of anti -seep collars.
Construction detail for anti -seep collars must be provided.
❑ Roadway or other crossings of riparian wetlands may require floodway culverts to
maintain existing hydrological conditions.
❑ Plans should show that the hydrology of remaining wetlands on the site will be
maintained.
Stream Impacts:
[f Stream impacts must be clearly shown on the plans. The centerline as well as
the banks of the stream must be surveyed or located by GPS for the portion of
the stream to be impacted.
[( The inlet and the outlet of all culverts should be aligned with the stream as
much as possible. Inlet and outlet elevations and streambed elevations should
be indicated. Any inlet or outlet protection must be shown and enumerated on
the impact map(s).
❑ For bottomless culverts or other spans, a vertical cross section should be
provided that shows the minimum distance from each span to each stream bank,
the stream cross section, the height of the span above the stream and the
minimum distance from the edge of each footer to each stream bank.
Additionally, please provide a signed and sealed geotechnical report of
subsurface soils at the proposed bottomless culvert location. The report must
comply with the Division of Highways — Guidelines for Drainage Studies and
Hydraulic Design, prepared by A.L. Hankins, Jr., State Hydraulics Engineer -
1999.
❑ Multiple culverts or sectioned box culverts typically require the use of sills, off-
setting or other means to match the cross section of the existing stream (in order
to maintain stream stability and provide aquatic life passage). A vertical cross
section of the culverts should be shown overlain with the up and downstream
stream cross section including the stream flood -prone area.
❑ Impacts associated with dam construction must indicate and enumerate all fill
associated with the dam footprint, spillway and any bank stream bank
stabilization. The length of stream impounded must also be indicated and
enumerated.

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1d.
Type(s) of approval sought from the DWQ (check all that apply).-
pply):❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
0
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑X No
For the record only for Corps Permit:
❑ Yes ❑X No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes ❑X No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑X No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a.
Name of project:
1045 Tomlin Mill Solar, LLC
2b.
County:
Iredell
2c.
Nearest municipality / town:
Statesville
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Paul Ray Lowman and Linda L Lowman
3b.
Deed Book and Page No.
799/389
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
334 Lundy Road
3e.
City, state, zip:
Statesville, NC 28625
3f.
Telephone no.:
[phone]
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ❑X Other, specify: Solar Developer
4b.
Name:
Rene Pretorius
4c.
Business name
(if applicable):
GreenGo Energy US, Inc.
4d.
Street address:
1447 S. Tryon St., Suite 201
4e. City, state, zip:
Charlotte, NC 28203
4f.
Telephone no.:
[phone]
4g. Fax no.:
4h.
Email address:
[e-mail]
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Christopher Hay
5b.
Business name
(if applicable):
EnviroTrac Ltd.
5c.
Street address:
7343 West Friendly Avenue, Suite J
5d.
City, state, zip:
Greensboro, NC 27410
5e.
Telephone no.:
[phone]
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
4759650060.000
1 b. Site coordinates (in decimal degrees):
Latitude: 35.9222 Longitude: -80.8396
1 c. Property size:
137 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Patterson Creek
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Yadkin
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The property presently consists of agricultural fields and wooded land with a residence in the southern portion. The property is surrounded by
agricultural fields, woodlands, and rural residential property.
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 3,624
3d. Explain the purpose of the proposed project:
Construction of a utility scale solar power facility. Access to the property requires crossing a stream at a former stream crossing location.
3e. Describe the overall project in detail, including the type of equipment to be used:
Construction of the project will require trackhoes, pile driving equipment, and lifts to unload and move construction materials.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
Yes No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
Preliminary ❑ Final
4c. If yes, who delineated the jurisdiction 1 reas?
Name (if known): k
Agency/Consultant Company:
Other:-�,,f'N�t kr
4d. If yes, list the dates of the Corps ju risdictionJ determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
Yes Wo ❑ Unknown
5b. If yes, explain in detail`` according to "help file" instructions
?TDU�d 4wrl2 -J:a
6. Future Project Plans
6a. Is this a phased project?
❑Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑X Streams —tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1
Choose one
Choose one
Yes/No
-
W2
Choose one
Choose one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
0
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 T
Excavation
UT Patterson Creek
PER
Corps
2
40
S2 P
Culvert
UT Patterson Creek
PER
Corps
2
82
S3
Choose one
-
S4
Choose one
S5 -
Choose one
S6 -
Choose one
3h. Total stream and tributary impacts
122
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then indivi ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
0
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d. 5e.
Stream Impacts (feet) Upland
(acres)
Flooded
Filled
Excavated
Flooded Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
0
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman []Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
131
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
0
0
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The stream crossing was located at a former crossing where the stream is narrow and straight to minimize total impacts to the stream and flood plain.
The pipe length is the shortest possible length to accomodate the crossing.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The crossing will be constructed as a dry crossing by use of dam and pump to minimize and avoid impacts to the water quality and habitat.
Construction of the crossing will be completed during dry weather and limited to a few days at most.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ❑X No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
Choose one
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
E] Yes ❑X No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
o
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ❑X No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
0
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ❑x No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
With the exception of a gravel paved access driveway and a small equipment pad, no impervious or semi -impervious
surfaces will be installed in
development of the solar facility.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e.
Who will be responsible for the review of the Stormwater Management Plan?
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
USMP❑
❑
apply (check all that apply):
Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
[]Coastal counties
❑HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ORW
(check all that apply):
❑Session Law 2006-246
❑Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
,Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
4Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ❑X No
use of public (federal/state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
El Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c.
If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑Yes Q No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑Yes ❑X No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
E] Yes ❑X No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4.
Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
The
solar facility will not generate wastewater.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ❑X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS IPaC review, NC Natural Heritage Program, site and vicinity survey.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ❑X No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC State Historic Preservation Office, National Register of Historic Places Digital Archive, and historical aerial photographs and topographic maps
8. Flood Zone Designation (Corps Requirement)
—T—
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA FIRM Panel 4799
Christopher Hay
oywnysp1. cy cnis Hay
Hay
Chris D- ezm5o vTa�az as oaaam
r
02-19-2019
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10

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WATERS OF THE US PAUL RAY LOWMAN & LINDA L. LOWMAN
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� S!' DEED BOOK 799, PAGE 388 �
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S13�. _•` '_ PIN# 4759650060
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PROPOSED INTERNAL INTERNAL II
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EXISTING PROPERTY LINE APPROXIMATE TOTAL SITE ACREAGE: 137 ACRES SOURCES: GREENGO DEVELOPMENT PLAN, DP -001 DATED FEBRUARY 28, FIGURE 2
EXISTING RIGHT OF WAYAPPROXIMATE TOTAL JURISDICTIONAL RPW 2019. IREDELL COUNTY GIS 2017 AERIAL PHOTOGRAPH. � ENVIRONMENTAL FINDINGS MAP
PERMANENT SECURITY FENCE TRIBUTARIES: 2,766 LINEAR FEET 200 0 200 400 nviro ra
1045 TOMLIN MILL SOLAR, LLC- SITE 1045
PROPOSED SOLAR ARRAY
OVERHEAD POWER LINE �— �—��� Environmental Services 712 TOMLIN MILL ROAD
APPROXIMATE SCALE (FEET) STATESVILLE, NORTH CAROLINA
POPOSED UTILITY POLE
STREAM - - - - - - - - - - - _ — NOTE: THIS MAP IS NOT FOR CONSTRUCTION OR ZONING AND DOES NOT 7343 W. FRIENDLY AVENUE, SUITE J REVISED BY: AB DRAWN BY: GGH APPROVED BY: SCALE: AS SHOWN
STREAM FLAG LOCATION • 3-1 INCLUDE SETBACKS, BUFFERS, AND OTHER PARAMETERS. GREENSBORO, NORTH CAROLINA DATE: 05/17/19 DATE: 07/06/17 CWH PROJECT NO: 11.990087.00

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TEMPORARY IMPACT - 40LFT
PERMANENT IMPACT - 82LFT
1045 Tomlin Mill Solar = Impact Area NSCALE. 1"_ 20'
Iredell County, NC 0 10' 20' 40'

35° 55'36"N
35° 54' 50" N
514200 514300 514400 514500 514600 514700 514800 514900
3
Map Scale: 1:6,860 if printed on A portrait (8.5" x 11") sheet.
Meters
N 0 100 200 400 600
Feet
,N\ 0 300 soo 1200 teoo
Map projection: Web Mercator Comer coordinates: WGS84 Edge tics: UTM Zone 17N WGS84
USDA Natural Resources Web Soil Survey
Conservation Service National Cooperative Soil Survey
3 Soil Map—Iredell County, North Carolina 3
a
515000 515100 515200
a
35° 55 36" N
I
12/18/2018
Page 1 of 4
35° 54'50" N

INC SAM FIELD ASSESSMENT FORM
Accompanies Draft User Manual: March 2013
USACE AID #: NCDWQ #
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5 -minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same property,
identify and number all reaches on the attached map, and include a separate form for each reach. See the NO SAM User Manual for
detailed descriptions and explanations of requested information. Record in the "Notes" section if supplementary measurements were
performed. See the NO SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT/SITE INFORMAT ``
1. Project name (if any): I '�-,tV>tV0, Wit SO lt�,(� 2. Date of evaluation: Z =
ffa
3. Applicant/owner name: j a c� 4. Assessor name/organization: 1
5. County:tN Nest named water body
7. River basin: �b on USGS 7.5 -minute qu d:
B. Site coordinates (decimal degrees, at lower end of assessment reach): S-5 ZZ. � 3o
A -
STREAM INFORMATION: (depth and width can be�pp roximations)
t number (show on attached map): C - t'i:" 13 10. Length opf assessment reach evaluated (feet): (p 3L _
ITr Channel depth from bed (in riffle, if present) to top of bank (feet): (p--� ❑Unable to asses channel depth.
12. Channel width at top of bank (feet): /� 13. is assessment reach a swamp stream? []Yes [XNo
14. Feature type:ePerennial flow ❑Intermittent flow ❑Tidal Marsh Stream
STREAM CATEGORY INFORMATION:
15. NC SAM Zone: ❑Mountains (M) 'INKiedmont (P) ❑Inner Coastal Plain (1) ❑Outer Coastal Plain (0)
16. Estimated geomorphic
valley shape (skip for ❑a
Tidal Marsh Stream): (more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip ❑Size 1 (< 0.1 mit) ❑Size 2 (0.1 to < 0.5 mit) (]Size 3 (0.5 to < 5 mit) Size 4 (a 5 mit)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
18. Were regulatory considerations evaluated?�es ❑No If Yes, check all that apply to the assessment area.
❑Section 10 water ❑Classified Trout Waters ❑Water Supply Watershed (01 ❑II ❑III ❑IV ❑V)
❑Essential Fish Habitat ❑Primary Nursery Area ❑High Quality Waters/Outstanding Resource Waters
❑Publicly owned property ❑NCDWQ riparian buffer rule in effect ❑Nutrient Sensitive Waters
❑Anadromous fish 0303(d) List ❑CAMA Area of Environmental Concern (AEC)
❑Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
❑Designated Critical Habitat (list species)
19. Are additional stream information/supplementary measurements included in "Notes/Sketch" section or attached? ❑Yes Wo
1. Ch nnel Water - assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
XA Water throughout assessment reach.
❑B No flow, water in pools only.
❑C No water in assessment reach.
2. Evidence of Flow Restriction - assessment reach metric
❑A At least 10% of assessment reach in -stream habitat or riffle -pool sequence is severely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes gr ponded water or impoundment on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates, debris jams,
beaver dams).
Not A
3. Feature Pattern - assessment reach metric
[]l A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
Not A
4. Feature Longitudinal Profile - assessment reach metric
❑A Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
these disturbances).
Not A
6. Signs of Active Instability -assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
ac' a bank failure, active channel down -cutting (head -cut), active widening, and artificial hardening (such as concrete, gabion, rip -rap).
< 10% of channel unstable
❑B 10 to 25% of channel unstable
❑C > 25% of channel unstable
vii

6. Streamside Area Interaction — streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
❑A ❑ Little or no evidence of conditions that adversely affect reference interaction
B Moderate evidence of conditions (examples: berms, levees, down -cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching))
❑C ❑C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplain/intertidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide
7. Water Quality Stressors — assessment reachlintertidal zone metric
Check all that apply.
❑A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
❑B Excessive sedimentation (burying of stream features or intertidal zone)
❑C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
❑D Odor (not including natural sulfide odors)
❑E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in "Notes" section.
❑F Livestock with access to stream or intertidal zone
❑G Excessive algae in stream or intertidal zone
❑H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc.)
❑I Other: (explain in "Notes/Sketch" section)
Little to no stressors
8. Recent Weather — watershed metric (skip for Tidal Marsh Streams)
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
❑A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
,iNo drought conditions
9. Large or Da gerous Stream — assessment reach metric
❑Yes jMo Is stream too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In -stream Habitat Types — assessment reach metric
10a. ❑Yes tNo Degraded in -stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in -stream hardening [for example, rip -rap], recent dredging, and snagging)
(evaluate for Size 4 Coastal Plain streams only, then skip to Metric 11)
10b. Check all that occur (occurs if> 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
❑A Multiple aquatic macrophytes and aquatic mosses [IF 5% oysters or other natural hard bottoms
(including liverworts, lichens, and algal mats) a ❑G Submerged aquatic vegetation
❑B Multiple sticks and/or leaf packs and/or emergento ❑H Low -tide refugia (pools)
vegetation L ❑I Sand bottom
EIC Multiple snags and logs (including lap trees) . ❑J 5% vertical bank along the marsh
0 5% undercut banks and/or root mats and/or roots ❑K Little or no habitat
in banks extend to the normal wetted perimeter
Little or no habitat
11. Bedform and Substrate— assessment reach metric
11a. Zes ❑No Is assessment reach in a natural sand -bed stream? (skip for Coastal Plain streams)
1lb. Bedform evaluated. Check the appropriate box(es). (skip for Tidal Marsh Streams)
Riffle -run section
❑B Pool -glide section
❑C Natural bedform absent (skip to Metric 12, Aquatic Life)
11c. In riffle sections, check all that occur below the normal wetted perimeter of the assessment reach — whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Piain streams and Tidal Marsh Streams). Not Present (NP) _
absent, Rare (R) = present but < 10%, Common (C) _ > 10-40%, Abundant (A) _ > 40-70%, Predominant (P) _ > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP R C A P
19 ❑ ❑ ❑ ❑ Bedrock/saprolite
U_ ❑ ❑ ❑ ❑ Boulder (256 — 4096 mm)
❑ -K ❑ ❑ ❑ Cobble (64 — 256 mm)
❑ ❑ Sr, ❑ ❑ Gravel (2 — 64 mm)
❑ ❑ ❑ ❑ gr Sand (.062 — 2 mm)
❑ ❑ ❑ .Q_ ❑ Silt (< 0.062 mm)
❑ ❑ JSR' ❑ ❑ Detritus
$;` ❑ ❑ ❑ ❑ Artificial (rip -rap, concrete, etc.)
11d. `MYes ❑No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
viii

*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS****************************
12. Aquatic Life — assessment reach metric (skip for Tidal Marsh Streams)
12a. CiOres ❑No Was an in -stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. [:)No Water [-]Other:
12b. '`Yes [:)No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check all that
apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to "individuals" for Size 1 and 2 streams and "taxa" for Size 3 and 4 streams.
❑ Kdult frogs
❑ ❑Aquatic reptiles
❑ ❑Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
❑ ❑Beetles (including water pennies)
❑ ❑Caddisfly larvae (Trichoptera [T])
❑ []Asian clam (Corbicula)
Cl4Ftrustacean (isopod/amphipoo/crayfish/shrimp)
❑ ❑Damselfly and dragonfly larvae
❑ ❑Dipterans (true flies)
❑ ❑Mayfly larvae (Ephemeroptera [E])
❑ ❑Megaloptera (alderfly, fishfly, dobsonfly larvae)
❑ ❑Midges/mosquito larvae
❑ ❑Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
❑ ❑Mussels/Clams (not Corbicula)
❑ ❑Other fish
❑ ❑Salamanders/tadpoles
❑ ❑Snails
❑ ❑Stonefly larvae (Plecoptera [P])
❑ ❑Tipulid larvae
❑ ❑Worms/leeches
13. Streamside Area Ground Surface Condition — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and upland
runoff,
LB RB
❑A ❑A Little or no alteration to water storage capacity over a majority of the streamside area
❑B ❑B Moderate alteration to water storage capacity over a majority of the streamside area
❑C ❑C Severe alteration to water storage capacity over a majority of the streamside area (examples: ditches, fill, soil
compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
❑A ❑A Unaltered or majority of streamside area with depressions able to pond water >_ 6 inches deep
❑B ❑B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
❑C ❑C Majority of streamside area with depressions able to pond water < 3 inches deep
15. Wetland Presence — streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the normal
wetted perimeter of assessment reach.
LB RB
gAre wetlands present in the streamside area?
N
16. Baseflow Contributors — assessment reach metric (skip for Size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
49( Streams and/or springs (jurisdictional discharges)
❑B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
❑C Obstruction that passes some flow during low -flow periods affecting assessment reach (ex: beaver dam, bottom -release dam)
❑D Evidence of bank seepage or sweating (iron oxidizing bacteria in water indicates seepage)
131� Stream bed or bank soil reduced (dig through deposited sediment if present)
❑F None of the above
17. Baseflow Detractors — assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
❑A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
❑B Obstruction not passing flow during low -flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
❑C Urban stream Pz 24% impervious surface for watershed)
❑D Evidence that the streamside area has been modified resulting in accelerated drainage into the assessment reach
❑E Assessment reach relocated to valley edge
RF None of the above
18. Shading — assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider "leaf -on" condition.
❑A Stream shading is appropriate for the stream category (may include gaps associated with natural processes)
';�8 Degraded (example: scattered trees)
❑C Stream shading is gone or largely absent
ix

19. Buffer Width - assessment area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top of bank out
to the first break.
Vegetated Wooded
LB RB LB RB
❑A ❑A ❑A ❑A >- 100 feet wide or extends to the edge of the watershed
❑B DB ❑B ❑B From 50 to < 100 feet wide
❑C ❑C ❑C ❑C From 30 to < 50 feet wide
nO :RD 06 NO From 10 to < 30 feet wide
❑E El ❑E ❑E < 10 feet wide or no trees
20. Buffer Structure- streamside area metric (skip for Tidal Marsh Streams)
Consider for left
bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB
RB
❑A
❑A
Mature forest
�
96
Non -mature woody vegetation or modified vegetation structure
❑C
❑C
Herbaceous vegetation with or without a strip of trees < 10 feet wide
❑D
❑D
Maintained shrubs
❑E
❑E
Little or no vegetation
21. Buffer Stressors - streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If no stressors, check here and skip to Metric 22: ❑No Stressors
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
❑A ❑A KA �A ❑A ❑A Row crops
❑B ❑B ❑B ❑B ❑B ❑B Maintained turf
❑C ❑C ❑C ❑C ❑C ❑C Pasture (no livestock)/commercial horticulture
❑D ❑D ❑D ❑D ❑D ❑D Pasture (active livestock use)
22. Stem Density - streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LB RB
�A Medium to high stem density
❑B ❑B Low stem density
❑C ❑C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer - streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10 feet wide.
LB RB
�
A The total length of buffer breaks is < 25 percent.
E313B The total length of buffer breaks is between 25 and 50 percent.
❑C ❑C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition - First 100 feet of streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes to
assessment reach habitat.
LB RB
❑A ❑A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native species,
with non-native invasive species absent or sparse.
B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
❑C ❑C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non -characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductivity - assessment reach metric (skip for all Coastal Plain streams)
25a. es ❑No Was conductivity measurement recorded?
If No, select one of the following reasons. ❑No Water ❑Other:
25b. Check the box corre ponding to the conductivity measurement (units of microsiemens per centimeter).
EIA < 46 46 to < 67 ❑C 67 to < 79 ❑D 79 to < 230 ❑E z 230
Notes/Sketch

NC DWO Stream Identification Form Version 4.11 ? W -N cceR_
Date: 2 JLJ 1
Project/Site. t ,"_ ,"," '1 1A �atltucle:
Evaluator: t�
County: �i�-xc�1� Longitude:-4cjp.��� t,l,
Total Points:
Stream is at least intermittent4j 3
_!!
Stream Determination (circle one) Other
Ephemeral Intermittent Perennial e.g. Quad Name: 14c%r 4
if >_ 19 orperennial if;? 30*
1
A. Geomorphology (Subtotal
Absent
Weak
Moderate
Strong
18 Continuity of channel bed and bank
0
1
2
0
2. Sinuosity of channel along thalweg
0
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
b
3
4. Particle size of stream substrate
0
1
2
1.5
5. Active/relict floodplain
0
1
2
6. Depositional bars or benches
0
1
2
1.
7, Recent alluvial deposits
0
1
2
1.5
8. Headcuts
0
1
2
3
9. Grade control
0
0.5
1
.5
10. Natural valley
0
0.5
1
5
11. Second or greater order channel
No = 0
Y s =
Sketch:
e artificial ditches are not rated; see digicus�ns in manual
R Hvdrnloav (Subtotal = C7 ;---> )
12. Presence of Baseflow 0 1 2
13. Iron oxidizing bacteria 0 1 2
14. Leaf litter 2ED 1 0.5 0
15. Sediment on plants or debris 0 0.5 1.5
16. Organic debris lines or piles 0 0.5 1 1.5
17. Soil -based evidence of high water table? No Yes = 3
C Biolo (Subtotal= Q }
18. Fibrous roots in streambed
2
1
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
0
2
3
21. Aquatic Mollusks
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0
0.5
1
24. Amphibians
0
0.5
1
1.
25. Algae
W
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5
Ot er = 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:

NC SAM FIELD ASSESSMENT FORM
Accompanies Draft User Manual: March 2013
USACE AID #: NCDWQ #
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5 -minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same property,
identify and number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User Manual for
detailed descriptions and explanations of requested information. Record in the "Notes" section if supplementary measurements were
performed. See the NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT/SITE INFORMATION:
1. Project name (if any): oLl'pr rI U-2. Date of evaluation: j
3. Applicant/owner name: p�3k LA. Assessor name/organization. vgV111C;
5. County: x O yImP%arest named water body
7. River basin:� on USGS 7.5 -minute quad: ?K erson cme*—
B. Site coordinates (decimal d—egrees, at lower end of assessment reach): W.QA
STREAM INFORMATION: (depth and width can be a roximations)
9. Site number (show on attached map): .5 -- 10. Length of assessment reach evaluated (feet): oute-
11. Channel depth from bed (in riffle, if present) to top of ban (feet): f 2 ❑Unable to assess channel depth.
12. Channel width at top of bank (feet): 14 13. Is assessment reach a swamp stream? ❑Yes 00
14. Feature type: IZgPerennial flow [Intermittent flow ❑Tidal Marsh Stream
STREAM CATEGORY INFORMATION:
15. NC SAM Zone:
❑Mountains (M) )KPiedmont (P) Dinner Coastal Plain (1) []Outer Coastal Plain (0)
16. Estimated geomorphic
f
valley shape (skip for
❑a
Tidal Marsh Stream):
(more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip
❑Size 1 (< 0.1 mit) j,�Size 2 (0.1 to < 0.5 mit) ❑Size 3 (0.5 to < 5 miz) ❑Size 4 (a 5 mit)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
Were
��,..,//
Yes El No if Yes, check all that apply to the assessment area.
18. regulatory considerations
evaluated?
El Section 10 water
❑Classified Trout Waters ❑Water Supply Watershed (❑I ❑II ❑III ❑1V ❑V)
El Essential Fish Habitat
[I Primary Nursery Area El High Quality Waters/Outstanding Resource Waters
❑Publicly owned property
❑NCDWQ riparian buffer rule in effect El Nutrient Sensitive Waters
❑Anadromous fish
❑303(d) List ❑CAMA Area of Environmental Concern (AEC)
El Documented presence of
a federal and/or state listed protected species within the assessment area.
List species:
[]Designated Critical Habitat (list species)
19. Are additional stream information/supplementary measurements included in "Notes/Sketch" section or attached? []Yes o
1. Channel Water- assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
;9A Water throughout assessment reach.
❑B No flow, water in pools only.
❑C No water in assessment reach.
2. Evidence of Flow Restriction - assessment reach metric
❑A At least 10% of assessment reach in -stream habitat or riffle -pool sequence is severely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impoundment on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates, debris jams,
,�
beaver dams).
XB Not A
3. Feature Pattern - assessment reach metric
)V❑.�
' A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
B Not A
4. Feature Longitudinal Profile - assessment reach metric
ELA Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
these disturbances).
❑B Not
5. Signs of Active instability - assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
ac . e bank failure, active channel down -cutting (head -cut), active widening, and artificial hardening (such as concrete, gabion, rip -rap).
A < 10% of channel unstable
B 10 to 25% of channel unstable
❑C > 25% of channel unstable
vii

6. Streamside Area Interaction - streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
[DA ❑A Little or no evidence of conditions that adversely affect reference interaction
KB _05, Moderate evidence of conditions (examples: berms, levees, down -cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of Flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
El ❑C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplain/intertidal zone access (examples:
impoundments, intensive mosquito ditching)) or floodplainlintertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide
7. Water Quality Stressors -assessment reach/intertidal zone metric
Check all that apply,
4❑ Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
Excessive sedimentation (burying of stream features or intertidal zone)
C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
❑D Odor (not including natural sulfide odors)
❑E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in "Notes" section.
El Livestock with access to stream or intertidal zone
❑G Excessive algae in stream or intertidal zone
❑H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc.)
❑I Other: (explain in "Notes/Sketch" section)
❑J Little to no stressors
8. Recent Weather -watershed metric (skip for Tidal Marsh Streams)
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
❑A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
❑ Drought conditions and rainfall exceeding 1 inch within the last 48 hours
No drought conditions
9. Large or Dangerous Stream - assessment reach metric
❑Yes -gNo Is stream too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural jn-stream Habitat Types - assessment reach metric
10a. Yes [I No PorSize
tream habitat over majority of the assessment reach (examples of stressors include excessive
edimentamining, excavation, in -stream hardening [for example, rip -rap], recent dredging, and snagging)
(eva ua a 4 Coastal Plain streams only, then skip to Metric 11)
10b. Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
❑A Multiple aquatic macrophytes and aquatic mosses ❑F 5% oysters or other natural hard bottoms
(including liverworts, lichens, and algal mats) ❑G Submerged aquatic vegetation
❑B Multiple sticks and/or leaf packs and/or emergenti; ❑H Low -tide refugia (pools)
vegetation Y = ❑I Sand bottom
❑C Multiple snags and logs (including lap trees) L ❑J 5% vertical bank along the marsh
❑D 5% undercut banks and/or root mats and/or roots ❑K Little or no habitat
in banks extend to the normal wetted perimeter
Little or no habitat
11. Bedform and Substrate -assessment reach metric
11a. JJYes ❑No Is assessment reach in a natural sand -bed stream? (skip for Coastal Plain streams)
11 b. Bedform evaluated. Check the appropriate box(es). (skip for Tidal Marsh Streams)
❑A Riffle -run section
E❑BB Pool -glide section
Natural bedform absent (skip to Metric 12, Aquatic Life)
11c. In riffle sections, check all that occur below the normal wetted perimeter of the assessment reach - whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams). Not Present (NP) _
absent, Rare (R) = present but < 10%, Common (C) _ > 10-40%, Abundant (A) _ > 40-70%, Predominant (P) _ > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP R C A P
R ❑ ❑ ❑ ❑ Bedrock/saprolite
❑ ❑ ❑ ❑ Boulder (256 - 4096 mm)
❑ ❑ ❑ Cobble (64 - 256 mm)
❑ ❑ X ❑ ❑ Gravel (2 - 64 mm)
❑ ❑ ❑ ❑ Sand (.062 - 2 mm)
❑ ❑ ❑ ❑ Silt (< 0.062 mm)
❑ ❑ ❑ -4EKr ❑ Detritus
❑ ❑ ❑ ❑ Artificial (rip -rap, concrete, etc.)
11d. Yes ❑No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
viii

*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS************************s.***
12. Aquatic We —assessment reach metric (skip for Tidal Marsh Streams)
12a.s ❑No Was an in -stream aquatic life assessment performed as described in the User Manual?
Noe, select one of the following reasons and skip to Metric 13. ❑No Water ❑Other:
12b. ❑Yes ❑No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check all that
apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to "individuals" for Size 1 and 2 streams and "taxa" for Size 3 and 4 streams.
❑ ❑Adult frogs
❑ ❑Aquatic reptiles
❑ kAquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
❑ El Beetles (including water pennies)
❑ ❑Caddisfly larvae (Trichoptera [T])
❑ ❑Asian clam (Corbicula)
❑ ❑Crustacean (isopod/amphipod/crayfish/shrimp)
❑ ❑Damselfly and dragonfly larvae
❑ ❑Dipterans (true flies)
❑ ❑Mayfly larvae (Ephemeroptera [E])
❑ ❑Megaloptera (alderfly, fishfly, dobsonfly larvae)
❑ ❑Midges/mosquito larvae
❑ El Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
❑ ❑Mussels/Clams (not Corbicula)
❑ ❑Other fish
❑ ❑Salamanders/tadpoles
❑ ❑Snails
❑ ❑Stonefly larvae (Plecoptera (P])
❑ ❑Tipulid larvae
❑ ❑Worms/leeches
13. Streamside Area Ground Surface Condition — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and upland
runoff.
LB RB
❑A ❑A Little or no alteration to water storage capacity over a majority of the streamside area
❑B ❑B Moderate alteration to water storage capacity over a majority of the streamside area
❑C ❑C Severe alteration to water storage capacity over a majority of the streamside area (examples: ditches, fill, soil
compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
❑A ❑A Unaltered or majority of streamside area with depressions able to pond water >_ 6 inches deep
❑B ❑B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
❑C ❑C Majority of streamside area with depressions able to pond water < 3 inches deep
16. Wetland Presence — streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the normal
wetted perimeter of assessment reach.
LB RB
�❑ Y Are wetlands present in the streamside area?
-: N N
16. Baseflow Contributors — assessment reach metric (skip for Size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
.8A Streams and/or springs (jurisdictional discharges)
❑B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
❑C Obstruction that passes some flow during low -flow periods affecting assessment reach (ex: beaver dam, bottom -release dam)
:RD Evidence of bank seepage or sweating (iron oxidizing bacteria in water indicates seepage)
❑E Stream bed or bank soil reduced (dig through deposited sediment if present)
❑F None of the above
17. Baseflow Detractors — assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
❑A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
❑B Obstruction not passing flow during low -flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
❑C Urban stream (>_ 24% impervious surface for watershed)
❑D Evidence that the streamside area has been modified resulting in accelerated drainage into the assessment reach
❑E Assessment reach relocated to valley edge
'�RF None of the above
18. Shading —assessment reach metric (skip for Tidal Marsh Streams)
Copsider aspect. Consider "leaf -on" condition.
Stream shading is appropriate for the stream category (may include gaps associated with natural processes)
❑ Degraded (example: scattered trees)
❑C Stream shading is gone or largely absent
ix

19. Buffer Width — assessment area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top of bank out
to the first break.
< 30 feet
Vegetated
Wooded
RB
La RB
LB
RB
❑A
29q ❑A
JA
❑A
Z 100 feet wide or extends to the edge of the watershed
❑B [3B
❑B
❑B
From 50 to < 100 feet wide
❑C ❑C
❑C
ffC
From 30 to < 50 feet wide
❑D ❑D
❑D
❑D
From 10 to < 30 feet wide
❑E ❑E
❑E
❑E
< 10 feet wide or no trees
20. Buffer Structure — streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB RB
A❑A Mature forest
WB Non -mature woody vegetation or modified vegetation structure
❑C ❑C Herbaceous vegetation with or without a strip of trees < 10 feet wide
❑D ❑D Maintained shrubs
❑E ❑E Little or no vegetation
21. Buffer Stressors — streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If no stressors, check here and skip to Metric 22: ❑No Stressors
Abuts
< 30 feet
30-50 feet
LB
RB
LB
RB
LB R
❑A
❑A
❑A
❑A
81A KA
❑B
❑B
❑B
❑B
❑B ❑B
❑C
❑C
❑C
❑C
❑C ❑C
❑D
❑D
❑D
❑D
❑D ❑D
Row crops
Maintained turf
Pasture (no livestock)/commercial horticulture
Pasture (active livestock use)
22. Stem Density — streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LQ RB
�ZA -14�9A Medium to high stem density
❑B ❑B Low stem density
❑C ❑C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer — streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10 feet wide.
Lid, RB,
A E�A The total length of buffer breaks is < 25 percent.
❑B ❑B The total length of buffer breaks is between 25 and 50 percent.
❑C ❑C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition — First 100 feet of streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes to
assessment reach habitat,
LB RQ,
kA A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native species,
with non-native invasive species absent or sparse.
❑B 0 Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or Gearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
❑C ❑C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non -characteristic species or communities inappropriately composed of a single species or no vegetation.
26. Conductivity — assessment reach metric (skip for all Coastal Plain streams)
25a. ,Yes ❑No Was conductivity measurement recorded?
If No, select one of the following reasons. ❑No Water ❑Other:
25b. Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
❑A < 46 [JB 46 to < 67 ]RC 67 to < 79 [JI) 79 to < 230 ❑ E >_ 230
Notes/Sketch:

NC DWn Stream Identification Form Version 4.11 'T'1
Date: j
Projec V�,,A1' Nj,, SDt
atitude:
Evaluator: Oti
County;
Longitude:
Total Points:
Stream is at least intermittent !_i ?
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other
e.g. Quad Mame:
if z 19 or perennial if >_ 30* 1 >
2. Sinuosity of channel along thalweg
0
A. Geomorphology (Subtotal = )
Absent
Weak
MoAerate
Strong
18. Continuity of channel bed and bank
0
1
14. Leaf litter
3
2. Sinuosity of channel along thalweg
0
1
0 0.5
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
V
2
3
4. Particle size of stream substrate
0
es m 3
2
3
5. Active/relict floodplain
0
1
2
1.5
6. Depositional bars or benches
0
1
2
1.5
7. Recent alluvial deposits
0
1
2
8. Headcuts
0
1
2
9. Grade control
0
0.5
1.5
10. Natural valley
0
0.5
1
d_5
11. Second or greater order channel
No = 0
es =
Sketch:
a artificial ditches are not rated; see discussions in manual
R Hvrimloav (Suhtntal = !V )
12. Presence of Baseflow
0 1
2
CO
13. Iron oxidizing bacteria
0 1
2
2
14. Leaf litter
1.5 1i
20. Macrobenthos (note diversity and abundance)
0
15. Sediment on plants or debris
0 0.5
rtJ
1.5
16. Organic debris lines or piles
0 0.5
1
.1
17. Soil -based evidence of high water table?
No = 0
es m 3
1
C' : Rinlnnv fSuhtntal = )
18. Fibrous roots in streambed
2
1
0
19. Rooted upland plants in streambed
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0
0.5
1.5
24. Amphibians
0
1
1.5
25. Algae
0
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5
Ot r =
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:

NC SAM FIELD ASSESSMENT FORM
urarr user imanuai: ivrarcn icww
USAGE AID #: NCDWQ #
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5 -minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same property,
identify and number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User Manual for
detailed descriptions and explanations of requested information. Record in the "Notes" section if supplementary measurements were
performed. See the NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT/SITE INFORMATIO
1. Project name (if any): UQ4p ---ot&Ju` -7 Ak'vlA Date of evaluation: Z Ad 1
3. Applicantiowner name: py1 ; AL,,, 4. Assessor name/organization: 4116 so
5. County: eQ merest named water body
7. River basin: on USGS 7.5 -minute quad: ?,JUS. <ne e�_,
8. Site coordinates (decimal degrees, at lower end of assessment reach): .aL�03g- 1 — SO • 8 Sy
STREAM INFORMATION: (depth and width can be ap roxl wtlons)
9. Site number (show on attached map): h l6o 10. Length of assessment reach evaluated (feet): yz
11. Channel depth from bed (in riffle, if present) to top of bank (feet): /-3 ❑Unable to asses�hannel depth.
12. Channel width at p of bank (feet): !� i3. Is assessment reach a swamp stream? ❑Yes QNo
14. Feature type: Perennial flow ❑Intermittent flow ❑Tidal Marsh Stream
STREAM CATEGORY INFORMATION:
15. NC SAM Zone: []Mountains (M) Piedmont (P) ❑Inner Coastal Plain (1) ❑Outer Coastal Plain (0)
16. Estimated geomorphic
valley shape (skip for ❑a 0 b
Tidal Marsh Stream): (more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip Wze 1 (< 0.1 mit) ❑Size 2 (0.1 to < 0.5 mit) ❑Size 3 (0.5 to < 5 mi) ❑Size 4 (a 5 mi)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION: �
18. Were regulatory considerations evaluated? EI/Yes ❑No If Yes, check all that apply to the assessment area.
❑Section 10 water ❑Classified Trout Waters ❑Water Supply Watershed (❑I (:III ❑III []IV ❑V)
❑Essential Fish Habitat ❑Primary Nursery Area ❑High Quality Waters/Outstanding Resource Waters
❑Publicly owned property ❑NCDWQ riparian buffer rule in effect ❑Nutrient Sensitive Waters
❑Anadromous fish ❑303(d) List ❑CAMA Area of Environmental Concern (AEC)
❑Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
[]Designated Critical Habitat (list species)
19. Are additional stream information/supplementary measurements included in "Notes/Sketch" section or attached? ❑Yes Wo
1. Chanel Water— assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
[fA Water throughout assessment reach.
❑B No flow, water in pools only.
❑C No water in assessment reach.
2. Evidence of Flow Restriction —assessment reach metric
❑A At least 10% of assessment reach in -stream habitat or riffle -pool sequence is severely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impoundment on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates, debris jams,
beaver dams).
B Not
3. Feature Pattern — assessment reach metric
❑/jam A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
[sNot A
4. Feature Longitudinal Profile — assessment reach metric
❑A Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
�,/ these disturbances).
L/B NotA
6. Signs of Active Instability — assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
ag6e bank failure, active channel down -cutting (head -cut), active widening, and artificial hardening (such as concrete, gabion, rip -rap).
A < 10% of channel unstable
❑B 10 to 25% of channel unstable
❑C > 25% of channel unstable
vii

6. Streamside Area Interaction — streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
❑ �. LSA Little or no evidence of conditions that adversely affect reference interaction
❑B Moderate evidence of conditions (examples: berms, levees, down -cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
❑C ❑C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplainlintertidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide
7. Water Quality Stressors — assessment reach/intertidal zone metric
Check all that apply.
❑/ji Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
[�I3 Excessive sedimentation (burying of stream features or intertidal zone)
❑C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
❑D Odor (not including natural sulfide odors)
❑E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in "Notes" section.
El Livestock with access to stream or intertidal zone
❑G Excessive algae in stream or intertidal zone
❑H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc.)
01 Other: (explain in "Notes/Sketch" section)
❑J Little to no stressors
8. Recent Weather — watershed metric (skip for Tidal Marsh Streams)
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
❑A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
UDrought conditions and rainfall exceeding 1 inch within the last 48 hours
C No drought conditions
9. Large orerous Stream — assessment reach metric
❑DaYes No Is stream too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural }1 �-stream Habitat Types — assessment reach metric
10a. QYes ❑No Degraded in -stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in -stream hardening [for example, rip -rap], recent dredging, and snagging)
(evaluate for Size 4 Coastal Plain streams only, then skip to Metric 11)
10b.
Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
❑A
Multiple aquatic macrophytes and aquatic mossesN
❑F 5% oysters or other natural hard bottoms
(including liverworts, lichens, and algal mats) a E
❑G Submerged aquatic vegetation
[1B
Multiple sticks and/or leaf packs and/or emergent o 2'
❑H Low -tide refugia (pools)
vegetation t
Multiple snags and logs (including lap trees) W m
❑I Sand bottom
ED 5% vertical bank along the marsh
D
5% undercut banks and/or root mats and/or roots
❑K Little or no habitat
in banks extend to the normal wetted perimeter
❑E
Little or no habitat
11. Bedforrmm and
Substrate —assessment reach metric
11a.
PYes
❑No Is assessment reach in a natural sand -bed stream? (skip for Coastal Plain streams)
11b.
Bedform
evaluated. Check the appropriate box(es). (skip for Tidal Marsh Streams)
❑ jr
Riffle -run section
[�B
Pool -glide section
❑C
Natural bedform absent (skip to Metric 12, Aquatic Life)
11c.
In riffle sections, check all that occur below the normal wetted perimeter of the assessment reach — whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams). Not Present (NP) _
absent, Rare (R) = present but < 10%, Common (C) _ > 10-40%, Abundant (A) _ > 40-70%, Predominant (P) _ > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP
R C A P
❑
❑ ❑ ❑ Bedrock/saprolite
[(
❑ ❑ ❑ ❑ Boulder (256 — 4096 mm)
[[y
❑ ❑ ❑ ❑ Cobble (64 — 256 mm)
❑
r2r� ❑ ❑ ❑ Gravel (2 — 64 mm)
❑
❑ ❑ ❑Sand (.062 — 2 mm)
❑
El El k, Silt (< 0.062 mm)
❑
❑ [� ❑ ❑ Detritus
[�//
❑ F] E]❑ Artificial (rip -rap, concrete, etc.)
11d.
P es
❑No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
viii

*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS"""'
12. Aquatic kife -
assessment reach metric (skip for Tidal Marsh Streams)
12a. OYes
[:]No Was an in-stream aquatic life assessment performed as described in the User Manual?
If No, select
one of the following reasons and skip to Metric 13. [:]No Water ❑0ther:
12b. HYes
❑No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check all that
apply. If No, skip to Metric 13.
1
>1 Numbers over columns refer to "individuals" for Size 1 and 2 streams and "taxa" for Size 3 and 4 streams.
❑
[Adult frogs
❑
❑Aquatic reptiles
❑
❑Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
❑
❑Beetles (including water pennies)
❑
❑Caddisfly larvae (Trichoptera [T])
❑
❑ ian clam (Corbicula)
❑
ErCrustacean (isopod/amphipod/crayfish/shrimp)
❑
❑Damselfly and dragonfly larvae
❑
❑Dipterans (true flies)
❑
❑Mayfly larvae (Ephemeroptera [E])
❑
❑Megaloptera (alderfly, fishfly, dobsonfly larvae)
❑
❑Midges/mosquito larvae
❑
❑Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
❑
❑Mussels/Clams (not Corbicula)
❑
❑Other fish
❑
❑Salamanders/tadpoles
❑
❑Snails
❑
❑Stonefly larvae (Plecoptera [P])
❑
❑Tipulid larvae
❑
❑Worms/leeches
13. Streamside Area Ground Surface Condition - streamside area metric (skip for Tidal Marsh Streams a B valle
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and upland
runoff.
LB RB
❑A ❑A
Little or no alteration to water storage capacity over a majority of the streamside area
❑B ❑B
Moderate alteration to water storage capacity over a majority of the streamside area
❑C ❑C
Severe alteration to water storage capacity over a majority of the streamside area (examples: ditches, fill, soil
compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area
Water Storage - streamside area metric (skip for Tidal Marsh Streams and valley type
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
❑A ❑A
Unaltered or majority of streamside area with depressions able to pond water >_ 6 inches deep
❑B ❑B
Majority of streamside area with depressions able to pond water 3 to 6 inches deep
❑C ❑C
Majority of streamside area with depressions able to pond water < 3 inches deep
16. Wetland Presence -streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the normal
wetted perimeter of assessment reach.
LB RB
Elly ❑Yi Are wetlands present in the streamside area?
16. Baseflow Contributors - assessment reach metric (skip for Size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
❑A Streams and/or springs (jurisdictional discharges)
❑B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
❑Ci Obstruction that passes some flow during low -flow periods affecting assessment reach (ex: beaver dam, bottom -release dam)
[4j Evidence of bank seepage or sweating (iron oxidizing bacteria in water indicates seepage)
❑E Stream bed or bank soil reduced (dig through deposited sediment if present)
OF None of the above
17. Baseflow Detractors - assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
❑A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
❑B Obstruction not passing flow during low -flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
NC/ Urban stream (>- 24% impervious surface for watershed)
Evidence that the streamside area has been modified resulting in accelerated drainage into the assessment reach
❑E Assessment reach relocated to valley edge
❑ F None of the above
18. Shading - assessment reach metric (skip for Tidal Marsh Streams)
Consi er aspect. Consider `leaf -on" condition.
❑ Stream shading is appropriate for the stream category (may include gaps associated with natural processes)
Degraded (example: scattered trees)
❑C Stream shading is gone or largely absent
ix

19. Buffer Width - assessment area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top of bank out
to the first break.
Vegetated Wooded
LB RB LB RB
❑A ❑ ❑A ❑A 100 feet wide or extends to the edge of the watershed
[1 c HPC-
❑$' From 50 to < 100 feet wide
C C C From 30 to < 50 feet wide
❑D El ❑D ❑D From 10 to < 30 feet wide
L1 ❑E ❑E n < 10 feet wide or no trees
20. Buffer Structure - streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB RB
❑j r_1 A.' Mature forest
l
[� B Non -mature woody vegetation or modified vegetation structure
❑C ❑C Herbaceous vegetation with or without a strip of trees < 10 feet wide
❑D ❑D Maintained shrubs
❑E ❑E Little or no vegetation
21. Buffer Stressors - streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If no stressors, check here and skip to Metric 22: E] No Stressors
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RSB
EIA EIA EIA ❑A ❑t &A Row crops
1113❑B EIB EIB W ❑B Maintained turf
❑C ❑C ❑C ❑C ❑C ❑C Pasture (no livestock)/commercial horticulture
❑D ❑D ❑D ❑D ❑D ❑D Pasture (active livestock use)
22. Stem Density - streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
VALB
&A Medium to high stem density
❑B ❑B Low stem density
❑C ❑C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer - streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10 feet wide.
LB R
E3< A The total length of buffer breaks is < 25 percent.
❑B ❑B The total length of buffer breaks is between 25 and 50 percent.
❑C ❑C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition - First 100 feet of streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes to
assessment reach habitat.
LB RB
❑A ❑A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native species,
� with non-native invasive species absent or sparse.
L'JB B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
❑C ❑C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non -characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductigity - assessment reach metric (skip for all Coastal Plain streams)
25a. 21es F-1 No Was conductivity measurement recorded?
If No, select one of the following reasons. ❑No Water ❑Other:
25b. Check the box corresponding to the conductivity measurement (unfiig of microsiemens per centimeter).
❑A < 46 ❑B 46 to < 67 ❑C 67 to < 79 ZD 79 to < 230 ❑E >- 230
Notes/Sketch:

7S4 - -)A vi;- l
IU!-' DWn CtrPam Trinntifir-nfinn Fnrm Vercinn 4.11 l 'L i ��- 4-G SZA-�I
Date:
Project/ ' t ��
Ptitude: wj%C1t�
Evaluator:
County:
Longitude: -to 18040
Total Points:
Stream is at least intermittent vl
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other
e.g. Quad Name: Q
if >_ f g or Perennial if? 30` J
2. Sinuosity of channel along thalweg
0
A. Geomorphology Subtotal ===U.J
Absent
Weak
Moderate
Strong
18Continuity of channel bed and bank
0
1
2
1.5
2. Sinuosity of channel along thalweg
0
1
2
0.5
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
01
0
©
3
4. Particle size of stream substrate
0
1
®
3
5. Activefrelict floodplain
0
1
1
3
6. Depositional bars or benches
0
CD
2
3
7. Recent alluvial deposits
0
1
1
3
8. Headcuts
0
1
2
9. Grade control
0
0.5
1
Notes:
10. Natural valley
0
0.5
1
11. Second or greater order channel
= 0
Yes = 3
Sketch:
a artificial ditches are not rated; see discussions in manual
R 1- Arnlnnv (q"Kfnfal
M V /
12. Presence of Baseflow
0
1
2 t)
13. Iron oxidizing bacteria
0
1
® 3
14. Leaf litter
1.5
1
0
15. Sediment on plants or debris
0
0.5
6> 1.5
16. Organic debris lines or piles
0
0.5
al .5
17. Soil -based evidence of high water table?
I
No = 0
s =
r, 011nnv !Q. 44nf71 = �& i
18. Fibrous roots in streambed
3
2
0
19. Rooted upland plants in streambed
3
2
1
a>
20. Macrobenthos (note diversity and abundance)
®
1
2
3
21. Aquatic Mollusks
0
n2
3
22. Fish
C63
0.5
1
1.5
23. Crayfish
0
<a)
1
1.5
24. Amphibians
0
CD
1
1.5
25. Algae
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5
Other = 0
•perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2019-00583 County: Iredell U.S.G.S. Quad: NC-Harmonv
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: GreenGo Energv US, Inc
Rene Pretorius
Address: 1447 S. Tryon St., Suite 201
Charlotte, NC 28203
Telephone Number: 704-890-1740
E-mail: n4igreengoenergy.com
Size (acres) 137 Nearest Town Statesville
Nearest Waterway Patterson Creek River Basin Upper Pee Dee
USGS HUC 03040102 Coordinates Latitude: 35.9222
Longitude: -80.8396
Location description: The aroiect area is located 0.477 miles Southeast of the intersection of Josey Road and Churchland Drive
in Iredell County. PIN: 4759650060
Description of projects area and activity: This verification authorizes:
- The temporary impact of 40 linear feet of perennial stream for excavation
- The permanent impact of 82 linear feet of perennial stream for a culvert
Applicable Law(s): ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: NWP 12. Utility Line Activities
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the enclosed
Conditions, your application signed and dated 2/19/2019, and the enclosed plans Figure 2 dated 6/6/2017 (Revised 05/17/2019).
Any violation of the attached conditions or deviation from your submitted plans may subject the permittee to a stop work order,
a restoration order, a Class I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified, suspended
or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or modified, this
verification will remain valid until the expiration date identified below, provided it complies with all requirements of the modified
nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the activity would
no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are under construction)
or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the activity is completed
within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless discretionary authority has
been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA), prior
to beginning work you must contact the N.C. Division of Coastal Management Morehead City, NC, at [phone].
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory program,
please contact Catherine M. Janiczak at 704-510-1438 or Catherine.M.Janiczakna,usace.army.mil.
Corps Regulatory Official �Ja�� 7g. Qa��Q�i Date: 06/10/2019
Expiration Date of Verification: 03/18/2022

The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete the Customer Satisfaction Survey located at
http://corpsmapu.usace.army.mil/cm_apex/f?p=136:4:0
Copy furnished:
Agent: EnviroTrac Ltd.
Christopher Hay
Address: 7343 West Friendly Avenue, Suite J
Greensboro, NC 27410
Telephone Number: 336-763-6025
E-mail: christopherh(&envirotrac.com

Action ID Number: SAW-2019-00583County: Iredell
Permittee: GreenGo Energy US, Inc, Rene Pretorius
Project Name: Paul Tomlin Mill Solar
Date Verification Issued: 06/10/2019
Project Manager: Catherine M. Janiczak
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: Catherine M. Janiczak
Charlotte Regulatory Office
U.S Army Corps of Engineers
8430 University Executive Park Drive, Suite 615
Charlotte, North Carolina 28262
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee Date

SAW -2019-00583
Determination of Jurisdiction:
A. ® There are waters on the above described project area that may be subject to Section 404 of the Clean Water Act (CWA) (33
USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). This preliminary determination is not an
appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part 331). However, you
may request an approved JD, which is an appealable action, by contacting the Corps district for further instruction. Please note, if
work is authorized by either a general or nationwide permit, and you wish to request an appeal of an approved JD, the appeal must
be received by the Corps and the appeal process concluded prior to the commencement of any work in waters of the United States
and prior to any work that could alter the hydrology of waters of the United States.
B. ❑ There are Navigable Waters of the United States within the above described project area subject to the permit requirements of
Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act (CWA) (33 USC §
1344). Unless there is a change in the law or our published regulations, this determination may be relied upon for a period not to
exceed five years from the date of this notification.
C. ❑ There are waters within the above described project area that are subject to the permit requirements of Section 404 of the
Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published regulations, this determination
may be relied upon for a period not to exceed five years from the date of this notification.
D. ❑ The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued DATE. Action ID: FILE NUMBER.
Basis For Determination: See the preliminary jurisdictional determination form dated 06/10/2019.
Remarks: None.
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination may not be valid for the wetland conservation provisions of the Food Security
Act of 1985. If you or your tenant are USDA Program participants, or anticipate participation in USDA programs, you should request
a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work.
F. Appeals Information ('Phis information applies only to approved jurisdiction determinations as indicated in B and C
above).
This correspondence constitutes an approved jurisdiction determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this determination you
must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1OM15
Atlanta, Georgia 30303-8801
Phone: [phone]
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by Not applicable.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
Corps Regulatory Official:
Catherine M. Ja czak
Date of JD: 06/10/2019
Expiration Date of JD:Not applicable

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: GreenGo Ener US Inc Rene Pretorius File Number: SAW -2019-00583 Date: 06/10/2019
Attached is: See Section below
❑ INITIAL PROFFERED PERMIT Standard Permit or Letter of ermission A
❑ PROFFERED PERMIT Standard Permit or Letter ofpermission) B
❑ PERMIT DENIAL C
F-11 APPROVED JURISDICTIONAL DETERMINATION D
M1 PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.army.mil/Missions/CivilWorks/Re ug latoryProgramandPertnits.aspx
or the Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.

SECTION 11- REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division
Mr. Jason Steele, Administrative Appeal Review Officer
Attn: Catherine M. Janiczak
CESAD-PDO
Charlotte Regulatory Office
U.S. Army Corps of Engineers, South Atlantic Division
U.S Army Corps of Engineers
60 Forsyth Street, Room 10M15
8430 University Executive Park Drive, Suite 615
Atlanta, Georgia 30303-8801
Charlotte, North Carolina 28262
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportunito participate in all site investigations.
Date:
Telephone number:
Signature of appellant oragent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: Catherine M. Janiczak, 69 Darlington Avenue, Wilmington, North
Carolina 28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Administrative Appeal
Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 06/10/2019
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: GreenGo Energy US, Inc, Rene Pretorius, 1447 S.
Tryon St., Suite 201,Charlotte, NC 28203
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District, Paul Tomlin Mill Solar, SAW -
2019 -00583
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The project area is located 0.477 miles
Southeast of the intersection of Josey Road and Churchland Drive in Iredell County. PIN: 4759650060
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County: Iredell City: Statesville
Center coordinates of site (lat/long in degree decimal format): Latitude: 35.9222 Longitude: -80.8396
Universal Transverse Mercator:
Name of nearest waterbody: Patterson Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
® Field Determination. Date(s): 05/16/2019
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Estimated amount of
Geographic authority to
Type of aquatic
aquatic resources in
which the aquatic resource
Latitude (decimal
Longitude (decimal
resources (i.e.,
"may
Site Number
degrees)
degrees)
review area (acreage
wetland vs. non -
be" subject (i.e.,
and linear feet, if
Section 404 or Section
applicable
wetland waters)
10/404)
T1
35.919504
-80.840628
1690 linear feet
Non -wetland
Sec. 404
T2
35.919095
-80.840548
942 linear feet
Non -wetland
Sec. 404
T3
35.916923
-80.838386
134 linear feet
Non -wetland
Sec. 404
Patterson
35.922330
-80.835811
632 linear feet
Non -wetland
Sec. 404
Creek

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in the review
area, and the requestor of this PJD is hereby advised of his or her option to request and obtain an
approved JD (AJD) for that review area based on an informed decision after having discussed the
various types of JDs and their characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a Nationwide General
Permit (NWP) or other general permit verification requiring "pre- construction notification" (PCN), or
requests verification for a non -reporting NWP or other general permit, and the permit applicant has
not requested an AJD for the activity, the permit applicant is hereby made aware that: (1) the permit
applicant has elected to seek a permit authorization based on a PJD, which does not make an official
determination of jurisdictional aquatic resources; (2) the applicant has the option to request an AJD
before accepting the terms and conditions of the permit authorization, and that basing a permit
authorization on an AJD could possibly result in less compensatory mitigation being required or
different special conditions; (3) the applicant has the right to request an individual permit rather than
accepting the terms and conditions of the NWP or other general permit authorization; (4) the applicant
can accept a permit authorization and thereby agree to comply with all the terms and conditions of that
permit, including whatever mitigation requirements the Corps has determined to be necessary; (5)
undertaking any activity in reliance upon the subject permit authorization without requesting an AJD
constitutes the applicant's acceptance of the use of the PJD; (6) accepting a permit authorization (e.g.,
signing a proffered individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a PJD constitutes agreement that all aquatic resources in the review area
affected in any way by that activity will be treated as jurisdictional, and waives any challenge to such
jurisdiction in any administrative or judicial compliance or enforcement action, or in any
administrative appeal or in any Federal court; and (7) whether the applicant elects to use either an AJD
or a PJD, the JD will be processed as soon as practicable. Further, an AJD, a proffered individual
permit (and all terms and conditions contained therein), or individual permit denial can be
administratively appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic jurisdiction exists over
aquatic resources in the review area, or to provide an official delineation of jurisdictional aquatic
resources in the review area, the Corps will provide an AJD to accomplish that result, as soon as is
practicable. This PJD finds that there "may be" waters of the U.S. and/or that there "may be"
navigable waters of the U.S. on the subject review area, and identifies all aquatic features in the
review area that could be affected by the proposed activity, based on the following information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources below where
indicated for all checked items:
® Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: Figure 2 (Dated 07/06/2017 [Revised 05/17/2019])_
® Data sheets prepared/submitted by or on behalf of the PJD requestor.
® Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
® USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: Harmony
❑ Natural Resources Conservation Service Soil Survey. Citation:
® National wetlands inventory map(s). Cite name: USFWS Wetlands Mapper website_
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100 -year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
® Photographs: ®Aerial (Name & Date): Iredell Co. GIS 2017
or ❑Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily been
verified by the Corps and should not be relied upon for later jurisdictional determinations.
7e. Q"401 aolg
Signature and date of P&4ulatoro
staff member completing PJD
06/10/2019
Signature and date of person requesting PJD
(REQUIRED, unless obtaining the signature is
impracticable) t
1 Districts may establish timeframes for requester to retum signed PJD forms. If the requester does not respond within the
established time frame, the district may presume concurrence and no additional follow up is necessary prior to finalizing an
action.

a
61-
>* 941 t
APPROXIMATE TOTAL SITE ACREAGE: 137 ACRES
SOURCES: GREENGO DEVELOPMENT PLAN, DP -001 DATED FEBRUARY 28,
FIGURE
EXISTING PROPERTY LINE
2019. ]BEDELL COUNTY GIS 2017 AERIAL PHOTOGRAPH.
ENVIRONMENTAL FINDINGS MAP
EXISTING RIGHT OF WAY
APPROXIMATE TOTAL JURISDICTIONAL RPW
PERMANENT SECURITY FENCE
TRIBUTARIES: 2,766 LINEAR FEET
200 0 2W ,aD
nviro ra
3045 TOMLIN MILL SOLAR, LLC -SITE 1045
PROPOSED SOLAR ARRAY
Environmental SaMCas
712 TOMLIN MILL ROAD
OVERHEAD POWER LINE — ^^—
"PROAMATE SCALE IFEEt7
STATESVILLE, NORTH CAROLINA
`^^^^—
POPOSED UTILITY POLE J
SCALE: AS SHOWN
_._._. _. _
_ ------
STREAM ---"'
NOTE: THIS MAP IS NOT FOR CONSTRUCTION OR ZONING AND DOES NOT
]343 W. FRIENDLY AVENUE, SUITEI
REVISED BY: AB
DRAWN BY: GGH
APPROVED BY:
STREAM FLAG LOCATION aS_1
INCLUDESETBACKS, BUFFERS, AND OTHER PARAMETERS.
GREENSBORO, NORTH CAROLINA
DATE: DS/i]/19
DATE:07/06/1]
[WH
P1101ER NO: 11.990087.00