This micro will take you to the very beginning of the Middle Island Creek. From Wikipedia:
Middle Island Creek is a river, 77 miles (124 km) long, in northwestern West Virginia in the United States. It is a tributary of the Ohio River, draining an area of 565 square miles (1,463 km²) on the unglaciated Allegheny Plateau. It is the longest stream in West Virginia to be named a "creek." The stream is named for Middle Island, which is located in the Ohio River at its mouth.
Middle Island Creek is formed at the community of Smithburg in Doddridge County by the confluence of Meathouse Fork and Buckeye Creek. It flows generally northwestwardly in a highly meandering course through Doddridge and Tyler Counties, past the towns of West Union and Middlebourne. From Middlebourne the creek turns to the southwest and flows roughly parallel to the Ohio River (excepting its numerous bends) as it enters Pleasants County, where it joins the Ohio in St. Marys. The lowermost 12 miles (19 km) of the creek are inundated by backup from the Willow Island Locks and Dam downstream on the Ohio River.
Cache is located just off of the very well maintained North Bend Rail Trail. Take time to enjoy the trail as well as the several caches placed on or near.
Best parking is just north of US Route 50. Trail can be accessed from there. Your GPS might try to tell you to park at a wide spot where tractor-trailers park very near the cache...don't do it - it's a trick. You'll see when you get to the cache site.
Cache is a painted preform, hidden in a very normal way. Confluence is easily visible from this location.
Congratulations to MEKABoyer for the FTF!