20130680 Ver 1_401 Application_20130713

20130680
Mitchell Environmental. P.A.
PRE- CONSTRUCTION NOTIFICATION APPLICATION
for
GLENCROFT TOWNHOMES
WAKE COUNTY, NORTH CAROLINA
Submitted to:
US Army Corps of Engineers
3331 Heritage Trade Drive - Suite 105
Wake Forest, NC 27587
and � 1
NC Division of Water Quality -�
WBSCP Unit
512 North Salisbury Street
Raleigh, NC 27601
Prepared for:
Cary Glen LLC
Mr. J.G. Loftin, Jr.
8310 Bandford Way
Raleigh, NC 27615 -2752
Prepared by:
Scott Mitchell, PE, LSS
DATE: July 1, 2013
PROJECT NO.: 0912
I-EMRE.0- e�2013
PO Box 341 Fuquay- Varina, North Carolina 27526
Ofjrce: 919 - 557 -4682 Fax: [phone]
P

PCN

Mitchell Environmental, P.A.
July 1, 2013
Mr. David Shaeffer Ms. Jennifer Burdette
US Army Corps of Engineers Division of Water Quality
Raleigh Regulatory Field Office WBSCP Unit
3331 Heritage Trade Drive, Suite #105 512 North Salisbury Street
Wake Forest, NC 27587 Raleigh, NC 27601
Re: Glencroft Townhomes Subdivision Pre - Construction Notification Application
Cary, NC - Wake County
Dear Mr. Shaeffer and Ms. Burdette:
Attached is a complete PCN Application package and Jurisdictional Determination for the
proposed Glencroft Townhomes Subdivision. Glencroft Townhomes is located on Cary Glenn
Road just south of Carpenter Fire Station Road in Cary, NC. This site is located in Wake County
(PIN.- 0735 -03- 5058). The 25.89 acre site will be developed into a residential subdivision for 150
townhomes.
Proposed impacts to jurisdictional areas of this site include two road crossings on two different
stream channels as shown on the attached maps. Stream impacts total 148 linear feet. Impacts to
jurisdictional areas have been minimized to the maximum extent practicable. The road system has
been designated to cross each channel at a perpendicular angle and located so as to minimize the
amount of fill needed to cross the stream valleys. Custom headwalls and endwalls will be
constructed in order to minimize impacts, as well.
Do not hesitate to call me if you have any questions or concerns regarding the attached PCN
Application or if you need any additional information. Thank you.
Sincerely,
G
Scott Mitchell, PE, LSS O0
Keely Lane
PO Box 341 Fuguay- Varina, North Carolina 27526
0ffice: 919 -557 -4682 Fax: 919 - 557 -4683
ol- 2b1?✓

ot WA 229
c
o �
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps:
® Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number.
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes ® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f. Is payment into a mitigation bank or in4leu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑Yes ®No
1 h. is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ® No
2. Project Information
2a. Name of project:
Glencroft Townhomes
2b. County:
Wake
2c. Nearest municipality / town:
Cary
2d. Subdivision name:
Glencroft Townhomes
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
Cary Glen LLC
3b. Deed Book and Page No.
15144, 1579
3c. Responsible Party (for LLC if
applicable):
J.G. Loftin, Jr.
3d. Street address:
8310 Bandford Way
3e. City, state, zip:
Raleigh NC, 27615 -2752
3f. Telephone no.:
(919) 870 -9711
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 ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
S. Agent(Consultant Information (if applicable)
5a. Name:
Scott Mitchell
5b. Business name
(if applicable):
Mitchell Environmental, PA
5c. Street address:
1501 Lakestone Village Lane Suite 205
5d. City, state, zip:
Fuquay- Vadna, NC 27526
5e. Telephone no.:
919 - 557 -4682
5f. Fax no.:
919 - 557 -4683
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):
10735036058
1b. Site coordinates (in decimal degrees):
I Latitude: 35.877639 Longitude: - 78.787472
1c. Property size:
25.89 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
UT to Panther Creek
2b. Water Quality Classification of nearest receiving water.
WS -IV, NSW
2c. River basin:
Cape Fear
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 site is moderately to heavily wooded with relief of approximately 58 feet. The site Is bordered on the west by an existing apartment complex, and
by undeveloped wooded areas to the north, south, and east. The central/southeast comer portions of the site slope downward toward a drainage
feature used primarily for surface water runoff, which bisects the site from the southwestem comer to the northeastem comer.
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: 1,245
3d. Explain the purpose of the proposed project:
Development of attached residential dwelling subdivisions.
3e. Describe the overall project in detail, including the type of equipment to be used:
Project will provide 150 single family attached homes on a currently undeveloped property. All equipment used will be common construction machinery
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
ro'ect (including all 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 jurisdictional areas?
Name (if known):
Agency /Consultant Company:
I Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
S. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Yes ®No ❑Unknown
5b. If yes, explain in detail according to 'help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
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 ® 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
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
-
UV3 -
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:
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 P
Fill
UT1 - Panther Creek
INT
DWQ
4.5
97
S2 P
Fill
UT2 - Panther Creek
INT
DWQ
4.5
51
S3 -
Choose one
S4 -
Choose one
-
-
S5 -
Choose one
_
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
148
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 individually list all open water impacts below.
4a.
Open water
Impact number
Permanent (P) or
Temporary
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
O4 -
Choose one
Choose
4f. Total open water impacts
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.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
I Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
Si. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
If project will impact a protected riparian buffer, then complete the chart below. if yes, then individually list all buffer impacts
below. If any impacts require mitt ation 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
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet )
6g.
Zone 2
impact
(square
feet
B1 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
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.
To minimize proposed impacts custom headwalls and endwalls will be constructed.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Headwalls and endwalls will be taller than normal.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
proles
❑ Mitigation bank
❑Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete N Using a Mitloation 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 Makina a Payment to In4lou 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 Pennifte 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?
0 Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
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 ® 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?
40.4%
2b. Does this project require a Stormwater Mana ement Plan?
® Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
There will be 8 stormwater BMPs constructed to handle the stormwater from this property. The Town of Cary will review the plan and submit it to the
DWQ for issuance.
2e. Who will be responsible for the review of the Stormwater Management Plan?
Town of Cary
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this roject?
Town of Cary
❑ Phase II
3b. Which of the following locally - implemented stormwater management programs
❑ NSW
USMP
apply (check all that apply):
® Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
[]Yes ® No
attached?
4. DWQ Stormwater Program Review
❑Coastal counties
❑HOW
4a. Which of the following state - implemented stormwater management programs apply
ORW
(check all that apply):
HSession Law 2006 -246
[]Other
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
S. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
® Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
® Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes
® No
use of public (federaUstate) land?
1 b. If you answered "yes° to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.)
❑Yes
No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑Yes
® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application?
❑Yes
® No
2c. If you answered 'yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes
® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
We do not anticipate an increase in development from the creation of this subdivision.
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 facil'
Wastewater generated by this site will be collected, conveyed, and treated by & Town of Cary's wastewater treatment system.
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 ® 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.
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
North Carolina Natural Heritage Program
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes © No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
North Carolina Natural Heritage Program
T. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
North Carolina State Historic Preservation Offioe (http: //www.hpo.ncdcx.gov�
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA - designated 100 -year floodplain?
❑ Yes © No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
North Carolina Flood Maps (http: //www.ncffoodmaps.com)
Scott Mitchell
07-01 -2013
Applicant/Agents Printed Name
Applicant/Agenrs Signature
Date
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)
Page 10 of 10

MAPS:
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PIN
0735035058
Real Estate ID
0029356
Map Name
073503
Owner
SEYMOUR, THOMAS E HATCHER, SIDNEY
M
Mailing Address 1
PO BOX 177
Mailing Address 2
APEX NC 27502 -0177
Mailing Address 3
Deed Book
14037
Deed Page
2298
Deed Date
8/17/2010
Deeded Acreage
25.89
Assessed Building
Value
$0.00
Assessed Land Value
$3,077,250.00
Total Assessed Value
$3,077,250.00
Billing Class
INDIVIDUAL
Property Description
SIDNEY W SEYMOUR JR ET AL
BM2003 -02276
Heated Area
Site Address
0 CARPENTER FIRE STATION RD
City
Township
WHITE OAK
Year Built
0
Total Sale Price
$0.00
Sale Date
Type and Use
Design Style
Land Class
FLORICULTURE -FARM
Old Parcel Number
454—
or
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COUNTY
NORTH CAROLINA

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TOWN OF CARY
CONCURRENCE

August 8, 2012
Scott Mitchell, PE, LSS
Mitchell Environmental, P.A.
P.C. Box 341
Fuquay- Varina, NC 27526
Subject: Jordan Lake Watershed - Urban Transition Buffer Rules
Seymour /Hatcher Tract (Forever Home, LLC)
0 Carpenter Fire Station Rd (Real ID: 0029356)
TCRB 12-006
Dear Mr. Mitchell:
ENGINEERING DEPARTMENT
The site location map and other information that was provided, allowed a determination to be made as
to whether or not the referenced site would require compliance with The Town of Cary Urban Transition
Buffer (UTB) Rules. This project is referenced by the Town of Cary as TCRB 12-006 and includes three
channels depicted on the Soil Survey Map. The table below summarizes the stream determinations
made in a site visit on April 4, 2012. This determination is valid until April 4, 2017.
Reference ID
USGS Ma 100 Ft. Buffer
Soil Survey Ma 50 Ft. Buffer
Not Subject
Channel A
x
Channel B
x
Channel C
x - Begin at Flag #WF 5006
Sincerely,
'94-
Patterson
Town of Cary Engineering Department
TOWN Of CARY
318 North Academy Street -Cary, NC 27513 -PO Box 8005 -Cary, NC 27512 -8005
tel [phone] fax 919- 460 - 4935 - www.townofcary.org

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IMPACT
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NOTES:1) SURVEY INFORMATION do WETLAND MAPPING PERFORMED BY
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AGENT
AUTII,s
FORM

Mitchell Environmental, P.A.
AGENT AUTHORIZATION FORM
ALL BLANKS TO BE FILLED IN BY CURRENT LANDOWNER
Name: J.G. Loftin, Jr.
Address: 8310 Bandford Way
Raleigh, NC 27615 -2752
Phone: [phone]
Project Name/Description: Glencroft Townhomes
Date: March 25, 2013
The Department of the Army
US Army Corps of Engineers
Wilmington District
PO Box 1890
Wilmington, NC 28402 -1890
Attn: David Shaeffer
Field Office: Raleigh Regional
Re: Wetlands Related Consulting & Permitting
To Whom It May Concern:
I, the current property owner, hereby designate and authorize Mitchell Environmental, P.A., to act on
my behalf as my agent in the processing of permit applications, to furnish upon request supplemental
information in support of applications, etc., from this day forward. This the 25th day of
March, 2013
This notification supercedes any previous correspondence concerning the agent for this p 'ect.
67, Lo r-riAl
PRINT Owner's Name PRO TY Owner's S ature
Cc: NCDENR — Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
PO Box 341 Fuquay Varina, North Carolina 27526
Office: 919 - 5574682 Fax: 919 - 5574683

JD FORM

F41-9 111 ;
Approved JD Form

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTTON I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: North Carolina County/parish/borough: Wake City: Garner
Center coordinates of site (lat/long in degree decimal format): Lat. 35.9° N_ , Long. -78.8° W.
Universal Transverse Mercator:
Name of nearest waterbody: UT to Panther Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Panther Creek
Name of watershed or Hydrologic Unit Code (HUC): Cape Fear
® Check if map /diagram of review area and/or potential jurisdictional areas is/are available upon request.
❑ Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Pick List "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required)
❑ Waters subject to the ebb and flow of the tide.
❑ Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply):'
❑ TNWs, including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
❑ Non -RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non - wetland waters: 1245 linear feet: 4.5 width (R) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: Pick List
Elevation of established OHWM (if known):
2. Non - regulated waters/wetlands (check if applicable):3
❑ Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
Boxes checked below shall be supported by completing the appropriate sections in Section III below.
2 For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year -round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
Supporting documentation is presented in Section M.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section HLA.1 and Section ULD.I. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections ID.A.1 and 2
and Section III.D.i.; otherwise, see Section HLB below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non - navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year -round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year -round
(perennial) flow, skip to Section HI.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section M.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody' is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section IH.B.1 for
the tributary, Section HLB.2 for any onsite wetlands, and Section I I.B.3 for all wetlands adjacent to that tributary, both onsite
and olfsite. The determination whether a significant nexus exists Is determined in Section IIILC below.
1. Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 20 acres
Drainage area: 8 acres
Average annual rainfall: 42 inches
Average annual snowfall: 7 inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
® Tributary flows directly into TNW.
❑ Tributary flows through Pick List tributaries before entering TNW.
Project waters are 1(or less) river miles from TNW.
Project waters are Pick List river miles from RPW.
Project waters are 1(or less) aerial (straight) miles from TNW.
Project waters are Pick List aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW':
Tributary stream order, if known:
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
' Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TKW.

(b) General Tributary Characteristics (check all that =W:
Tributary is: ® Natural
❑ Artificial (man - made). Explain:
❑ Manipulated (man - altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: 4.5 feet
Average depth: 1 feet
Average side slopes: Vertical (1:1 or less).
Primary tributary substrate composition (check all that apply):
® Silts ® Sands ❑ Concrete
❑ Cobbles ® Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks). Explain: Stable.
Presence of run/riiile/pool complexes. Explain: Riffle pool complexes were observed.
Tributary geometry: Relatively straight
Tributary gradient (approximate average slope): 0 -3 %
(c) Flow:
Tributary provides for: Intermittent but not seasonal flow
Estimate average number of flow events in review area/year: 20 (or greater)
Describe flow regime:
Other information on duration and volume:
Surface flow is: Discrete and confined. Characteristics:
Subsurface flow: Unknown. Explain findings: No studies
completed.
❑ Dye (or other) test performed:
Tributary has (check all that apply):
® Bed and banks
® OHWM6 (check all indicators that apply):
® clear, natural line impressed on the bank
®
the presence of litter and debris
® changes in the character of soil
®
destruction of terrestrial vegetation
® shelving
®
the presence of wrack line
® vegetation matted down, bent, or absent
®
sediment sorting
® leaf litter disturbed or washed away
®
scow
® sediment deposition
❑
multiple observed or predicted flow events
® water staining
®
abrupt change in plant community
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
❑ High Tide Line indicated by: ❑ Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other (list):
(ill) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
6A natural or man -made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average width): Forested, 100+ ft.
❑ Wetland fringe. Characteristics:
® Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
® Aquatic/wildlife diversity. Explain findings: Wildlife Habitat.
2. Characteristics of wetlands adjacent to non -TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain:
Wetland quality. Explain:
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non -TNW:
Flow is: Pick List. Explain:
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non -TNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the Pick-L- i-s-t floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation typelpercent cover. Explain:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aquatic /wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any) _
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

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

Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 1245 linear feet 4.5 width (ft).
❑ Other non - wetland waters: acres.
Identify type(s) of waters:
3. Non -RPWs8 that flow directly or indirectly into TNW9.
❑ Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section HI.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non - wetland waters: acres.
Identify type(s) of waters:
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
❑ Wetlands directly abutting an RPW where tributaries typically flow year - round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
❑ Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section III.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs.
❑ Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
❑ Demonstrate that impoundment was created from "waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA- STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
❑ Other factors. Explain:
Identify water body and summarize rationale supporting determination:
%ce Footnote # 3.
To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
t0 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps1EPA Mwwiandam Regwi ft CWA Ad Jarlsdlcdon Following Rwanos.

Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non - wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
F. NON - JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
❑ If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
❑ Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
❑ Other: (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
Non - wetland waters (i.e., rivers, streams): linear feet width (ft).
❑ Lakes/ponds: acres.
❑ Other non - wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
❑ Non - wetland waters (i.e., rivers, streams): linear feet, width (ft).
❑ Lakes/ponds: acres.
❑ Other non - wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply -chocked items shall be included in case file and, where checked
and requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant:
® Data sheets prepared/submitted by or on behalf of the applicant/consultant.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name:
® USDA Natural Resources Conservation Service Soil Survey. Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/F1RM maps:
❑ 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Applicable/supporting case law:
❑ Applicable/supporting scientific literature:
❑ Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD: