HomeMy WebLinkAbout20140717 Ver 1_401 Application_20140714O�OF W A r4�9�G
2 0 1 4 0 7 1 7
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
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
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes
® No
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Roten Project
2b.
County:
Ashe
2c.
Nearest municipality / town:
West Jefferson
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state
project no:
N/A
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Michael Dean Roten
3b.
Deed Book and Page No.
Deed Book 192, page 631
3c.
Responsible Party (for LLC if
applicable):
Michael Dean Roten
3d.
Street address:
5272 Highway 16 North Lot 1
3e.
City, state, zip:
Crumpler NC 28617
3f.
Telephone no.:
336- 982 -3307
3g.
Fax no.:
3h.
Email address:
mr300mag @yahoo.com
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
-licani,
"X'Af 6LOea—b7-bq47NI."(F"
ff�djffer t-_fr6m-,6rn6rj
.4 b7--,
me
Tom Davis
4'-,BIu5QI�raQE- -
L c pi siness-name
f I a I MI'l)_
NAA
Lt--_We_eMd�C:ejs'
?iATS 5`d:
573 John Griffith Road
246 Kf5ijt'
yC,A?a'tIp-
Lansing NC 28643
,4_f Ulep e n�
336-384-4135
4g Fax no
N/A
rh, AW Fa I CF W-d _Fksl-'
Cni-dfii—s sky--at-o
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5a Name
5b Business name
(if applicable)
5c Street address
5d City, state, zip
5e Telephone no
5f Fax no
5g Email address
Page 2 of 11
Page 3of11
PCN Form - Version 1 3 December 10, 2008 Version
1 Property Identification
la Property identification no (tax PIN or parcel ID)
10076-016
itMrs
T�tb
East Roaring Fork
2b Water Quality Classification of nearest receiving water
C,Tr,ORW
�Riv'i-,0N6'rsih:—VW 00T
3. Project Description
Kist'Ln"gTLcy,niliti—C,n-ti-c�-'n F`31
Ta
The project site is located in a rural area, with mainly Christmas tree farming and some residential The property is
located on Roaring Fork Road, approximately 1 5 mile from the intersection of NC Hwy 88 and Roaring Fork Road The
owner would like to place,& culvert in EastRoaring Fork branch to access a home that-will placed in a open field just west
of the stream
The owner would like to place a culvert in East Roaring Fork branch to access a home that will placed in a open field just
west of,the stream
ect =in
A 30' long culvert1with a diameter of 4' will be placed by a small track hoe i - n East Roaring Fork branch to access,said
home The culvert will be buried 0 5 feet into the bottom of the,stream, so that all stream aquatics can pass up and down
stream unimpaired A silt fence will be placed at the bottom of all fill slopes to prevent any runoff that may occur until
vegetation is,established
4 Jurisdictional Determinations
.Let_drm7i-h5t(6h,W6s-m d6?,
!Ca
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ERA
Page 3of11
PCN Form - Version 1 3 December 10, 2008 Version
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Page 4 of 11
C. Proposed Impacts Inventory
1, Impacts Summary
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El DWQ
W3 [:1 P F� T
El Yes
[:1 Corps
El No
[:1 DWQ
W4 0 P F�j
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0 Corps
E] No
[:1 DWQ
W5 MPFT
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El 6orps
El No
DWQ
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East Fork Roaring
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31 Comments
Page 5 of 11
4` IV Water hm ac st
Ifthe e_are�proposedimpacts to lakespondsesti as�t�ibutanes, sounds the Atlantic,Oceanort.any other open wat re of
tlie�U�S �thenridwiduall ist�3alho en w t ��m actsb'�elow`�
4a
4b
4c
4d
4e
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P
04 ❑P
z� -�.
,4fTot. algenw,aterimpacts
'o
0
4g Comments,,
5 POrld or L� ake C- rZ ruct of n
Ifs and or lake construction `'ro ed theri "com letetthe chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
_
(acres)
number
of pond
Flooded
"
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f� tal
-
CM
M
0
-
5g Comments
5h Is a dam high hazard permit required
❑ Yes ®No If yes, permit ID no
51 Expected pond surface'area (acres)
51 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
❑ Neuse ❑ Tar-Pa mlico El Other
Project is in which protected'basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number -
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet),
Temporary T
impact
required?
B1 ❑P ❑T
El Yes
❑ No
-
B2 ❑P ❑T
El Yes
❑ No
B3 ❑ P ❑ T
❑ Yes
❑ No
6h Total buffer impacts
0
61 Comments
Page 6 of 11
D I,mpact:Justi icf ationand Mitig tia on
�1:Avoidanceandl Minimiiation
,gcifcally describe em asures taken t_osavoitl or minim a the proposed ripacts mdesigrnng2protect1
The culvert will be buried 0 5 feet into the bottom of the stream, ,so that all stream aquatics can pass up and down stream
unimpaired A silt fence will be placed at,the bottom of all fill slopes to prevent any runoff that,may occur until vegetation
is established
"u"�l1$^ w�"�'T '� F"R df%T"r-
b Specifically descnbemeasurestaken to avoid or mmimizethegproPosedimpactsthrough�constructionaechniques
During construction, equipment will not access the stream For this project, it is anticipated that all of the track hoe,work
can be accomplished from the top of1the bank Soil disturbance will be limited to what can be seeded and stabilized in
one day Banks will be seeded and coir matting will be, placed and anchored with wooden stakes Flat areas will be
seeded and covered with straw
2 ",Cmp satory Mitigation- for'Impa ts�to Waters of'ttie U S. or Waters of the State
®Yes ® No
2a -Des th pro ear _equireCompnsa�toryMitigatonfo
rnpa� ctsto Watersof tleUSor,Waters oftheState�?,
2b If yes, mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
R9 j! anon bank
2c If yes,,p h-, mitigat o so tion will be used or th s
- �P
t: - -- -- �
®Payment toinwliefeearp�ogram
prole, ct
❑ Perrmittee Responsib ee Mitigation
3 Complete �f s rig .WMitig fl &n:6
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4 Completeif_M =king P maymay e t t_o ln= lienFee rogue m
4a Approval letter from in- lieu,fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation, stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non - riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres,
4h Comments
Page 7 of 11
PCN Form — Version 1 3 December 10, 2008 Version
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? If'yes, you will have to fill out this entire form — please
contact the.State,for more information
E:1 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'8 of 11
E
Stormwater Management and,Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1a
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
lb
If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes ❑ No
Comments
2
Stormwater Management Plan
2a
What'is the overall percent imperviousness of this project?
2b
Does,this project require a�Stormwater Management 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 prowde,a brief, narrative description of the plan
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ_401 Unit
3.
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this project?
❑ Phase II
❑ NSW
3b
Which of'the following Ibcally- 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
❑ 0 R
(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?
❑ Yes ❑ No
Page 9 of 11
PCN Form —Version 1 3, December 10, 2008 Version
F.
Supplementary Information
1-
Environmental Documentation (DWQ Requirement)
�1 a
Does -the project involve an expenditure of public (federal /state_ /local) funds or the
❑ Yes ® No
use of public (federal /state) land?
lb
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
❑`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 (1'5A NCAC 2H 1300), DWQ Surface Water of Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2blsthis�anfafter ,�the�;factermit application';
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
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,
Page 10 of 11
PCN Form — Version 1 3 December 1'0, 2008 Version
S. 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 USFW&concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c If yes, indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat ?,
US;Fish and Wildlife Service website hftp / /www fws gov /nc- es /es /countyfr html
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
,http //ocean flondamarine org /efh= coral /ims /viewer htm
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 ® 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?
National Register of Historic Places athttp / /www hpo ncdcr gov /nrlist htm
8� FlootlZone .Designation�,(Corps�Regtiir
8a` Wdlahisprotectroccur mMa�FEMA -desi nated,100- ear4 flood
F 9� Yrp
®ryes® N�o
8b �If yesplam"�h w pro�t meets�F�EMArequirem nts�_
8c'�Whatsou cr e(s tlid you a eto�make�theafloo '�d�lain�determmation
Tom Davis
July 3rd 2014
�...:a
C - - - 2 TT °i PT ?b '�f
A licant/Ag_ -V,s Pr nteN,- ame
R
Date
i'�i t s+a» `�a� M 5 $
Applicant/Agent s Slgmature
(Agents "ignatus�valid onlyrif an authorization letterfrom "dthe�apph� c _ant
is, rovided1`
Page 11 of 11
I, designate Tom Davis of Davis Consulting to act
as my duly authorized agent concerning all US Army Corps of Engineers and NC
DENR permitting regarding th_e culvert placement project on my property in
� e_ County, NC.
Ar
Name
Address
11(9 -713- 07 49
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3D V 6
E -mail address
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Alm
Fax number
7/9//z�i
Signature Date
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APPROVED JURISDICTIONAL DETERMINATION FORM
U S Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION 1: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER-Western Peidmont Region Coordinator 3855 Idlewild Road Kernerville
NC 27284 -9,180
,C. PROJECT LOCATiION AND BACKGROUND INFORMATION.
State NC County/parish /borough Ashe City West Jefferson
Center coordinates of site (lat/long in degree,Aecimal format) Lat 36'2956° T, Long -813858' W
Universal Transver'se,Mercator
Name of nearest waterbody East Fork Roarmg,Fork
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows North Fork New River
Name of watershed or Hydrologic Unit Code (HUC)
® 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) July P, 2014
SECTION II: SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICyTION
There Are o "navigable waters of the US" withinRi`vers and,Harbors Act (RH;A) Jurisdiction (as,defined,by 33 CFR part 329) in the
review area [Required]
® Waters subject to the ebb and flow of the,tide
FBI 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 "waters of the US" 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):'
R TNWs, including territorial seas
Wetlands adjacent to TNWs
Relatively'permanent waters2'(RPWs) that flow directly or indirectly into TNWs
N Non -RPWs that flow directly or indirectly into TNWs
Wetlands directly .*abutting RPWs +that flow directly or indirectly into TNWs
R Wetlands adjacent to but not directly abutting RPWs that flow directlyior indirectly into TNWs
M Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
R2 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 30 linear feet 5 width (ft) and /or 0 003 acres
Wetlands 0 acres
c Limits (boundaries) of Jurisdiction based on Established by OHWsM�.
Elevation ofestablished OHWM,(if known)
2 Non - regulated waters /wetlands (eheck;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 forni, 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)
3S
upporting documentation is presented in Section III F
SECTION III• CWA,ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agenciesi will assert'jurisdiction over TNWs and wetlands adjacent to TNWs If the�aquatic, resource is a, TNW, complete
Section, III Al and Section III D 1 only; if the�aquatm resource is a wetland'adjacent to,a TNW,,complete Sections III A I and,2
and Section III D 1',votherwise,,seeiSection III B below
1 TNW
Identify TNW
,Summari'ze,rationale'supportmg determination
Wetlandiadjacent4o TNW
Sdrnmanze�rationale #supportmg conclusion'that wetland,is "adjacent"
B CHARACTERISTICS "OF TRIBUTARY (THAT ISINOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This seetion sum=marizes information regarding'chaeacteristicVoUthe tributary and its adjacent wetlands, if any, and it helps
determine, whether or not thefstandards for jurisdiction established ,,under Rapanos have beentmet.
The agencies will assert, jurisdiction aover,non - navigable tributaries,of TNWs4Jtfere the,tributarie&are "relatively (permanent
waters" (RP-WA); i.e. tributaries thaYtypically, flow year -round or have,contmuous flow,at least seasonally,(e:g., typically 3
months)' A wetland thatadieectly abuts an RPW is also jurisdictional If the aquatic resource,is not -a TNW,, but,has year -round
(perennial) flow, skip to Section. III:D.2., If,the�aquatwresource is a wetland directly abutting,a tributary with perennial flow,
skip tolSection >II:D.4.
A Wetland that is adjacentfito'but that does notAirectly abut an RPW,requires a significant nexus, eval u atib n. Corps, districts, and
EPA regions will mcludehmethe record any available information that documents the,existence of a,significant nexusdbefween a
relatively permanent tributary °that is not perennial (and its adjacent wetlands,if any) and a traditional navigable water, even
though a signifi_caint nexus finding is not required4as a,mattee of IaW.
If the Water'_body' is not an RPW, or a,wetlii directly abutting an RPW,,a JD Will req"uireladditional data,to'determme if the
waterbody has a significant nexus with a TNW,. If the,tributary has adjacent wetlands; <the siguificant,nezus evaluation must
consider tfie'tributary in cornbination,withiall of it`,adjacent wetlands. This significant nexus evaluation that combines, `for
analytical purposes, theltributary 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 mtributary, with adjacent wetlands, complete Section III B t 466
the,tributary, Seetioif 111'13.2r176r,any onsite Wetlands, and` Section.H1 B'3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether, °a significant nexustexists is ,determined in Section III C below
1. Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) Geneeal Area Conditions.
Watershed size 264,,� r
Drainage area 264 acres
,Average annual rainfall 3,7,'mches
Averagetannual snowfall 35 inches
,(u) P,hysical`Characteristics
(a) Relationship with TNW
❑ Tributary flows directly into TNW
®'Tributary`flows through I tributaries before entermgsTNW
Project,waters are F - ;0 river miles,from'TNW
Project waters are ore s river,miles from RPW,
Project waters are, 6,aerial (straight) miles from TNW
Project waters are (0 1 aenal (straight) miles from RPW
Project'waters cross or serve as state boundaries Explain
Identify flow route`to TNW5
Tributary stream order, if known
a N6te,thabthe' Instructional ',Guidebook- contams,additi6nal information regardwgFswales, ditches, washes, and erosional,features generally and in the arid
West
5 Flow route'can be described by'identifymg, e g , tributary a „which,flows through the review area, to flow into tributary b, which then flows,mto TNW
(b) General Tributary Characteristics (check all that apply)
Tributary is ® Natural
❑ Artificial (man -made) Explain
❑ Manipulated (man - altered) Explain
Tributary properties with respect to top of bank (estimate)
Average width 5 feet
Average depth 5 feet
Average side slopes 2a.
Primary tributary substrate composition, (check all that apply)
® Silts ® Sands
® Cobbles ® Gravel
® Bedrock ® Vegetation Type /%icover
❑ Other Explain
❑ Concrete
❑ Muck
Tributary condition /stability [e g, highly erodmg,,sloughing banks] Explain Banks are relatively stable
Presence of run/riffle /pool complexes Explain Mostly,one big riffle with,somexpools
Tributary geometry Relativel 'str "ai�ht
Tributary gradient (approximate. average slope) 51 /o
(c) Flow
Tributary provides for Seasonal)tlow
Estimate average number of flow events in review area/year , 5
Describe flow regime
Other information on duration and volume
Surface flow is Discreteandconfined Characteristics
Subsurface flow Unitno_wn Explain findings
❑ Dye (or other) test performed
Tributary has (check all that apply)
® Bed and,banks
❑,OHWM6 (check -all indicators that apply)
❑ clear, natural line impressed on the bank
❑
the presence of litter and debris
❑ changes in the character ofisoil
❑
destruction of terrestrial vegetation
❑ shelving
❑
the presence of wrack line
❑ vegetatiow matted down,,benf, or absent
❑
sedimenusortmg
❑ leaf litter disturbed or washed away
❑
scour
❑ 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 determ
High Tide Line indicated by n
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings /characteristics
❑ tidal gauges
❑ other (list)
me lateral extent of CWA jurisdiction (check all that apply)
Mean High Water Mark indicated by
❑.survey to available datum,
❑ physical markings,
❑ vegetation lines /changes in vegetation types
(w) Chemical Characteristics:
Characterize tributary (e g , water color is clear, discolored, oily film, water quality, general watershed characteristics, etc`)
Explain water color clear
Identify specific pollutants, if known
6A naturabor man- madeidiscontmuity 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 m4he OHWM that is,unrelated to the waterbody s flow
regime (egg , flow over a rock outcrop or through a culvert) „the agencies will look for indicators of flow above and below the break
'Ibid
(rv) Biological Characteristics. Channel supports (check all that apply).
® Riparian corridor Characteristics (type, average width)
❑ Wetland fringe Characteristics
® Habitat for
❑ Federally Listed species Explain findings
® Fish/spawn areas Explain findings observation of fish
❑ Other environmentally - sensitive species Explain findings
® Aquatic /wildlife diversity Explain findings observation of aquatic life
2. Characteristics of wetlands adjacent to non -TNW thabtlow 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 L Explain
Surface flow is- c L
Characteristics
Subsurface flow =ckl is 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 P;I�ZT st river miles from TNW
Project waters are Y =Jtkhsaerial (straight) miles from TNW
Flow is from , iP List
Estimate approximate location of wetland as,within the Pick Lis floodplam
(u) 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
(m) Biological Characteristics. Wetland supports (check all'that apply).
❑ Ripari'an buffer Characteristics (type, average width)_
❑ Vegetation type /percent cover Explain
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish /spawn areas Explain findings
❑ Other environmentally - sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s)'being considered in the cumulative analysis &C Ell pal t
Approximately ( ),acreOn total are,being considered in.the cumulative analysis
For each wetland, specify the following
Directly abuts? (YIN) 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,followmg 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 6apanos 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 TNW9
• 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 TNW9
• Does`the,tributary, in combination with its adjacent wetlands,(if any), have the capac►ty'to transfer nutrients and orgamc,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 TNW9
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, wherefthe non -RPW flows directly or indirectly into
TNWs Explain findings of presence or, absence of significant nexus below, based on,the,tributary m,corribmation 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'm combination with all of its adjacent wetlands, then go to
Sectlon;Ill D
D DETERMINATIONS OF JURISDICTIONAL FINDINGS.'THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1 TNWs'and AdjacenfWetlands Check all thavapply and provide size estimates in review area
R TNWs linear feet width (ft), Or, acres
Q Wetlands'adjacenvto TNWs 0 acres
2. 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 perenmal
® Tributaries of TNW where tributaries have continuous flow "seasonally" (e g , typically three months each year),are
jurisdictional Data supporting this=conclusion is provided at Section III B Provide rationale indicating that tributary flows
seasonally -
Provide estimates for. jurisdictional waters in the review area (check all that apply)
0 Tributary waters '30 linear feet 5 width (ft)
® Other non - wetland waters acres
Identify type(s) of waters
3. Non -RPWss that flow directly or indirectly into TNWs
El Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is. jurisdictional Data supporting this conclusion is provided at Section III C
Provide estimates for jurisdictional waters Within the review area (check all that apply)
M. Tributary waters 30 linear feet 5 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
t Wetlands directly abutting an RPW where tributanes'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" Provi&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`m 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 Impoundmentsiof jurisdictional waters 9
As a,general'rule, the impoundment,of a jurisdictional °tributary remains jurisdictional
Demonstrate, that impoundment wasncreated from,'"waters of the U S , ",or
Demonstrate, that water meets the criteria for one +of the3categories,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
El 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
Q Other factors Explain
Identify water body and summarize rationale supporting determination
8See Footnote # 3
9 To,complete the analysis refer to the key in Section iiI D 6 of the Instructional Guidebook
10 Prior to asserting or declining CWA jurisdiction based solely on thisicategory, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process) described in the Corps /EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos
Provide estimates for Jurisdictional waters in the review area (check all that apply)
R Tributary waters linear feet width (ft)
® Other non - wetland waters acres
Identify type(s) of waters
Q Wetlands acres
F. NON - JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
M 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
A 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
0 Other (explain, if not covered above)
Provide�acfeage,estimates for non -jurisdwtional °waters in the review area, where the sole potential basis of Jurisdiction is,the MBR
factors (re , presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
Judgment,(check all that apply)
K 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
Provideacreage 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)
M Non - wetland waters (i e , rivers, streams) linear feet, width (ft)
® Lakes /ponds acres
El Other non - wetland waters acres List type of aquatic resource
0 Wetlands acres
SECTION IV DATA SOURCES.
A. SUPPORTING DATA Data reviewed for JD (check all that apply - checked itemsishall 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
fi Corps navigable waters' study
Q 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;Su_rvey Citation
® National wetlands inventory maps) Cite name
Q State/Local wetland inventory map(s)
MC FEN A /FIRM maps
® 100 -year Floodplam 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
MR Apphcable/supporting case law
' Applicable /supporting scientific1hterature
Other information (please specify)
13. ADDITIONAL COMMENTS TO SUPPORT JD: