20091207 Ver 1_Application_20091110

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STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION + ?n
BEVERLYPERDUE GENE
GOVERNOR SECRETARY
November 6, 2009
U. S. Army Corps of Engineers
Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
ATTN: Mr. Dave Baker
NCDOT Coordinator
F091207
Subject: Application for Section 404 Nationwide Permit 33 for the proposed replacement
of Bridge No. 32 over Webb's Creek on SR 1913 (Oak Grove Church Road) in
Rutherford County, Federal Aid Project No. BRZ-1913(2); Division 13; TIP No. B-
4633; WBS 33807.1.1
Dear Sir:
The North Carolina Department of Transportation (NCDOT) proposes to replace Bridge No. 32
over Webb's Creek on SR 1913. There will be 0.07 acres of temporary surface water impacts and
<0.01 acre of temporary fill in wetlands.
Please see enclosed copies of the Pre-Construction Notification (PCN), Stormwater Management
Plan, permit drawings, design plans and Rapanos form. The Programmatic Categorical Exclusion
(PCE) was completed in August 2008. Documents were distributed shortly thereafter. Additional
copies are available upon request.
This project calls for a letting date of March 16, 2010 and a review date of January 26, 2010;
however, the let date may advance as additional funding becomes available.
Please note that this project is an accelerated bridge project on NCDOT's Maintenance of Effort
list. The NCDOT Administration has deemed these projects highest priority.
MAILING ADDRESS:
NC DEPARTMENT OF TRANSPORTATION
PROJECT DEVELOPMENT AND ENVIRONMENTAL ANALYSIS
1598 MAIL SERVICE CENTER
RALEIGH NC 27699-1548
TELEPHONE: [phone]
FAX: [phone]
WESSITE. WWW..NCDOT.ORG
LOCATION:
ENVIRONMENTAL RESOURCE CENTER
4701 ATLANTIC AVENUE, SUITE 116
RALEIGH NC 27604
1 r..,
A copy of this permit application will be posted on the NCDOT Website at:
http://www.ncdot.org/doh/preconstruct/pe/. If you have any questions or need additional
information, please call Jeremy Learner at [phone].
Sincerely
? 'J' Ok
Gregory J. Thorpe, Ph.D.
Environmental Management Director, PDEA
w/attachment
Mr. Brian Wrenn, NCDWQ (2 copies)
Ms. Marla Chambers, NCWRC
Ms. Marella Buncick, USFWS
w/o attachment (see permit website for attachments)
Dr. David Chang, P.E., Hydraulics
Mr. Mark Staley, Roadside Environmental
Mr. Victor Barbour, P.E., Project Services Unit
Mr. Greg Perfetti, P.E., Structure Design
Mr. J. Jay Swain, Jr., P.E., Division 13 Engineer
Mr. Mark Davis, DEO
Mr. Jay Bennett, P.E., Roadway Design
Mr. Majed Alghandour, P. E., Programming and TIP
Mr. Art McMillan, P.E., Highway Design
Mr. Scott McLendon, USACE, Wilmington
Ms. Brenna Poole, PDEA
10
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Office Use Only:
Corps action ID no.
DWO project no.
Form Version 1.3 Dec 10 2008
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: 33 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1d. 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 in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in lieu
fee program. E3 Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
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: Replacment of Bridge 32 over Webb's Creek on SR 1913 (Oak Grove Church Road)
2b. County: Rutherford
2c. Nearest municipality / town: Forest City
2d. Subdivision name: not applicable
2e. NCDOT only, T.I.P. or state
project no: 8-4633
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. not applicable
3c. Responsible Party (for LLC if
applicable):
not applicable
3d. Street address: 1598 Mail Service Center
3e. City, state, zip: Raleigh, NC 27699-1598
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: [e-mail]
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name: not applicable
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: not applicable
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
II
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): not applicable
1b. Site coordinates (in decimal degrees): Latitude: 35.315528 Longitude: - 81.799371
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 1.25 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to yyebb's Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-IV
2c. River basin: Broad
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:
SR 1913 is a two lane rural local route transecting a semi-rural area with mostly agricultural and residential development.
3b. List the total estimated acreage of all existing wetlands on the property:
0.03
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
80
3d. Explain the purpose of the proposed project:
To replace bridge No. 32 which is considered structurally deficient.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project involves replacing the existing 150-foot bridge with a new 150-foot bridge providing a minimum 28 feet clear
deck width, on the existing alignment with an off-site detour. Standard road building equipment, such as trucks, dozers,
and cranes will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property
/
project (including all prior phases) in the past?
Comments: Dave Baker made a desktop determination ® Yes ? No ? Unknown
declaring a wetland adjacent to Webb's Creek on October
26, 2009 from information provided by NCDOT's field
descriptions, pictures and a wetland data form.
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: NCDOT
Name (if known): Jeremy Leamer Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
October 26, 2009
5. Project History
5a. Have permits or certifications been requested or obtained for ? Yes ® No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-004, other) (acres)
Temporary T
Site 1 ? P ®T Causewa
y Non-tidal
freshwater marsh ? Yes
®No ® Corps
? DWQ 0.001
Site 2 ? P ? T ? Yes ? Corps
? No ? DWQ
Site 3 ? P ? T ? Yes. ? Corps
? No ? DWQ
Site 4 ? P ? T ? Yes ? Corps
? No ? DWQ
Site 5 ? P ? T ? Yes ? Carps
? No ? DWQ
Site 6 ? P ? T ? Yes ? Corps
? No ? DWQ
0 Permanent
2g. Total wetland impacts <0.01
Temporary
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. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of Average Impact length
number - (PER) or jurisdiction stream (linear feet)
Permanent (P) or intermittent (Corps - 404, 10 width
Temporary (T) (INT)? DWQ - non-404, (feet)
other)
Site 1 ? P ® T Causeway Webb's Creek ® PER
? INT ® Corps
? DWQ 12 NIA
Site 2 ? P ? T ? PER ? Corps
? INT ? DWQ
Site 3 ? P ? T ? PER ? Corps
? INT ? DWQ
Site 4 ? P ? T ? PER ? Corps
? INT ? DWQ
Site 5 ? P ? T ? PER ? Corps
? INT ? DWQ
Site 6 ? P ? T ? PER ? Corps
? INT ? DWQ
0 Perm
3h. Total stream and tributary impacts 0.07 acres
Temp
3i. Comments:
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 individual) list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number- waterbody Type of impact Waterbody type Area of impact (acres)
Permanent (P) or (if applicable)
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
0. Total open water impacts X Permanent
X Temporary
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond Excavat
Flooded Filled ed Flooded Filled Excavated Flooded
P1
P2
5f. Total
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
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 an impacts require mitig ation, then you MUST fill out Section D of this form.
6a.
? Neuse
?Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason for impact Buffer Zone 1 impact Zone 2 impact
Permanent (P) or Stream name mitigation (square feet) (square feet)
Temporary T required?
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
There will be no permanent impacts. The proposed structure will be in the same location as the existing structure with an
off-site detour. The "do-nothing" alternative is not practicable due to the resulting elimination of the use of SR 1913 and
closing or removing the bridge. The roadway grade will be the same as the existing structure. 3:1 fill slopes will be utilized
where practicable.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The two causeways will not be in use at the same time. The first will be used and then removed before the second one is
constructed. Surficial bridge runoff will not be directed into Webb's Creek via deck drains. Causeways will not cover more
than 50% of the stream channel at any time.
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
If no, explain: Minimal temporary impacts of less than 0.01
acres are from two temporary causeways which will be
removed and result in no "loss of waters". Webb's Creek is
not a trout stream, HQW or ORW.
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c.
If yes, which mitigation option will be used for this

pro
project? ? Mitigation bank

El Payment to in-lieu fee program

? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: not applicable
3b. Credits Purchased (attach receipt and letter) Type 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: ? 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:
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.
8
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? ? 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:
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. 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? N/A
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 provide a brief, narrative description of the plan:
See attached permit drawings.
? 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? not applicable
? 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
4a . Which of the following state-implemented stormwater management programs apply ? HQW
(check all that apply): ? ORW
? 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
10
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 (federal/state) land?
1b. 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 (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
additional development, which could impact nearby downstream water quality? ®No
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.
Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence nearby
land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be necessary. .
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.
not applicable
11
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?
? 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?
Habitat assessment and survey by NCDOT biologists. NHP database check.
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?
NMFS County Index
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?
NEPA Documentation
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: NCDOT Hydraulics coordination with FEMA
8c. What source(s) did you use to make the floodplain determination? FEMA Maps

I'
Dr. Gregory J. Thorpe, Ph D
' D
t
Applicant/Agent
s Printed Name
' a
e
A plican Agent
s Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
12
STORMWATER MANAGEMENT PLAN
Project: 33807.1.1
TIP No. B-4633
Rutherford County 10/21/2009
Hydraulics Project Manager: Dennis Hoyle, P.E. (URS Corporation)
Marshal Clawson, P.E. (NCDOT Hydraulics Unit)
ROADWAY DESCRIPTION
The project B-4633 consists of constructing a new bridge 150 feet long to replace the
existing bridge #32 in Rutherford County on SR-1913 over Webbs Creek. The total
project length is 0.102 miles. The project creates impacts to Webbs Creek, which is
located in the Broad River Basin. The project drainage system consists of a grated inlet
with associated pipe system, and riprap pads at the pipe outlet to an existing Swale.
Jurisdiction Stream: Webbs Creek
ENVIRONMENTAL DESCRIPTION
The project is located within the Broad River Basin in Rutherford County. A temporary
causeway will be required for removal of the existing structure and construction of the
proposed structure. Degradation has been minimized by using a riprap pad at the pipe
outlet into an existing swale. Open deck drains will be utilized to drain the structure but
will not discharge directly over Webbs Creek which will reduce the impacts to the
channel.
BEST MANAGEMENT PRACTICES AND MAJOR STRUCTURES
The primary goal of Best Management Practices (BMPs) is to prevent degradation of the
states surface waters caused by the location, construction and operation of the highway
system. The BMPs are activities, practices and procedures taken to prevent or reduce
stormwater pollution. The BMP measures used on this project to reduce stormwater
impacts are:
• Retain existing grass swale to Webbs Creek
• Riprap pad at outlet of pipe in existing grass swale
• Open deck drains discharging over land (will not discharge directly into channel)
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WETLAND/STREAM
IMPACTS
DIVISION OF HIGHWAYS
RUTHERFORD COUNTY
PROJECT: SW7.L1 (B-4633)
BRIDGE NO. 32
OVER WEBBS CREEK
ON SR 1915
(OAK GROVE CHURCH ROAD)
SHEET OF 10 / 19 / OS
r°? RUTHERFORD COUNTY

PROPERTY OWNERS
NAMES AND ADDRESSES
PARCEL NO. NAMES ADDRESSES
5 W. D. MELTON P.O. BOX 428
ELLENBORO, NC 28040
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DIVISION OF HIGHWAYS
RUTHERFORD COUNTY
PROJECT: 33807.1.1 (B-4633)
BRIDGE NO. 32
OVER WEBBS CREEK
ON SR 1913
(OAK GROVE CHURCH ROAD)
:T OF 10/19/(

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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 1D Form Instructional Guidebook.
SECTION 1: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER: 84633 (Replacement of Bridge 32 on SR 1913 over Webb's Creek)
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: NC County/parish/borough: Rutherford City: Forest City
W.
Center coordinates of site (lat/long in degree decimal format): Lat. 35.315528° N, Long. -81.799371'0
Universal Transverse Mercator:
Name of nearest waterbody: Webb's Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Second Broad River
Name of watershed or Hydrologic Unit Code (HUC): 03050105
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
R 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):
Q Office (Desk) Determination. Date:
® Field Determination. Date(s): 10/19/2009
SECTION 11: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There rA_roC_ "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 s
a Waters subject to the ebb and flow of the tide.
ED Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain: Webb's Creek is large enough for navigation use in some areas.
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There A e "waters o the U.S." within Clean Water Act CWA jurisdiction as defined b 33 CFR art 328 in the review area. Re uire
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
Q Wetlands adjacent to TNWs
® Relatively permanent waters' (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
Q 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 TN Ws
O Impoundments ofjurisdictional waters
t° Isolated (interstate or intrastate) waters, including isolated wetlands
It. Identify (estimate) size of waters of the U.S. in the review area:
Non-wetland waters: 80 linear feet: 12 width (ft) and/or acres.
Wetlands: 0.03 acres.
c. Limits (boundaries) of jurisdiction based on: FVotAppitcabie:
Elevation of established OH WM (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.
' For purposes of this form, an RP W is defined as a tributary that is not a TN W and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
' Supporting documentation is presented in Section III.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 III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section IILB 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 III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.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 III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section II1.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section IILC below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(1) General Area Conditions:
Watershed size: 10.5 squareiniles
care es
Drainage area: 14.35 square_.tnlleq
Average annual rainfall: 50 inches
Average annual snowfall: 5.5 inches
(ii) Physical Characteristics:
(a) Relationshin with TNW:
® Tributary flows directly into TNW.
? Tributary flows through IP:(o amore) tributaries before entering TN W.
Project waters are h(or!1b) river miles from TNW.
Project waters are PiPJ?Yiiiit river miles from RPW.
Project waters are PWL st 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': 3,000 feet downstream to the Second Broad River.
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 mute can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into 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: 12 feet
Average depth: 1 feet
Average side slopes: 31
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:
Presence of run/riffe/pool complexes. Explain:
Tributary geometry: Mespi7erlag
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for Seasonal flow
Estimate average number of flow events in review area/year 20.(_;___eateg)
Describe flow regime:
Other information on duration and volume:
Surface flow is: Piift-Wtt. Characteristics:
Subsurface flow: UAkniwp. Explain findings:
? Dye (or other) test performed:
Tributary has (check all that apply):
? Bed and banks
? OHWM' (check all indicators that apply):
? clear, natural line impressed on the bank ?
? changes in the character of soil ?
? shelving ?
? vegetation matted down, bent, or absent ?
? leaf litter disturbed or washed away ?
? sediment deposition ?
? water staining ?
? other (list):
? Discontinuous OHWM.' Explain:
If factors other than the OH W M were used to determ
High Tide Line indicated by: Q
? oil or scum line along shore objects
? fine shell or debris deposits (foreshore)
? physical markings/characteristics
? tidal gauges
? other (list):
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
ne 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.
(iii) 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:
'A natural or man-made discontinuity in the OH WM does not necessarily severjurisdiction (e.g., where the stream temporarily flows underground, or where
the OH W M has been removed by development or agricultural practices). Where there is a break in the OH WM that is unrelated to the watedrody'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):
? 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:
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 Intermittent flow. Explain:
Surface flow is:.1-1 e;endcotifined
Characteristics:
Subsurface flow: Unlown. 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 30'(ijaira e) river miles from TNW.
1-'f
Project waters are 3D(orytnoie) aerial (straight) miles from TNW.
a Pv r s+m
Flow is from: Wetland tb/frotn nev?gable watela.
Estimate approximate location of wetland as within the $00; gR?r greeted floodplain.
(11) 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 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)-
Tfi,YM
All wetland(s) being considered in the cumulative analysis: 30;(oFtti0re)
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? (YIN) Size (in acres)
0.03
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 Rapanos 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
TN Ws, 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 III.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:
Q TNWs: linear feet width (ft), Or, acres.
Q Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
Q Tributaries of TN Ws where tributaries typically flow year-round arejurisdictional. Provide data and rationale indicating that
tributary is perennial: Flow is constant year-round.
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:
r
Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 80 linear feet12 width (ft).
® Other non-wetland waters: acres.
Identify type(s) of waters:
3. Non-RPWss that flow directly or indirectly into TNWs.
tr Waterbody that is not a TN W or an RPW, but flows directly or indirectly into a TN W, and it has a significant nexus with a
TN W 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):
0 Tributary waters: linear feet width (ft).
El 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.
Q 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: Wetland is adjacent and abutting Webb's Creek.
0 Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section 111.6 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: 0.03 acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
Q 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 TN W arejurisidictional. 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.
Q 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
Q Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
0 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):"
0 which are or could be used by interstate or foreign travelers for recreational or other purposes.
Q 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:
0 Otherfactors. Explain:
Identify water body and summarize rationale supporting determination:
"See Footnote # 3.
To complete the analysis refer to the key in Section III. D.6 of the Instructional Guidebook.
's 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 Corp"PA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

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):
Q 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.
Q 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).
0 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).
T• 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 forjurisdiction (check all that apply):
Q Non-wetland waters (i.e., rivers, streams): linear feet, width (ft).
Q Lakes/ponds: acres.
Q Other non-wetland waters: acres. List type of aquatic resource:
Q Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall be included in case file and, where checked
and requested, appropriately reference sources below):
Q Maps, plans, plots or plat submitted by or on behalf of the applirant/oonsultanC
Q Data sheets prepared/submitted by or on behalf of the applicantlconsultant.
? 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:
Q U.S. Geological Survey Hydrologic Atlas:
? USGS NHD data.
? USGS 8 and 12 digit HUC maps.
Q U.S. Geological Survey map(s). Cite scale & quad name:
Q USDA Natural Resources Conservation Service Soil Survey. Citation:
Q National wetlands inventory map(s). Cite name: -
O State/Local wetland inventory map(s):
FEMA/FIRM maps:
-
?T. 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
Q Photographs: ? Aerial (Name & Date):
or ? Other (Name & Date):
Previous determination(s). File no. and date of response letter:
Applicable/supporting case law:
Q Applicable/supporting scientific literature:
© Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD: Phone conversation with USACE (Dave Baker) on October 26, 2009 where USACE
determined the wetland to bejurisdictional.
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