20140451 Ver 1_401 Application_20140414

Letter of Transmittal
S &ME, Inc S&m'mE
9751 Southern Pine Blvd -;
Charlotte, NC 28273
(704) 523 -4726
(704) 525 -3953 fax
N C Division of Water Resources
512 North Salisbury Street
Raleigh, North Carolina, 27604
WE ARE SENDING YOU:
❑ Shop drawings
❑ Copy of letter
DATE: April 18, 2014 1 JOB NO: 4335 -14 -073
ATTENTION: Ms. Karen Higgins
RE: Gaynor Storm Drainage Improvement Project
® Attached ❑ Under separate cover via
❑ Prints ® Plans ❑ Draft
® Report
_ the following items:
❑ Specifications
COPIES
DATE
NO
DESCRIPTION
5
4.18 2014
1
Nationwide Permit No. 3 and 27 for Pre - Construction Notification and request for
Jurisdictional Determination (with abbreviated Design Plans)
1
4.18.2014
2
CD Copy of Preliminary Design Plans
4.18.2014
3
Check No. 023020 in the amount of $570.00 (Processing fee)
THESE ARE TRANSMITTED AS CHECKED BELOW:
® For approval
❑ As requested
❑ FORBIDS DUE:
❑ For your record
❑ For review and comment ❑
❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS: Attached please find the above Please let Isaac Hinson or David Homans know if you have questions, Thank you
- Darnn Peme
SIGN:,
COPY TO File, USACE, CMSWS, NC SHPO, USFWS
IF ENCLOSURES ARE NOT AS NOTED, PLEASE NOTIFY US AT ONCE.
This Letter of Transmittal and the documents accompanying this Letter of Transmittal contain information from S &ME, Inc , which is confidential and legally
privileged The information is intended only for use of the individual or entity named on this Letter of Transmittal If you are not the intended recipient, you
are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on these documents is strictly prohibited
S &ME SFG -001
(Rev 04/04)

April 18, 2014
U.S. Army Corps of Engineers
Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, North Carolina 28801 -5006
Attention: Mr. Steven Kichefski
N.C. Division of Water Resources
401 and Buffer Permitting Unit
1650 Mail Service Center
Raleigh, North Carolina 27699 -1650
Attention: Ms. Karen Higgins
20140451
APR 2 9 2014
Reference: Pre - Construction Notification for Nationwide Permits 3 and 27, and
Request for Jurisdictional Determination
Gaynor Storm Drainage Improvement Project (SDIP)
Charlotte, North Carolina
S &ME Project No. 4335 -14 -073
Dear Mr. Kichefski and Ms. Higgins:
On behalf of Charlotte- Mecklenburg Storm Water Services (CMSWS), S &ME, Inc.
(S &ME) is submitting this Pre - Construction Notification (PCN) for impacts to waters of
the U.S. in accordance with Department of the Army Nationwide Permits (NWP) 3
(Maintenance) and 27 (Aquatic Habitat Restoration, Establishment, and Enhancement),
along with supporting documentation for verification of the on -site jurisdictional
boundaries. The proposed project will primarily involve extensive improvements to a
residential storm water drainage system which will result in permanent impact to 26
linear feet (If) of unnamed tributaries of McMullen Creek, in Charlotte, North Carolina.
In association with the storm drainage infrastructure improvements, stream enhancements
are proposed throughout the drainage system, which will require an additional 575 if of
temporary stream disturbance. An additional area of channel piping is proposed as a
part of this project to protect a residence, authorization for this impact under NWP 29
will be sought by the landowner under a separate request /PCN
Impacts proposed associated with the aspects of this project described herein are
authorized under North Carolina Division of Water Resources (DWR) Water Quality
Certifications (WQC) Nos. 3883 and 3885. As the proposed project will involve channel
enhancement with greater than three structures per 100 feet of stream bank, written
concurrence from DWR is required for authorization under WQC 3885.
In support of this application, please find enclosed the following:
S &ME, INC / 9751 Southern Pine Boulevard / Charlotte, NC 28273 -5560 / p 704 523 4726 f 704 525 3953 / www smcinc corn

PCN (NWP 3, 27) / Request for Jurisdictional Determination SWE Project No 4335 -14 -073
Gaynor SDIP, Charlotte, N C April 18. 2014
• Figures: Site Vicinity Map (Figure 1), USGS Topographic Map (Figure 2),
Approximate Waters of the U.S. and Proposed Impacts (Figures 3A and 313);
• Appendix I: Pre - Construction Notification (PCN);
• Appendix II: Site Photographs;
• Appendix III: Jurisdictional Impact Site Plans;
• Appendix IV: Jurisdictional Determination Request Form;
• Appendix V: N.C. Division of Water Quality (DWQ) Stream Identification
Forms;
• Appendix VI: Wetland Determination Data Form (Upland Form for DPI);
• A check for DWR Processing Fee
BACKGROUND INFORMATION
CMSWS is planning to construct storm drainage infrastructure improvements and stream
enhancements along approximately 2,6001f of an unnamed tributary to McMullen Creek
in the vicinity of Gaynor Road in Charlotte, North Carolina. The goals of the project are
to upgrade storm water infrastructure in order to meet City design capacity, protect
adjacent properties from flooding and channel erosion, as well as to improve channel
bank stability and habitat quality. In order to achieve these goals, much of the existing
storm system piping will be upgraded and replaced, sections will be connected and
extended, and approximately 575 if of channel will be enhanced via bank reshaping and
installation or cross vanes, rock sills, and constructed riffles. The location of the project
area is depicted on the Site Vicinity Map (Figure 1), the appropriate portions of the
Charlotte East, N.0 (1993) USGS Topographic Map (Figure 2), and on the 2010 Aerial
Photographs (Figures 3A & 313).
The proposed project designs have been developed over the last four years by
collaboration between CMSWS, Armstrong Glen P.C. (the storm water design engineer),
and Wildlands Engineering, Inc. (the restoration design engineer).
FIELD OBSERVATIONS
On March 25, 2014, Mr. D. David Homans of S &ME visited the site to verify the
location and classification of jurisdictional waters along the drainage system where
disturbance associated with the project is proposed. Stream and wetland assessments
were conducted in accordance with DWR and USACE guidelines. Results of the
assessment are depicted on Figures 3A and 313 and representative photographs of the
project area are included in Appendix II.
S &ME's field review of the project area identified two jurisdictional relatively permanent
waters (RPWs); Streaml is classified as a perennial RPW, Stream 2 is classified as
intermittent. Descriptions of the jurisdictional features based on field conditions
observed during S &ME's assessment are described below:
Stream 1
Stream 1 is the main channel running throughout the project area. It is a moderate sized
perennial tributary to McMullen Creek with a watershed area of approximately 200 acres.
Land use adjacent to the stream and throughout its watershed is largely made up of

PCN (NWP 3, 27) / Request for Jurisdictional Determination SWE Project No 4335 -14 -073
Gaynor SDIP, Charlotte, N C April 18 2014
medium density maintained residential areas. The channel originates at a storm sewer
outfall north of Linda Lane (see photo 10, Appendix II). The channel has been
extensively impacted throughout the project area; it is piped for approximately 1,8001f
(photo 11), concrete -lined for approximately 3001f north of North Sharon Amity Road,
riprap lined in multiple areas, and appears to have been previously straightened for most
of the free - flowing portion within the review area. Channel condition was poor as well;
numerous areas along the channel were deeply incised to bedrock and with actively
eroding banks. Bed material was largely made up of unconsolidated fine material,
bedrock / hardpan clay, or non - native materials such as riprap or broken concrete. The
riparian area was made up largely of maintained or partially maintained residential yards.
Non - maintained areas of riparian area adjacent to Stream 1 were dominated by invasive
understory and herbaceous vegetation such as Chinese privet (Ligustrum sinense),
bamboo (Phyllostachys sp.), English ivy (Hedera helix) and Japanese honeysuckle
(Lonicera japonica)
,S'tream 2
Stream 2 originates at a culvert outfall and flows southeast for approximately 991f before
its confluence with Stream 1 immediately upstream of the culvert under North Sharon
Amity Road (Figure 313). The bed and banks of Stream 2 have been stabilized with riprap
fill for all but the portion immediately adjacent to the outfall. The channel was classified
as an intermittent jurisdictional channel based on a North Carolina Stream Identification
Form score of at least 19.5 (soil based evidence of a connection to the water table could
not be assessed due to the riprap fill). Vegetation in the riparian area was characterized by
a shrub layer of Japanese privet (Ligustrumjaponica) and herbaceous vegetation
dominated by monkey grass (Ophiopogon japonicas).
The remainder of the jurisdictional review area was made up of residential lawns, single
family homes, residential streets, and upland riparian areas. A low lying area adjacent to
Stream 1 was evaluated for wetland conditions (DPI, see Figure 3B), but did not exhibit
any of the criteria indicative of a wetland. It should be noted that a small area adjacent to
Stream 1 upstream from DP 1 could not be readily accessed due to fencing across the
stream; no project disturbance is proposed in this area therefore no further effort to
characterize this area was made.
CMSWS requests a Preliminary Jurisdictional Determination from the USACE in support
of these findings; as such, a completed USACE Jurisdictional Determination Request
Form is included in Appendix IV. Completed DWQ Stream Identification Forms for
each stream are included in Appendix V; a USACE Wetland Determination Form for the
upland area identified as DPI is included in Appendix VI.
PROPOSED PROJECT IMPACTS
Proposed jurisdictional impacts associated with this project are depicted on Figures 3A
and 313, detailed in Table 1, and are highlighted on relevant portions of the 99% complete
project plans in Appendix I1I. Due to size limitations, full project plans including
longitudinal cross sections, natural channel design cross sections, full planting plans, and
plans for repairs outside of jurisdictional areas cannot be include in this submittal; a
digital version of these plans can be downloaded for review here: http: / /goo.gl /SK -mKI

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PCN (NWP 3, 27) / Request for Jurisdictional Determination S &ME Project No 4335 -14 -073
Gaynor SDIP, Charlotte, N C April 14, 2014
All proposed permanent impacts addressed in this request are associated with storm water
system maintenance (S2, S6 and S8) and consist of minor extensions of existing pipe
systems that are required in order to better integrate the upgraded piping system into the
existing channel.
All temporary impacts proposed are associated with channel bed and bank enhancements
that have been designed according to natural channel design principles. A large portion
of the enhancement proposed involves the installation of constructed riffles. These
constructed riffles will be keyed in with coarse cobble material to the current bed
elevation and interspersing it with finer gravels and sands in order to provide bed stability
and mimic typical riffle conditions. Unlike riprap bed armoring, constructed riffles
provide grade stability while mimicking natural channel riffle conditions and providing
essential habitat for aquatic organisms. A detailed planting plan has also been devised
for restoration areas utilizing a native riparian seed mix and containerized, live stake, and
bare root native woody vegetation plantings.
Additionally, piping of an aggressively eroding segment of Stream 1 on the property of
864 Linda Lane is proposed to occur simultaneously with the storm drainage
improvements discussed in this PCN. The impacts associated with this piping have
previously been submitted for approval under NWP 29 (residential development) by the
property owner, Mark C. Holoman. Based on previous correspondence and an on -site
meeting with the agencies and Mr. Holoman, it was agreed that this activity would be
considered separate from this authorization request. CMSWS is unaware of the approval
status of Mr. Holoman's application.
Protected Species
S &ME's consideration of potential protected species habitat began with a review of
existing records obtained from federal and state sources. The U.S. Fish & Wildlife
Service (USFWS) list of federally protected species (updated December 26, 2012) was
consulted for a listing of protected species documented within Mecklenburg County,
North Carolina. This review identified four protected species, three plants and one
animal. Listed flora and fauna and their federal rank and county status are identified in
Table 2. Explanations of rankings are included at the end of the table.
Table 2: Federally Protected Flora and Fauna Summary
Species ,
Federal Rank *,,
County Status
Habitat Present
Echinacea laevigata
E
Current
No
Smooth coneflower
Hehanthus schweindtzu
E
Current
No
Schwemitz's sunflower
Lasmigona decorata
E
Historical
No
Carolina heelsplitter
Rhus michawn
E
Historical
No
Michaux's sumac
E = Endangered
As part of the protected species review, S &ME also reviewed the North Carolina Natural
Heritage Program (NCNHP) Geographic Information Systems (GIS) files of Element

PCN (NWP 3, 27) / Request for Jurisdictional Determination SWE Project No 4335 -14 -073
Gaynor SDIP, Charlotte, N C April 14, 2014
Occurrence (EO) and Natural Heritage Areas available from NC OneMap. This review
found no extant EOs of protected species on record within a two -mile radius of the
project area.
S &ME completed a field reconnaissance of the project area on March 25, 2014. The
project area was identified as consisting of well- maintained lawn and roadside with areas
of narrow wooded riparian corridor with a dense understory of invasive vegetation.
Dense understory or riparian corridors are not the preferred habitat for the plant species
of concern, and none of the three listed plant species were observed. Based on the level
of disturbance observed, the project area was not considered to provide potential habitat
for protected terrestrial species with a likelihood of occurring in Mecklenburg County.
Though the Carolina heelsplitter is listed (historically) for Mecklenburg County, the
receiving drainage of the project (McMullen Creek, a tributary to McAlpine Creek) has
no documented occurrences of Carolina heelsplitter and these tributaries are not part of
its designated critical habitat. The heavily incised banks and unsuitable bed sediment
present throughout Stream 1 also makes it poor habitat for mussels.
A copy of this PCN will be provided to the USFWS - Asheville Field Office.
Cultural Resources
A copy of this PCN will be provided to the North Carolina State Historic Preservation
Office (SHPO), requesting that they review their records regarding cultural,
archaeological, or historical resources in or near the project area and to provide written
comments regarding the interests of their agency. A review of the HPOWEB GIS Web
Service indicated that there were no properties currently listed or determined eligible for
listing in the National Register of Historic Places within a one mile radius of the project.
AVOIDANCE AND MINIMIZATION
Impacts have been avoided and minimized to the extent practicable and have been limited
to what is necessary to facilitate storm water infrastructure upgrades and stream
enhancement. Overall permanent stream impacts associated with maintenance aspects of
this project have been limited to 26 If, and culvert improvements have largely been
designed to fit within the footprint of existing culverts. Where possible, perched culverts
will be replaced with box culverts keyed in below the channel grade that better allow for
movement of stream organisms. Riprap placement has been minimized to one small area
of a channel already almost fully stabilized with riprap. Additional placement of riprap
was avoided through the use of natural channel design structures such as rock sills and
riffle construction, which will serve to stabilize the channel while also providing
improvements to the channel habitat. Efforts have been made to limit clearing of trees
within the project corridor to the minimum amount required for safe construction of the
restoration channels, and tree protection measures will be installed to safeguard trees
within the limits of disturbance that are to remain.
To prevent sedimentation of downstream portions of the affected streams, construction
will be conducted in the dry through the use of coffer dams and pump - arounds.
Temporary erosion and sediment control measures placed in waters will be removed and

PCN (NWP 3, 27) / Request for Jurisdictional Determination SWE Project No 4335 -14 -073
Gaynor SDIP, Charlotte, N C April 14, 2014
the original grade restored upon completion of the project. Banks temporarily affected by
maintenance work will be matted, re- seeded and restored to stable bank conditions.
ADDITIONAL REGULATORY CONSIDERATIONS
Efforts have been made to meet the conditions of NWP 3 and 27 as well as the regional
conditions of the NWPs and conditions associated with the North Carolina Water Quality
Certifications (WQC) that correspond to these NWPs (WQC 3883 and 3885).
Replacement culverts installed within the stream will be keyed in below the channel
grade to better allow for movement of stream organisms.
Appropriate erosion and sediment control practices will be implemented to meet water
quality turbidity standards. Best Management Practices employed for the project will be
in compliance with the most recent version of the "North Carolina Sediment and Erosion
Control Planning and Design Manual," and the local governing authority. Impacts have
been avoided and minimized, and appropriate measures will be taken during construction
to allow flow and circulation patterns of waters of the U.S. to remain unaffected.
Following construction, disturbed areas adjacent to the work site will be restored to a
stable grade and disturbed areas will be appropriately seeded and restored. A native
restoration seed mix and native tree planting plan has been designed for the channel
banks and disturbed uplands adjacent to the proposed channel enhancements.
The proposed project will not result in additional impervious surface.
MITIGATION
Based on conversations with the USACE for similar projects, we anticipate that
mitigation will not be required for this project due to minimal area or stream permanently
impacted, the already highly degraded status of impacted channels, and as appropriate
avoidance and minimization procedures have been implemented during the design phase
of the project. Since efforts result in the loss of less than 150 if (26 If) of stream bed and
maintenance efforts have been designed to meet the ecological functions of the stream
and best serve the stream enhancement efforts, no further mitigation measures are
proposed in association with activities authorized under NWP 3. Though enhancement
efforts associated with NWP 27 are designed to provide ecological uplift to Stream 1,
CMSWS has opted to not seek mitigation credit for these enhancements.

PCN (NWP 3, 27) / Request for Jurisdictional Determination SWE Project No 4335 -14 -073
Gaynor SDIP, Charlotte, N C April 14, 2014
CLOSING
By copy of this correspondence and completed PCN, we are requesting your written
concurrence with authorization of this project under NWPs 3 and 27. If you have
questions or require additional information, please feel free to contact Isaac Hinson at
(704) 336 -4495 or ihinson @charlottenc.gov.
Sincerely,
AL��
D. David Homans
Project Scientist
Julie Bennett - Hudel, P.G. LEED AP
Senior Reviewer
Reviewed and Authorized by:
Isaac Hinson, P.W.S.
Wetland Specialist
Charlotte- Mecklenburg Storm Water Services
Attachments
D 8" Atpe_�
Darrin M. Peine, QEP
Project Manager
cc: Charlotte- Mecklenburg Storm Water Services
USFWS, Asheville Field Office
SHPO, Raleigh

Figure 1 - Site Vicinity Map
• Figure 2 - USGS Topographic Map
• Figures 3A & 3B — Approximate Waters of the U.S. and
Proposed Project Impacts

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REFERENCE:
BASE MAPPING PROVIDED BY ESRI. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY IT IS NOT MEANT FOR
DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO GUARANTEES ABOUT ITS ACCURACY. SBME, INC. ASSUMES NO
RESPONSIBILITY FOR ANY DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION n U g Q General Project Area
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Pre - Construction Notification

20140451
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Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 12
PCN Form — Version 1 3 December 10, 2008 Version
Pre - Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a
Type(s) of approval sought from the
Corps
®Section 404 Permit El Section 10 Permit
1 b
Specify Nationwide Permit (NWP) number 3, 27 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 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
Gaynor Storm Drainage Improvement Project
2b
County
Mecklenburg
2c
Nearest municipality / town
Charlotte
2d
Subdivision name
N/A few/ a
2e
NCDOT only, T I P or state
project no
FN/A
3.
Owner Information ppR
3a
Name(s) on Recorded Deed
Multiple Owners
firy
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable)
N/A
3d
Street address
3e
City, state, zip
3f
Telephone no
3g
Fax no
3h
Email address
Page 1 of 12
PCN Form — Version 1 3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ® Other, specify Charlotte - Mecklenburg Storm Water Services
4b
Name
Isaac Hinson, PWS
4c
Business name
(if applicable)
Charlotte - Mecklenburg Storm Water Services
4d
Street address
600 East Fourth Street
4e
City, state, zip
Charlotte, NC 28202
4f
Telephone no
704 - 336 -4495
4g
Fax no
704- 336 -6586
4h
Email address
thinson @charlottenc gov
5.
Agent/Consultant Information (if applicable)
5a
Name
David Homans
5b
Business name
(if applicable)
S &ME, Inc
5c
Street address
9751 Southern Pine Blvd
5d
City, state, zip
Charlotte, NC 28273
5e
Telephone no
704 - 523 -4726
5f
Fax no
704- 525 -3953
5g
Email address
dhomans @smeinc com
Page 2 of 12
PCN Form — Version 1 3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a Property identification no (tax PIN or parcel ID)
Multiple Parcels
Latitude 35177847 Longitude -
1 b Site coordinates (in decimal degrees)
80 793013
(DD DDDDDD) ( -DD DDDDDD)
1 c Property size
Review Area= 71 acres, Disturbance Area= 12 acres
2. Surface Waters
2a Name of nearest body of water (stream, river, etc ) to
McMullen Creek
proposed project
2b Water Quality Classification of nearest receiving water
McMullen Creek 11- 137 -9 -5, Class C
2c River basin
Lower Catawba River Basin (WBD HUC 03050103)
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 project area is composed almost entirely of medium density residential development
3b List the total estimated acreage of all existing wetlands on the property
None
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
3,297
3d Explain the purpose of the proposed project
The goals of the project are to upgrade storm water infrastructure in order to meet City design capacity, protect adjacent
properties from flooding and channel erosion, as well as to improve channel bank stability and habitat quality
3e Describe the overall project in detail, including the type of equipment to be used
Improvements to the storm drainage system involve a combination of drain pipe upgrades, improvements to system
connectivity, and natural channel design enhancements Undersized culverts will be replaced with appropriately sized
replacements and will largely remain within the current pipe footprint Street storm drainage structures will be upgraded
and added and system connections will be improved Additionally, natural channel design measures such as riffle
construction, vane installation, and bank reshaping will be used to stabilize areas of channel and to better integrate the
proposed storm system into the existing stream channel Disturbed areas will be planted with a native seed mix and
native woody vegetation All work will be conducted in the dry using pump arounds and will be installed with standard
construction equipment, generally the smallest construction equipment possible will be used to conduct channel
enhancements in order to minimize impacts to existing vegetation
4. Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
ED Yes No Unknown
project (including all prior phases) in the pasty
Comments
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
Name (if known)
Other
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
Page 3 of 12
PCN Form — Version 1 3 December 10, 2008 Version

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
The impacts associated with the proposed piping at 864 Linda Lane have previously been submitted for approval under
NWP 29 (residential development) by the property owner, Mark C Holoman Based on previous correspondence and an
on -site meeting with the agencies and Mr Holoman, it was agreed that this activity would be considered separate from
this authorization request CMSWS is unaware of the approval status of Mr Holoman's application
6. Future Project Plans
6a Is this a phased project?
❑ Yes ® No
6b If yes, explain
Page 4 of 12
PCN Form — Version 1 3 December 10, 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la 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 -404, other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h Comments No wetlands were observed within the project area
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 jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
31 Comments See attached table
Page 5 of 12
PCN Form — Version 1 3 December 10, 2008 Version

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 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 ❑T
04 ❑P ❑T
4f. Total open water impacts
4g Comments No open waters are located within the project area
S. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below
5a I 5b I 5c 5d 5e
Wetland Impacts (acres) Stream Impacts (feet)
Pond ID Proposed use or purpose
number of pond
Flooded I Filled I Excavated Flooded I Filled I Excavated
P1
P2
5f. Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes, permit ID no
Upland
(acres)
Flooded
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.
Project is in which protected basin?
6b 6c 6d
Buffer impact
number — Reason
Permanent (P) or for
Temporary T impact
131 ❑P ❑T
B2 ❑P ❑T
B3 ❑P ❑T
61 Comments
❑ Neuse ❑ Tar - Pamlico ❑ Other
❑ Catawba ❑ Randleman
6e I 6f I 6g
Buffer
Stream name mitigation
required?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
6h Total buffer impacts
Zone 1 impact I Zone 2 impact
(square feet) (square feet)
Page 6 of 12
PCN Form — Version 1 3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Impacts have been avoided and minimized to the extent practicable and have been limited to what is necessary to facilitate
stream restoration and storm water infrastructure upgrades and reduce erosion risk in the affected streams Stream
restoration efforts utilizing natural channel design have been proposed to the full extent practicable in lieu of bank armoring or
other non - restorative measures Where it was possible, maintenance work has been designed to limit impacts by installing
system upgrades within the footprint of existing piping
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Stream restoration is being constructed in a way that minimizes impacts to existing vegetation Tree protection will be
installed on trees that are to remain within the limits of disturbance Construction will follow sediment and erosion control best
management practices In- channel construction will occur "in- the -dry" using pump arounds
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
projects
❑ Mitigation bank
❑Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type
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
S. Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
Page 7 of 12
PCN Form — Version 1 3 December 10, 2008 Version

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
Page 8 of 12
PCN Form — Version 1 3 December 10, 2008 Version

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?
0%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why The proposed project is a municipal
stormwater maintenance project
2d
If this project DOES require a Stormwater Management Plan, then provide 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?
City of Charlotte
❑ Phase II
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state - implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 -246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes No
❑
attached?
5.
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 12
PCN Form — Version 1 3 December 10, 2008 Version

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?
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 (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
The project is not considered a "growth- inducing" project in that only maintanence, restoration and replacement of
existing infrastructure is proposed The area served by by these improvements is already fully built out
4. Sewage Disposal (DWQ Requirement)
4a Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility
The proposed project will not generate wastewater
Page 10 of 12
PCN Form — Version 1 3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a WIII 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?
A copy of this application will be provided to the USFWS - Asheville Field Office Field review of the project area did not
indicate the presence of habitat or endangered species listed for Mecklenburg County The project area and vicinity are
not located In a Designated Critical Habitat Review of Element Occurrences on the North Carolina Natural Heritage
Program Geographic Information Systems (GIS) files found that there were no known extant occurences of threatened or
endangered species within a 2 -mile radius of the proposed project
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 flondamanne org /efh— coral /Ims /viewer htm
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a WIII 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?
A copy of this application will be provided to the North Carolina State Historic Preservation Office (SHPO) A review of
the HPOWEB GIS Service Indicated that there were no properties currently listed or determined eligible for listing in the
National Register of Historic Places within a one mile radius of the project
8. Flood Zone Designation (Corps Requirement)
8a WIII 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? The proposed project will be constructed outside of the
100 -year FEMA floodplain http//polarismecklenburgcountyncgov
Isaac Hinson, PWS
C
ow<,
4 18 2014
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided )
Page 11 of 12
PCN Form — Version 1 3 December 10, 2008 Version

Page 12 of 12
PCN Form — Version 1 3 December 10, 2008 Version

Stream Impact Table
3a. Impact
Permant(P)/
Temporary(T)
3b. Type of impact
3c.
Stream
Name
3d.
Perennial
(PER) or
intermittent
(INT)
3e. Type of
jurisidiction
3f.
Average
Stream
width
(feet)
3g.
Impact
length
(If)
S1 (T)
(NWP 27) Channel enhancement
Stream 1
PER
Corp & DWQ
15
135
S2 (P)
(NWP 3) Culvert extension
Stream 1
PER
Corp & DWQ
18
4
S3 (T)
(NWP 27) Channel enhancement
Stream 1
PER
Corp & DWQ
18
76
S4 (T)
(NWP 27) Channel enhancement
Stream 1
PER
Corp & DWQ
16
57
S5 (T)
(NWP 27) Channel enhancement
Stream 1
PER
Corp & DWQ
11
240
S6 (P)
(NWP 3) Riprap apron installation
Stream 2
INT
Corp & DWQ
3
14
S7 (T)
(NWP 27) Channel enhancement
Stream 1
PER
Corp & DWQ
10
67
S8 (P)
(NWP 3) Pipe extension / system
connection
Stream 1
PER
Corp & DWQ
8
8
3h. Total stream and tributary impactsl
Temporary (NWP 27)
575
Permanent (NWP 3)
26
Total
I 601

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Jurisdictional Determination Request

jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address
City, State:
County:
Directions:
Vicinity of Gaynor Road
Charlotte, North Carolina
Mecklenburg
Near the intersection of Randolph and N Sharon Amity Road, see Figure 1 and 2
Parcel Index Number(s) (PIN)
B. REQUESTOR INFORMATION
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address'
Multiple Parcels
Isaac Hinson (CMSWS) / D David Homans (S &ME)
600 East Fourth Street, Charlotte, NC 28202
704 - 336 -4495 /704- 523 -4726
ihinson @charlottenc gov / dhomans @smeinc corn
Select one:
❑ I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultant
❑ Interested Buyer or Under Contract to Purchase
✓❑ Other, please explain.
Mr Hinson is a representative of Charlotte - Mecklenburg Storm Water Services
(CMSWS) which owns the storm drainage easements throughout the project area
Mr Homans is an authorized assisting environmental consultant
C. PROPERTY OWNER INFORMATION
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address
3
Charlotte- Mecklenburg Storm Water Services
600 East Fourth Stree
Charlotte, NC 28202
704 - 336 -4495
ihinson @charlottenc gov
❑ Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel /Tax Record data)
1 If available
2 Must attach completed Agent Authorization Form
3 If available
Version: December 2013 Page 3

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION'
I, the undersigned, a duly authorized owner of record of the property /properties identified herein,
do authorize representatives of the Wilmington District, U.S Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on -site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Property Owner (please print)
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
Date
4/18/2014
❑V I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
F1I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
❑ I am requesting that the Corps investigate the property /project area for the presence or
absence of WoUS5 and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
❑ I am requesting that the Corps delineate the boundaries of all WoUS on a property /project
area and provide an approved JD (this may or may not include a survey plat).
❑ I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property /project area and provide an approved JD (may or may not
include a survey plat).
4 For NCDOT requests following the current NCDOT /USACE protocols, skip to Part E
5 Waters of the United States
Version- December 2013 Page 4

Jurisdictional Determination Request
F. ALL REQUESTS
WlMap of Property or Project Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.
❑✓ Size of Property or Project Area 71 Acres acres
W/1 I verify that the property (or project) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.
G. JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests:
❑✓ Completed and signed Preliminary Jurisdictional Determination Form6.
❑
✓
Project Coordinates: 35 177847
Latitude -80 793013
Maps (no larger than 11 x 17) with Project Boundary Overlay:
Longitude
❑l Large and small scale maps that depict, at minimum: streets, intersections, towns
❑✓ Aerial Photography of the project area
F✓ USGS Topographic Map
❑ Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
6 See Appendix A of this Form From Regulatory Guidance Letter No. 08 -02, dated June 26, 2008
Version: December 2013 Page 5

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
❑ Wetland Data Sheets
Upland Data Sheets
Landscape Photos, if taken
Tributaries:
❑ USACE Assessment Forms
Field Sketch overlain on legible Map that includes:
Other Assessment Forms
(when appropriate)
• All aquatic resources (for sites with multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
• Approximate acreage /linear footage of aquatic resources
(2) Approved JDs including Verification of a Delineation:
❑ Project Coordinates:
Latitude
Longitude
Maps (no larger than 11 x 17) with Project Boundary Overlay:
❑ Large and small scale maps that depict, at minimum: streets, intersections, towns
❑ Aerial Photography of the project area
❑ USGS Topographic Map
❑ Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
1987 Manual Regional Supplements and Data forms can be found at
http / /www usace army mil/ Missions/ CrvilWorks /ResulatoryProsramandPermits /reg supp aspx
Wetland and Stream Assessment Methodologies can be found at:
http / /portal ncdenr ors /c /document library/set file?uuid= 76f3c58b -dab8- 4960- ba43- 45b7faf06f4c &groupld =38364 and,
http / /www saw usace army mil/ Portals /59 /docs /regulatory /publicnotices /2013 /NCSAM Draft User Manual 130318 pdf
8 Delineation information must include, at minimum, one wetland data sheet for each wetland /community type
Version: December 2013 Page 6

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands•
❑ Wetland Data Sheets
Tributaries:
❑ USACE Assessment Forms
❑ Upland Data Sheets ❑ Other Assessment Forms
(when appropriate)
❑ Landscape Photos, if taken
❑ Field Sketch overlain on legible Map that includes:
• All aquatic resources (for sites with multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
• Approximate acreage /linear footage of aquatic resources
Supporting Jurisdictional Information (for Approved JDs only)
❑ Approved Jurisdictional Determination Form(s) (also known as "Rapanos
Form(s) ")
❑ Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc. to navigable waters.
9 Delineation information must include, at minimum, one wetland data sheet for each wetland /community type
Version: December 2013 Page 7

Jurisdictional Determination Request
I. REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT
Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps project manager for
review.
Due to storage limitations of our administrative records, the Corps requires that all hard -
copy submittals include at least one original Plat (to scale) that is no larger than 11 "x17"
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11 "x 17 ", may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Document Format (PDF) file. Upon verification, the Corps can electronically sign these
plats and return them via e-mail to the requestor.
(1) PLATS SUBMITTED FOR APPROVAL
❑ Must be sealed and signed by a licensed professional land surveyor
❑ Must be to scale (all maps must include both a graphic scale and a verbal scale)
❑ Must be legible
❑ Must include a North Arrow, Scale(s), Title, Property Information
❑ Must include a legible WoUS Delineation Table of distances and bearings /metes
and bounds /GPS coordinates of all surveyed delineation points
❑ Must clearly depict surveyed property or project boundaries
Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)
❑ When wetlands are depicted:
• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system
Version: December 2013 Page 8

jurisdictional Determination Request
F] When tributaries are depicted:
• Must include either a surveyed, approximate centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) of tributary
• Must identify each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area (using approximate
widths or surveyed OHWM)
• Must include name of tributary (based on the most recent USGS topographic
map) or, when no USGS name exists, identify as "unnamed tributary"
❑ all depicted WoUS (wetland polygons and tributary lines) must intersect or tie -to
surveyed project/property boundaries
Must include the location of wetland data points and/or tributary assessment
reaches
❑ Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. "isolated wetlands ", "non -
jurisdictional waters "). NOTE: An approved JD must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.
❑ Must include and survey all existing conveyances (pipes, culverts, etc.) that
transport WoUS
Version: December 2013 Page 9

Jurisdictional Determination Request
(2) CERTIFICATION LANGUAGE
FWhen the entire actual Jurisdictional Boundary is depicted:
include the following Corps Certification language:
"This certifies that this copy of this plat accurately depicts the boundary of the jurisdiction
of Section 404 of the Clean Water Act as determined by the undersigned on this date.
Unless there is a change in the law or our published regulations, the determination of
Section 404 jurisdiction may be relied upon for a period not to exceed five (5) years from
this date. The undersigned completed this determination utilizing the appropriate Regional
Supplement to the 1987 U.S. Army Corps of Engineers Wetlands Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
When uplands may be present within a depicted Jurisdictional Boundary:
include the following Corps Certification language:
"This certifies that this copy of this plat identifies all areas of waters of the United States
regulated pursuant to Section 404 of the Clean Water Act as determined by the
undersigned on this date. Unless there is change in the law or our published regulations,
this determination of Section 404 jurisdiction may be relied upon for a period not to exceed
five years from this date. The undersigned completed this determination utilizing the
appropriate Regional Supplement to the 1987 U.S. Army Corps of Engineers Wetlands
Delineation Manual."
Regulatory Official-
Title:
Date•
USACE Action M No.:
Version- December 2013 Page 10

Jurisdictional Determination Request
(3) GPS SURVEYS
For Surveys prepared using a Global Positioning System (GPS), the Survey must include
all of the above, as well as.
❑ be at sub -meter accuracy at each survey point.
❑ include an accuracy verification-
One or more known points (property corner, monument) shall be located with the
GPS and cross - referenced with the existing traditional property survey (metes and
bounds).
❑ include a brief description of the GPS equipment utilized.
Version: December 2013 Page 11

N.C. Division of Water Quality (DWQ) Stream Identification
Forms

NC Division of Water Quality — Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC DWO Stream Identification Form Version 4.11
Date:3/25/2014
Project/Site Stream 1
Latitude:35 1794817
Evaluator: D. David Homans (S &ME)
county Mecklenburg
Longitude- -80.7934406
Total Points:
Stream least 38.5
Stream Determination (circle one)
Other
is at intermittent
Perennial
e g Quad Name.
if? 19 or perennial if 2! 30*
2
3
A Geomorphology (Subtotal = 22 )
Absent
Weak
Moderate
Strong
1' Continuity of channel bed and bank
0
10
20
3 Q
2 Sinuosity of channel along thalweg
0
1•
2
3
3 In- channel structure ex riffle -pool, step -pool,
ripple-pool se uence
0©
10
2®
3 O
4 Particle size of stream substrate
0 0
110—
2
30
5 Active /relict floodplain
00
10
2
30
6 Depositional bars or benches
0
1
2
3•
7 Recent alluvial deposits
0
1
2
3•
8 Headcuts
0
1
2•
3
9 Grade control
0 0
0
1
1 50
10 Natural valley
00
1 0
1 0
1 50
11 Second or greater order channel
No = 0 •
Yes = 3
a artificial ditches are not rated, see discussions in manual
B H drolo Subtotal = 10
12 Presence of Baseflow
00
10
20
3 Q
13 Iron oxidizing bacteria
0•
10
20
30
14 Leaf litter
1 •
1Q
050
0
15 Sediment on plants or debris
00
050
1•
1 5
16 Organic debris lines or piles
00
1 05C)
1
1 5•
17 Soil -based evidence of high water table?
No = 0
Yes = 3 •
C Bloloav (Subtotal= 65
18 Fibrous roots in streambed
3
2 •
in
0
19 Rooted upland plants in streambed
3 •
20
1
0
20 Macrobenthos (note diversity and abundance)
0
1 •
20
3
21 Aquatic Mollusks
0 •
1
2
3
22 Fish
0•
050
in
1 5
23 Crayfish
06
0 5Q
1
1 5
24 Amphibians
0•
05(D
10
1 5
25 Algae
0
05
1
1 5
26 Wetland plants in streambed
IG
FACW = 0 75{QOBL = 1 500ther = 0
'perennial streams may also be identified using other methods Seep 35 of manual
Notes Channel is deeply incised
Sketch
41

NC Division of Water Quality — Methodology for Identification of Intermittent and
Perennial Streams and Their Oriqins v. 4.11
NC DWQ Stream Identification Form Version 4.11
Date 3/25/2014
ProjectfSite Stream 2
Latitude.35.177676
Evaluator D. David Homans (S &ME)
County- Mecklenburg
Longitude- $0.793477
Total Points:
Stream least 19.5
Stream Determination (circle one)
Other
is at intermittent
Intermittent
e g Quad Name.
if? 19 or perennial if? 30*
2
3
A Geomorphology (Subtotal o )
Absent
Weak
Moderate
Strong
1a Continuity of channel bed and bank
0
1 0
2 0
30
2 Sinuosity of channel along thalweg
0
1•
2
3
3 In- channel structure ex riffle -pool, step -pool,
ripple-pool se uence
0 0
1 0.
2 0
30
4 Particle size of stream substrate
0
1
2
30
5 Active /relict floodplain
00
1•
2
30
6 Depositional bars or benches
0
1.
2
3
7 Recent alluvial deposits
0
1•
2
3
8 Headcuts
0•
1
2
3
9 Grade control
00
00
10
1 50
10 Natural valley
00
0 •
10
150
11 Second or greater order channel
No = 0 •
Yes = 3
a artificial ditches are not rated, see discussions in manual
B Hydrology Subtotal = 5
12 Presence of Baseflow
00
10
2E)
30
13 Iron oxidizing bacteria
0
10
2 •
3
14 Leaf litter
1 •
10
050
0
15 Sediment on plants or debris
0Q
0 5•
10
15
16 Organic debris lines or piles
0 Q
0 5•
10
1 5
17 Sod -based evidence of high water tables
No = 0 •
Yes= 3
C Biology (Subtotal = 45 )
18 Fibrous roots in streambed
3(—)
2 • )
in
0
19 Rooted upland plants in streambed
3
20
1 •
0
20 Macrobenthos (note diversity and abundance)
0
1 •
2
3
21 Aquatic Mollusks
0 •
1
20
3
22 Fish
0•
050
1
1 5
23 Crayfish
0•
05C)
1
1 5
24 Amphibians
0•
050
1
1 5
25 Algae
0
050
1
1 5
26 Wetland plants in streambed
10
FACW = 0 75()OBL = 1 500ther = 0
(F)
'perennial streams may also be identified using other methods See p 35 of manual
Notes Bed and bank area was underlain with riprap, making it hard to effectively evaluate for soil based evidence of a high water table
ironomi s observed
Sketch
41

Wetland Determination Data Form (Upland Form for DP1)

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont
Project/Site Gaynor SDIP City /County Mecklenburg Sampling Date 3/25/2014
Applicant/Owner Charlotte - Mecklenburg Storm Water Services State NC Sampling Point DP1
Investigators) D David Homans Section, Township, Range Charlotte / Cotswold
Landform (hillslope, terrace, etc ) Riparian Floodplain Local relief (concave, convex, none) concave Slope
Subregion (LRR or MLRA) LRR P Lat 35 177847 Long -80 793013 Datum
Soil Map Unit Name Helena sandy loam, 2 to 8 percent slopes NWI classification
Are climatic / hydrologic conditions on the site typical for this time of year? Yes FV( I— No _E_ (If no, explain in Remarks)
Are Vegetation ✓ , Sod or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes I • 1 No I-1
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks )
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes - No
— — Is the Sampled Area
Hydnc Sod Present? Yes No within a Wetland? Yes I 1 No I—I
Wetfand Hydrology Present? Yes 4=71 No l_
Remarks
Regular vegetation has been disrupted by invasive species.
HYDROLOGY
Wetland Hydrology Indicators.
Secondary Indicators (minimum of two reaUEp.
Primary Indicators (minimum of one is required check all that apply)
_ Surface Sod Cracks (136)
Surface Water (Al)
_ True Aquatic Plants (1314)
_ Sparsely Vegetated Concave Surface (138)
High Water Table (A2)
_ Hydrogen Sulfide Odor (Cl)
_ Drainage Patterns (1310)
Saturation (A3)
_ Oxidized Rhizospheres on Living Roots (C3)
Moss Trim Lines (1316)
_ Water Marks (B1)
_ Presence of Reduced Iron (C4)
_ Dry- Season Water Table (C2)
_ Sediment Deposits (132)
_ Recent Iron Reduction in Tilled Sods (C6)
_ Crayfish Burrows (C8)
_ Drift Deposits (133)
_ Thin Muck Surface (C7)
_ Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (64)
Other (Explain in Remarks)
_ Stunted or Stressed Plants (D1)
_ Iron Deposits (135)
_ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (137)
_ Shallow Aquitard (D3)
_ Water - Stained Leaves (139)
_ Microtopographic Relief (D4)
Aquatic Fauna (1313)
_ FAC- Neutral Test (D5)
Field Observations
Surface Water Present? Yes No
Depth (inches)
Water Table Present? Yes No
`� Depth (inches)
Saturation Present? Yes No
`� Depth (inches)
Wetland
Hydrology Present? Yes No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available
Remarks
US Army Corps of Engineers Eastern Mountains and Piedmont – Version 2 0

VEGETATION (Four Strata) — Use scientific names of plants.
Tree Stratum (Plot size )
1 Salix nigra
2
3
4
5
6
7
8
Sapling /Shrub Stratum (Plot size )
1 Phyllostachys sp
2
3
4
5
6
7
8
9
10
Herb Stratum (Plot size )
1
2
3
4
5
6
7
8
9
10
11
12
Woody Vine Stratum (Plot size )
1
2
3
4
5
6
Sampling Point DP1
Absolute Dominant Indicator
Dominance Test worksheet
% Cover Species? Status
Number of Dominant Species
10 YES OBL
That Are OBL, FACW, or FAC 1 (A)
Total Number of Dominant
Species Across All Strata 2 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC 50 (A/B)
_
Prevalence Index worksheet
Total % Cover of Multiply by
10
OBL species 10 x 1 = 10
= Total Cover
FACW species x 2 =
95 YES UPL
FAC species x 3 =
-
FACU species x 4 =
-
UPL species 95 x5= 475
-
Column Totals 105 (A) 485 (B)
Prevalence Index = B/A = 4 61
Hydrophytic Vegetation Indicators.
1 - Rapid Test for Hydrophytic Vegetation
_ 2 - Dominance Test is >50%
_ 3 - Prevalence Index is <_3 0'
4 4 - Morphological Adaptations' (Provide supporting
95 = Total Cover
data in Remarks or on a separate sheet)
✓ Problematic Hydrophytic Vegetation' (Explain)
0 = Total Cover
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic
Definitions of Four Vegetation Strata
Tree — Woody plants, excluding vines, 3 in (7 6 cm) or
more in diameter at breast height (DBH), regardless of
height
Sapling /Shrub — Woody plants, excluding vines, less
than 3 in DBH and greater than 3 28 ft (1 m) tall
Herb — All herbaceous (non- woody) plants, regardless
of size, and woody plants less than 3 28 ft tall
Woody vine — All woody vines greater than 3 28 ft in
height
Hydrophytic
Vegetation
Present'7 Yes No F
0 = Total Cover
Remarks (Include photo numbers here or on a separate sheet )
Vegetation Is totally dominated by sapling height thick bamboo, shading out herbaceous vegetation
US Army Corps of Engineers Eastern Mountains and Piedmont —Version 2 0

V
SOIL
Sampling Point DP1
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
Matrix
Indicators for Problematic Hydnc Sods'
Redox Features
(inches)
Color (moist)
%
Color (moist) % Type Loc Texture Remarks
0 -2
10YR 4/3
100
sandy loam
2 -5
2 5Y 6/4
100
sandy clay
5 -15+
7 5YR 4/6
100
clay
'Type C= Concentration, D =De letion, RM= Reduced Matrix, MS= Masked Sand Grains 2Location PL =Pore Lining, M= Matrix
Hydnc Sod Indicators.
Indicators for Problematic Hydnc Sods'
Histosol (Al)
_ Dark Surface (S7)
_ 2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_ Coast Prairie Redox (A16)
Black Histic (A3)
_ Thin Dark Surface (S9) (MLRA 147, 148)
(MLRA 147, 148)
Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
_ Piedmont Floodplam Soils (F19)
_ Stratified Layers (A5)
_ Depleted Matrix (F3)
(MLRA 136, 147)
2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
_ Very Shallow Dark Surface (TF12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (F8)
_ Other (Explain in Remarks)
Sandy Mucky Mineral (S1) (LRR N,
_ Iron - Manganese Masses (F12) (LRR N,
MLRA 147, 148)
MLRA 136)
_ Sandy Gleyed Matrix (S4)
_ Umbric Surface (F13) (MLRA 136, 122)
'Indicators of hydrophytic vegetation and
_ Sandy Redox (S5)
_ Piedmont Floodplain Sods (F19) (MLRA 148)
wetland hydrology must be present,
_ Stripped Matrix (S6)
Red Parent Material (F21) (MLRA 127, 147)
unless disturbed or problematic
Restrictive Layer (if observed)
Type
Depth (inches)
Hydnc
Sod Present? Yes No
US Army Corps of Engineers Eastern Mountains and Piedmont —Version 2 0