20051980 Ver 2_401 Application_20110113

DS - ?' 80 01
? ? ? Kimley-Horn
and Associates, Inc.
DEC y RECD
01ViS" OF VMTER QUAUTY January 13, 2010
Mr. Eric Alsmeyer
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trail Drive, Suite 105
Wake Forest, NC 27587
Mr. Ian McMillan
Archdale Building
512 North Salisbury Street
Raleigh, North Carolina 27604
Re: Varsity Drive Widening
Nationwide Permit #14 Application Submittal
Raleigh, Wake County, North Carolina
Dear Mr. Alsmeyer and Mr. McMillan:
A®
¦
suite 600
333 Fayetteville Street
Raleigh, North Carolina
27601
?§@fflowop
JAN 1 3 2011
DENR - WATER OUAUTY
WETLANDS AND STORMWATER BRANCH
On behalf of North Carolina State University, Kimley-Horn and Associates, Inc.
is submitting the enclosed joint 404/401 Pre-Construction Notification
Application for authorization to construct the above referenced project under
Nationwide Permit Number 14 and General 401 Water Quality Certification
number 3820. The following information is included as part of this application
submittal:
• Project Summary Sheet
• Pre-Construction Notification Form
• NCDWQ check for $240 permit application fee
• Project Vicinity/USGS Topographic Map (Figure 1)
• Aerial Photograph (Figure 2)
• Soils Map (Figure 3)
• Project Plans (Sheets 1-5)
• Stream Delineation Mapping
• Preliminary Jurisdictional Determination request
• NCDWQ Stream Classification Forms
• USACE Stream Quality Assessment Forms
Varsity Drive is currently a two-lane roadway with shoulder sections to the south
of Western Blvd. North of Western Blvd., the corridor is and existing three-lane
¦
TEL [phone]
FAX [phone]
? M ? Kimley-Horn
and Associates, Inc.
road (two travel lanes and a two-way left-turn lane with curb and gutter sections).
This project proposes to improve the intersection of Western Blvd. and Varsity
Drive by adding turn lanes. These improvements will widen Varsity Drive to
five lanes (three travel lanes and two turn lanes) in the vicinity of the
intersection. The length of the project will include curb and gutter, storm
drainage, and sidewalks on the west side of the road. The project allows
improved intersection movement and alleviates traffic congestion. The Varsity
Drive Widening is being constructed and is funded by North Carolina State
University.
The project will include installing a new 40 foot long 30" Reinforced Concrete
Pipe (RCP) to extend the existing 30" RCP over an unnamed tributary to Rocky
Branch, resulting in 42 linear feet of intermittent stream impact (including outlet
protection). The project is located within the Neuse River basin, therefore
Neuse regulated riparian buffer impacts occur. Due to the proposed project
resulting in less than 150 linear feet of stream impact, no mitigation for this
project is anticipated.
The stream was located by a licensed surveyor and reviewed in the field by
KHA. Martin Richmond with DWQ reviewed the impacted channel on
Wednesday, August 25, 2010 and confirmed that the channel was a Neuse
buffered feature.
If there is any additional information you need to assist in the processing of this
application, please do not hesitate to contact me at [phone].
Very truly yours,
KIMLEY-HORN AND ASSOCIATES, INC.
??L 4,L_
Stephanie Hachem, P.E.
Project Manager
Enclosures
IDS- lqgb v9L
OF WATF9
\o?, pG Office Use Only:
Corps action ID no.
o < DWQ 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
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ® Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ? Yes ® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Varsity Drive Widening
2b. County: Wake County
2c. Nearest municipality / town: City of Raleigh
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina State University
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable): Steve Bostian
3d. Street address: Admin Services III Suite 331, Campus Box 7520
3e. City, state, zip: Raleigh, NC 27695-7520
3f. Telephone no.: [phone]
3g. Fax no.:
3h. Email address: [e-mail]
Page I of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: North Carolina State University
4b. Name: Steve Bostian
4c. Business name
(if applicable): North Carolina State University
4d. Street address: Admin Services III Suite 331, Campus Box 7520
4e. City, state, zip: Raleigh, NC 27695-7520
4f. Telephone no.: [phone]
4g. Fax no.:
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Stephanie Hachem
5b. Business name
(if applicable):
Kimley-Horn and Associates, Inc.
5c. Street address: 3001 Weston Parkway
5d. City, state, zip: Cary, NC 27513
5e. Telephone no.: [phone]
5f. Fax no.: [phone]
5g. Email address: [e-mail]
Page 2 of 11
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):
1 b. Site coordinates (in decimal degrees): Latitude: 35.78478 Longitude: - 78.68179
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: -0.27 miles acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Rocky Branch
proposed project:
2b. Water Quality Classification of nearest receiving water: C, NSW
2c. River basin: Neuse
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 corridor is an existing two-lane road with shoulder sections to the south of Western Blvd. North of Western
Blvd., the corridor is an existing three lane road (two travel lanes and a two-way left-turn lane with curb and gutter
sections. The surrounding area is a combination of cultivated land and heavily developed or disturbed land.
3b. List the total estimated acreage of all existing wetlands on the property:
0.0 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
42 L.F.
3d. Explain the purpose of the proposed project:
This project proposes to improve the intersection of Western and Varsity Drive by adding turn lanes. These
improvements will widen Varsity Drive to five lanes (three travel lanes and two turn lanes) in the vicinity of the
intersection. The length of the project will include curb and gutter, storm drainage, and sidewalks on the West side. The
project allows improved intersection movement and alleviates traffic congestion.
3e. Describe the overall project in detail, including the type of equipment to be used:
The Varsity Drive Widening is being costructed and is funded by North Carolina State University and federal funds
administered by NCDOT. The project will consist of asphalt road widening, milling and resurfacing. Equipment will
consist of excavators, backhoes, asphalt pavers, milling machines, and pipe jacking equipment.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ? Yes [I No Unknown
project (including all prior phases) in the past?
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: Kimley-Horn and Assoc.,
Name (if known): Beth Reed, PWS Inc.
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
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.
Page 3 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries ® Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 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 0
2h. Comments: No wetlands were identified
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) (I NT)? other) (feet) feet)
S1 ®P ? T Culvert UT1 to Rocky ? PER ? Corps 5 42
Branch ® 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 42
3i. Comments:
Page 5 of 11
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 were identified
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 purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments: No ponds or lakes were id entified
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. 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 mitigation, 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 Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
131 ®P ? T Culvert UT1 to Rocky Branch ? Nos 3,107 1,698
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 3,107 1,698
6i. Comments:
Page 6 of 11
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.
All practical measures have been taken to avoid and minimize impacts to the streams. Topographic constraints have limited
the locations for some impacts. Varsity Drive is being widened to the west due to existing building locations.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The project is utilizing the existing pavement section and widening to the west. The side slopes are at a maximum 3:1 to
minimize stream impacts. Erosion control measures will be installed during construction to help reduce the impact of sediment
laden water washing into receiving waters. Measures will include check dams, rock inlet protection, temporary ditch liners,
and silt fencing.
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
project? ? 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:
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.
Page 7 of 11
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 Road widening 0 3 (2 for Catawba) 0
Zone 2 Road widening 0 1.5 0
6f. Total buffer mitigation required: 0
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: Buffer impacts "Allowable"
Page 8 of 11
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ® Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes No
Comments: The conveyance within the buffer will not be altered (culvert).
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? %
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Linear public transportation projects will
be required to treat stormwater runoff to the Maximum Extent Practicable in accordance with the practices described in
the NCDOT Best Management Practices (BMP) Manual.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
(See Attached Stormwater Management Plan)
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
® DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
? Phase II
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
? ORW
(check all that apply):
? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ® Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ® Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ? No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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?
The USFWS Endangered and Threatened Species county list for Wake County and the NC Natural Heritage program
database were reviewed as part of this project. There are no current or historic occurances of threatened or endangered
species in the project corridor. In addition, suitable habitat was not observed for any species listed by USFWS during field
reconaissance.
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?
The project does not occur in a coastal county.
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?
No historical or archaeological features will be impacted based on a review of the SHPO database reviewed at the NC
Department of Archives and information from Susan Myers, NC State Archaeologist (11/22/2010).
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA floodmaps panel 37183C0526E
off. e s 6 . Le- 9c I-- /- *I.
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.)
VICE CPANCELLOR FOR
FM %4a AND 11111005
Page 11 of 11
PCN Form - Version 1.3 December 10, 2008 Version

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ATTACHMENT
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Steve Bostian
North Carolina State University
Admin Services III Suite 331, Campus Box 7520
Raleigh, NC 27695-7520
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The
project is located on Varsity Drive, south of Western Boulevard in Raleigh, NC.
The project corridor is an existing two-lane road with shoulder sections to the
south of Western Blvd. North of Western Blvd, the corridor is an existing three
lane road (two travel lanes and a two-way left-turn lane with curb and gutter
sections). The project proposes to improve the intersection of Western and
Varsity Drive to five lanes (three travel lanes and two turn lanes) in the vicinity of
the intersection. The length of the project will include curb and gutter, storm
drainage, and sidewalks on the west side. The project allows improved
intersection movement and alleviates traffic congestion.
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES
AT DIFFERENT SITES)
State:NC County/parish/borough: Wake City: Raleigh
Center coordinates of site (lat/long in degree decimal format): Lat. 35.78478°
N, Long. 78.68179°W.
Universal Transverse Mercator:
Name of nearest waterbody: Rocky Branch and Walnut Creek
Identify (estimate) amount of waters in the review area:
Non-wetland waters: 42 linear feet: 5 width (ft) and/or acres.
Cowardin Class:
Stream Flow: Intermittent
Wetlands: acres.
Cowardin Class:
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal:
Non-Tidal:
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
? Office (Desk) Determination. Date:
? Field Determination. Date(s):
1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre-construction notification" (PCN), or requests verification for a non-reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
2
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.
This preliminary JD finds that there "may be"waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
SUPPORTING DATA. Data reviewed for preliminary JD (check all that apply
- checked items should be included in case file and, where checked and
requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant:
® Data sheets prepared/submitted by or on behalf of the
applicant/consultant.
? Office concurs with data sheets/delineation report.
? Office does not concur with data sheets/delineation report.
? Data sheets prepared by the Corps:
? Corps navigable waters' study:
? U.S. Geological Survey Hydrologic Atlas:
? USGS NHD data.
? USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name:
® USDA Natural Resources Conservation Service Soil Survey.
Citation:Wake County NRCS.
? National wetlands inventory map(s). Cite name:
? State/Local wetland inventory map(s):
? FEMA/FIRM maps:
? 100-year Floodplain Elevation is: (National Geodectic Vertical Datum
of 1929)
? Photographs: ? Aerial (Name & Date):
or ? Other (Name & Date):
? Previous determination(s). File no. and date of response letter:
? Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified by the Corps and should not be relied upon for
later jurisdictional determinations.
Signature and date of
Regulatory Project Manager
(REQUIRED)
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)
SAMPLE

Site
number

Latitude

Longitude
Cowardin
Class Estimated
amount of
aquatic
resource in
review area
Class of
aquatic
resource
1 42 linear feet
2
3
4

NC DWO Stream Identification Form Version 4.11
Date: ProjectlSite: ?• Latitude: N
Evaluator: g County: Longitude:
Total Points:
Stream is at least Intermittent
' Stream Determination (circle one)
Ephemeral Intermittent Perennial Other
e.g. Quad Name:
If 2 19 or Perennial if z 30
A. Geomorphology Subtotal = S Absent Weak Moderate Strong
i" Continuity of channel bed and bank 0 1 3
2. Sinuosity of channel along thalweg 0 1 2 3
3. In-channel structure: ex. riffle-pool, step-pool,
ripple-pool sequence 0 © 2 3
4. Particle size of stream substrate 0 1 2 3
5. Activelrelict floodplain 1 2 3
6. Depositional bars or benches 1 2 3
7. Recent alluvial deposits 0 1 2 3
8. Headcuts 0 (1-75 2 3
9. Grade control 0 0.5 1 1.5
10. Natural valley 0 0.5 1 1.5
11. Second or greater order channel No 0 Yes = 3
° artificial ditches are not rated; see discussions in manual
B. Hvdroloav !Subtotal = '5". S )
12. Presence of Baseflow 0 © 2 3
13. Iron oxidizing bacteria 0 - 1 2 3
14. Leaf litter 1.5 i 0. 0
15. Sediment on plants or debris 0 0.5 • 1 1.5
16. Organic debris lines or piles 4 (0-5)_ 1 1.5
17. Soil-based evidence of high water table? No = 0 Yes 3
C. Bloloav (Subtotal = `f- D )
18. Fibrous roots in streambed 3 1 0
19. Rooted upland plants in streambed 3 2 1 0
20. Macrobenthos (note diversity and abundance) 0 1 2 3
21. Aquatic Mollusks 1 2 3
22. Fish (0) 0.5 1 1.5
23. Crayfish 0 0.5 1 1.5
24. Amphibians 0.5 1 1.5
25. Algae 0 0.5 1 1.5
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other 0
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:

Sketch: O1 AS"4tL9'f0_qtx1 ^'lootorq/itjj c?)4rnv4jm? civoad• tJ? 't

',J A00C r,gW j tl C
f r
V41 S00 6S 6eM 9C-0 ? w
Acv 1 v6p c ??
??-??? F ?
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment: r? p
t? Ol
1. Applicant's name: ?N zt:4t', V,\'w' 06144,
3. Date of evaluation:/ -T / 10
5. Name of stream UT koc-W Z mv.e.k
7. Approximate drainage area:_ r 14 au+.-5
9. Length of reach evaluated: to b"
2. Evaluator's name:
4. Time of evaluation: 10' O L-3 a w.
6. River basin: W{.yb e.
8. Stream order: °
10. County: ??J+tt?
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): 3`Z ,L a • y ?" Longitude (ex. -77.556611): \A
\n)
Method location determined (circle): OPS T4-!het Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s)
location): W efa3t \Jo?f Qty v,n w? - 0 4• v -aun? ATO C3J\v?rv 11`L 13rl99
v?sa?bc:
14. Proposed channel work (if any): u\.re.:t
4Aa
15. Recent weather conditions: C1ov&S aA4\
16. Site conditions at time of visit:
17. Identify any special waterway classifications known: Section 10 Tidal Waters Essential Fisheries Habitat
Trout Waters Outstanding Resource Waters Nutrient Sensitive Waters Water Supply Watershed (I-IV)
18. Is there a pond or lake located upstream of the evaluation point?a NO If yes, estimate the water surface area: ©
19. Does channel appear on USGS quad map? YES`0 20. Does channel appear on USDA Soil Survey NO
21. Estimated watershed land use:
% Residential Sd/o Commercial
A! % Forested % Cleared / Logged
22. Bankfull width: 2' '
24. Channel slope down center of stream: Flat (0 to 2%) ?
% Industrial % Agricultural
% Other ()
23. Bank height (from bed to top of bank): Z •?
Gentle (2 to 4%) Moderate (4 to 10%) Steep (>10%)
25. Channel sinuosity:. Straight Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points to
each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the characteristics
identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a characteristic cannot
be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the comment section. Where
there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture into a forest), the stream
may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each reach. The total score
assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the highest quality.
Total Score (from reverse): 775 to Comments: Z)n,\LA Stn4 CeaG1P. r (A)
Evaluator's Signature.
Date
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in gathering
the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream quality. The total score
resulting from the completion of this form is subject to USACE approval and does not imply a particular mitigation ratio or
requirement. Form subject to change - version 06/03. To Comment, please call 919-876-8441 x 26.

Stream Quality Assessment Worksheet
# Ch
i
i Eco-r •on Point Range S
aracter
st
cs
Coastal
Piedmont
Mountain core
1 Presence of flow / persistent pools In stream 0-5 0-4 0-5
1
no flow or saturation - 0; strop flow = max points)
2 Evidence of past human alteration 0-6 0-5, 0-5
rZ
extensive alteration = 0; no alteration = max points)
3 Riparian zone 0-6 0-4 0-5
no buffer = 0; contiguous, wide buffer = max points)
4 Evidence of nutrient or chemical discharges 0-5 0-4 0-'4
3
extensive discharges - 0; no discharges = max points)
a 5 Groundwater discharge 0.3 0-4 0-4
a no discharge = 0; s rin s; s s, wetlands etc. = max points)
,V.
6 Presence of adjacent floodplain
0-4
0 - 4
0.2

p
y no flood lain = 0; extensive flood lain - max points)
?i
7
Entrenchment/ floodplain access
0-5
0-4
0.2
O
a (deeply entrenched = 0; frequent flooding = max points)

$ Presence of adjacent wetlands
'
0-6
0.4,
0-2
no wetlands = 0; large ad
scent wetlands = max points)
9 Channel sinuosity 0-5 0-4 0-3
b
extensive channelization = 0; natural meander = max points)
10 Sediment input 0-5 0- 4 0-4
(extensive deposition= 0; little or no sediment = max points)
I 1 Size & diversity of channel bed substrate NA* 0-4 0-5
fine, homogenous = 0; large, diverse sizes = max points)
12 Evidence of channel incision or widening 0-5 0-4 0-5
5+ (deeply incised = 0; stable bed & banks = max points)
13 Presence of major bank failures 0-5 0-5 0-5
S
severe erosion = 0; no erosion, stable banks = max points)
M - -
14 Root depth and density on banks
0-3
0-4
0-5
1-4 no visible roots - 0; dense roots throughout = max points)
(A 15 Impact by agriculture, livestock, or timber production 0-5 0-4 0-5

substantial impact =0; no evidence - max points)
1
1
16 Presence of riffle-pool ripple-pool complexes 0-3 0-5 0-6
F no riffles/ripples or pools = 0; well-developed = max points)
Q 17 Habitat complexity 0-6 0-6 0-6
ittle or no habitat = 0; frequent, varied habitats = max points)
18 Canopy coverage over streambed 0-5 0-5 0-5
L
no shading vegetation = 0; continuous canopy = max points)
19 Substrate embeddedness NA* 0-4 0-4
(deeply embedded = 0; loose structure = max
20 Presence of stream Invertebrates (see page 4) 0-4 0-5 0-5
y? no evidence = 0; common numerous types = max points)
0 21 Presence of amphibians 0-4 0-4 0-4
O no evidence = 0• common, numerous types = max points) 0
04
22 Presence offish
no evidence = 0; common, numerous types = max points)
0-4
0.4
0-4
23 Evidence of wildlife use 0-6 0-5 0-5
b
no evidence = 0• abundant evidence - max points)
Total Points Possible 100 loo 100
TOTAL SCORE (also enter on first page) 3(o
* These characteristics are not assessed in coastal 'streams.