20110061 Ver 1_Application_20110119

Cffs P17
1 9 2011
I?; I,I 1.992W1 DENR - WATER QUALITY
ra hATER ANDSTORMWATERBRi?,TE OF NORTH CAROLINA
WETU?DS wo„sT EPARTIENT OF TRANSPORTATION
BEVERLY PERDUE
GovrRVoR
U. S. Army Corps of Engineers
Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
ATTN: Ms. Loretta Beckwith
NCDOT Coordinator
Subject: Application for Section 404 Nationwide Permit 23 for the proposed replacement
of Bridge No. 56 over Bill Moore Creek on SR 3439 (Reeves Cove Road) in
Buncombe County, Federal Aid Project No. BRZ-3439(1); Division 13;
TIP No. B-3619
Dear Madam:
The North Carolina Department of Transportation (NCDOT) proposes to replace Bridge No. 56
over Bill Moore Creek on SR 3437. There will be 30 feet of permanent surface water impacts due
to the installation of a 128-foot bottomless culvert.
Please see enclosed copies of the Pre-Construction Notification (PCN), Stormwater Management
Plan, permit drawings, design plans and Rapanos form. The Categorical Exclusion (CE) was
completed in December 2007. Documents were distributed shortly thereafter. Additional copies
are available upon request.
This project calls for a letting date of September 20, 2011 and a review date of August 2, 2011;
however, the let date may advance as additional funding becomes available.
Comments from the North Carolina Wildlife Resources Commission (NCWRC) will be required
prior to authorization by the Corps of Engineers. By copy of this letter and attachments, NCDOT
hereby requests NCWRC review NCDOT requests that NCWRC forward their comments to the
January 3, 2011
GENE CONTI
SECRETARY
11®®61
Corps of Engineers and the NCDOT within 30 calendar days of receipt of this application.
MAILING ADDRESS:
NC DEPARTMENT OF TRANSPORTATION
PROJECT DEVELOPMENT ANO ENVIRONMENTAL ANALYSIS
1598 MAIL SERVICE CENTER
RALEIGH NC 27699-1548
TELEPHONE: [phone]
FAX: [phone]
WEBSITE: WVVW.NCDOT.ORG
LOCATION:
ENVIRONMENTAL RESOURCE CENTER
4701 ATLANTIC AVENUE, SUITE 116
RALEIGH NC 27604
., 1
A copy of this permit application will be posted on the NCDOT Website at:
http://www.ncdot.org/doh/preconstruct/pe/. If you have any questions or need additional
information, please call Jeremy Learner at [phone].
Sincerely,
I-tvk
? Gregory J. Thorpe, Ph.D., Manager
Project Development and Environmental Analysis Branch
w/attachment
Mr. Brian Wrenn, NCDWQ (2 copies)
Ms. Marla Chambers, NCWRC
Ms. Marella Buncick, USFWS
w/o attachment (see permit website for attachments)
Dr. David Chang, P.E., Hydraulics
Mr. Mark Staley, Roadside Environmental
Mr. Victor Barbour, P.E., Project Services Unit
Mr. Greg Perfetti, P.E., Structure Design
Mr. J. J. (Jay) Swain, Jr., P.E., Division 13 Engineer
Mr. Roger Bryan, DEO
Mr. Jay Bennett, P.E., Roadway Design
Mr. Majed Alghandour, P. E., Programming and TIP
Mr. Art McMillan, P.E., Highway Design
Mr. Scott McLendon, USACE, Wilmington
Ms. Stacy Oberhausen, PDEA
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
la. Type(s) of approval sought from the
Corps:
® Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 23 or General Permit (GP) number:
1c. Has the N WP or GP number been verified by the Corps? ? Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
? 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
® Yes ? No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? 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: Replacment of Bridge 56 over Bill Moore Creek on SR 3439 (Reeves Cove Road)
2b. County: Buncombe
2c. Nearest municipality / town: Asheville
2d. Subdivision name: not applicable
2e. NCDOT only, T.I.P. or state
project no: B-3619
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. not applicable
3c. Responsible P arty (for LLC if
applicable): not applicable
3d. Street address: 1598 Mail Service Center
3e. City, state, zip: Raleigh, NC 27699-1598
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: [e-mail]
.i
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name: not applicable
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: not applicable
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): not applicable

1 b. Site coordinates (in decimal degrees):
35.51803 Longitude: - 82.65244
Latitude:
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 0.8 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Bill Moore Creek
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: French Broad
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
SR 3439 is a two lane local route transecting a semi-rural area heavily forested with low-density residential development.
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
150
3d. Explain the purpose of the proposed project:
To replace bridge No. 56 which is considered structurally deficient.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project involves replacing the existing 26-foot bridge with a new 128-foot three-sided culvert on new alignment,
maintaining traffic on-site. Standard road building equipment, such as trucks, dozers, and cranes will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments: Request per this application
? Yes ®No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
? Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company:
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
this project (including all prior phases) in the past? ? Yes ® No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ®No
6b. If yes, explain.
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
Site 1 ? P ? T ? Yes ? Corps
? No ? DWQ
Site 2 ? P ? T ? Yes ? Corps
? No ? DWQ
Site 3 ? P ? T ? Yes ? Corps
? No ? DWQ
Site 4 ? P ? T ? Yes ? Corps
? No ? DWQ
Site 5 ? P ? T ? Yes ? Corps
? No ? DWQ
Site 6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of Average Impact length
number - (PER) or jurisdiction stream (linear feet)
Permanent (P) or intermittent (Corps - 404, 10 width
Temporary (T) (INT)? DWQ - non-404, (feet)
other)
Site 1 ® P ? T "Culvert Bill Moore Creek ® PER
? INT ® Corps
? DWQ 9 30
Site 2 ? P ? T ? PER ? Corps
? INT ? DWQ
Site 3 ? P ? T ? PER
? INT ? Corps
? DWQ
Site 4 ? P ? T ? PER
? INT ? Corps
? DWQ
? PER ? Corps
Site 5 ? P ? T ? INT ? DWQ
? PER ? Corps
Site 6 ? P ? T ? INT ? DWQ
3h. Total stream and tributary impacts 30' Perm
3i. Comments: '28 foot x 6 foot three-sided bottomless culvert - 128 feet overall length
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual) list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number - waterbody Type of impact Waterbody type Area of impact (acres)
Permanent (P) or (if applicable)
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts X Permanent
X Temporary
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed , then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond Excavat
Flooded Filled ed Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No if yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer
impacts below. If an impacts require mitig ation, then you MUST fill out Section D of this form.
6a.
? Neuse
?Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number- Reason for impact Buffer Zone 1 impact Zone 2 impact
Permanent (P) or Stream name mitigation (square feet) (square feet)
Temporary required?
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:

D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Roadway improvements taper into the existing 18-foot roadway without widening towards Bill Moore Creek and 2:1 fill
slopes will be utilized where practicable. A bottom less culvert will be used to replace the bridge.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Surficial bridge runoff will not be directed into Bill Moore Creek via deck drains. A trout moratorium prohibits in-stream
work during January 1 to April 15 in addition to Design Standards in Sensitive Watersheds.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State

2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
If no, explain: Minimal impacts of 30 linear feet result from
the installation of a three-sided culvert into bedrock. Bill
Moore Creek is not designated a HOW or ORW.
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigat ion 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: not applicable
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
41h. 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.
7
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan

la. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan

2a. What is the overall percent imperviousness of this project? NSA
2b. Does this project require a Stormwater Management Plan? ® Yes ? No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached permit drawings.
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? . ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review

3a. In which local government's jurisdiction is this project? not applicable
? Phase II
El 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
4a. Which of the following state-implemented stormwater management programs apply ? HQW
(check all that apply): ? ORW
? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review

5a. Does the Stormwater Management Plan meet the appropriate requirements? ® Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ® Yes ? No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ® Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to th a above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
® Yes ? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes
additional development, which could impact nearby downstream water quality? ® No
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence nearby
land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be necessary.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
not applicable
10
S. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ® Yes ? No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
? Raleigh
5c. If yes, ind icate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Habitat assessment and survey by NCDOT biologists. NHP database check. Surveys were updated for Virginia spiraea
(June 2010) and the BC remains No Effect.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NMFS County Index
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NEPA Documentation
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: NCDOT Hydraulics coordination with FEMA
8c. What source(s) did you use to make the floodplain determination? FEMA Maps
? 3• it
Dr. Gregory J. Thorne, Ph D
.
Date
Applicant/Agent's Printed Name q lican gent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
11
STORMWATER MANAGEMENT PLAN
Project: B-3619(33167.1.1) February 4, 2010
County: Buncombe / Division 13
Hydraulics Project Manager:. Marshall Clawson, PE
ROAD WAY DESCRIPTION
The project involves the replacement of Br. No. 56 over Bill Moore Creek on SR 3439.
The overall length of the project is 0.14 mi., and the existing 26'-long bridge is being
replaced with a 1 @ 28' x 6' Bottomless Box Culvert. The proposed roadway utilizes
shoulder section throughout. This is the only major crossing.
ENVIRONMENTAL DESCRIPTION
The project is located in the French Broad River Basin. Bill Moore Creek has a best
usage classification of C, Trout (WRC).
There are no wetland areas impacted by this project. There are temporary surface water
impacts on the project. The impact is less than 0.01 acre. There is 124 linear feet of
temporary existing channel impact.
BEST MANAGEMENT PRACTICES
Best Management Practices (BMPs) and measures used on the project to reduce
stormwater impacts are listed below. A bottomless culvert was used to reduce stream
impact. The banks were stabilized to prevent channel erosion.

1
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BUNCOMBE COUNTY
SEE INSET
BELOW

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VICINITY MAP

WETLAND % STREAM
IMPACTS
VICINITY MAP
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N. C' DEPT:OF- TRANSPORTATION
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DIVISION OF HIGHWAYS '
'BUNCOMBE COUNTY
ERICT:33167.1.1 (B-3619) 1
BRIDGE NO.56 OVER- BILL
MOORE CREEK ON SR 3439
SHEET OF 8/26/09

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PROPERTY
NAMES AND
PARCEL NO.
I
2
3
NAMES
BASF CORP.
OWNERS
ADDRESSES
U.S.GOVERMENT FOREST SERVICE
RONALD E. SEARSEY
ADDRESSES
BILTMORE LAKE, LLC.
1 TOWNE SQUARE SUITE 330
ASHEVILLE, NC 28803
160 ZILLICOA STREET
ASHEVILLE, NC 28801
163 REEVES COVE ROAD
CANDELR, NC 28715
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a?
APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the 1D Form Instructional Guidebook.
SECTION 1: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER: B-3619 (Replacement of Bridge 56 on SR 3439 over Bill Moore Creek)
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: NC County/parish/bomugh: Buncombe City: Asheville
W.
Center coordinates of site (lat/long in degree decimal format): Lat. 35.51803° N, Long. -82.65244'0
Universal Transverse Mercator:
Name of nearest waterbody: Bill Moore Creek
Name of nearest Traditional Navigable Water (TN W) into which the aquatic resource flows: Enka Lake
Name of watershed or Hydrologic Unit Code (HUC): 06010105
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
? Check if other sites (e.g., offsite mitigation sites, disposal sites, etc... ) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
0 Office (Desk) Determination. Date:
Q Field Determination. Date(s):
SECTION H: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Pick List "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
F1 Waters subject to the ebb and flow of the tide.
F1 Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters ofthe U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFRpart 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply):'
Q TNWs, including territorial seas
n Wetlands adjacent to TNWs
® Relatively permanent waters (RPWs) that flow directly or indirectly into TNWs
Non-RPWs that flow directly or indirectly into TNWs
0 Wetlands directly abutting RPWs that flow directly or indirectly into TN Ws
`ms's Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
El Impoundments of jurisdictional waters
n- Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non-wetland waters: 80 linear feet: 9 width (fl) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: Not Applicable?
Elevation of established OHWM (if known):
2. Non-regulated waters/wetlands (check if applicable):3
Q Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
Boxes checked below shall be supported by completing the appropriate sections in Section Ill below.
' For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
' Supporting documentation is presented in Section III.F.
1 SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.I and Section III.D.I. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 1
and Section III.D.1.; otherwise, see Section IILB below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non-navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody° is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section 111.6.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.C below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: Pick istL
- -
Drainage area: Pick'List
Average annual rainfall: i nches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
? Tributary flows directly into TNW.
? Tributary flows through Pick'List tributaries before entering TNW.
Project waters are P.i&List river miles from TNW
Project waters are PickList river miles from RPW.
Project waters are Pick List aerial (straight) miles from TNW.
Project waters are Pi& ist aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain
Identify flow route to TNW': 3.000 feet downstream to the Second Broad River.
Tributary stream order, if known:
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
' Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into nbutary b, which then flows into TNW.

(b) General Tributary Characteristics (check all that apply):
Tributary is: ? Natural
? Artificial (man-made). Explain:
? Manipulated (man-altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: 12 feet
Average depth: 1 feet
Average side slopes: Pick_List.
Primary tributary substrate composition (check all that apply):
? Silts ? Sands ? Concrete
? Cobbles ? Gravel ? Muck
? Bedrock ? Vegetation. Type/%cover:
? Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain:
Presence of rim/riffle/pool complexes. Explain:
Tributary geometry: EiMf si
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for: P.i&List
Estimate average number of flow events in review area/year: Pick.:List
Describe flow regime:
Other information on duration and volume:
Surface flow is: Pick List. Characteristics:
Subsurface flow: Pi& List. Explain findings:
? Dye (or other) test performed:
Tributary has (check all that apply):
? Bed and banks
? OH W M6 (check all indicators that apply):
? clear, natural line impressed on the bank ?
? changes in the character of soil ?
? shelving ?
? vegetation matted down, bent, or absent ?
? leaf litter disturbed or washed away ?
? sediment deposition ?
? water staining ?
? other (list):
? Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to detenn
High Tide Line indicated by: ?
? oil or scum line along shore objects
? fine shell or debris deposits (foreshore)
? physical markings/characteristics
? tidal gauges
? other (list):
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
ne lateral extent of CWA jurisdiction (check all that apply)
Mean High Water Mark indicated by:
? survey to available datum;
? physical markings;
? vegetation lines/changes in vegetation types.
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
`A natural or man-made discontinuity in the OH WM does net necessarily severjurisdiction (e.g., where the stream temporarily flows underground, or where
the OH WM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break
'Ibid.
it
(iv) Biological Characteristics. Channel supports (check all that apply):
? Riparian corridor. Characteristics (type, average width):
? Wetland fringe. Characteristics:
? Habitat for:
? Federally Listed species. Explain findings:
? Fish/spawn areas. Explain findings:
? Other environmentally-sensitive species. Explain findings:
? Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain:
Wetland quality. Explain:
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Pick,List. Explain:
Surface flow is: Pick List
Characteristics:
Subsurface flow: Piik'List. Explain findings:
? Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW
? Directly abutting
? Not directly abutting
? Discrete wetland hydrologic connection. Explain:
? Ecological connection. Explain:
?. Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are A2QU;t river miles from TNW.
Project waters are Pick Liss aerial (straight) miles from TNW.
Flow is from: F NW List. -_
Estimate approximate location of wetland as within the FickList floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear
characteristics; etc.). Explain:
Identify specific pollutants, if known:
brown, oil film on surface; water quality; general watershed/
(iii) Biological Characteristics. Wetland supports (check all that apply):
? Riparian buffer. Characteristics (type, average width):
? Vegetation type/percent cover. Explain:
? Habitat for
? Federally Listed species. Explain findings:
? Fish/spawn areas. Explain findings:
? Other environmentally-sensitive species. Explain findings:
? Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)_ ?A
All wetland(s) being considered in the cumulative analysis: PickList
Approximately ( ) acres in total are being considered in the cumulative analysis.
For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (YIN) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the now characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section IILD:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section IILD:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
0 TNWs: linear feet width (ft), Or, acres.
E] Wetlands adjacent toTNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
® Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: Flow is constant year-round.
?i Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 80 linear feet 9 width (ft).
E] Other non-wetland waters: acres.
Identify type(s) of waters:
3. Non-RPWs° that flow directly or indirectly into TNWs.
Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TN W, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
Q Tributary waters: Ii near feet width (ft).
Q Other non-wetland waters: acres.
Identify type(s) of waters:
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Q Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
Q Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
Q Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section III.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters.'
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
El Demonstrate that impoundment was created from "waters of the U.S.," or
Q Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
Q Demonstrate that water is isolated with a nexus to commence (see E below).
E. ISOLATED (INTERSTATE OR INTRA-STATE) WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):"
0 which are or could be used by interstate or foreign travelers for recreational or other purposes.
Q from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
Q which are or could be used for industrial purposes by industries in interstate commerce.
0 Interstate isolated waters. Explain:
0 Other factors. Explain:
Identify water body and summarize rationale supporting determination
°See Footnote N 3.
° To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Ac[ Jurisdiction Following Rapanos.

Provide estimates for jurisdictional waters in the review area (check all that apply):
Tributary waters: linear feet widt h (ft).
? Other non-wetland waters: a Gres.
Identify type(s) of waters:
E3 Wetlands: acres.
NON-JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
Q If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
? Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
? Prior to the Ian 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
r? Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
"[]',' Other: (explain, if not covered above):
Provide acreage estimates for non-jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
Non-wetland waters (i.e., rivers, streams): Ii new feet width (ft).
Lakes/ponds: acres.
Other non-wetland waters: acres. List type of aquatic resource:
Q Wetlands: acres.
Provide acreage estimates for non-jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required forjurisdiction (check all that apply):
Non-wetland waters (i.e., rivers, streams): li near feet, width (ft).
Lakes/ponds: acres.
Other non-wetland waters: acres. List type of aquatic resource:
Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall be included in case file and, where checked
and requested, appropriately reference sources below):
Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant
? Data sheets prepared/submitted by or on behalf of the applicant/consultant.
? Office concurs with data sheets/delineation report.
? Office does not concur with data sheets/delineation report.
? Data sheets prepared by the Corps:
? Corps navigable waters' study:
U.S. Geological Survey Hydrologic Atlas:
? USGS NHD data.
? USGS 8 and 12 digit HUC maps.
U.S. Geological Survey map(s). Cite scale & quad name:
USDA Natural Resources Conservation Service Soil Survey. Citation:
? National wetlands inventory map(s). Cite name:
State/Local wetland inventory map(s):
FEMA/FIRM maps:
0 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
? Photographs: ? Aerial (Name & Date):
or ? Other (Name & Date):
0 Previous determination(s). File no. and date of response letter:
? Applicable/supporting case law:
? Applicable/supporting scientific literature:
® Other information (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD:
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