20120315 Ver 1_401 Application_20120312

QC rol a Wetl d Servwes
Carolina Wetland Services, Inc
550 East Westinghouse Boulevard
Charlotte NC 28273
704 527 1177 Phone
704 527 1133 Fax
20 1203 1 5
Date 03 28 12
CWS Protect # 2012 2914
TO Mr Ian McMillan SIq_ N C Division of Water Quality 401 Wetlands Unit 512 N Salisbury St 9th Floor Archdale Building "Memo 9 2012 Raleigh NC 27603 0""'+- aw ��� ►�LITy
LETTER OF TRANSMITTAL
WE ARE SENDING YOU ®Attached ❑Under separate cover via the following items
❑ Prints ❑ Plans ❑ JD Package ❑ Specifications
❑ Copy of letter ❑ Change order ❑ Wetland Survey ® Other
TF PW('T OCTTRFC AT?P RIOT AC WOTFTI VTRTTIT V XTnTTGV T Tc AT nATrT7
IHESE ARE TRANSMITTED as checked below
❑For approval ❑Approved as submitted
®For your use ❑Approved as noted
❑As requested ❑Returned for corrections
❑For review and comment
❑Resubmit copies for approval
❑Submit copies for distribution
❑Return corrected prints
❑For your verification and signature
REMARKS Ian,
Please find attached five copies of the Preconstruction Notification and application for Water Oualrty Certification
No 3883 for the 711 Bethune Place Maintenance Project A check for the application fee is also attached
Copy to File
Th y
omas Blackwell PWS
Project Scientist
NORTH CAROLINA SOUTH CAROLINA
DAI
cc(0:0
D 19 M. o--rTff-KM
1
03/28/12
5
Application for Water Quality Certification No 3883
2
03/28/12
1
Application Fee Check ($240)
IHESE ARE TRANSMITTED as checked below
❑For approval ❑Approved as submitted
®For your use ❑Approved as noted
❑As requested ❑Returned for corrections
❑For review and comment
❑Resubmit copies for approval
❑Submit copies for distribution
❑Return corrected prints
❑For your verification and signature
REMARKS Ian,
Please find attached five copies of the Preconstruction Notification and application for Water Oualrty Certification
No 3883 for the 711 Bethune Place Maintenance Project A check for the application fee is also attached
Copy to File
Th y
omas Blackwell PWS
Project Scientist
NORTH CAROLINA SOUTH CAROLINA

Corps Submittal Cover Sheet 2® 12 0 3 15
A
Please provide the following info
1 Project Name 711 Bethune Place Maintenance Project
2 Name of Property Owner /Applicant Charlotte Storm Water Services (CSWS)
3 Name of Consultant/Agent CSWS Mr Isaac Hinson, PWS
*Agent authorization needs to be attached
4 Related/Previous Action ID number(s) N/A
5 Site Address 711 Bethune Place Charlotte, NC,
6 Subdivision Name N/A
J
7 City Charlotte
8 County Mecklenbur
9 Lat N35 129239° Long W80 746586° (Decimal Degrees Please)
10 Quadrangle Name Mint Hill, NC, dated 1996
11 Waterway UT to McAlpine Creek
12 Watershed Santee (HU# 03050103)
13 Requested Action
• Nationwide Permit # 3 D
General Permit #
MAR 2012
• Jurisdictional Determination Request BEN
Pre Application Request $ BAH
- - -- - - - - - -- - - - - - -- - - - -- - - - -- - - - - - --
The following information will be completed by Corps office
E
Prepare File Folder Assign number in ORM Begin Date
Authorization Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose
Site /Waters Name
Keywords

A
ti 1 1; i
ICWSI
Carolina Wetland &erv�ces
March 28 2012
Ms Amanda Jones
U S Army Corps of Engineers
151 Patton Avenue Room 208
Asheville NC 28801
550 E WESTINGHOUSE BLVD
CHARLOTTE NC 28273
866 527 1177 (office)
704 527 1133 (fax)
Mr Ian McMillan
NCDWQ — Wetlands and Stormwater Branch
512 N Salisbury St
9th Floor Archdale Building
Raleigh NC 27603
Subject Pre Construction Notification Pursuant to Nationwide Permit No 3 and Water
Quality Certification No 3883
Bethune Place Drainage Improvement Protect
Charlotte, North Carolina
Carolina Wetland Services Project No 2012 2914
The Bethune Place drainage improvement project is located at 711 Bethune Place in Charlotte North
Carolina (Figure l USGS Site Location Map attached) The purpose of this project is to repair an
existing failed concrete ditch along the rear property line of 711 Bethune Place The project will also
install gabions along the existing undercut stream bank to provide stabilization and prevent further
erosion Charlotte Storm Water Services (CSWS) has contracted Carolina Wetland Services Inc
(CWS) to provide Section 404/401 permitting services for this project
Applicant Name Charlotte Storm Water Services Isaac J Hinson PWS
Mailing Address 600 East Fourth Street Charlotte NC 28202
Phone Number of Owner /Applicant 704 336 4495
Street Address of Protect 711 Bethune Place Charlotte NC
Tax Parcel ID 213 261 39 213 261 40 213 261 41 213 261 42 213 261 48 and 213 261 51
Waterway UT to McAlpine Creek
Basin Santee (HU# 03050103)
City Charlotte
County Mecklenburg
Decimal Degree Coordinate Location of Protect Site N35 129239 W80 746586
USGS Quadrangle Name Mint Hill NC dated 1996
Current Land Use
The project area is approximately 1 45 acres in extent and is comprised of single family residential
properties with a mix of maintained grass and wooded lots Dominant vegetation within the project
area consists of sweetgum (Liquidambar styraciflua) tulip poplar (Lii iodendron tulipifera) redbud
(Cercis canadensis) Japanese honeysuckle (Lonicerajaponica) wild garlic (Album vineale) purple
deadnettle (Lamium purpureum) and fescue (Festuca sp )
NORTH CAROLINA SOUTH CAROLINA
WWW CWS INC NET

711 Bethune Place Maintenance Protect March 28, 2012
Nationwide Permit No 3 Protect No 2012 2914
According to the Soil Survey of Mecklenburg County' (Figure 2 NRCS Soil Survey Map attached)
on site soils consist of Cecil sandy clay loam 2 to 8 percent slopes eroded (CeB2) and Monacan Soils
(MO) Cecil sandy clay loams are well drained Monacan soils are somewhat poorly drained drained
and are listed on the North Carolina Hydric Soils List for Mecklenburg Countyz and on the National
Hydric Soils List3 as having hydric inclusion (Hydric Criteria 2133 4)
Jurisdictional Determination
On March 16 2012 CWS scientist Thomas Blackwell PWS delineated jurisdictional waters of the
U S within the project area Jurisdictional areas were delineated using the U S Army Corps of
Engineers (USAGE) Routine On Site Determination Method This method is defined in the 1987
Corps of Engineers Wetlands Delineation Manual4 with further technical guidance from the Eastern
Mountains & Piedmont Interim Regional Supplements dated July 2010 A Wetland Determination
Data Form representative of non Jurisdictional upland areas has been enclosed (DPI)
Jurisdictional stream channels were classified according to recent USACE and North Carolina
Division of Water Quality (NCDWQ) guidance These classifications included sampling with a D
shaped dip net taking photographs and defining approximate breakpoints (location at which a channel
changes classification) within each on site stream channel A NCDWQ Stream Classification Form
and USACE Stream Quality Assessment Worksheet representative of Stream A are enclosed (SCPI)
The results of the on site field investigation indicate that there is one Jurisdictional stream channel (Stream
A) located within the project area (Figure 3 attached) Stream A is an unnamed tributary to McAlpine
Creek McAlpine Creek is within the Santee River basm (HU# 03050103)6 and is classified as Class C
waters by the NCDWQ, On Site Jurisdictional waters are summarized in Table 1 below
Table I Summary of On Site Jurisdictional Waters
Jursdictional
Feature
Jurisdiction
SCP
No
NCDWQ
Steam
Classification
Score
USACE
Stream
Assessment
Score
Approx
Length
Linear Feet
(if)
Approx
Acreage
ac g
( )
USACE/EPA
Rapanos
Classification
Intermittent/
Perennial
Stream A
RPW
Perennial
SCP1
425
5.)
108
0 025
On Site Total
108
0 025
' United States Department of Agnculture 1971 Soil Survey of Mecklenbur Count-, North Carolina
z United States Department of Agriculture —Natural Resources Conservation Service 1999 North Carolina Hydnc Soils List USDA
NRCS North Carolina State Office Raleigh
3 United States Department of Agriculture — Natural Resources Conservation Service 2010 2010 National H} dne Soils List by State
4 Environmental Laboratory 1987 Corps of Engineers Wetlands Delineation Manual Technical Report Y 87 1 US Army Engineer
Water"ays Experiment Station Vicksburg Mississippi
5 US Army Corps of Engineers Jul} 2010 Interim Regional Supplement to the Corps of Engineers Wetland Delineation Manual Eastern
Mountains and Piedmont Region US Army Engineer Research and Development Center Vicksburg Mississippi
6 HU# is the Hydrologic Unit Code U S Geological Survey 1974 Hydrologic Unit Map State of North Carolina
2

711 Bethune Place Maintenance Protect March 28, 2012
Nationwide Permit No 3 Protect No 2012 2914
Relatively Permanent Waters with Perennial Flow
Stream A flows west across the southern portion of the project area for approximately 108 linear feet
Stream A exhibited a strong bed and bank strong substrate sorting strong flow moderate sinuosity
depositional bars and benches and an average ordinary high water width of ten feet Biological
sampling revealed a weak presence of iron oxidizing bacteria algae fish and amphibians Stream
characteristics indicate that continuous flow is present year round in a typical year Stream A was
classified as a Relatively Permanent Water with perennial flow (RPW) according to USACE/EPA
guidance Perennial RPW Stream A scored 53 out of a possible 100 points on the USACE Stream
Quality Assessment Worksheet and 42 5 out of a possible 63 points on the NCDWQ Stream
Classification Form indicating perennial status (SCPI enclosed) Photographs A and B (Figure 3
attached) are representative of Perennial RPW Stream A
Agency Correspondence
Cultural Resources
A letter was forwarded to the State Historic Preservation Office (SHPO) on March 26 2012 to
determine the presence of any areas of architectural historic or archaeological significance that would
be affected by the project As of the date of this submittal a response from SHPO has not yet been
received CWS consulted the Charlotte Mecklenburg Historic Landmarks Commission database and
found no listed properties within the project area
Protected Species
A letter was forwarded to the North Carolina Natural Heritage Program ( NCNHP) on March 26 2012
to determine the presence of any federally listed candidate endangered threatened species or critical
habitat located within the project area As of the date of this submittal a response from the NCNHP
has not yet been received
In addition the NCNHP Geographic Information Systems (GIS) database Virtual Workroom and
Element Occurrence (EO) database was reviewed for a listing of EOs of endangered or threatened
species within or near the project area The EO database identified no endangered or threatened species
within a one mile radius of the project area
Purpose and Need for the Protect
The existing concrete ditch running along the rear property line of 711 Bethune Place has failed and is
severely undercut (Figure 3 Photograph C attached) This is causing active erosion of the stream
bank and downcutting of the ditch bottom In addition the stream bank downstream of the ditch
discharge point is actively eroding and undercut (Photograph A attached)
The purpose of this project is to repair the existing failed concrete ditch by removing the concrete and
regrading an earthen ditch to be protected with permanent matting Approximately 25 linear feet of
30 inch reinforced concrete pipe (RCP) will be used to cross the existing sewer easement running
parallel to Perennial RPW Stream A (Figures 4 and 5 attached) The project will also install gabions
along the existing stream bank to provide stabilization and prevent erosion The gabions are necessary
in order to protect the stream bank hold the grade of and prevent erosion of the newly graded storm
water ditch and to protect the existing adjacent sanitary sewer line The upstream contributing non
jurisdictional pipe system will also be replaced as it is in poor condition with severe point separations
throughout

711 Bethune Place Maintenance Protect March 28, 2012
Nationwide Permit No 3 Protect No 2012 2914
Avoidance and Minimization
Impacts to on site Jurisdictional waters of the U S have been reduced to the maximum extent possible
Proper sediment and erosion control measures will be used to minimize disturbances to downstream
waters All work will be constructed in the dry in accordance with Water Quality Certification No 3883
Impacts to the bed of the existing stream channel have been avoided There will be no piping or
permanent loss of Jurisdictional stream channel Permanent impacts to Jurisdictional waters of the US
will be limited to approximately 42 bank feet of gabion wall necessary to maintain stability and prevent
erosion to the right hand stream bank at the point of discharge of the repaired non Jurisdictional storm
water ditch This impact is necessary as the existing stream bank in this area is unstable and undercut in
places (Figure 3 Photograph A attached)
Proposed Impacts to Jurisdictional Waters
Unavoidable impacts to Jurisdictional Waters of the U S total 50 linear feet of impacts to Perennial RPW
Stream A These impacts include 42 linear feet (0 002 acre) of permanent impacts and approximately 8
linear feet (0 002 acre) of temporary impacts Impacts to Perennial RPW Stream A are the result of
gabion wall installation and the installation of a temporary coffer dam (Figures 4 and 5 attached) The
temporary cofferdam is necessary in order to allow work on the gablons to be conducted in the dry A
cross section view of the cofferdam is attached (Figure 5 attached)
Table 2 Summary of Impacts to On Site Jurisdictional Waters
Jurisdictional
Intermittent
NWP
Temporary / Permanent
Approx
Feature
/ Perennial
Impact Type
No
Approximate
Acreage
Length(H)
Gabion Wall
3
42 if (Permanent)
0 002
RPW Stream A
Perennial
0 002
Coffer Dam
3
8 if (Temporary)
(Temp)
Stream Impacts (Total)
501f
0 004 acre
Stream Impacts (Temporary)
8 if
0 002 acre
Stream Impacts (Permanent)
421f
0 002 acre
On behalf of CSWS CWS is submitting a Pre Construction Notification Application with attachments in
accordance with Nationwide Permit General Condition No 31 (enclosed) and pursuant to Nationwide
Permit No 3
Compensatory Mitigation
Permanent impacts to Jurisdictional waters of the U S have been limited to 42 linear feet of perennial
stream channel Therefore no mitigation is proposed for these impacts
4

711 Bethune Place Maintenance Protect March 28, 2012
Nationwide Permit No 3 Protect No 2012 2914
Please do not hesitate to contact Isaac Hinson at 704 336 4495 or ihmson @cl charlotte nc us should
you have any questions or comments regarding these findings
lcr
Isaac J Hi son PWS
Wetland Specialist
C 79ZZT,
re Antemann PWS
Principal Scientist
Enclosures Figure 1 USGS Site Location Map
Figure 2 USDA NRCS Mecklenburg County Soil Survey
Figure 3 Approximate Jurisdictional Boundary Field Map
Figure 4 Project Overview
Figure 5 Proposed Impacts
Request for Jurisdictional Determination Form
Pre Construction Notification Pursuant to Nationwide Permit No
NCDWQ Stream Classification Form (SCPI)
USACE Stream Quality Assessment Worksheet (SCPI)
USACE Wetland Determination Data Form (DPI)
Approved Jurisdictional Determination Form
cc Mr Mark Cantrell U S Fish & Wildlife Service

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1

REQUEST FOR JURISDICTIONAL DETERMINATION
DATE March 26, 2012
COUNTY Mecklenburg County, North Carolina TOTAL ACREAGE OF TRACT 145 acres
PROJECT NAME (►f applicable) 711 Bethune Place Maintenance Project
PROPERTY OWNERIAPPLICANT (name address and phone)
Charlotte Storm Water Services
POC Mr Isaac J Hinson, PWS at [phone]
600 East Fourth Street
Charlotte, North Carolina 28202
NAME OF CONSULTANT ENGINEER, DEVELOPER (if applicable)
STATUS OF PROJECT (check one)
( ) On going site work for development purposes
( X) Project in planning stages
(Type of project maintenance )
( ) No specific development planned at present
( ) Project already completed
(Type of project
ADDITIONAL INFORMATION REQUIRED
Check items submitted forward as much information as is available At a minimum the following first two items must be
forwarded
(X) Figure 1 USGS 7 5 Minute Mint Hill NC and Charlotte East, NC Topographic Quadrangles
(X) Figure 2 USDA NRCS Mecklenburg County Soil Survey
(X) Figure 3 Approximate Jurisdictional Boundary Field Map
(X) Pre Construction Notification Pursuant to Nationwide Permit No 3
(X) NCDWQ Stream Classification Forms (SCP1)
(X) USACE Stream Quality Assessment Worksheets (SCPI)
(X ) USACE Wetland Determination Data Form (DPI)
(X ) Approved Jurisdictional Determination Form n \ c
Signature of Property Owner or
Authorized Agent
Mr Isaac J Hinson PWS

aot W ALeo
O QG
=' r
O Y
20120315
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
la
Type(s) of approval sought from the
Corps
®Section 404 Permit E] Section 10 Permit
1 b
Specify Nationwide Permit (NWP) number 3 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
Id
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?
I the record only for DWQ 401
ifi cation
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
If
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 1 h
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
711 Bethune Place Maintenance Project
2b
County
Mecklenburg
2c
Nearest municipality / town
Charlotte
2d
Subdivision name
N/A
2e
NCDOT only T I P or state
project no
N/A
3
Owner Information
3a
Name(s) on Recorded Deed
Henely Matthew T and Tracy G
3b
Deed Book and Page No
13631 38
3c
Responsible Parry (for LLC if
applicable)
N/A
3d
Street address
711 Bethune Place
3e
City state zip
Charlotte NC 28105
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 City of Charlotte Storm Water Services
4b
Name
Mr Isaac Hinson PWS
4c
Business name
(if applicable)
City of Charlotte Storm Water Services (CSWS)
4d
Street address
600 E Fourth Street
4e
City state zip
Charlotte NC 28202
4f
Telephone no
[phone]
4g
Fax no
[phone]
4h
Email address
ihinson @ci charlotte nc us
5
Agent/Consultant Information (if applicable)
5a
Name
Gregg Antemann PWS
5b
Business name
(if applicable)
Carolina Wetland Services Inc
5c
Street address
550 E Westinghouse Blvd
5d
City state zip
Charlotte NC 28273
5e
Telephone no
704 527 1177
5f
Fax no
704 527 1133
5g
Email address
gregg @cws inc net
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)
213 261 39 213 261-40 213 261-41 213 261-42 213
261 48 and 213 261 51
1 b
Site coordinates (in decimal degrees)
Latitude 35 12923 Longitude 80 746586
(DD DDDDDD) ( DD DDDDDD)
1c
Property size
1 45 acres
2
Surface Waters
2a
Name of nearest body of water (stream river etc ) to
McAlpine Creek
proposed project
2b
Water Quality Classification of nearest receiving water
Class C
2c
River basin
Santee (HU# 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 approximately 1 45 acres in extent and is comprised of single family residential properties with a mix
of maintained grass and wooded lots Dominant vegetation within the project area consists of sweetgum (Liqudambar
styraciflua) tulip poplar (Lmodendron tulipifera) redbud (Cercis canadensis) Japanese honeysuckle (Lorncera japonica)
wild garlic (Allium vineale) purple deadnettle (Lamium purpureum) and fescue (Festuca sp )
3b
List the total estimated acreage of all existing wetlands on the property
0
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
108 linear feet of intermittent stream channel
3d
Explain the purpose of the proposed project
The existing concrete ditch running along the rear property line of 711 Bethune Place has faded and is severely undercut
(Figure 3 Photograph C attached) This is causing active erosion of the stream bank and downcutting of the ditch
bottom In addition the stream bank downstream of the ditch discharge point is actively eroding and undercut
(Photograph A attached)
The purpose of this project is to repair the existing faded concrete ditch by removing the concrete and regrading an earthen
ditch to be protected with permanent matting The project will also install gabions along the existing stream bank to
provide stabilization and prevent erosion The gabions are necessary in order to protect the stream bank hold the grade
of and prevent erosion of the newly graded storm water ditch and to protect the existing adjacent sanitary sewer line
3e
Describe the overall project in detail including the type of equipment to be used
The project will involve removing the existing concrete ditch and regrading an earthen ditch to be protected with
permanent matting Approximately 25 linear feet of 30 inch reinforced concrete pipe (RCP) will be used to cross the
existing sewer easement running parallel to Perennial RPW Stream A (Figures 4 and 5 attached) The project will also
install gabions along the existing stream bank to provide stabilization and prevent erosion The upstream contributing
non jurisdictional pipe system will also be replaced as it is in poor condition with severe joint separations throughout A
track hoe and other typical construction equipment will be used to construct this project
Page 3 of 12
PCN Form — Version 1 3 December 10 2008 Version

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
El Yes ®No El 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 pnor 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
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
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
Gabion Wall
Perennial RPW
® PER
® Corps
10
42
Stream A
❑ INT
❑ DWQ
S2 ❑ P ®T
Coffer Dam
Perennial RPW
® PER
® Corps
10
8
Stream A
❑ INT
❑ DWQ
S3 ❑ P FIT
❑ 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
50
31 Comments Permanent Impacts to Jurisdictional Streams total 42 If (0 002 acre) of perennial stream
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
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a I 5b I 5c 5d 5e
Pond ID I Proposed use or purpose
number of pond
Wetland Impacts (acres) I Stream Impacts (feet) I Upland
Flooded I Filled I Excavated I Flooded I Filled I Excavated I Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 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 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 M impact
B1 ❑ PEI T
132 ❑P ❑T
B3 ❑P ❑T
61 Comments
❑ Neuse ❑ Tar Pamlico ❑ Other
❑ Catawba El Randleman
6e
Buffer
Stream name mitigation
required?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
6h Total buffer impacts
Zone 1 impact 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 to on site jurisdictional waters of the U S have been reduced to the maximum extent possible Proper sediment and
erosion control measures will be used to minimize disturbances to downstream waters All work will be constructed in the dry
in accordance with Water Quality Certification No 3883
Impacts to the bed of the existing stream channel have been avoided There will be no piping or permanent loss of
jurisdictional stream channel Permanent impacts to jurisdictional waters of the U S will be limited to approximately 42 bank
feet of gabion wall necessary to maintain stability and prevent erosion to the right hand stream bank at the point of discharge
of the repaired non jurisdictional storm water ditch This impact is necessary as the existing stream bank in this area is
unstable and undercut in places (Figure 3 Photograph A attached)
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Impacts to on site jurisdictional waters of the U S have been reduced to the maximum extent practicable Proper sediment
and erosion control measures will be used to minimize disturbances to downstream waters All work will be constructed in the
dry in accordance with Water Quality Certification No 3883
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
❑ Yes ® No
impacts to Waters of the U S or Waters of the State'?
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
❑ Mitigation bank
2c If yes which mitigation option will be used for this
El Payment to in lieu fee program
project
❑ 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 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
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?
1 b
If yes then is a diffuse flow plan included? If no explain why
❑ Yes No
❑
Comments
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan explain why There is no change in inpervious area
associated with this 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
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 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) land9
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
The project will not result in additional future development
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
N/A
Page 10 of 12
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
El 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 letter was forwarded to the North Carolina Natural Heritage Program ( NCNHP) on March 26 2012 to determine the
presence of any federally listed candidate endangered threatened species or critical habitat located within the project
area As of the date of this submittal a response from the NCNHP has not yet been received In addition the NCNHP
Geographic Information Systems (GIS) database Virtual Workroom and Element Occurrence (EO) database was
reviewed The EO database identified no endangered or threatened species within a one mile radius of the project area
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?
NOAA Fisheries http / /sharpfin nmfs noaa gov/website /EFH_Mapper /map aspx
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?
A letter was forwarded to the State Historic Preservation Office (SHPO) on March 26 2012 to determine the presence of
any areas of architectural historic or archaeological significance that would be affected by the project As of the date of
this submittal a response from SHPO has not yet been received CWS consulted the Charlotte Mecklenburg Historic
Landmarks Commission database and found no listed properties within the project area
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 FIRM No 3710457000J
Mr Isaac Hinson PWS
�p�,��� .,`�
0328 12
Applicant/Agent s Printed Name
Date
Applicant/Agent s Signature
(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

NC DWQ Stream Identification Form Virsion 4 11
Date ., y
ProlectlSite''
Weak
Latitude j 3.5 1 x o
Evaluator
County ����
Longitude 0 90 �
Total Points
Stream is at least intermittent a�, �°
-
Stream Determination (circle one
Ephemeral Intermittent erennia
Other
e g Quad Name
►f z 19 or perennial ►f z 30
0
1
A Geomorphology (Subtotal = 'Jr )
Absent
Weak
Moderate
Strong
V Continuity of channel bed and bank
0
1
2
3
2 Sinuosity of channel along thalweg
0
1
05
3
3 In channel structure ex riffle pool step pool
ripple ool sequence
0
1
1
3
4 Particle size of stream substrate
0
1
2
1
5 Active /relict floodplain
0
1
2
15
6 Depositional bars or benches
0
2
3
7 Recent alluvial deposits
0
1
2
3
8 Headcuts
0
1
2
3
9 Grade control
0
05
15
10 Natural valley
0
05
1
1 5
11 Second or greater order channel
No = 0
Yes
3
° artificial ditches are not rated see discussions in manual
B Hydrology (Subtotal = I_,)
12 Presence of Baseflow
0
1
2
3
13 Iron oxidizing bacteria
0
1
2
3
14 Leaf litter
1 5
1
05
0
15 Sediment on plants or debris
0
0 5
1
I 5,
16 Organic debris lines or piles
0
05
1
1
17 Soil based evidence of high water table?
No = 0
Yes 3
C Biology (Subtotal= -) .1 )
18 Fibrous roots in streambed
2
1
0
19 Rooted upland plants in streambed
3
2
1
0
20 Macrobenthos (note diversity and abundance)
1
ZD
3
21 Aquatic Mollusks
0
2
3
22 Fish
0
0 5
1
15
23 Crayfish
IiQ 5
1
15
24 Amphibians
0
1
15
25 Algae
0
.25
k2�2
1 1
15
26 Wetland plants in streambed
FACW = 0 75 OBL = 15 Other = 0
perennial streams may also be identified using other methods See p 35 of manual
Notes
Sketch

OFFJCE USE ONLY USACE AID# DWQ #
SCP1— Perennial RPW Stream A
STREAM QUALITY ASSESSMENT WORKSHEET
1
1 Applicants Name CSWS 2 Evaluators Name Thomas Blackwell
3 Date of Evaluation 3 16 12 4 Time of Evaluation 10 00 AM
5 Name of Stream Perennial Stream A 6 River Basin Santee (HU# 03050103)
7 Approximate Drainage Area 427 acres 8 Stream Order second
9 Length of Reach Evaluated 108 feet 10 County Mecklenburg
I1 Location of reach under evaluation (include nearby roads and landmarks) Site located at the rear of 711 Bethune Place in
Charlotte, North Carolina
12 Site Coordinates (if known) N35 129239 , W80 746586
13 Proposed Channel Work (if any) bank stabilization
14 Recent Weather Conditions warm, rain within last 24 hours
15 Site conditions at time of visit warm, 75
16 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)
17 Is there a pond or lake located upstream of the evaluation pomt'?(D NO If yes estimate the water surface area 125 acre
18 Does channel appear on USGS quad map ?Q NO 19 Does channel appear on USDA Soil Survey ?(D NO
20 Estimated Watershed Land Use 90 % Residential % Commercial _% Industrial _% Agricultural
10 % Forested _% Cleated / Logged _% Other ( )
21 BankfuIl Width 10 22 Bank Height (from bed to top of bank)
23 Channel slope down center of stream _Flat (0 to 2 %) X Gentle (2 to 4 %) _Moderate (4 to 10 %) _Steep ( >10 %)
24 Channel Sinuosity Straight X 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 eN aluated due to site or
weather conditions enter 0 in the scoring boa and provide an explanation in the comment section Where there are obvious changes in the character
of a stream under reN iew (e g the stream flows from a pasture into a forest) the stream may be divided into smaller reaches that displav 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 v<ith a score
of 100 representing a stream of the highest quality
Total Score (from reverse) 53 Comments
Evaluator s Signature ,1 i &a Date 3/16/2012
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 in order 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 05/03 To Comment please call 919 876 8441 x 26

STREAM QUALITY ASSESSMENT WORKSHEET
SCP1— Perennial RPW Stream A
* 7 here characteristics are not assessed in coastal streams
ECOREGION POINT
RANGE
#
CHARACTERISTICS
SCORE
Coastal
Piedmont
Mountain
Presence of now / persistent pools in stream
1
0-5
0 — 4
0-5
4
no flow or saturation = 0 strong flow = max points)
2
Evidence of past human alteration
0-6
0-5
0-5
2
extensive alteration = 0 no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
2
no buffer = 0 contiguous wide buffer = max points)
4
Evidence of nutrient or chemical discharges
extensive discharges = 0 no discharges = max points)
0-5
0-4
0-4
3
*4
Groundwater discharge
0— 3
0— 4
0— 4
1
U5
no discharge = 0 springs sees wetlands etc = max points)
6
Presence of adjacent floodplam
0-4
0-4
0-2
3
0
m m
no flood la = 0 extensive flood la = max points)
/ floodplam access
aEntrenchment
(deeply entrenched = 0 frequent flooding = max points)
0— 5
0— 4
0— 2
1
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
no wetlands = 0 large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
2
extensive channelization = 0 natural meander = max points)
10
Sediment input
0-5
0-4
0-4
3
extensive deposition= 0 little or no sediment = max points)
Size & diversity of channel bed substrate
11
NA*
0-4
0 - 5
3
fine homogenous = 0 large diverse sizes = max points)
12
Evidence of channel incision or widening
y+
(deeply incised = 0 stable bed & banks = max points)
0-5
0 - 4
0-5
2
�'.
13
Presence of major bank failures
0-5
0 — 5
0-5
2
a
severe erosion = 0 no erosion stable banks = max points)
14
Root depth and density on banks
no visible roots = 0 dense roots throughout = max points)
0-3
0 - 4
0-5
3
Impact by agriculture or livestock production
15
0-5
0 — 4
0-5
4
substantial impact =0 no evidence = max points)
16
Presence of riffle pool/ripple pool complexes
no riffles/ripples or pools = 0 well developed = max points)
0-3
0 - 5
0-6
3
17
Habitat
Habitat complexity
0-6
0 — 6
0-6
4
or no habitat = 0 frequent varied habitats = max points)
18
Canopy coverage over streambed
0— 5
0— 5
0— 5
4
x
no shading vegetation = 0 continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
3
(deeply embedded = 0 loose structure = max
20
Presence of stream invertebrates
0-4
0-5
0-5
2
no evidence = 0 common numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
no evidence = 0 common numerous es = max points)
22
Presence of fish
0-4
0 — 4
0-4
l
no evidence = 0 common numerous es = max points)
23
Evidence of wildlife use
0-6
0— 5
0-5
1
no evidence = 0 abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
53
* 7 here characteristics are not assessed in coastal streams

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont
Project/Site 711 Bethune Place Maintenance City/County Mecklenburg Sampling Date 3/16/12
Applicant /Owner Charlotte Storm Water Services State NC Sampling Point DP1
Investigator(s) Thomas Blackwell PWS Section Township Range Charlotte NC
Landform (hdislope terrace etc) Floodplain Local relief (concave convex none) None Slope(/) 0 2%
Subregion (LRR or MLRA) MLRA Lat N35 129239 Long W80 746586 Datum NAD 83
Sod Map Unit Name Cecil sandy clay loam 2 to 8 percent slopes eroded (CeB2) NWI classification N/A
Are climatic / hydrologic conditions on the site typical for this time of year'? Yes ✓ No (If no explain in Remarks )
Are Vegetation Sod or Hydrology significantly disturbed? Are Normal Circumstances present? Yes ✓ No
Are Vegetation Sod 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 No ✓
Wetland Hydrology Present? Yes No
Remarks
Area is representative of a non jurisdictional upland area
HYDROLOGY
Wetland Hydrology Indicators
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required, check all that apply) _
Surface Sod Cracks (136)
_ Surface Water (Al)
_ True Aquatic Plants (814) _
Sparsely Vegetated Concave Surface (138)
High Water Table (A2)
_ Hydrogen Sulfide Odor (C1) _
Drainage Patterns (610)
Saturation (A3)
_ Oxidized Rhizospheres on Living Roots (C3) _
Moss Trim Lines (1316)
Water Marks (61)
_ Presence of Reduced Iron (C4) _
Dry Season Water Table (C2)
Sediment Deposits (62)
_ Recent Iron Reduction in Tilled Soils (C6) _
Crayfish Burrows (C8)
Drift Deposits (B3)
_ Thin Muck Surface (C7) _
Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (134)
_ Other (Explain in Remarks) _
Stunted or Stressed Plants (D1)
Iron Deposits (135)
_
Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (137)
_
Shallow Agwtard (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) >18
Wetland Hydrology Present? Yes No V
includes capillary fringe)
Describe Recorded Data (stream gauge monitoring well aerial photos previous inspections) if available
Remarks
No Indicators of wetland hydrology were present at the sampling point
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

VEGETATION (Four Strata) — Use scientific names of plants
Sampling Point DP1
Remarks (Include photo numbers here or on a separate sheet)
75% of the dominant species are FAC or wetter
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version
Absolute
Dominant Indicator
Dominance Test worksheet
Tree Stratum (Plot size )
/ Cover
Species?
Status
Number of Dominant Species
1
Quercus michauxii
20
Yes
FACW
That Are OBL FACW or FAC 9 (A)
2
Liquidambar styraciflua
20
Yes
FAC
3
Liriodendron tulipifera
20
Yes
FAC
Total Number of Dominant
12
Species Across All Strata (B)
4
Acer rubrum
20
Yes
FAC
5
Fraxinus pennsylvanica
20
Yes
FACW
Percent of Dominant Species o
75 /o
That Are OBL FACW or FAC (p /g)
6
7
Prevalence Index worksheet
8
Total / Cover of Multiply by
100
= Total Cover
OBL species x 1 =
Sapling /Shrub Stratum (Plot size
)
FACW species x 2 =
1
Carpinus caroliniana
20
Yes
FAC
FAC species x 3 =
2
Cercis canadensis
20
Yes
FACU
FACU species x 4 =
3
Ulmus alata
20
Yes
FACU
UPL species x 5 =
4
Column Totals (A) (B)
5
6
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators
7
8
1 Rapid Test for Hydrophytic Vegetation
9
— 2 Dominance Test is >50 /
3 Prevalence Index is s3 0'
10
60
_ 4 Morphological Adaptations' (Provide supporting
= Total Cover
data in Remarks or on a separate sheet)
Herb Stratum (Plot size )
1
Lamium purpureum
25
Yes
--
_ Problematic Hydrophytic Vegetation' (Explain)
2
Allium vineale
25
Yes
FACU
3
Lonicera Japonica
25
Yes
FAC
'Indicators of hydric soil and wetland hydrology must
be present unless disturbed or problematic
4
Gallium sp
10
No
—
Definitions of Four Vegetation Strata
5
6
Tree — Woody plants excluding vines 3 in (7 6 cm) or
more in diameter at breast height (DBH) regardless of
7
height
ig
Sapling /Shrub — Woody plants excluding vines less
9
than 3 in DBH and greater than 3 28 ft (1 m) tall
10
11
Herb — All herbaceous (non woody) plants regardless
of size and woody plants less than 3 28 ft tall
12
85
= Total Cover
Woody vine — All woody vines greater than 3 28 ft in
Woody Vine Stratum (Plot size
)
height
1
Vitis rotundifolia
5
Yes
FAC
2
Smilax rotundifolia
5
Yes
FAC
3
4
5
Hydrophytic
Vegetation
✓
6
Present? Yes No
10
= Total Cover
Remarks (Include photo numbers here or on a separate sheet)
75% of the dominant species are FAC or wetter
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

SOIL Sampling Point DP1
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of indicators)
Depth Matrix Redox Features
(inches) Color (moist) / Color (moist) / Type Loc Texture Remarks
012 5YR 4/6 100 N/A Slit Loam
I
'Type C= Concentration D= Depletion RM= Reduced Matrix MS= Masked Sand Grains
Hydnc Sod Indicators
_ Histosol (Al)
_ Histic Epipedon (A2)
_ Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
_ Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N
MLRA 147 148)
Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
_ Stripped Matrix (S6)
Type
Depth (inches)
Location PL =Pore Lining M =Matnx
Indicators for Problematic Hydnc Sc
_ Dark Surface (S7)
_ Polyvalue Below Surface (S8) (MLRA 147 148)
_ Thin Dark Surface (S9) (MLRA 147 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
_ Iron Manganese Masses (F12) (LRR N
MLRA 136)
_ Umbnc Surface (F13) (MLRA 136 122)
_ Piedmont Floodplam Soils (F19) (MLRA 148)
Remarks
No Indicators of hydric soils are present
2 cm Muck (A10) (MLRA 147)
Coast Prairie Redox (A16)
(MLRA 147 148)
_ Piedmont Floodplain Soils (1`19)
(MLRA 136 147)
_ Red Parent Material (TF2)
_ Very Shallow Dark Surface (TF12)
_ Other (Explain in Remarks)
3Indicators of hydrophytic vegetation and
wetland hydrology must be present
unless disturbed or problematic
Hydnc Sod Present? Yes No V
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

APPROVED JURISDICTIONAL DETERMINATION FORM
U S Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION I BACKGROUND INFORMATION
A REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD) 3 26 12
B DISTRICT OFFICE FILE NAME AND NUMBER Asheville NC
C PROJECT LOCATION AND BACKGROUND INFORMATION PERENNIAL RPW STREAM A
State North Carolina County/parish/borough Mecklenburg City Charlotte
Center coordinates of site (lat/long in degree decimal format) Lat 35 129239 N Long 80 746586 W
Universal Transverse Mercator NAD 83
Name of nearest v aterbody McAlpine Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flour s Catawba River
Name of v<atershed or Hydrologic Unit Code (HUC) Santee (HU# 03050103)
❑ Check if map /diagram of review area and/or potential jurisdictional areas is /are available upon request
❑ Check if other sites (e g offsite mitigation sites disposal sites etc ) are associated with this action and are recorded on a
different JD form
D REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY)
❑ Office (Desk) Determination Date
® Field Determination Date(s) 3 16 12
SECTION 11 SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There Are no navigable waters of the US u` [thin Rivers and Harbors Act (RHA) Jurisdiction (as defined by 33 CFR part 329) in the
review area [Requued]
❑ Waters subject to the ebb and flow of the tide
❑ Waters are presently used or haN a been used in the past, or may be susceptible for use to transport interstate or toreign commerce
Explain
B CWA SECTION 404 DETERMINATION OF JURISDICTION
There Are N aters of the U S xN [thin Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area [Required]
1 Waters of the U S
a Indicate presence of waters of U S in review area (check all that apply) '
❑ TNWs including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent m aters2 (RPWs) that flow directly or indirectly into TNWs
❑ Non RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectl) into TNWs
❑ Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters including isolated wetlands
b Identify (estimate) size of waters of the U S in the review area
Non wetland waters 108 linear feet 10 width (ft) and/or 0 025 acres
Wetlands acres
c Limits (boundaries) of jurisdiction based on fstabhshed by OHWM
Elevation of established OHWM (if known)
2 Non regulated waters /wetlands (check if applicable) 3
❑ Potentially jurisdictional Aaters and/or wetlands were assessed within the review area and determined to be not jurisdictional
Explain
Boxes checked below shall be supported by completing the appropriate sections in Section IiI below
For purposes of this form an RPW is defined as a tributary that is not a TNW and that typically floe s ) ear round or has continuous now at least seasonally
(e g q pically 3 months)
Supporting documentation is presented in Section III F

SECTION III CWA ANALYSIS
A TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs If the aquatic resource is a TNW complete
Section III A 1 and Section III D 1 only if the aquatic resource is a wetland adjacent to a TNW complete Sections III A 1 and 2
and Section IiI D 1 otherwise see Section III B 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 Rapanoshave been met
The agencies will assert jurisdiction over non navigable tributaries of TNWs where the tributaries are relatively permanent
waters (RPWs) i e tributaries that typically flow year round or have continuous flow at least seasonally (e g typically 3
months) A wetland that directly abuts an RPW is also jurisdictional If the aquatic resource is not a TNW but has year round
(perennial) flow skip to Section III D 2 If the aquatic resource is a wetland directly abutting a tributary with perennial flow
skip to Section III D 4
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water even
though a significant nexus finding is not required as a matter of law
If the waterbody° is not an RPW or a wetland directly abutting an RPW a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW If the tributary has adjacent wetlands the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands This significant nexus evaluation that combines for
analytical purposes the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary or its adjacent wetlands or both If the JD covers a tributary with adjacent wetlands complete Section III B 1 for
the tributary Section III B 2 for any onsite wetlands and Section 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
I Characteristics of non TNWs that flow directly or indirectly into TNW
(i) General Area Conditions _
Watershed size Pick List
Drainage area TPiek List
Average annual rainfall inches
Average annual snowfall inches
(n) Physical Characteristics
(a) Relationship with TNW
❑ Tributary flows directly into TNW
❑ Tributary flows through Pick List tributaries before entering TNW
Project waters are Pick List river miles from TNW
Project w aters are Pick List river miles from RPW
Project w aters are Pick List aerial (straight) miles from TNW
Project eaters are Pick List aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TNW5
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 tributary b which then floes 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 feet
Average depth feet
Average side slopes P ek List
Primary tributary substrate composition (check all that apply)
❑ Silts ❑ Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock [:]Vegetation Type //o cover
❑ Other Explain
Tributary condrtion/stabilit} [e g highly eroding sloughing banks] Explain
Presence of run/riffle/pool complexes Explain
Tributary geometry Pick List
Tributary gradient (approximate average slope) /
(c) Flow
Tributary prof ides for Ptck List
Estimate average number of flow events in review area/} ear Ptek List
Describe flow regime
Other information on duration and volume
Surface flow is Pick List. Characteristics
Subsurface flow Pick Ltst Explain findings
❑ Dye (or other) test performed
Tributary has (check all that apply)
❑ Bed and banks
❑ OHWM6 (check all indicators that apply)
❑ clear natural line impressed on the bank
❑
the presence of litter and debris
❑ changes in the character of soil
❑
destruction of terrestrial vegetation
❑ shelving
❑
the presence of wrack line
❑ i egetation matted down bent or absent
❑
sediment sorting
❑ leaf litter disturbed or washed away
❑
scour
❑ sediment deposition
❑
multiple obsen ed or predicted flow events
❑ water staining
❑
abrupt change in plant community
❑ other (list)
❑ Discontinuous OHWM 7 Explain
If factors other than the OHWM were used to determ
❑ High Tide Line indicated by ❑
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings /characteristics
❑ tidal gauges
❑ other (list)
ine 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 t} pes
(m) 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 OHWM does not necessarily sever jurisdiction (e g where the stream temporarily flows underground or where
the OHWM has been removed by development or agricultural practices) Where there is a break 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

(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 sensjgNe species Explain findings
❑ Aquatic /wildlife diversity Explain findings
2 Characteristics of wetlands adjacent to non TNW that flow directly or indirectly into TNW
(j) 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 Pick ListList 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) Proximjty (Relationship) to TNW
Project wetlands are Pick List, river miles from TNW
Project waters are Fick List aerial (straight) miles from TNW
Flow is from Pick List
Estimate approximate location of wetland as within the Pick L— floodplain
(u) Chemical Characteristics
Characterize wetlands) stem (e g watercolor is clear brown oil film on surface water quality general watershed
characteristics etc) Explain
Identify specific pollutants if know n
(w) 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 sensjtjx e species Explain findings
❑ Aquatic /wildlife diversity Explain findings
3 Characteristics of all wetlands adjacent to the tributary (if any
All wetland(s) being considered in the cumulative anal) sjs Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis

For each wetland specify the following
Directly abuts" (YIN) Size in acres) Directly abuts9 (Y/N) Size (in acres)
Summarize overall biological chemical and physical functions being performed
C SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical physical and biological integrity
of a TNW For each of the 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 floodplam 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 w aters to
TNWs or to reduce the amount of pollutants or flood waters reaching a TNW9
Does the tributary in combination with its adjacent wetlands (if any) provide habitat and lifec) cle support functions for fish and
other species such as feeding nesting spawning or rearing young for species that are present in the TNW9
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs'?
e Does the tributary in combination with its adjacent wetlands (if any) have other relationships to the physical chemical or
biological integrity of the TNW9
Note the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below
1 Significant nexus findings for non RPW that has no adjacent wetlands and flows directly or indirectly into TNWs Explain
findings of presence or absence of significant nexus below based on the tributary itself then go to Section III D
2 Significant nexus findings for non RPW and its adjacent wetlands where the non RPW flows directly or indirectly into
TNWs Explain findings of presence or absence of significant nexus below based on the tributary in combination with all of its
adjacent wetlands then go to Section III D
3 Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW Explain findings of
presence or absence of significant nexus below based on the tributary in combination with all of its adjacent wetlands then go to
Section III D
D DETERMINATIONS OF JURISDICTIONAL FINDINGS THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY)
1 TNWs and Adjacent Wetlands Check all that apply and provide size estimates in review area
❑ TNWs linear feet width (ft) Or acres
El Wetlands adjacent to TNWs acres
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 Stream A flows west across the southern portion of the project area for approximately 108 linear feet
Stream A exhibited a strong bed and bank strong substrate sorting strong flow moderate sinuosity depositional bars and
benches and an average ordinary high water width of ten feet Biological sampling revealed a weak presence of iron
oxidizing bacteria, algae fish and amphibians Stream characteristics indicate that continuous flow is present ) ear round in a
typical year Stream A was classified as a Relatn ely Permanent Water with perennial flow (RPW) according to USACE/EPA
guidance Perennial RPW Stream A scored 53 out of a possible 100 points on the USACE Stream Quality Assessment

Worksheet and 42 5 out of a possible 63 points on the NCDWQ Stream Classification Form indicating perennial status
(SCP1 enclosed) Photographs A and B (Figure 3 attached) are representame of Perennial RPW Stream A
❑ 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 108 linear feet 10 width (ft)
❑ Other non w etland waters acres
Identify type(s) of waters
3 Non RPWs8 that flow directly or indirectly Into TNWs
❑ Waterbody that is not a TNW or an RPW but flows directly or indirectly into a TNW and it has a significant nexus with a
TNW is jurisdictional Data supporting this conclusion is provided at Section III C
Provide estimates for jurisdictional waters within the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non w etland 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 arejurisdictional as adjacent wetlands
❑ Wetlands directly abutting an RPW w here 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
❑ 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 tor jurisdictional wetlands in the review area acres
5 Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs
❑ Wetlands that do not directly abut an RPW but when considered in combination with the tributary to which they are adjacent
and with similarl) situated adjacent wetlands have a significant nexus with a TNW are jurtsidictional Data supporting this
conclusion is provided at Section III C
Provide acreage estimates torjunsdictional wetlands in the review area acres
6 Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to such w aters and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands ha%e a significant nexus with a TNW are jurisdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands in the review area acres
7 Impoundments of jurisdictional waters 9
As a general rule the impoundment of ajurisdictional tributary remains jurisdictional
❑ Demonstrate that impoundment was created from waters of the U S or
❑ Demonstrate that water meets the criteria for one of the categories presented abox a (1 6) or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below)
E ISOLATED [INTERSTATE OR INTRA STATE] WATERS INCLUDING ISOLATED WETLANDS THE USE
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY) 10
See Footnote # 3
To complete the analysis refer to the key in Section III D 6 of the Instructional Guidebook
Prior to asserting or declining CNVA 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 Act Jurisdiction Following Rapanos

r
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes
❑ from w hich fish or shellfish are or could be taken and sold in interstate or foreign commerce
❑ which are or could be used for industrial purposes by industries in interstate commerce
❑ Interstate isolated waters Explain
❑ Other factors Explain
Identify water body and summarize rationale supporting determination
Provide estimates for. jurisdictional a aters in the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non w etland waters acres
Identify type(s) of w aters
❑ Wetlands acres
F NON JURISDICTIONAL WATERS INCLUDING WETLANDS (CHECK ALL THAT APPLY)
❑ It 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 w aters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in SiEANCC the review area would have been regulated based solely on the
Migratory Bird Rule (MBR)
❑ Waters do not meet the Signitcant Nexus standard where such a finding is required for_jurisdiction Explain
❑ Other (explain if not covered abo� e)
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of.jurisdiction is the MBR
factors (i a 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 a rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
Provide acreage estimates for non ,jurisdictional waters in the review area that do not meet the Significant Nexus standard where such
a finding is required for. jurisdiction (check all that apply)
❑ Non wetland waters (i a rivers streams) linear feet, width (tt)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List t}pe 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
❑ Otfice 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
❑
US Geological Sun ey Hydrologic Atlas
❑ USGS NHD data
❑ USGS 8 and 12 digit HUC maps
® U S Geological Survey map(s) Cite scale & quad name 7 5 Topographic Map Series 1 24 000 Mint Hill NC Quadrangle
® USDA Natural Resources Conservation Service Soil Sun ey Citation Mecklenburg County Soil Survey
❑ National wetlands inventory map(s) Cite name
❑ State/Local wetland mventory map(s)
❑ FFMA /FIRM maps
❑ 100 year Floodplain Elevation is (National Geodectic Vertical Datum of 1929)
❑ Photographs ❑ Aerial (Name & Date)
or ® Other (Name & Date) Site Photographs 3 16 12
❑ 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