20120843 Ver 1_Application_20120907

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STATE OF NORTH CAROLINA " R),
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE EUGENE A CONTI JR
GOVERNOR SECRETARY
August 20, 2012
U S Army Corps of Engineers
1 4)/ 0 8 4 3
Regulatory Field Office
331 Heritage Trade Drive Suite 105
Wake Forest,NC 27587
ATTN Mr Andy Williams
NCDOT Coordinator
Subject Application for Section 404 Nationwide Permits 13,23,33 and Section
401 Water Quality Certification for the proposed replacement of Bridge
No 32 over Little Jacob's Creek on SR 2361 (New Lebanon Church Road) in
Rockingham County Federal Aid Project No BRZ-2361(1), Division 7 TIP
No B 4963
$240 00 debit WBS 40241 1 1
Dear Sir
The North Carolina Department of Transportation(NCDOT)proposes to replace Bridge No
32 over Little Jacob s Creek on SR 2361 (New Lebanon Church Road)with a culvert
There will be a total of 106 linear feet of permanent stream impact to Little Jacob s Creek
due to culvert placement and bank stabilization An additional 0 02 acres of temporary
stream impact will occur due to handling of water during culvert installation
Please see enclosed copies of the Pre-Construction Notification(PCN),NCEEP acceptance
letter,jurisdictional determination forms stormwater management plan,permit drawings
and design plans for the above mentioned project The Programmatic Categorical Exclusion
(PCE)was completed in November 2011 Copies were distributed shortly thereafter
Additional copies are available upon request
This project calls for a letting date of May 21, 2013 and a review date of Apnl 2, 2013,
however,the let date may advance as additional funding becomes available
II
II
MAILING ADDRESS TELEPHONE [phone] LOCATION
NC DEPARTMENT OF TRANSPORTATION FAX [phone]
PROJECT DEVELOPMENT AND ENVIRONMENTAL ANALYSIS 1020 BIRCH RIDGE DRIVE
1598 MAIL SERVICE CENTER WEBSITE WWW NCDOT ORG RALEIGH NC 27610-4328
RALEIGH NC 27699 1598

A copy of this permit application and its distribution list will be posted on the NCDOT
website at http //www ncdot org/doh/preconstruct/pe/neu/permit html If you have any
questions or need additional information please call Jason Dilday at(919) 707-6111
Smcerel Avile_
g
_y Gregory J Thorpe Ph D , Manager
Project Development and Environmental Analysis Umt
The "cc"List
NCDOT Permit Application Standard Distribution List
2

�oF WA r€,9 Office Use Only
i 1 o Corps action ID no
1 , , 1 > _ _ ` DWQ project no
1 0 < Form Version 1 3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A Applicant Information
1 Processing
1 a Type(s)of approval sought from the
Corps ® Section 404 Permit ❑ Section 10 Permit
1b Specify Nationwide Permit(NWP) number 13 23 33 or General Permit(GP) number
1c Has the NWP or GP number been venfied 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 ❑ Ripanan Buffer Authonzation
1 e Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit
because written approval is not required? Certification
❑Yes ® No ❑Yes ® No
1f Is payment into a mitigation bank or in lieu fee program proposed for mitigation ®Yes ❑ No
of impacts? If so attach the acceptance letter from mitigation bank or in lieu
fee program
1g Is the project located in any of NC s twenty coastal counties If yes answer 1h ❑Yes ® No
below
1 h Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑Yes ® No
2 Project Information
2a Name of project Replacement of Bndge 32 over Little Jacob s Creek on SR 2361 (New Lebanon Church
Road)
2b County Rockingham
2c Nearest municipality/town Ellisboro
2d Subdivision name not applicable
2e NCDOT only T I P or state
B-4963
project no
3 Owner Information
3a Name(s)on Recorded Deed North Carolina Department of Transportation
3b Deed Book and Page No not applicable
3c Responsible Party(for LLC if not applicable
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 iIddday©ncdot gov
I
1

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 j
4g Fax no
4h Email address
5 Agent/Consultant Information Of applicable)
5a Name not applicable
5b Business name
Of applicable)
5c Street address
5d City state zip
5e Telephone no
5f Fax no
5g Email address
2

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID) not applicable
lb Site coordinates(in decimal degrees) Latitude 36 345310 Longitude 79 835573
(DD DDDDDD) (DD DDDDDD)
1c Property size 1 2 acres
2 Surface Waters
2a Name of nearest body of water(stream river etc)to Little Jacobs Creek
proposed project
2b Water Quality Classification of nearest receiving water C
2c River basin Roanoke
3 Project Description
3a Descnbe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
SR 2361 is a rural local route Land use within the project vicinity consists of forested lands agriculture interspersed with
residential development
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
200
3d Explain the purpose of the proposed project
To replace a structurally deficient and functionally obsolete bndge
3e Describe the overall project in detail including the type of equipment to be used
The project involves replacing a three span 100 foot bridge with a two barrel box culvert on the existing alignment with
an off site detour Standard road building equipment such as trucks dozers and cranes will be used
4 Jurisdictional Determinations
4a Have junsdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property/ ❑Yes el No ❑ Unknown
project(including all pnor phases)in the past?
Comments
4b If the Corps made the junsdictional determination what type ❑ preliminary ❑ Final
of determination was made?
4c If yes who delineated the junsdictional areas? Agency/Consultant Company
Name (if known) Other
4d If yes list the dates of the Corps junsdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for ❑Yes 0 N ❑ Unknown
this project(including all pnor phases) in the past?
5b If yes explain in detail according to help file instructions
6 Future Project Plans
6a Is this a phased project? ❑Yes 0 No
6b If yes explain
, 1
1
3

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project(check all that apply)
❑Wetlands ® Streams tnbutanes ❑ 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 Of known) DWQ—non-404 other) (acres)
Temporary(T)
Site 1 ❑ P❑T ❑Yes ❑ Corps
❑ No ❑ DWQ
Site 2 ❑ P❑T ❑Yes ❑Corps
❑ No ❑ DWQ
Site 3 ❑ P❑T ❑Yes ❑Corps 1
❑ No ❑ DWQ
Site 4 ❑ P❑T ❑Yes ❑ Corps
❑ No ❑ DWQ
Site 5 ❑ P❑T ❑Yes ❑Corps
❑ No ❑ DWQ
Site 6 ❑ P❑T ❑Yes ❑Corps
0 N ❑ DWQ
2g Total wetland impacts 0 Permanent
0 Temporary
2h Comments There are no wetland impacts associated with this project
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 junsdiction stream (linear feet) i
Permanent(P)or intermittent (Corps 404 10 width
Temporary(T) (INT)? DWQ—non-404 (feet)
other)
Site 1 Z P❑T
2© 12 x11 Little Jacobs ® PER ® Corps 30 76
RCBC Creek ❑ INT CO DWQ
Site 1 ❑ P®T 2@ 12 x11 Little Jacobs ® PER ®Corps 30 85
RCBC Creek ❑ INT ® DWQ
Site 2/3 ® P❑T Bank Little Jacob s ® PER ® Corps 30 30
Stabilization Creek ❑ INT ® DWQ
Site 4 ❑ P❑T ❑ PER ❑Corps
❑ INT ❑ DWQ
Site 5 ❑ P❑T ❑ PER ❑ Corps
❑ INT ❑ DWQ
Site 6 ❑ P ❑T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h Total stream and tributary impacts 106 If perm
85 If temp
3i Comments Temporary impacts due to handling of water during installation of culvert
4

4 Open Water Impacts
If there are proposed impacts to lakes ponds estuanes tnbutanes 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
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
1 1 4f Total open water impacts 0 Permanent
0 Temporary
4g Comments
5 Pond or Lake Construction
If pond 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
51 Expected pond surface area(acres)
5j Size of pond watershed (acres)
5k Method of construction
1
5

6 Buffer Impacts (for DWQ)
If project will impact a protected npanan 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
❑ Neuse 0 Tar Pamlico 0 Other
Project is in which protected basin'? ❑ Catawba ❑ Randleman
6b 6c 6d 6e 6f 6g
Buffer impact
number— Reason for impact Buffer Zone 1 impact Zone 2 impact
Permanent(P)or Stream name mitigation (square feet) (square feet)
Temporary(T) required'?
B1 ❑ P ❑T ❑Yes
❑ No
B2 ❑ P❑T ❑Yes
❑ No
B3 ❑ P❑T ❑Yes
❑ No
6h Total buffer impacts
6i Comments
D Impact Justification and Mitigation
1 Avoidance and Minimization
la Specifically descnbe measures taken to avoid or minimize the proposed impacts in designing project
There is no direct discharge into the receiving water An off site detour will be used dunng construction Ditches on the
project will be np rap lined so as to reduce the velocity of stormwater A sill will be placed in one barrel of the culvert to
restrict low flow to one barrel
lb Specifically descnbe measures taken to avoid or minimize the proposed impacts through construction techniques
NCDOT Best Management Practices for Bndge Demolition and Removal will be implemented dunng the removal of the
existing bndge Best Management Practices for the Protection of Surface Waters will be employed
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'?
If no, explain
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
project? ® 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
6

' 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 76 linear feet @ 2 1 = 152 linear feet
4c If using stream mitigation stream temperature ®warm ❑cool ❑cold
4d Buffer mitigation requested (DWQ only) square feet
4e Ripanan wetland mitigation requested acres
4f Non npanan 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 descnption of the proposed mitigation plan
6 Buffer Mitigation (State Regulated Riparian Buffer Rules)—required by DWQ
6a Will the project result in an impact within a protected npanan buffer that requires ❑Yes ® No
buffer mitigation?
6b If yes then identify the square feet of impact to each zone of the npanan buffer that requires mitigation Calculate the
amount of mitigation required
6c 6d 6e
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1 5
6f Total buffer mitigation required 0
6g If buffer mitigation is required discuss what type of mitigation is proposed(e g payment to pnvate mitigation bank
permittee responsible npanan buffer restoration payment into an approved in lieu fee fund)
6h Comments
r

E Stormwater Management and Diffuse Flow Plan (required by DWQ)
1 Diffuse Flow Plan
1 a Does the project include or is it adjacent to protected npanan buffers identified ®Yes ❑ No
within one of the NC Ripanan Buffer Protection Rules?
1 b If yes then is a diffuse flow plan included? If no explain why
Comments See attached permit drawings ®Yes ❑ No
2 Stormwater Management Plan
2a What is the overall percent imperviousness of this project? N/A
2b Does this project require a Stormwater Management Plan? ®Yes ❑ No
2c If this project DOES NOT require a Stormwater Management Plan explain why
2d If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
See attached permit drawings
❑ Certified Local Government
2e Who will be responsible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3 Certified Local Government Stormwater Review
3a In which local government s jurisdiction is this project? not applicable
❑ Phase 11
3b Which of the following locally implemented stormwater management programs ❑ NSW
apply(check all that apply) El USMP
❑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
attached? ❑Yes ❑ No
5 DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropnate requirements? ❑Yes ❑ No N/A
5b Have all of the 401 Unit submittal requirements been met? ❑Yes ❑ No N/A
8

F Supplementary Information
1 Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public(federal/state/local)funds or the ®Yes ❑ No
use of public(federal/state)land?
lb If you answered yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State ®Yes ❑ No
(North Carolina) Environmental Policy Act(NEPA/SEPA)?
lc 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 Ripanan 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
9

5 Endangered Species and Designated Critical Habitat(Corps Requirement)
5a Will this project occur in or near an area with federally protected species or ®Yes ❑ No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act ®Yes ❑ No
impacts?
® Raleigh
5c If yes indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Cntical
Habitat?
N C Natural Heritage Heritage Program database USFWS Raleigh Field Office website biological surveys for protected
species listed for Randolph County which include the James spinymussel Roanoke logperch and smooth coneflower
All species received a Biological Conclusion of No Effect It was determined that no further surveys were required for
James spinymussel and Roanoke logperch Habitat for smooth coneflower exists but a survey conducted of the study
area on 6/6/2012 resulted in no specimens being found
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 (31 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 Unit coordination with FEMA
8c What source(s)did you use to make the floodplain determination? FEMA Maps
Dr Gregory J Thorpe, PhD C 8 23-(Z
Applicant/Agents Printed Name Date
Appllc nt/Agents Signature
(Agents signature is valid only rf an authorization letter from the applicant
is provided)
10

Ecosystem
PROGRAM
August 14 2012
Mr Gregory J Thorpe Ph D
Manager Project Development and Environmental Analysis Unit
North Carolina Department of Transportation
1548 Mail Service Center
Raleigh North Carolina 27699 1 548
Dear Dr Thorpe
Subject EEP Mitigation Acceptance Letter
B 4963 Replace Bridge Number 32 on SR 2361 (New Lebanon Church Road)over
Jacob s Creek Rockingham County
The purpose of this letter is to notify you that the Ecosystem Enhancement Program(EEP)will provide the
compensatory stream mitigation for the subject project Based on the information supplied by you on August 10
2012 the impacts are located in CU 03010103 of the Roanoke River basin in the Central Piedmont(CP)Eco
Region and are as follows
Roanoke Stream Wetlands Buffer(Sq Ft)
03010103 Non Coastal
CP Cold Cool Warm Riparian Riparian Marsh Zone I Zone 2
Impacts 0 0 76 0 0 0 0 0
(feet/acres)
This impact and associated mitigation need were under projected by the NCDOT in the 2012 impact data
EEP will commit to implement sufficient compensatory stream mitigation credits to offset the impacts associated
with this project as determined by the regulatory agencies using the delivery timeline listed in Section F 3 c in of the
N C Department of Environment and Natural Resources Ecosystem Enhancement Program In Lieu Fee Instrument
dated July 28 2010 If the above referenced impact amounts are revised then this mitigation acceptance letter will
no longer be valid and a new mitigation acceptance letter will be required from EEP
If you have any questions or need additional information please contact Ms Beth Harmon at 919 715
1929
Sincerely
CI\C* )a41 (C° &V-
Suzan limek
EEP Acting Director
cc Mr Andy Williams USACE—Raleigh Regulatory Field Office
Mr David Wainwright Division of Water Quality Wetlands/401 Unit
File B 4963
Ratoratg Eititaacuig Protectuti Our Stat& '�
Moe
North Carolina Ecosystem Enhancement Program 1652 Mail Service Center Raleigh NC 27699 1652 1 919 715 0476/www nceep net

cre k
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)
B DISTRICT OFFICE FILE NAME AND NUMBER B-4963
C PROJECT LOCATION AND BACKGROUND INFORMATION
State NC County/pansh/borough Rockingham City Ellisboro
Center coordinates of site(lat/long in degree decimal format) Lat 36 345020 B Long 79 835382
Universal Transverse Mercator
Name of nearest waterbody Little Jacob s Creek
Name of nearest Traditional Navigable Water(TNW)Into which the aquatic resource flows Dan River
Name of watershed or Hydrologic Unit Code(HUC) 03010103
�aa Check if map/diagram of review area and/or potential junsdictional 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)
SECTION II SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There �u
• `i+_`l ' navigable waters of the U S within Rivers and Harbors Act(RHA)junsdiction(as defined by 33 CFR part 329)in
�
the review area [Required]
Waters subject to the ebb and flow of the tide
Waters are presently used or have been used in the past or may be susceptible for use to transport interstate or foreign commerce
Explain
B CWA SECTION 404 DETERMINATION OF JURISDICTION
There waters of the US within 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) i
TNWs including territorial seas
Wetlands adjacent to TNWs
►;� Relatively permanent waters2(RPWs)that flow directly or indirectly into TNWs
Non RPWs that flow directly or indirectly into TNWs
7 Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
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
E 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 400 linear feet 30 width(ft)and/or acres
Wetlands acres
c Limits(boundaries)of jurisdiction based on tab rty.-f rr +i
Elevation of established OHWM(if known)
2 Non regulated waters/wetlands(check if applicable)3
Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional
Explain
Boxes checked below shall be supported by completing the appropnate sections in Section III below
2 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)
3 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 South Fork Catawba River
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 waterbody4 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
1 Characteristics of non TNWs that flow directly or indirectly into TNW
(i) General Area Conditions
Watershed size
Drainage area ':47.411
Average annual rainfall mches
Average annual snowfall inches
(ii) Physical Characteristics
(a) Relationship with TNW
Tnbutary flows directly into TNW
❑Tributary flows through • 1 tributaries before entenng TNW
Project waters are ' river miles from TNW
Project waters are river miles from RPW
Project waters are h aerial(straight)miles from TNW
Project waters are ='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
5 Flow route can be descnbed by identifying e g tributary a,which flows through the review area,to flow into tributary b which then flows into TNW

(b) General Tributary Characteristics(check all that apply)
Tributary is ❑Natural
❑Artificial(man made) Explain
❑Manipulated (man altered) Explain
Tributary properties with respect to top of bank(estimate)
Average width feet
Average depth feet
Average side slopes
Pnmary 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 sloughmg banks] Explain
Presence of run/riffle/.ool complexes Explain
Tnbutary geometry
Tributary gradient(approximate average slope)
(c) Flow
Tributary provides for
Estimate average number of flow events in review area/year
Descnbe flow regime
Other information on duration and volume
Surface flow is 7 1, Characteristics
Subsurface flow a, Explain findings
El 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
❑ vegetation matted down bent,or absent ❑ sediment sorting
❑ leaf litter disturbed or washed away ❑ scour
❑ sediment deposition ❑ multiple observed 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 determine lateral extent of CWA jurisdiction(check all that apply)
• High Tide Line indicated by Mean High Water Mark indicated by
❑ oil or scum line along shore objects ❑survey to available datum
❑ fine shell or debris deposits(foreshore) ❑physical markings
❑ physical markings/charactenstics ❑vegetation lines/changes in vegetation types
❑ tidal gauges
❑ other(list)
(m) Chemical Characteristics
Charactenze tributary(e g water color is clear discolored oily film water quality general watershed characteristics etc)
Explain
Identify specific pollutants if known
6A 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
7Ibid

(iv) Biological Characteristics Channel supports(check all that apply)
❑ Riparian corridor Characteristics(type average width)
❑ Wetland fringe Characteristics
❑ Habitat for
El 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 Explain
Surface flow is
Charactenstics
Subsurface flow 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(Relationshi s to TNW
Project wetlands are river miles from TNW
Project waters are b 7 aenal(straight)miles from TNW
Flow is from
Estimate approximate location of wetland as within the floodplam
(n) Chemical Characteristics
Characterize wetland system(e g water color is clear brown oil film on surface water quality general watershed
charactenstics etc) Explain
Identify specific pollutants if known
(iii)Biological Characteristics Wetland supports(check all that apply)
❑ Riparian buffer Charactenstics(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 fmdings
❑Aquatic/wildlife diversity Explain findings
3 Characteristics of all wetlands adjacent to the tributary(if an
All wetland(s)being considered in the cumulative analysis
Approximately( )acres in total are being considered in the cumulative analysis

For each wetland specify the following
Directly abuts9(Y/N) Size(in acres) Directly abuts?(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 hes 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 TNW9
• 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 TNW9
• Does the tributary in combination with its adjacent wetlands(if any) have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs9
• 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
Wetlands adjacent to TNWs acres
2 RPWs that flow directly or indirectly into TNWs
ate! Tributaries of TNWs where tributaries typically flow year round are jurisdictional Provide data and rationale indicating that
tributary is perennial Little Jacob s Creek has a NCDWQ stream rating scores greater than 30
Tnbutaries 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)
4 Tributary waters 400 linear feet 30 width(ft)
Other non wetland waters acres
Identify type(s)of waters
3 Non RPWss 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)
Tnbutary waters linear feet width(ft)
Other non wetland waters acres
Identify type(s)of waters
4 Wetlands directly abutting an RPW that flow directly or indirectly into TNWs
al Wetlands directly abut RPW and thus are junsdictional as adjacent wetlands
gi 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
gl 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
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 junsidictional Data supportmg 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
JJ Wetlands adjacent to such waters and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands have a significant nexus with a TNW are jurisdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands in the review area acres
7 Impoundments of jurisdictional waters 9
As a general rule the impoundment of a jurisdictional tributary remains junsdictional
Demonstrate that impoundment was created from waters of the U S or
Demonstrate that water meets the cntena for one of the categones presented above(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
which are or could be used by interstate or foreign travelers for recreational or other purposes
l from which fish or shellfish are or could be taken and sold in interstate or foreign commerce
a 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
'See Footnote#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 descnbed in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos

Provide estimates for jurisdictional waters in the review area(check all that apply)
Tributary waters linear feet width(ft)
Other non wetland waters acres
Identify type(s)of waters
EN Wetlands acres
Ii
F NON-JURISDICTIONAL WATERS INCLUDING WETLANDS(CHECK ALL THAT APPLY)
® If potential wetlands were assessed within the review area,these areas did not meet the cntena in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements
Ea Review area included isolated waters with no substantial nexus to interstate(or foreign)commerce
❑ Prior to the Jan 2001 Supreme Court decision m SWANCC the review area would have been regulated based solely on the
Migratory Bird Rule (MBR)
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 ofjunsdiction 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(►e rivers streams) linear feet width(ft)
Lakes/ponds acres
Other non wetland waters acres List type of aquatic resource
1 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 e rivers streams) lmear 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
IN National wetlands inventory map(s) Cite name
State/Local wetland inventory map(s)
FEMA/FIRM maps
9 100 year Floodplain Elevation is (National Geodectic Vertical Datum of 1929)
Photographs ❑Aerial(Name&Date)
or❑Other(Name&Date)
i i Previous determination(s) File no and date of response letter
Appl►cable/supportmg case law
Applicable/supporting scientific literature
Other information(please specify)
B ADDITIONAL COMMENTS TO SUPPORT JD

STORMWATER MANAGEMENT PLAN
B-4963,WBS No 40241 1 1
ROCKINGHAM COUNTY
Hydraulics Project Manager Stephen R Morgan PE
Date 8/07/2012
ROADWAY DESCRIPTION
The project involves the replacement of bndge number 32 over Jacobs Creek on SR 2361
(New Lebanon Church Road) in Rockingham County The overall length of the project
is 0 133 mile The project will replace an existing 100 foot length bndge with a new 2 @
12 X 11' RCBC An off-site detour will be required
ENVIRONMENTAL DESCRIPTION
The project is located within the Roanoke River The proposed bridge is over Jacobs
Creek which is classified as C
Approximately 0 06 acre of surface water will be permanently impacted and 0 01 acre
will be temporarily impacted
BEST MANAGEMENT PRACTICES AND MAJOR STRUCTURES
Best Management Practices (BMPs)and measures used in the project are non-structural
and are an attempt to reduce the storm water impacts to the receiving stream due to
erosion and runoff as well as attenuate and disperse storm water before entenng the
receiving waters There is no direct discharge into the receiving water
CULVERT
-L- STA 16+10 18
Replace existing bndge over Jacobs Creek with double barrel culvert(2 @12 x10 )
A sill is used to restrict low flow to one barrel to prevent over-widening of the stream
near the culvert

PROPIE1' TY OWNERS
NAMES AND ADDRESSES
PARCEL NO NAMES ADDRESSES
1 MCNAIRY, 662 NEW LEBANON
AMELIA MCCOLLUM CHURCH RD
REIDSVILLE, NC 27320
1 GALLOWWAY, 648 NEW LEBANON
JAMES LEE & CHURCH RD
ELSIE M REIDSVILLE, NC 27320
NCDOT
DIVISION OF HIGHWAYS
ROCKINGHAM COUNTY
PROJECT 40241 LI (B-4%3)
BRIDGE NO 32 OVER
JACOBS CREEK
ON SR 2361
SHEET 7 OF 7 7/17/12

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' DENOTES IMPACTS IN PROJECT 4024L11 (B-4963)
` SURFACE WATER BRIDGE NO 32 ON SR 2361
N1.6, ��∎ DENOTES TEMPORARY (NEW LEBANON CHURCH RD.)\` �� IMPACTS IN SURFACE WATER OVER LITTLE JACOBS CREEK
1 SHEET OF 7 08/14/12
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