20121079 Ver 1_Application_20121128

STATE OF NORTH CAROLINA
19
OS f� Ile
DEPARTMENT OF TRANSPORTATION
BEVERLY PERDUE EUGENE CONTI
GOVERNOR SECRETARY
November 15 2012
SUBJECT Forsyth County — SR 2683 Hedgecock Road
Mr John Thomas 2 2 Q
US Army Corps of Engineers
3331 Heritage Trade Drive Suite 105
Wake Forest NC 27615
Dear Mr Thomas
In an effort to obtain the necessary permits for the subject pipe replacement we are providing a
pre construction notification application with supporting documentation for the work on Hedgecock Road
SR 2683 in Forsyth County This is a permit for a defined stream with distinct stream banks We propose
to replace the 36 inch, 55 feet long CMP with 60 inch 76 feet long CMP There will be 21 feet of
extension on the downstream side of the new pipe with additional 7 feet of rip, rap The existing pipe is
rusted out under sized and floods the roadbed The stream is the Pmetree Branch of Abbott s Creek which
is 303(d) No endangered species were found on 03/03/2011 We believe this project can be accomplished
under Nationwide Permit 14
During construction which is expected to take a few weeks NCDOT plans to work in the dry
All disturbed areas will be re vegetated
If you have any questions comments or need additional information after reviewing this material please
contact me at [phone] Thank you for your cooperation in this matter
NlRect y
raquet
Division Environmental 3pecialist
Enclosures
CC Ms Amy Chapman NCDENR DWQ Transportation Permitting Unit Manager (2)
Mr Pat Ivey P E NCDOT Division Engineer
Mr Gary Neal NCDOT County Maintenance Engineer
Division of Highways • Division Nine • 375 Silas Creek Parkway Winston Salem NC 27127
Telephone [phone] a Fax [phone] • Couner Box 13 12 04

0 0O WATF9pG
Uj 9
�oQo9 0 <
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 0 November 2008
Page 1 of 11
PCN Form — Version 1 0 November 2008 Version
Pre - Construction Notification (PCN) Form
A
Applicant Information
1
Processing
1 a
Type(s) of approval sought from the
Corps
® Section 404 Permit El Section 10 Permit
lb
Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
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
Hedgecock Road
2b
County
Forsyth
2c
Nearest municipality / town
Union Cross
2d
Subdivision name
2e
NCDOT only T I P or state
project no
3
Owner Information
3a
Name on Recorded Deed
North Carolina Department of Transportation
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable)
Stephanie Braquet
3d
Street address
375 Silas Creek Parkway
3e
City state zip
Winston Salem North Carolina 27127
3f
Telephone no
[phone]
3g
Fax no
[phone]
3h
Email address
scbraquet @ncdot gov
Page 1 of 11
PCN Form — Version 1 0 November 2008 Version

Section A Applicant Information continued
4 Applicant Information (if different from owner)
4a Applicant is
❑ Agent ❑ Other specify
4b Name
4c Business name
(if applicable)
4d Street address
4e City state zip
4f Telephone no
4g Fax no
4h Email address
5 Agent/Consultant Information (if applicable)
5a Name
5b Business name
(if applicable)
5c Street address
5d City state zip
5e Telephone no
5f Fax no
5g Email address
Page 2 of 11
PCN Form — November 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
lb Site coordinates (in decimal degrees)
36 0573 N 80 1058 W
1 c Property size
<0 10 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
proposed project
Pinetree Branch
2b Water Quality Classification of nearest receiving water
WS III
2c River basin
Yadkin Pee Dee
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
rural/woodland /pastureland
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
25
3d Explain the purpose of the proposed project
Pipe replacement due to a rusted out undersized pipe that causes the road to flood NCDOT will be adding a drop box
per recommendation by the USACE
3e Describe the overall project in detail including the type of equipment to be used
NCDOT will be replacing an undersized pipe using trackhoes backhoes and other mechanized equipment
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?
❑ Yes ® No ❑ Unknown
4b If the Corps made the jurisdictional determination what type
of determination was made
❑ Preliminary ❑ Final
4c If yes who delineated the jurisdictional areas
Name (if known)
Agency /Consultant Company
Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b If yes explain in detail according to help file instructions
6 Future Project Plans
6a Is this a phased project?
❑ Yes ® No
6b If yes explain
The road will be widen and paved at a later date
Page 3 of 11
PCN Form — Version 1 0 November 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
Type of wetland
Forested
(Corps 404 10
Area of impact (acres)
Permanent (P) or
impact
(if known)
DWQ — non -404 other)
Temporary
W1 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W2 ❑ P [IT
❑ Yes ❑ No
❑ Corps
❑ DWQ
W3 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes ❑ No
El Corps
❑ 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
Stream impact
Type of
Stream name
Perennial (PER) or
Average stream width (feet)
Impact
number
impact
intermittent (INT)?
length
Permanent (P) or
(linear feet)
Temporary (T)
S1 ❑ P ® T
pipe
Pinetree Branch
® PER ❑ INT
10
21
S2 ❑ P ®T
np rap
Pinetree Branch
® PER ❑ INT
10
7
S3 ❑ P ❑ T
❑ PER ❑ INT
S4 ❑P ❑T
El PER [:1 INT
S5 ❑P ❑T
F] PER [:1 INT
S6 ❑P ❑T
[:J PER E:1 INT
3g Total stream and tributary impacts
28
3h Comments
Page 4 of 11
PCN Form — Version 1 0 November 2008 Version

C Proposed Impacts Inventory continued
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 o en 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
(if
(P) or
applicable)
Temporary
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
4g Comments
Page 5 of 11
PCN Form — November 2008 Version

C Proposed Impacts Inventory continued
5 Pond or Lake Construction
If pond or lake construction pro osed then complete the chart below
5a
Pond ID
number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Failed
Excavated
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
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 y ou MUST fill out Section D of this form
6a
Project is in which protected basin?
❑ Neuse El Tar Pamlico [-I Other
❑ Catawba ❑ Randleman
6b
Buffer impact
number —
Permanent (P)
or Temporary
6c
Reason
for impact
6d
Stream name
6e
Buffer
mitigation
required?
6f
Zone 1 impact (square
feet)
6g
Zone 2 impact
(square feet)
B1 ❑P ❑T
El Yes ❑No
B2 ❑P ❑T
El Yes ❑No
B3 ❑P ❑T
❑Yes El No
6h Total buffer impacts
61 Comments
Page 6 of 11
PCN Form — November 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
NCDOT will be using a drop box to minimize the impacts that several linear feet of step -pools would cause
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes ® No
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4 Complete if Making a Payment to In lieu Fee Program
4a Approval letter from in lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation stream temperature
warm cool cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5 Complete if Using a Permi tee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 7 of 11
PCN Form — Version 1 0 November 2008 Version

D Impact Justification and Mitigation continued
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
Reason for impact
Total impact
(square feet)
Multiplier
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
Total buffer mitigation required
6c 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)
6d Comments
Page 8of11
PCN Form — November 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1a
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
lb
If yes then is a diffuse flow plan included?
❑ Yes ❑ No
2
Determination if the Project Requires a Stormwater Management Plan
2a
Does the project require a Non -404 Jurisdictional General Permit?
❑ Yes ® No
2b Is the project subject to General Certification 3704 or 3705?
❑ Yes ® No
3
Determination of Stormwater Review Jurisdiction
3a
is this project subject to any of the following state implemented stormwater
❑ Coastal counties
management programs (check all that apply)?
❑ HQW
❑ ORW
If so attach one copy of the approval letter from the DWQ and one copy of the
❑ Session Law 2006 246
approved stormwater management plan
❑ Other
3b
In which local government s jurisdiction is this project?
3c Is this local government certified to implement a state stormwater program?
❑ Yes ❑ No
If so attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved)
4
Information Required for DWQ 401 Unit Stormwater Review
4a
What is the overall percent imperviousness according to the most current site plan?
4b Does this project contain any areas that meet the criteria for high density per
❑ Yes ❑ No
General Certifications 3704 and 3705?
4c
If the site is over 24% impervious and /or contains high density areas then provide a brief narrative description of the
stormwater management plan
4d
Has a completed BMP Supplement Form with all required items been submitted
❑ Yes ❑ No
for each stormwater BMP?
Page 9 of 11
PCN Form — Version 1 0 November 2008 Version

F
Supplementary Information
1
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes
❑ No
use of public (federal /state) land
lb
If you answered yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c
If you answered yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
❑ Yes
❑ No
letter)
Comments
2
Violations (DWQ Requirement)
2a
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after the fact permit application?
❑ Yes
® No
2c
If you answered yes to one or both of the above questions provide an explanation of the violation(s)
3
Cumulative Impacts (DWQ Requirement)
3a
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes
® No
additional development which could impact nearby downstream water quality?
3b
If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
4
Sewage Disposal (DWQ Requirement)
4a Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
the proposed project or available capacity of the subject facility
Page 10 of 11
PCN Form — Version 1 0 November 2008 Version

F Supplementary Information continued
5
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a
Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b
Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c
if yes indicate the USFWS Field Office you have contacted
❑ Asheville
5d
What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
ArcMap and site visit
6
Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitats
❑ Yes ® No
6b
What data sources did you use to determine whether your site would impact Essential Fish Habitat?
ArcMap and site visit
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?
ArcMap and site visit
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 Flood Zone Designation Map
Stephanie Braquet
Aimog�-
11/15/2012
Applican ent's Signature
Applicant/Agents Printed Name
(Agents signatLife is valid only if authonzation letter from the applicant
Date
i ovided
Page 11 of 11
PCN Form — November 2008 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) 11/15/2012
B DISTRICT OFFICE FILE NAME AND NUMBER
C PROJECT LOCATION AND BACKGROUND INFORMATION
State North Carolina County /pansh/borough Forsyth City Union Cross
Center coordinates of site (latilong in degree decimal format) Lat 36 0573 N Long 80 1058 W
Universal Transverse Mercator
Name of nearest waterbody Pmetree Branch
Name of nearest Traditional Navigable Water (TN W) into which the aquatic resource flows Abbott s Creek
Name of watershed or Hydrologic Unit Code (HUC) Yadkin Pee Dee
® 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 Detemmnation Date(s) 03/03/2011
SECTION II SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There Are no navigable waters of the US 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 Are 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) '
® TNWs, including terntonal 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
❑ 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
❑ Impoundments of Junsdictional 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 1201mear feet 10width (ft) and/or acres
Wetlands 0 acres
c Limits (boundaries) of jurisdiction based on Established by OHWM
Elevation of established OHWM (if known)
2 Non regulated waters /wetlands (check if applicable) 3
❑ Potentially 3unsdictional waters and/or wetlands were assessed within the review area and determined to be not Jurisdictional
Explain
Boxes checked below shall be supported by completing the appropriate sections in Section 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 HI 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 Rapanos have been met.
The agencies will assert jurisdiction over non navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs) i e tributaries that typically flow year round or have continuous flow at least seasonally (e g typically 3
months) A wetland that directly abuts an RPW is also jurisdictional If the aquatic resource is not a TNW but has year round
(perennial) flow skip to Section III D 2 If the aquatic resource is a wetland directly abutting a tributary with perennial flow
skip to Section III D 4
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water even
though a significant nexus finding is not required as a matter of law
If the waterbody° is not an RPW or a wetland directly abutting an RPW a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW If the tributary has adjacent wetlands the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands This significant nexus evaluation that combines for
analytical purposes the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary or its adjacent wetlands or both If the JD covers a tributary with adjacent wetlands complete Section III B 1 for
the tributary Section 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 116acres
Drainage area 120 acres
Average annual rainfall 43 inches
Average annual snowfall 9 00 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 5 10 river miles from TNW
Project waters are 2 5 river miles from RPW
Project waters are 5 10 aerial (straight) miles from TNW
Project waters are 5 10 aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TNW5 Pmetree Branch flows south into Abbott s Creek
Tributary stream order if known 1
" 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 described by identifying, e g tributary a, which flows through the review area, to flow into tributary b which then flows into TNW

(b) General Tnbutary 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 10 feet
Average depth 3 feet
Average side slopes 2 1
Primary tributary substrate composition (check all that apply)
® Silts ® Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ® Vegetation Type /% cover shrubs /20%
❑ Other Explain
Tributary condition/stability [e g highly eroding sloughing banks] Explain banks are eroding due to cows
Presence of run/nflle /pool complexes Explain none observed
Tributary geometry Relatively straight
Tributary gradient (approximate average slope) 3 1 %
(c) Flow
Tributary provides for Seasonal flow
Estimate average number of flow events in review area/year 20 (or greater)
Describe flow regime perrenial
Other information on duration and volume
Surface flow is Confined Characteristics
Subsurface flow Unknown 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
• 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 determ
❑ High Tide Line indicated by ❑
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings /charactenstics
❑ tidal gauges
❑ other (list)
me lateral extent of CWAjunsdiction (check all that apply)
Mean High Water Mark indicated by
❑ survey to available datum
❑ physical markings
❑ vegetation lines /changes in vegetation types
(m) Chemical Characteristics
Characterize tributary (e g water color is clear discolored, oily film water quality general watershed characteristics etc )
Explain tributary was flowing and water was clear and free of debris
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) trees shrubs herbaceous vegetation
❑ Wetland fringe Characteristics
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
2 Characteristics of wetlands adjacent to non TNW that flow directly or indirectly into TNW
(i) Physical Characteristics
(a) General Wetland Characteristics
Properties
Wetland size acres
Wetland type Explain
Wetland quality Explain
Protect 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 List Explain findings
❑ Dye (or other) test performed
(c) Wetland Adjacency Determination with Non TNW
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection Explain
❑ Ecological connection Explain
❑ Separated by berm/barrier Explain
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW
Project waters are Pick List aerial (straight) miles from TNW
Flow is from Pick List.
Estimate approximate location of wetland as within the Pick List floodplain
(n) Chemical Characteristics
Characterize wetland system (e g water color is clear brown oil film on surface water quality general watershed
characteristics etc ) Explain
Identify specific pollutants if known
(m) Biological Characteristics Wetland supports (check all that apply)
❑ Riparian buffer Characteristics (type average width)
❑ Vegetation type /percent cover Explain
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
3 Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis Pick List
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 abuts9 (Y/N) Size (in acres)
Summanze 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 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 mtegnty 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 m 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 lmear feet width (ft) Or acres
❑ Wetlands adjacent to TNWs acres
2 RPWs that flow directly or indirectly into TNWs
® Tributaries of TNWs where tributaries typically flow year round are jurisdictional Provide data and rationale indicating that
tributary is perennial Abbott s Creek has continual flow
❑ Tributaries of TNW where tributaries have continuous flow seasonally (e g typically three months each year) are
jurisdictional Data supporting tlus 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 linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
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)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands
❑ 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
❑ 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 junsdictional wetlands in the review area acres
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 supporting this
conclusion is provided at Section III C
Provide acreage estimates for junsdictional wetlands in the review area acres
Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to such waters and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands have a significant nexus with a TNW are jurisdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands in the review area acres
7 Impoundments of jurisdictional waters'
As a general rule the impoundment of a jurisdictional tributary remains jurisdictional
❑ Demonstrate that impoundment was created from waters of the U S or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1 6) or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below)
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
❑ from which 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
$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 described in the Corps/EPA Memorandum Regarding CWA Act Jurtsdtcdon Following Rapano&

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
❑ Wetlands acres
NON JURISDICTIONAL WATERS INCLUDING WETLANDS (CHECK ALL THAT APPLY)
❑ If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in 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 Junsdiction Explain
❑ Other (explain if not covered above)
Provide acreage estimates for non Jurisdictional waters in the review area, where the sole potential basis of Junsdiction is the MBR
factors (i a presence of migratory buds 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 (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/subtmtted 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 1 24000/Kernersville
❑ USDA Natural Resources Conservation Service Soil Survey Citation
❑ National wetlands inventory map(s) Cite name
❑ State/Local wetland inventory map(s)
® FEMA/FIRM maps FEMA Flood Zone Designation Map
❑ 100 year Floodplam Elevation is (National Geodectic Vertical Datum of 1929)
❑ Photographs ❑ Aerial (Name & Date)
or ❑ Other (Name & Date)
❑ Previous determination(s) File no and date of response letter
❑ Applicable /supporting case law
❑ Applicable /supporting scientific literature
® Other information (please specify) site review
B ADDITIONAL COMMENTS TO SUPPORT JD

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FEET SR 2643

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Construction Sequence - Hedgecock Road Forsyth County SR 2683
1 Advertise road closure via press release and VMS sign on site
2 Close road to traffic
3 Install EC devices per plan
4 Remove pavement and overburden surrounding pipe
5 Install pump around
6 Remove pipe
7 Grade new pipe bed
8 Install drop box install pipe
9 Backfill
10 Pave roadway
11 Rebuild slopes and roadway subgrade
12 Rebuild pavement structure
13 Dress and seed
If there are any questions, please call Mr John Rhyne, PE, District Engineer
336 703 6600

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