20130031 Ver 1_Application_20130114

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STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION �a0S 0STORRO oy
PATRICK L MCCRORY ANTHONY JRTjyA
GOVERNOR SECRETARY
January 7, 2013
Ms Lori Beckwith
US Army Corps of Engineers
151 Patton Avenue, Room 208 2 0 1 3 0 0 1
Asheville, NC 28801 -5006
Subject Nationwide Permit #14
SR 1179 Meadow Fork School Road
State Project No 13C 057122 (DWQ Minor Permit Fee $240)
Madison County, NC
Dear Ms Beckwith
I have enclosed a straight -line diagram with erosion control plan, a PCN application for
NWP #14, and a vicinity map relative to the proposed secondary road project on SR 1179
Meadow Fork School Road, Madison County, NC
We propose to replace /extend one (1) pipe culvert on an unnamed tributary (UT) to
Meadow Fork Total culvert extension will be 20 linear feet with a temporary impervious
dike for dewatering during installation The UT to Meadow Fork is an approximately 2
feet wide stream with a predominately sand/gravel substrate Meadow Fork is classified
C,Tr,ORW
Existing channel morphology will be maintained upstream and downstream of the
culvert The culvert will be placed below existing streambed elevation whenever
possible Riparian vegetation will be reestablished along disturbed areas associated with
the culvert extensions Stormwater will be diverted through grass -lined ditches or
vegetated buffers prior to entering streams
No effect on federally listed species (threatened or endangered) or their habitats is
anticipated
As a part of the 401 Certification process, a copy of the application will be forwarded to
the NC State Historic Preservation Office as required by Section 106 of the National
Historic Preservation Act of 1966 and GS 121 -12(a)
Division Thirteen Office Post Office Box 3279 Asheville, NC 28802
Phone [phone] Office of the Division Engineer Fax [phone]
www ncdot gov /doh /operations /drvisionl3

Ms Lori Beckwith
Page —2 SR 1179, Madison County
January 7, 2013
By copy of this letter, we request Marla Chambers, North Carolina Wildlife Resources
Commission Western Region Coordinator, to comment directly to the Corps concerning
the permit request with a copy to Division 13 Environmental Officer
By copy of this letter, we are asking the Area Roadside Field Operations Engineer, to
comment on the above project The UT to Meadow Fork is classified as C,Tr,ORW A
buffer variance will be required for the project
By copy of this letter, I am forwarding one copy of the application package to Soma
Carillo, NC Division of Water Quality, Transportation Permitting Unit and an additional
copy to Mike Parker, NC DWQ Asheville Regional Office for review and comment
Please charge the application fee of $240 00 to WBS element # 13C 057122 Please
forward comments directly to the Corps with copy to Division 13 Environmental Officer
Your earliest consideration for this request would be greatly appreciated If you have any
questions or information needs, please contact me at (828) 251 -6171
Sincerely,
P�
UV rY
Roger D B r
g
Division 13 Environmental Officer
Enclosures
cc J J Swain, Jr , P E
Chad Bandy, P E
Reid Whitehead, CPESC
Marla Chambers
Mike Parker
Sonia Carillo

Corps Submittal Cover Sheet
Please provide the following info
1 Project Name SR 1179 Meadow Fork School Road
2 Name of Property Owner /Applicant NC DOT
3 Name of Consultant/Agent
*Agent authorization needs to be attached
4 Related/Previous Action ID number(s)
5 Site Address N/A
6 Subdivision Name
7 City
8 County Madison
9 Lat 35 789300 Long 8290381 Decimal Degrees Please )
10 Quadrangle Name Lemon Gan
11 Waterway UT to Meadow Fork
12 Watershed French Broad
13 Requested Action
X Nationwide Permit # 14
General Permit #
Jurisdictional Determination Request
Pre- Application Request
The following information will be completed by Corps office
AID
Prepare File Folder Assign number in ORM
Authorization Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose
Site/Waters Name
Keywords
Begin Date

� iI ° p _ II 'Ar - . . n �
Date Received
Fee Paid
Permit Number
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
LINEAR ROADWAY PROJECT
This for m maybe photocopied for use as an original
DWO Stormwater Management Plan Review
A complete stormwater management plan submittal includes this application form, a supplement form for each BMP
proposed (see Section V), design calculations, and plans and specifications showing all road and BMP details
PROJECT INFORMATION
NCDOT Protect Number 13C,057122 County Madison
Protect Name SR 1179 Wcadqw.fork School Road) Secondary Road Improvement
Protect Location SR 1179 is located off SR 1175 (Meadow Fork Road) approximately 0 3 mile south of Joe
Contact Person Yates Allen Phone 828 - 251 -6171 Fax
Receiving Stream Name UT to. Fork River Basin French Broad Class C. Tr, ORW
Proposed linear feet of protect 1056
Proposed Structural BMP and Road Station (attach a list of station and BMP type rf more room is needed)
No structural BMP's are proposed The project will have sheet flow on Vass shoulders and Qxassed roadway ditches
Type of proposed project (check all that apply)
❑ New ®Widening 02 lane* ❑4 lane* ❑Curb and Gutter []Bridge Replacement
® Other (Describe) Widen grade drain and nave to current NCDOT Secondary Road Standards
*2 lane and 4 lane imply that roadside ditches are used unless Curb and Gutter is also checked
U REQUIRED ITEMS CHECKLIST
Initial in the space provided below to indicate the following design requirements have been met and supporting
documentation is attached. Supporting documentation shall, at a mimmum, consist of a brief narrative description
— including (1) the scope of the project, (2) how the items below are met, (3) how the proposed best management practices
minimize water quality impacts, and (4) any significant constraints and /or justification for not meeting a, b, c and d to the
maximum extent practicable
Designer's Initials
�b _a The amount of impervious surface has been minimized as much as possible
tiD b The runoff from the impervious areas has been diverted away from surface waters as much as possible
LID c Best Management Practices are employed which minimize water quality impacts
C,fD d Vegetated roadside ditches are 3 1 slope or flatter
V" eArvenI -WrnnT r ­Par Ana.i.,ra.i_RP„ 1 port. 1 of')

M. OPERATION AND MAINTENANCE AGREEMENT
I acknowledge and agree by my initials below that the North Carolina Department of Transportation is responsible for the
implementation of the four maintenance items listed I agree to notify DWQ of any operational problems with the BMP's
that would impact water quality or prior to making any changes to the system or responsible party
Maintenance Engineer's Initials
BMP's shall be inspected and maintained in good working order
C51) b Eroded areas shall be repaired and reseeded as needed
t: s c Stormwater collection systems, including piping, inlets, and outlets, shall be maintained to insure proper
functioning
Maintenance Engineer's Name Chris Denton
Title Madison County Maintenance Engineer
IV. APPLICATION CERTIFICATION
I, (print or type name) Yates Allen of Division 13 - Division Office Branch,
certify that the information included on this permit application form is, to the best of my knowledge, correct and that the
project will be constructed in conformance with the approved plans and that the proposed project complies with the
requirements of 15A NCAC 2H 1000
Title Division Environmental Specialist
Address P O Box 3279 Asheville NC 28802
Signature ^49AS�Y— aAeX l Date /1-/ re. 13
V SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each BMP
specified for this project Contact the Stormwater and General Permits Unit at (919) 733 -5083 for the status and
availability of these forms
Form SW401 -Low Density
Form SW401 -Curb Outlet System
Form SW401 -Off -Site System
Form SW401 -Wet Detention Basin
Form SW401- Infiltration Basin
Form SW401- Infiltrabon Trench
Form SW401- Biorebention Cell
Form SW401 -Level Spreader
Form SW401- Wetland
Form SW401- Grassed Swale
Form SW401 -Sand Filter
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretenbon Cell Supplement
Level Spreader /Filter Stnp /Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
17nr MUM -N(`r $nT 7 -noar R—A-0 -Rnv 1 P..0,7 of')

APPROVED JURISDICTIONAL DETERMINATION FORM
U S Army Corps of Engineers
This form should be completed by following the instructions provided in Section 1V 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
C PROJECT LOCATION AND BACKGROUND INFORMATION
State NC County /parish/borough Madison City Joe
Center coordinates of site (lat/long in degree decimal format) Lat 35 79300° N, Long 82 90381' W
Universal Transverse Mercator
Name of nearest waterbody UT to Meadow Fork
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows French Broad River
Name of watershed or Hydrologic Unit Code (HUC) 06010105
® Check if map /diagram of review area and/or potential Jurisdictional areas is /are available upon request
❑ Check if other sites (e g , offsite mitigation sites, disposal sites, etc ) are associated with this action and are recorded on a
different JD form
D REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY)
❑ Office (Desk) Determination Date
® Field Determination Date(s) 8/21/2012
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) Jurisdiction (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
(here 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) 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
❑ 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 IN Ws
❑ 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 360 linear feet 2 width (ft) and/or acres
Wetlands acres
c Limits (boundaries) of jurisdiction based on Established by OHWM
blevation of established OI IWM (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 appropriate sections in Section III below
: I or numoses of this form an RPW is defined as a trihutary that is not a TN W and that tvnicaliv flows vear -round or has continuous flow at least seasonally

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 Ill A I and Section III D I only, if the aquatic resource is a wetland adjacent to a TNW, complete Sections III A I and 2
and Section III D 1 , otherwise, see Section I II B below
1 TNW
Identify TN W
Summarize rationale supporting determination
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 ofTNW9 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 Ill 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 ora 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 Ill B I 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 ofisite The determination whether a significant nexus exists is determined in Section III C below
1 Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) General Area Conditions
Watershed size Pick List
Drainage area Pick List
Average annual rainfall inches
Average annual snowfall inches
(n) Physical Characteristics
(a) Relattonship 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 waters are Pick List river miles from RPW
Project waters are Pick List aerial (straight) miles from TNW
Project waters are Pick List aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TN WS
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, a 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 feet
Average depth feet
Average side slopes Pick List.
Primary tributary substrate composition (check all that apply)
❑ Slits ❑ Sands
❑ Cobbles ❑ Gravel
❑ Bedrock ❑ Vegetation Type/%cover
❑ Other Explain
❑ Concrete
❑ Muck
Tributary condition /stability [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 provides for Pick List
Estimate average number of flow events in review area/year Pick List
Describe flow regime
Other information on duration and volume
Surface flow is Pick List Characteristics
Subsurface flow Pick List 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
❑
❑ changes in the character of soil
❑
❑ shelving
❑
❑ vegetation matted down, bent, or absent
❑
❑ leaf litter disturbed or washed away
❑
❑ sediment deposition
❑
❑ water staining
❑
❑ other (list)
❑Discontinuous OHWM ' Explain
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack Ime
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
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 Zinc along shore objects ❑ survey to available datum,
❑ fine shell or debris deposits (foreshore) ❑ physical markings,
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation types
❑ tidal gauges
❑ other (list)
(in) 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 - 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) Phvsical 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 List Explain findings
❑ Dye (or other) test performed
(c) Wetland Adiacency 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 1NW
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
(iii) Biological Characteristics Wetland supports (check all that apply)
❑ Riparian buffer Characteristics (type average width)
❑ Vegetation type/percent cover Explain
❑ Habitat for
❑ Federally 1 fisted 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 abuts? (YIN) Size (in acres)
Summarize overall biological, chemical and physical functions being performed
C SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the 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 withal[ 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 TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for Fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TN W9
• Does the tributary, in combination with its adjacent wetlands (if any) have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW9
Note the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below
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 Ill D
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 lit D
D DETERMINATIONS OF JURISDICTIONAL FINDINGS THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY)
TNWs and Adjacent Wetlands Check all that apply and provide size estimates in review area
❑ TNWs linear feet width (R), Or, acres
❑ 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 has prominent bed/bank features
❑ frbutaries 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 360 linear feet 2 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 TN W or an RPW, but flows directly or indirectly into a TN W, and it has a significant nexus with a
TNW is jurisdictional Data supporting this conclusion is provided at Section III C
Provide estimates for jurisdictional waters within the review area (check all that apply)
❑ Tributary 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
❑ 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 tnbutary 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 TN W are junsidictional Data supporting this
conclusion is provided at Section [if C
Provide acreage estimates for jurisdictional wetlands in the review area acres
6 Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TN W 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 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)
E ISOLATED [iNTERSTATE OR INTRA- STATEI WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY) 1D
❑ 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 111 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 Jurisdicdon 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
❑ Wetlands acres
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 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.jurisdiction Explain
❑ Other (explain, if not covered above)
Provide acreage estimates for non - jurisdictional waters in the review area, where the sole potential basis of.jurisdiction is the MBR
factors (i e , presence of migratory birds, presence of endangered species, use of water for irigated agriculture), using best professional
,judgment (check all that apply)
❑ Non - wetland waters (i e, 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 e, 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/submitted by or on behalf of the applicant/consultant 1
❑ 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, Lemon Gap Quadrangle
❑ USDA Natural Resources Conservation Service Soil Survey Citation
❑ National wetlands inventory map(s) Cite name
❑ State/Local wetland inventory map(s)
❑ FEMA/FiRM maps NC Floodplain Mapping Program
❑ 100 -year Floodplain Elevation is (National Geodectic Vertical Datum of 1929)
® Photographs ❑ Aerial (Name & Date)
or ® Other (Name & Date) Stream photos in N WP Application, 6/5/2012
❑ 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

Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 10
nrrni r...-.. %I-.- ^_ eon..,..,,ti...
Pre- Construction Notification (PCN) Form
A
Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
X Section 404 Permit ❑ Section 10 Permit
1 b Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1 c
Has the NWP or GP number been verified by the Corps?
X Yes
❑ No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
X 401 Water Quality Certification — Regular ❑ NonA04 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes X No
For the record only for Corps Permit
❑ Yes X No
1f
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program
❑Yes
X No
1g
Is the project located in any of NC's twenty coastal counties If yes, answer 1h
below
❑ Yes
X No
1h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
X No
2
Project Information
2a
Name of project
SR 1179 Meadow Fork School Road
2b
County
Madison
2c
Nearest municipality / town
Joe
2d
Subdivision name
NIA
2e
NCDOT only, T I P or state
project no
13C 057122
3
Owner Information
3a
Name(s) on Recorded Deed
North Carolina Department of Transportation
3b
Deed Book and Page No
NIA
3c
Responsible Party (for LLC if
applicable)
N/A
3d
Street address
N/A
3e
City, state, zip
N/A
3f
Telephone no
NIA
3g
Fax no
NIA
3h
Email address
NIA
Page 1 of 10
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4
Applicant Information (if different from owner)
4a
Applicant is
North Carolina Department of Transportation
4b
Name
J J Swain, Jr, P E, Division Engineer
4c
Business name
(if applicable)
N C Department of Transportation
4d
Street address
55 Orange Street, P O Box 3279
4e
City, state, zip
Asheville, NC 28802
4f
Telephone no
828- 251 -6171
4g
Fax no
828 - 251 -6394
4h
Email address
yallen .ncdot gov
5
Agent/Consultant Information (if applicable)
5a
Name
NIA
5b
Business name
(if applicable)
NIA
5c
Street address
N/A
5d
City, state, zip
NIA
5e
Telephone no
NIA
5f
Fax no
N/A
5g
Email address
N/A
Il...... n ..i 4 n

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
N/A
1b Site coordinates (in decimal degrees)
Latitude 35 79300° N Longitude -82 90381 °W
1c Property size
1 09 acres
2 Surface Waters
2a Name of nearest body of water (stream, river, etc ) to
proposed project
UT to Meadow Fork
2b Water Quality Classification of nearest receiving water
C, Tr, ORW
2c River basin
French Broad
3 Project Description
3a Describe the existing conditions on the site and the general land use in the vicarnty of the project at the time of this
application
Existing gravel secondary road
3b List the total estimated acreage of all existing wetlands on the property
00
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
500
3d Explain the purpose of the proposed project
Increase the typical section and pave the secondary road
3e Describe the overall project in detail including the type of equipment to be used
Grade, drain, base and pave the roadway Extend one pipe on jurisdictional stream Equipment used will include
excavators trucks and graders,
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 field confirmed by NCDOT and DWQ
El Yes X 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) N/A
Agency /Consultant Company
Other N/A
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 X No ❑ Unknown
5b If yes, explain in detail according to "help file" instructions
6 Future Project Plans
6a Is this a phased project?
❑ Yes X No
6b If yes, explain
Page 3 of 10
n rlkl C....... \r.... -- 4 7 r'%-- . —L.... AA

C Proposed Impacts Inventory
1 Impacts Summary
1a Which sections were completed below for your project (check all that apply)
❑ Wetlands X 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)
T
—Temporary
El Yes
❑Corps
W1 El P El T
❑ No
❑ DWQ
El Yes
❑ Corps
W2 El P F1 T
❑ No
❑ DWQ
W3 [I P ❑ T
El Yes
❑ No
❑ Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
❑ Yes
❑ Corps
W5 ❑ P ❑ T
❑ 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 X P ❑ T
Pipe Culvert
UT to Meadow
Fork
X PER
❑ INT
X Corps
X DWQ
2
20
S1 ❑ P X T
Dewatenng
UT to Meadow
Fork
X PER
❑ INT
X Corps
X DWQ
2
25
El PER
❑Corps
S2 ❑P ❑T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S2 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S3 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S5 ❑ P ❑ T
❑ INT
❑ DWQ
3h Total stream and tributary impacts
45
31 Comments 20 feet of permanent and 25 feet of temporary impacts at same location
Page 4 of 10
n/-hl r_'_ % /..... __ 4 7

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 indiv ually 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
58
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
5g Comments
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
❑ Neuse ❑ Tar - Pamlico ❑ Other
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
❑Yes
131 ❑P ❑T
❑ No
❑Yes
B2 ❑P ❑T
❑ No
El Yes
B3 ❑P ❑T
❑ No
6h Total buffer Impacts
61 Comments

D Impact Justification and Mitigation
1 Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Minimum pipe length used to obtain needed typical section and shoulder width for safety
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
N/A
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 X 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
El 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 -lleu Fee Program
4a Approval letter from in -lieu fee program is attached
❑ Yes
4b Stream mitigation requested
Iinear 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 - 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 description of the proposed mitigation plan
Page 6 of 10
nt-1.1 C....... \ /.... __ 4 0 1'\.......... L.... AA nAAO \ /.........

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 ❑ Yes X No
buffer mitigation?
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
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
6g If buffer mitigation is required, discuss what type of mitigation is proposed (e g, payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund)
6h Comments

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
la
Does the project include or is it adjacent to protected riparian buffers identified
E] Yes X No
within one of the NC Riparian Buffer Protection Rules?
lb
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?
NIA
2b
Does this project require a Stormwater Management Plan?
X Yes ❑ No
2c
If this project DOES NOT require a Stormwater Management Plan explain why NC DOT Project
2d
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative
description of the plan
The project will use BMP's to the Maximum Extent Practicable (MEP) in compliance with NCDOT's NPDES Permit No
000250 Post Construction Stormwater Program
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
X DWQ Stormwater Program
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this project?
N/A
❑ Phase II
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other N/A
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state - implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 -246
❑ Other N/A
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements'?
❑ Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8of10

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 (federallstate) land?
lb
If you answered "yes" to the above, does the project require preparation of an
❑ Yes
® No
environmental document pursuant to the requirements of the National or State
(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
❑ 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 quality9
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
N/A
Page 9 of 10
nflKI C.....n \ /..... .... 4 7 P1......«.t— 4/\ '1/\/\O \/..... ....

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?
field survey, USFWS county list, habitat requirements
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?
Current Maps /Database
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?
Current Maps /Database
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA- designated 100 -year floodplain?
Fo Yes ®No
8b If yes, explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination? Current FEMA Maps
Roger D Bryan
X0)3
Applicant/Agent's Printed Name
4tp-plicant/AA
Date
nt's Signature
(Agents signature is valid only if an authorization letter from the applicant
is provided
n— 4 n ..s e n

kow
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•)6

N.C. DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
SECONDARY ROAD SURVEY
SUBJECT: SR 1179 Meadow Fork School Rd.
LOCATION: From SR 1175 to EOM
WORK TYPE: Grade, Drain, Base, and Pave
WORK ORDER: 13C.057122 PRIORITY: Rural #27
COUNTY: Madison TOWNSHIP: Spring Creek
DATE 5 -24 -12 SCALE: I"'= 50'
NOTES: R/W 45'
Length: 1056 ft or .20 mi
PREPARED BY: JSA/JMD
ASPHALT 1 PAVEMENT
5' sj m — 9t ak 91 41 — + 4'

PIPE DATA
SR 1179, Meadow Fork School Rd.
County:
Buncombe
WORK ORDER : 13G - OS7) 1 Z2
STATION
PRESENT
SIZE
PROPOSEDI
SIZE
NOTES
11 +92
55'x36 "CMP
Drive Pipe
12 +50
20'x24 "CMP
Drive Pipe
16 +26
Crushed CMP
Cross Pipe Remove to 18" HDPE & plug
16 +44
18 "HDPE
Drive Pipe
16 +70
L10'X 14 "6.,jq
Proposed cross pipe
18 +96
20'x18 "CMP
40'x18 "CMP
Cross Pipe
19 +85
40'x15 "CMP
Drive Pipe

install low & or endpoint measures in TSF
Construct using the 30 day option
'°
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��
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