20130078 Ver 1_Application_20130128

JAN282013
201 30078
STATE OF NORTH CAROLINANDJ��DSrpR�gRRRR ^r
DEPARTMENT OF TRANSPORTATION c"
PATRICK L. MCCRORY ANTHONY J. TATA
GOVERNOR SECRETARY
January 16, 2013
Ms. Lori Beckwith
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801 -5006
Subject: Nationwide Permit #14
SR 1169 Caldwell Road
State Project No. 13C.057020 (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 1169
Caldwell Road, Madison County, NC.
We propose to replace /extend one (1) pipe culvert on Caldwell Branch. Total culvert
extension will be 10 linear feet with a temporary impervious dike for dewatering during
installation. Caldwell Branch is an approximately 4 feet wide stream with a
predominately sand /gravel /cobble /rock substrate. Caldwell Branch 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.i-tcdot.gov/doh/operations/division13

Ms. Lori Beckwith
Page —2 SR 1169, Madison County
January 16, 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 us
with comments on the above project. Caldwell Branch 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 Sonia
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.057020. 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 61 %-.-,
Roger D. Bryan
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 1169 Caldwell 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: Spring Creek
8. County: Madison
9. Lat: 35.80190 Long: 82.84845 (Decimal Degrees Please )
10. Quadrangle Name: Springy Creek
11. Waterway: Caldwell Branch
12. Watershed: French Broad
13. Requested Action:
X Nationwide Permit # 14
General Permit #
Jurisdictional Determination Request
T Pre - Application Request
-------------------------------------------------------------------------------------------------------------
The following information will be completed by Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose:
Site /Waters Name:
Keywords:

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
LINEAR ROADWAY PROJECT
Thisform maybe photocopled for use as an original.
DWQ 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.
L PROJECT INFORMATION
NCDOT Project Number: 13C.057020 County: Madison
ProjectName: SR 1169 (Caldwell Road) Secondary Road Improvement
Project Location: SR 1169 is located off SR 1168 (West Road) approximately 1.1 miles north of Spring Creek.
Contact Person: Yates Allen Phone: [phone] Fax:
Receiving Stream Name: Caldwell Branch River Basin: French Broad Class: C. Tr: ORW
Proposed linear feet of project: 800
Proposed Structural BMP and Road Station (attach a list of station and BMP type if more room is needed):
No structural BMP's are proposed The prpoicct will have sheet flow on grass shoulders and grassed 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 pave to current NCDOT Secondary Road Standards.
*2 lane and 4 lane imply that roadside ditches are used unless Curb and Gutter is also checked.
II. 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 minimum, 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
1•� 1 a. The amount of impervious surface has been minimized as much as possible.
,!!f 5,D_b. The runoff from the impervious areas has been diverted away from surface waters as much as possible.
C Sc. Best Management Practices are employed which minimize water quality impacts.
1' 51)_d. Vegetated roadside ditches are 3:1 slope or flatter.
T+-n CU /AM _ATMAT T innar 1 • porro 1 nil

III. 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
G _ -a. BMP's shall be inspected and maintained in good working order.
G 1� b. Eroded areas shall be repaired and reseeded as needed.
�D c. Stormwater collection systems, including piping, inlets, and outlets, shall be maintained to insure proper
functioning.
Maintenance Engineer's Name: Chris Devton
Title: Madison Counly 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 I SA NCAC 2H. 1000.
Title: Division Environmental Specialist
Address: P.O. Box 3279, Asheville, NC 28802 -
Signature: Date:- &
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- Infiltration Trench
Form SW401- Bioretention 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
Bioretention Cell Supplement
Level Spreader /Filter Strip /Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
T:nrn+ CwAn i Ai! nn r T 1n .-ar T? nari.vov_RPO 1 Dan.- I nr7

,.: .,v �. ,. ... ....
",7 �.,i {. +:�;i':J ":i �'::1:. =_ �'I:" ^+'IAY •11A �u `kH.4+ I•i; j'i.�; u;•,j.• •I. .. :., ... ;
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
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
LINEAR ROADWAY PROJECT
Thisform maybe photocopied for use as an original.
DWO Stormwater Management Flan 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.
L PROJECT INFORMATION
NCDOT Project Number: 13C.057020 County: Madison
Project Name: SR 1169 (Caldwell Road) Secondary Road Improvement
Project Location: SR 1169 is located off SR 1168 (West Road) approximately 1.1 miles north of Spring Creek.
Contact Person: Yates Allen Phone: [phone] Fax:
Receiving Stream Name: Caldwell Branch River Basin:• French Broad Class: C.
Proposed linear feet of project: 800 -
Proposed Structural BMP and Road Station (attach a list of station and BMP type if more room is needed):
No structural BMP's are proposed The project will have sheet flow on grass shoulders and grassed 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 pave to current NCDOT Secondary Road Standards.
*2 lane and 4 lane imply that roadside ditches are used unless Curb and Gutter is also checked,
II. 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 minimum, 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
1's ?) a. The amount of impervious surface has been minimized as much as possible.
L) The runoff from the impervious areas has been diverted away from surface waters as much as possible.
_a Best Management Practices are employed which minimize water quality impacts.
f' Vegetated roadside ditches are 3:1 slope or flatter.
Finn QUTAM _Nlrnf)T 7 ;..ar P? adty --R— 1 • Pump 1 nil
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
LINEAR ROADWAY PROJECT
Thisform maybe photocopied for use as an original.
DWO Stormwater Management Flan 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.
L PROJECT INFORMATION
NCDOT Project Number: 13C.057020 County: Madison
Project Name: SR 1169 (Caldwell Road) Secondary Road Improvement
Project Location: SR 1169 is located off SR 1168 (West Road) approximately 1.1 miles north of Spring Creek.
Contact Person: Yates Allen Phone: [phone] Fax:
Receiving Stream Name: Caldwell Branch River Basin:• French Broad Class: C.
Proposed linear feet of project: 800 -
Proposed Structural BMP and Road Station (attach a list of station and BMP type if more room is needed):
No structural BMP's are proposed The project will have sheet flow on grass shoulders and grassed 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 pave to current NCDOT Secondary Road Standards.
*2 lane and 4 lane imply that roadside ditches are used unless Curb and Gutter is also checked,
II. 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 minimum, 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
1's ?) a. The amount of impervious surface has been minimized as much as possible.
L) The runoff from the impervious areas has been diverted away from surface waters as much as possible.
_a Best Management Practices are employed which minimize water quality impacts.
f' Vegetated roadside ditches are 3:1 slope or flatter.
Finn QUTAM _Nlrnf)T 7 ;..ar P? adty --R— 1 • Pump 1 nil

III. 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
GS D a. BMP's shall be inspected and maintained in good working order.
G S 1D,—b. Eroded areas shall be repaired and reseeded as needed.
c. Stormwater collection systems, including piping, inlets, and outlets, shall be maintained to insure proper
functioning.
Maintenance Engineer's Name: Chris Devton
Title:_ Madison CougV 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 ZHU"l
A Date; _ AG Te , 13
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement forms) 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- Infiltration Trench
Form SW401- Bioretention 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
Bioretention Cell Supplement
Level Spreader /Filter Strip /Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
F^an CVJdA1 T,T!`ll(1T r inAar R^arlurwv_RP.r 1 pAfTP 7 nf7

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[: 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: Spring Creek
Center coordinates of site (lat /long in degree decimal format): Lat. 35.80190° N, Long. 82.84845° W.
Universal 'transverse Mercator:
Name of nearest waterbody: Caldwell Branch
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: French Broad River
Name of watershed or Hydrologic Unit Code (I IUC): 06010105
® Check if map /diagram of review area and /or potential jurisdictional areas is/are available upon request.
❑ Check if other sites (e.g., olTsite 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 APPLV):
❑ Office (Desk) Determination. Date:
® Field Determination. Datc(s): 1/8/2013
SECTION 11: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable waters of 1he (I.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
❑ Waters subject t o t he 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.
EAplain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters of the U.S." 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
❑ IN Ws. including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent waters' (RPWs) that flow directly or indirectly into TNWs
❑ Non -IU'Ws 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'INWs
❑ Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
❑ Impoundments ofjurisdictional 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- 250 linear feet: 4 width (ft) and /or acres.
Wetlands: acres
c. Limits (boundaries) of jurisdiction bused on: Established by OHWM.
Elevation of established OI I W M (t f known):
2. Non - regulated waters /wetlands (check if applicable) :3
❑ Potentiallyjurisdictional waters and /or wetlands were assessed within the review area and determined to be notjurisdictional.
l.izplain:
Boxes checked below shall be supported by completing the appropriate sections in Section III below.
' For purposes of this form, an RPW is delincd as a tributary that is not a TNW and that typically flows year -round or has continuous flow at least "seasonally"
(c g.. typically 3 months).
' Supporling documentation is presented in Scclion III F.

SECTION 111: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. if the aquatic resource is a TNW, complete
Section III.A.I and Section Il1.D.l. 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 111.6 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, evert
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.I for
the tributary, Section 111.6.2 for any onsite wetlands, arid Section I11.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.0 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 snowlall inches
(ii) Physical Characteristics:
(a) Relationship with I'NW:
❑ Tributary flows directly into TNW.
❑ 'I ributary flows through Pick List tributaries before entering TNW.
Project eaters are Pick List river miles from TNW.
Project waters ate Pick List river miles from RPW.
Project waters arc Pick List aerial (straight) miles from TNW.
Project eaters are Pick List aerial (straight) miles from RPW.
Project %%alers cross or serve as state boundaries. Explain:
Identify flow route to'IT1W5:
Tributary stream order, if known:
'Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the arid
West.
` Flow route can be described by identifying. e.g . tributary a, which flows through the review area, to flow into tributary b, which then flows into 'I'N W.

(b) General I ributary Charactci istics (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 (clieck all that apply):
❑ Silts ❑ Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type / %cover:
❑ Other. Explain:
Tributary condition /stability, le.g., highly eroding. sloughing banks]. Explain:
Presence of run /riffle /pool complexes. Explain:
Tributary geometry: Pick List
"Tributary gradient (approximate average slope): %
(c) flow.
,FributUuy provides tor: Pick List
Estimate average number of flow events in review area/year: Pick List
Describe flow regime:
Other information on duration and volume:
Surface Ilow is: Pick List. Characteristics:
Subsurl'ace (low: Pick List. Explain findings
❑ Dye (or other) test perl'ornied:
Tributary has (check all that apply):
❑ Bed and banks
❑ OEi WM6 (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
❑
❑ watel staining
❑
❑ other (list):
❑ Discontinuous OI IWM.' Explain:
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
If tlnctois 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:
❑ line shell or debris deposits (foreshore) ❑ physical markings:
❑ physical markings/characteristics ❑ vegetation lincs/changes in vegetation types.
❑ tidal gauges
❑ other(list):
(iii) Chemical Characteristics:
Characterize tributary (e.g.. water color is clear, discolored
Explain:
Identify specific pollutants, if known:
oily film. water quality: general watershed characteristics, etc.).
'A natural or man -made discontinuity in the OH WM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the 01-IWM has been removed by development or agricultural praclices). 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 culverq, 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:
❑ Flabitallirr:
❑ Fcdcraily listed species. Explain findings:
❑ Dish /spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aqualic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non -TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Welland Characteristics:
Properties:
Welland size: acres
Welland type. Explain:
Welland quality. Explain:
Protect wetlands cross or serve as state boundaries. Explain:
(b) General Plow Relationship with Non -TNW:
Plow is: Pick List. Explain:
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ D3 e (or other) test performed:
(c) Welland Adjacency Determination with Non =FNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm /barrier. Explain:
(d) Proximity (Relationship) to'FNW
Proiccl wetlands are Pick List river miles from TNW.
Proiecl %%alers aic Pick List aerial (straight) miles from TNW.
Flow is floor: Pick List.
Estimale approximate location of wetland as within the Pick List floodplain.
(ii) Chemical Characteristics:
Charactenie wetland system (e.g., water color is clear, brown, oil film on surface, water quality: general watershed
characteristics: etc.). Explain:
Identify specific pollutants, il'known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian butler. Characteristics (type, average width):
❑ Vegetation type /percent cover. Explain:
❑ I labitat 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 nctland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total arc being considered in the cumulative analysis.

For each N%elland. specify the l'ollo%%ing:
Dheclly abuts? (Y/N) Size (in acres) Directly abuts? (YIN) Size (in acres)
Sunnnarire 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 Iloodplain 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 (il'any), have the capacity to cant' pollutants or flood waters to
TNWs, or to reduce the amount ol'pollutants or flood waters reaching a TNW?
• Does the t ibutary. in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions 11or fish and
other species, such as feeding. nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tribmaty. 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 ol'theTNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
I. Significant nexus findings for non -RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings ol'presence or absence of significant nexus below, based on the tributary itself, then go to Section II1.1):
2. Significant nexus findings for non -RPW and its adjacent wetlands, where the non -RPW flows directly or Indirectly into
TNWs. Explain lindings of'picsence or absence of significant nexus below, based on the tributary in combination with all of its
ad_lacent wetfunds, then go to Section I11.1):
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 WATERSIWETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear Ices width (11), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into'TNWs.
® 'Tributaries of'I'NWs where tributaries typically flow year -round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: Stream has prominent bed /bank features and OHWM and appears as blue line stream on topo map.
❑ "Tributaries of TN W 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: 250 linear feet 4 width (It).
❑ Other non - wetland waters: acres.
identity type(s) of waters:
Non -RPWss that Row directly or indirectly into TNWs.
❑ Waterbody that is not a TNW or an RPW. but tlows directly or indirectly into a TNW, and it has a significant nexus with a
'I N W is jurisdictional. Data supporting this conclusion is provided at Section II1.C.
Provide estimates lorjurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feel width (ft).
❑ Other non - wetland waters: acres.
Identity 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 Row 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 111.13 and rationale in Section IILD.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates fbrjurisdictional wetlands in the review area: acres.
S. Wetlands adjacent to but not directly abutting an RPW that Row 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 jurisidictional. Data supporting this
conclusion is provided at Section III.C.
Provide acreage estimates f'or jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non -RPWs that flow directly or indirectly into TNW&
❑ 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 11I.C.
Provide estimates for jurisdictional wetlands in [tie review area: acres.
Impoundments of jurisdictional waters'
As a general ride, the impoundment of a,iurisdictional 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- sTATEj 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 he used by interstate or foreign travelers for recreational or other purposes.
❑ frorn 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 watets. [:,,plain:
❑ Other factors. Explain:
Identify water body an([ suinnnarize rationale supporting determination:
"See Footnote H 3.
'To complete the analysis retcr to the key in Scclion 111 D.6 of the Instructional Guidebook.
" Prior to asserting or declining C%VA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA IIQ for
review consistent with file process described in the Corps /EPA Afentorandtnn Regarding Cl3'A Act Jurisdldion Following Raptnnos.

Providc estimates tirr.jurisdictionaI waters in the review area (check all that apply):
❑ Tributary waters: linear feet width ((I).
❑ Other non- wetland walers: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
NON - JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
❑ Ifpotential wetlands were assessed within the review area. these areas did not meet the criteria in the 1987 Corps of Engineers
Weiland Delineation Manual and /or appropriate Regional Supplements.
❑ Rcview area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in' "SiVANCC," the review area would have been regulated based solel on the
"Migratory laird Rule' (MBR)
❑ Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
❑ Other: (explain. ifnot covered above):
Provide acreage estimates for non - jurisdictional waters in the review area. where the sole potential basis ofjurisdiction is the M13R
factors (i.e., presence of migratory birds, presence of cndaagcrcd species, use of water for irrigated 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 -wel land 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 linding is required for jurisdiction (check all that apply):
❑ Non - wetland waters (i.e., rivers, streams): linear feet, width (11).
❑ 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 ieques(ed, 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 (lie Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey t lydrologic Atlas:
❑ USGS Ni lD data.
❑ USGS 8 and 12 digit I Il.1C maps.
® U.S. Geological Survey map(s). Cite scale & quad name: 1:24000, Spring Creek Quadrangle.
❑ USDA Natural Resources Conservation Service Soil Survey. Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ NI:MA/F1RM maps:NC I'loodplain Mapping Program.
❑ 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
® Photographs: ❑ Aerial (Name & Date):
or ® Other (dame & Datc):Strcam photos in NWP Application, 1/8/13.
❑ Previous de(cnnination(s). Nile no. and date of response letter:
❑ Applicable / suppoiling case law:
❑ Applicable /supporting scientific literature:
❑ Other inlorniation (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD:

i
i
1
i
ff
I
i
�oF wArE90 2 0 1 3 0 0 7$ office use only: �^
Corps action ID no.
o DWQ project no.
Form Version 1.3 Dec 10 2008
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
la. Type(s) of approval'sought, from the
Corps:
X Section 404 Permit 0 Section 10 Permit
1b. 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
1d. Type(s) of approval sought from the DWQ (check all that apply):
X 401 Water Quality Certification - Regular 0 Non -404 Jurisdictional General Permit
0 401 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:
0 Yes X No
For the record only for Corps Permit.
0 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.
0 Yes
X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
0 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 1169 Caldwell Road
2b. County:
Madison
2c. Nearest municipality / town:
Spring Creek
2d. Subdivision name:
NIA
2e. NCDOT only, T.I.P. or state
project no:
130.057020
3. Owner Information
3a. Name(s) on Recorded Deed:
North Carolina Department of Transportation
3b. Deed Book and Page No.
N/A
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.:
N/A
3h. Email address:
NIA
Page 1 of 10

t
t
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
6. AgentlConsultant Information (if applicable)
5a. Name:
NIA
5b. Business name
(if applicable):
N/A
5c. Street address:
N/A
5d. City, state, zip:
N/A
5e. Telephone no.:
N/A
5f. Fax no.:
N/A
5g. Email address:
N/A
r
n..,.., n ..c 4r%
f

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
NIA
1b. Site coordinates (in decimal degrees):
Latitude: 35.80190° N Longitude: - 82.84845 °W
1c. Property size:
0.83 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Caldwell Branch
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 vicinity 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:
0.0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Caldwell Branch -250'; UT to Caldwell Branch 45'
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: blue line stream; field confirmed by NCDOT
❑ 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: NIA
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 —T—E]
6a. Is this a phased project?
X No
6b. If yes, explain.
Page 3 of 10

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.
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)
Tem ora T
Pipe Culvert
Caldwell Branch
❑ Yes
❑ No
❑ Corps
❑ DWQ
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts)
W1 ❑ P ❑ T
question for all stream sites impacted:
Dewatering
Caldwell Branch
❑ Yes
❑ No
❑ Corps
❑ DWQ
3a.
Stream impact
W2 ❑ P ❑ T
W3 ❑P ❑T
3d.
Perennial
3e.
Type of jurisdiction
❑ Yes
El No
❑ Corps
E] DWQ
number -
(PER) or
❑ Yes
[:1 No
❑ Corps
❑ DWQ
(linear
W4 ❑ P ❑ T
intermittent
❑ Yes
❑ No
❑ Corps
❑ DWQ
feet)
W5 ❑ P ❑ T
W6 ❑ P ❑ T
S3 [] P ❑ T
(INT)?
C] Yes
❑ No
❑ Corps
❑ DWQ
2g. Total wetland Impacts
2h. Comments:
Pipe Culvert
Caldwell Branch
X PER
❑ INT
X Corps
X DWQ
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:
Dewatering
Caldwell Branch
X PER
❑ INT
X Corps
X DWQ
3a.
Stream impact
3b.
Type of impact
C.
Stream name
3d.
Perennial
3e.
Type of jurisdiction
3f.
Average
Impact
m
length
number -
(PER) or
(Corps - 404, 10
stream
width
(linear
Permanent () or
intermittent
DWQ — non -404,
(feet)
feet)
Temporary (T)
S3 [] P ❑ T
(INT)?
other)
Si X P ❑ T
Pipe Culvert
Caldwell Branch
X PER
❑ INT
X Corps
X DWQ
4
10
Dewatering
Caldwell Branch
X PER
❑ INT
X Corps
X DWQ
4
_ 15
Si ❑ P X T
S2 ❑ P [] T
❑ PER
❑ INT
❑ Corps
❑ DWQ
❑ PER
❑ INT
❑ Corps
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
S3 [] P ❑ T
❑ PER ❑ Corps
85 ❑ P ❑ T ❑ INT ❑ DWQ
3h. Total stream and tributary impacts 25
3i. Comments: 10 feet of permanent and 15 feet of temporary impacts at same location.
Page 4of10
C �� . A O n . . L .. An nnn0 �� ..:, .
nrlhl

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
impact number --
Name of waterbody
(if applicable)
Type of impact
Waterbody type
Area of impact (acres}
Permanent (P) or
Temporary T
01 ❑P ❑T
02 ❑P[]T
03 ❑P ❑T
04 ❑P❑T
0. Total open water Impacts
4g. Comments:
6. 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 purpose
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
number
of pond
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i, Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If 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)
impact
required?
—Temporary
El Yes
61 ❑P ❑T
❑ No
❑ Yes
B2 ❑ P [IT
❑ No
El
B3 ❑P ❑T
[] ❑ No
6h. Total buffer Impacts
6i. Comments:

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. 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
j] 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 Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10

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 X 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
[Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
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
1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑ Yes X No
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
N/A
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
3b. Which of the following locally- implemented stormwater management programs
apply (check all that apply):
❑ NSW
El [I ❑ 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
4a. Which of the following state - implemented stormwater management programs apply
(check all that apply):
❑ HQW
❑ ORW
❑ Session Law 2006 -246
❑ Other: N/A
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
6. 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 8 of 10

F. Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1 a.
Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes
❑ No
use of public (federal /state) land?
1 b.
if you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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.
NIA
Page 9 of 10

S. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c. If yes, 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?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
Be. What source(s) did you use to make the floodplain determination? Current FEMA Maps
Roger-D.Bryan
16 Jan 13
Applicant/Agent's Printed Name
pplicant/Age 's Signature
(Agent's signature is valid only if an authorization letter from the applicant
Date
is provided.)
n..... +n -9 +n

N.C. DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
SECONDARY ROAD SURVEY
SUBJECT: SR 1169 Caldwell Rd.
LOCATION: From 1168 to EOM
WORK TYPE: Grade, Drain, Base, and Pave
WORK ORDER: 13C.057020 PRIORITY: Rural #13
COUNTY: Madison TOWNSHIP: Spring Creek
DATE 12 -07 -11 SCALE: F5= 50'
NOTES: R/W 45'
Length: 800 ft or. 15 mi
PREPARED BY: JSA/JMD

0
PIPE DATA
SR 1169 Caldwell Rd.
County:
Madison
WORK ORDER:
STATION
PRESENT
SIZE
PROPOSED
SIZE
NOTES
10 +47
30'x36 "CUP
40'x36 "CUP
Crass pipe/Ext. 10'
11 +79
40'X24 "CUP
Cross Pipe
11 +97
30'x24 "CNW
i
I Cross pipe/ Remove!!!!!!

m
/ — \.d �"l �
.0
H IQ
V4
f 1.�
QK-
I v3Vz►p,
,og.33c .oP coq © � i ��" �
SR Wfmf WIFtTRIO
SR, mc? C lc/we ff Re(
Inadi-VAI COW041
* Imt,all,low-& or endpoint measures in TSF.
* Construct using the 30 day option.
* All wattles require PAM.
* All basins located at a 5% or greater grade
must be tiered.
117,tj i. ptemmoo.,
DiS. S-X 'Af- 1601
TYPr !t
OAPTS
-iypr. 4 "" 0-
rqp,e d jjASj F)
LCx j P61m jAF.FUS
A RacK 09"
Smoy
300 jW7
100','$A BUFFet
�RAFK
YyFEARocK
C
?X(,jrz. rppeg, OASO
11/1 Coi.- FA040. &Wlts
j y,#X A (dot k 4 NA K
100' fSA SUFW,

v✓oc>4%s
z4-,o
15".t 50
V3,
of
/o' GR---
-ri� -
, , —
-S K // 6'1 Ca Id we I I Kd
f4,,,J;so,j Cov,,J+%
* Install low & or endpoint, measures in TSF.
* Construct using the 30 day option.
* All wattles require PAM.
* All basins located at a 5% or greater grade
must be tiered.
) $+0t)
-TW
WOODS
""j
3X16 x2.
T-Y?F- %
lyff: A
0(kc--vY.,

Figure 1 Site 1 inlet
Figure 2'Site 1 outfall

N
Y,
'u, k Qk,1- �' 1 1, Z.
lal
,
Ili fj
'l
2
J, W �'j
>
{ =(7 € %N
1V
N
0- sp- �1
f
V14,
2"
4r
/
I'v— -
71
1
F 2
V-,
V"
N
VX Z�; S
gi
N
WY End SR 1169
c
V,
N,I
J6
169
A', Begin SR 1
i4ryV,
\'; �; :zq: :e w. 3•' � " `� rn ��„�:• „r'� i � (' ": =^ °.,J _may _� !'•�', r
I N
Q
V
N-A 11"
", �1 - , I,--- � ,,, 7 1 X"
KEW
W
V\
/ 5
gi
A" Al
I %N'=
� , , <<•2r ,> ri�� r �::+ :' tr. e�.:.:•,.:%; Y' ���� , ; Ii�'��1/ f, %.r'�•w'I ��,c "� •"'�` y ?'�
t
-,Z
;�O
W? ..YTOPC
SCALE 1:24000 SR 11,69
0 1000 200g===31600 40 600 Caldwell Road
140= 0
— I - A100 Madison County, NC
N FEET Spring Creek quad topo

J
/ 1307 "
r .
c /
+ ! L
f;
j1 •
144
e
f•^ .�' 130
1434 ®'
_ %
If
l
>>
P�oclk
RICH
`I
MOD
317. 318
�~ n�•o� �
f Yg
`1`
�
*
ss'ay' t �J
/
J y�
rte/
�
%
� �.GuMSAOwn
� •I�g. 1318 " `?
I
V4uFE
��`
__
\
10 , ' 2
6�
' I
>•t �. G
r
1322 .,
' 334
:
,l
13,8
• r - -
! _ , /
i WALHUf
KNOB
320, ksen 5C'
1321 ,I
SODOM ,
`� ,�j
OJT
v14_40 0 1321 a 4325
v ' w�UT
�.
HOT SPRINGS i
POP. 554 1
41 +
MO NTAINS —
LAMB MOB
FRENC
(/
1
1173
BLUFF M. IL74
1153
1175 > vfl -
/
-
1153
�-
r 1 , 182 1j 117
1
u
71
`
BARNARD
KNOB
�' 17
a
® '
za 1155
yq
.,
HOP
MTN
�
-
�S
911 1199 \ ,t5f
,
{
78
YnP�„ lid i - 1167
0 "1179
77uB
, "its
t
,u J
♦ .
•$
;
MAPSHALL
,�I g , POP. B)l.
N rv.
, 118)��PP'
S ze,iy5 Wndq i
GeeF 1 '
J 155
/A 1133
'
�1
1181 /" 1175 �
1158
1160 151 - n
1
ARMON DEN
NILIOLIFE
rt
zo 1188
,+ 'X 1158 ?� 11551132
Eti
�� '
IANAGEMENT
=5
RICHKNOB
AREA
-
HOTSPRINGS
' \
1 x:
•�
L
KNOB
P'M
1111
1125
�182 � - 1184 ,� ' ®
.\ � - 1105
J w
1117
/ -
>
.---
�
/ 1113
°
1114 a 1116
it
_
1108"
1001
1114
R
T M1NEa 10108
1109'0
PUG
1163
\
1103 ° 41108 w 4
1001 1113
C) KNOB
, C \ IIQ2
11 0
O IM 1, � I d
ush
9ET9EYSOAP
1160
NEBO
N MTN.
Al
C
,� E
o M