20130476 Ver 1_Application_20130502

2 0 1 3 0 4 7 8
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
PAT MCCRORY ANTHONY J. TATA
GOVERNOR SECRETARY
April 30, 2013
SUBJECT: Forsyth County — SR 2095 Emorywood Road
lt4R Mr. John Thomas US Army Corps of Engineers AY 2 2 013
3331 Heritage Trade Dr.
Suite 105 de WA at VMC
Wake Forest, NC 27615
Dear Mr. Thomas,
In an effort to obtain the necessary permits for bank stabilization and for the impact that has
already occurred on the above mentioned road in Forsyth County, we are providing a pre - construction
notification application with supporting documentation. An NCDOT Forsyth County Maintenance crew
was starting work to widen/ pave Emorywood Road and placed fill consisting of class `B' rip -rap and
washed #57 stone in a wetland. The total area of impact is 0.003 acres of wetland. Amy Euliss, NCDENR-
DWQ, on a site visit to approve the use of gabion baskets observed the impact. A Notice of Deficiency
(NOD) was issued and NCDOT is submitting a PCN for the temporary impact to the wetland.
No endangered species were found on 04/02/2013. During construction, which is expected to take
two weeks, erosion control devices will be installed The roadway slope has already been reseeded. All
disturbed areas will be re- vegetated and the project will be released by NCDOT's Roadside Field
Operations Engineerfrechnician once 70% vegetative cover is achieved. We believe this project can be
accomplished under Nationwide Permit 14 for the temporary impact to the wetland and NW 13 for the 50
feet of bank stabilization for the gabion baskets. For NCDENR DWQ, the WBS number for this project is
9C.034089.
If you have any questions, comments or need additional information after reviewing this material
please contact me at (336) 703 -6500. Thank you for your cooperation in this matter.
V ly,._
Braquet
nvironme Specialist
Enclosures
CC: Mr. Amy Chapman, NCDENR -DWQ, Transportation Permitting Unit Supervisor (3)
Ms. Amy Euliss, NCDENR -DWQ, Environmental Specialist
Mr. Pat Ivey, P.E., Division Engineer
Mr. David Spainhour, P.E., Division Maintenance Engineer
Mr. Gary Neal, Forsyth County Maintenance Engineer
Mrs. Kiera Keen, Division 9 Roadside Environmental Technician
Division of Highways • Division Nine • 375 Silas Creek Parkway, Winston - Salem, NC 27127
Telephone [phone] • Fax [phone] • Courier Box 13 -12-04

�aot W A4§,
o -c
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
® Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 13 and 14 or General Permit (GP) number.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
Id. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le. Is this notfication solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
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
® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h. is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
SR 2095 Emorywood Road
2b. County:
Forsyth
2c. Nearest municipality / town:
Rural Hall
2d. Subdivision name:
Emorywood
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name on Recorded Deed:
North Carolina Department of Transportation
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
375 Silas Creek Parkway
3e. City, state, zip:
Winston- Salem, North Caroliina 27127
3f. Telephone no.:
(336) 747 -7800
3g. Fax no.:
(336) 703 -6693
3h. Email address:
scbmquet @ncdot.gov
Page 1 of 11
PCN Form — Version 1.0 November 2008 Version

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

S. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees):
36.2419'N 50.2548'W
1c. Property size:
<1 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Buffalo Creek
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Roanoke
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:
subdivision
3b. List the total estimated acreage of all existing wetlands on the property:
0.003 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
50
3d. Explain the purpose of the proposed project:
Widen and pave the road and place fifty (50) linear feet of gabion baskets for bank stabilization.
3e. Describe the overall project in detail, including the type of equipment to be used:
The existing 0.003 acres of wetland was impacted with fill consisting of class 'B' rip-rap and washed #57 stone. The PCN
is for the temporary impact to the wetland and fifty (50) feet of gabion baskets. Trackhoes, backhoes and excavators will
be used to complete the work. All disturbed areas will be seeded and mulched upon completion and all work will be done
in the dry.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
❑ preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency /Consultant Company:
Other.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
6. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? "'TO
Yes ®No ❑Unknown
5b. If yes, explain in detail according to "help file* instructions.
S. Future Project Plans
6a. Is this a phased project?
❑Yes 10 No
6b. if yes, explain.
Page 3 of 11
PCN Form — Version 1.0 November 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
la. Which sections were completed below for your project (check all that apply):
® Wetlands ❑ Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of
Type of wetland
Forested
(Corps - 404, 10
Area of impact (acres)
Permanent (P) or
impact
(if known)
DWQ — non-404, other)
Temporary
W1 []POT
fill
upland
® Yes ❑ No
❑ Corps
® DWQ
0.003
W2 ❑P ❑T
❑Yes ❑No
C1 Corps
❑ DWQ
W3 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W4 ❑ P [IT
❑ Yes ❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
2g. Total wetland Impacts
0.003
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
Stream impact
Type of
Stream name
Perennial (PER) or
Average stream width (feet)
Impact
number -
impact
intermittent (INT)?
length
Permanent (P) or
(linear feet)
Temporary (T)
S1 []POT
sandbag
Buffalo Creek
® PER ❑ INT
2 -3
8
S2 ®P ❑ T
bas iota
Buffalo Creek
® PER ❑ INT
2 -3
50
S3 ❑P ❑T
PER ❑INT
S4 ❑ P ❑ T
❑ PER ❑ INT
S5 ❑ P ❑ T
❑ PER ❑ INT
S6 ❑ P ❑ T
❑ PER ❑ INT
3g. Total stream and tributary Impacts
58
3h. Comments:
Page 4 of 11
PCN Form — Version 1.0 November 2008 Version

C. Proposed Impacts Inventory, continued
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all o n water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of
impact number
waterbody
Type of impact
Waterbody type
Area of impact (acres)
— Permanent
(if
(P) or
applicable)
Temporary
01 ❑PEIT
02 ❑P []T
03 ❑P [IT
04 ❑PQT
M. Total open water impacts
4g. Comments:
Page 5 of 11
PCN Form — November 2008 Version

C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If pond or lake construction pro sect then complete the chart below.
58.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or
(acres)
number
purpose 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, perms ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
S. 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 ou 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 (square
Zone 2 impact
Permanent (P)
for impact
Stream name
mitigation
feet)
(square feet)
or Temporary
required?
B1 ❑P ❑T
❑Yes 0 N
B2 ❑P ❑T
❑Yes [I No
B3 ❑P ❑T
❑Yes ❑No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form — November 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
NCDOT only impacted 0.003 acres of wetland and the gabion baskets are to help prevent further erosion of the
streambank.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through constriction techniques.
The gabion baskets will be placed by hand and the fill will be taken out by hand after scraping only the top of the area, not
coming in to contact with the surface of the wetland.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the Stab
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
proj
❑ Mitigation bank
❑ Payment to iMieu fee program
❑ Perrnittes 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 In4lou 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 Permitbe Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form — Version 1.0 November 2008 Version

D. Impact Justification and Mitigation, continued
S. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ❑ No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
Reason for impact
Total impact
(square feet)
1
Multiplier
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1
1
1.5
Total buffer mitigation required:
6c. if buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6d. Comments:
Page 8 of 11
PCN Form — November 2008 Version

E. Stormwater Management and Diffuse f=low Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included?
❑ Yes ❑ No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non -404 Jurisdictional General Permit?
❑ Yes ® No
2b. Is the project subject to General Certification 3704 or 3705?
❑ Yes ® No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state - implemented stormwater
❑ Coastal counties
management programs (check all that apply)?
❑ HQW
❑ ORW
If so, attach one copy of the approval letter from the DWQ and one copy of the
❑ Session Law 2006 -246
approved stormwater management plan.
❑ Other:
3b. In which local govemmenrs jurisdiction is this project?
3c. Is this local government certified to implement a state stormwater program?
❑ Yes ❑ No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stomiwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site plan?
4b. Does this project contain any areas that meet the criteria for "high density' per
❑ Yes ❑ No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
4d. Has a completed BMP Supplement Form with all required Items been submitted
TO
Yes ❑ No
for each stormwater BMP?
Page 9 of 11
PCN Form — Version 1.0 November 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
® Yes ❑ No
use of public (federal/state) land?
1b. 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 ayes' 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): It is an after -the-
fact application for the 0.003 acres of wetland impact because the Maintenance crew was unaware they were impacting a
wetland. It is not an after- the -fact applicaton for the impacts related to the fifty (50) feet of gabion baskets.
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development, which could impact nearby downstream water quality?
3b. if you answered "yes' to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 10 of 11
PCN Form —Version 1.0 November 2008 Version

F. Supplementary Information, continued
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
Yes No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
ArcMap and site visit.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑Yes ®No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
ArcMap and site visit.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
ArcMap and site visit.
8. Flood Zone Designation (Corps Requirement)
Be. Will this project occur in a FEMA - designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Stephanie Braquet
04/30/2013
Applicant/Agent's Printed Name
plicant/Agen ignature
(Agents signature ' valid only if an authdkizatlon letter from the applicant
Date
is rovid
Page 11 of 11
PCN Form — November 2008 Version

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD): 041308013
B. DISTRICT OFFICE, FILE NAME, AND NUMBER
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State-North Carolina County/parish/borough: Forsyth City: Rural Hall
Center coordinates of site (lat/long in degree decimal format): Lat. 362419° N, Long. 80.2548° W.
Universal Transverse Mercator.
Name of nearest waterbody: Buffalo Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Town Fork Creek
Name of watershed or Hydrologic Unit Code (HUC): Yadkin -Pee Dee
® Check if map /diagram of review area and/or potential jurisdictional areas istare 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): 04/02/2013
SECTION H: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable waters of the U.S." 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.
There Are 'waters ofthe U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area [Required)
Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply). r
❑ TNWs, including territorial seas
® Wetlands adjacent to TNWs
® Relatively permanent waters-2 (RPWs) that flow directly or indirectly into TNWs
❑ Non -RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
❑ Impoundments of 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: 501inear feet: 3width (ft) and/or acres.
Wetlands: 0.003 acres.
c. Limits (boundaries) of jurisdiction based on: Established by OHWM.
Elevation of established OHWM (if known):
2. Non - regulated waterstwetlands (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.
2 For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year -round or has continuous flow at least "seasonally"
(e.g., typically 3 momhs).
' Supporting documentation is presented in Section M.F.

SECTION HI: 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 IILA.1 and Section IH.D.1. only, if the aquatic resource is a wetland adjacent to a TNW, complete Sections ID.A.1 and 2
and Section III.D.1.; otherwise, see Section HLB 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 (H' 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. Ifthe aquatic resource is not a TNW, but has year -round
(perennial) flow, skip to Section IH.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section IILDA.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section IILB.1 for
the tributary, Section IILB.2 for any onsite wetlands, and Section IILB.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section IILC below.
1. Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 35acres
Drainage area: 34 acres
Average annual rainfall: 4 inches
Average annual snowfall: 3 inches
(ii) Physical Characteristics:
(a) Relati2gft with TNW:
® Tributary flows directly into TNW.
❑ Tributary flows through Pick List tributaries before entering TNW.
Project waters are 2-5 river miles from TNW.
Project waters are 1 -2 river miles from RPW.
Project waters are 5-10 aerial (straight) miles from TNW.
Project waters are 2-5 aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNWS: the tributary flows north into Buffalo Creek which then flows north into Town Fork Creek
which flows north into the Dan River..
`Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
s Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Tributary stream order, if known: 2.
(b) General Tributary Characteristics (check all that applv):
Tributary is: ® Natural
❑ Artificial (man - made). Explain:
❑ Manipulated (man - altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: 3 feet
Average depth: 1 -1.5 feet
Average side slopes: 2:1.
Primary tributary substrate composition (check all that apply):
❑ Silts ❑ Sands ❑ Concrete
® Cobbles ® Gravel ❑ Muck
❑ Bedrock ® Vegetation. Type/% cover. 85
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain: normal condition, great stability.
Presence of run/riffle/pool complexes. Explain: yes.
Tributary geometry: Meandering
Tributary gradient (approximate average slope): 2 %
(c) Flow:
Tributary provides for Seasonal flow
Estimate average number of flow events in review area/year: 20 (or greater)
Describe flow regime: continual.
Other information on duration and volume:
Surface flow is: Discrete. Characteristics:
Subsurface flow: Unknown. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
® Bed and banks
® 0~ (check all indicators that apply):
® clear, natural line impressed on the bank
❑
the presence of litter and debris
❑ changes in the character of soil
❑
destruction of terrestrial vegetation
❑ shelving
❑
the presence of wrack line
® vegetation matted down, bent, or absent
❑
sediment sorting
❑ leaf litter disturbed or washed away
®
scour
® sediment deposition
❑
multiple observed or predicted flow events
❑ water staining
❑
abrupt change in plant community
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
❑ High Tide Line indicated by: ❑ Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/chamcteristics ❑ vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain: water is clearwith water quality appearing to be good.
Identify specific pollutants, if known:
6A natural or man -made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break
'Ibid.

Qv) Biological Characteristics. Channel supports (check all that apply):
❑ Riparian corridor. Characteristics (type, average width):
® Wetland fringe. Characteristics: upland and forested.
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aquatic /wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non -TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size:0.003acres
Wetland type. Explairimpland.
Wetland quality. ExplainAccent, good soils and vegetation.
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non -TNW:
Flow is: Perennial flow. Explain:
Surface flow is: Discrete
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacencv Determination with Non -TNW:
® Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are 2-5 river miles from TNW.
Project waters are 2-5 aerial (straight) miles from TNW.
Flow is from: Wetland to navigable waters
Estimate approximate location of wetland as within the Pick List floodplain.
(ii) 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 lmown:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. Explain:
❑ Habitat for
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aquatic /wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wedand(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 abuts? (Y/N) Size (in acres) Directiv abuts? (Y/N) Size (in acres?
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the now
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 floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a 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 TNW?
• 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 TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non -RPW that has no adjacent wetlands and flows directly or indirectly into TNWL Explain
findings of presence or absence of significant now below, based on the tributary itself; then go to Section III.D:
2. Significant nexus findings for non -RPW and its adjacent wetlands, where the non -RPW flows directly or indirectly into
TNWL Explain findings of presence or absence of significant now 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 IIl.D:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet width (ft), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWL
❑ Tributaries of TNWs where tributaries typically flow year -round are jurisdictional. Provide data and rationale indicating that
tributary is perennial:
® Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally: NCDENR -DWQ states soil angered indicates a wetland.

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:
3. Non -RPWsa that flow directly or indirectly into TNWL
❑ Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section M.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 TNWL
❑ 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 HI.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
❑ Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWL
❑ 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 M.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWL
❑ 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 now with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section M.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters?
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
❑ Demonstrate that impoundment was created from "waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (I-6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA -STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ 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:
%ee Footnote d 3.
9 To complete the analysis refer to the key in Section UDA of the histrncdonal 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 Memorw4m Regardbg CWA Ad lartsdidlon FollowhW Rq mros.

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 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 - 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.
❑ 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:I inch equals 2000 feet/Midway.
❑ USDA Natural Resources Conservation Service Soil Survey. Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter.
❑ Applicable/supporting case law:
❑ Applicabletsupporting scientific literature:
® Other information (please specify):site review.
B. ADDITIONAL COMMENTS TO SUPPORT JD:

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Construction Sequence Gabion Baskets
1. Build gabion baskets on maintenance yard.
2. Transport baskets to site.
3. Fill baskets with rock by hand.
4. Excavate a solid foundation for baskets.
5. Place baskets on excavated foundation, off setting them for stability.
6. Secure baskets in place.
7. Seed and mulch.
Please note: all work will be done in the dry.

Construction Plans
We are unable to provide construction drawings for this project as there is no drainage
involved. If there is something you can think of that you would like to see on paper
please let me know and I can get that to you as soon as possible.
EVI TIM,