20140431 Ver 1_Application_20140429

Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name:_Bridge 990235, SR 1317
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: Burnsville
8. County: Yancey
9. Lat: 35.97566 Long: -82.23064 (Decimal Degrees Please )
10. Quadrangle Name: Micaville
11. Waterway: Brush Creek
12. Watershed: French Broad
13. Requested Action:
X Nationwide Permit # 3
General Permit #
Jurisdictional Determination Request
Pre-Application Request
The following information will be completed by Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose:
Site/Waters Name:
Keywords:

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STATE OF NORTH CAROLINA
DEPAR`I'MENT OF TRANSPORTAT`ION
PAT MCCRORY
GOVF.RNOR
April 30, 2014
Ms. Lori Beckwith
US Army Corps oFEngineers
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
ANTHONY J. TA'PA
SFCRETARY
Subject: Nationwide Permit #3
Bridge 990235, SR 1317 Big Brush Creek Road
State Project No. 17BP.13.R.109 (DWQ Minor Permit Fee $240)
Yancey County, NC
Dear Ms. Beckwith:
I have enclosed a set of plans, a PCN application for NWP #3, and a vicinity map relative
to the proposed bridge replacement project on SR 1317 Big Brush Creek Road, Yancey
County, NC.
We propose to replace the existing 18' single-span bridge with a 40'single-span bridge.
A permanent impact to 67 linear feet of Brush Creek will be necessary for rip rap scour
protection. In addition, temporary impacts to lO linear feet of Brush Creek will occur for
bridge access during construction. Brush Creek is an approximately ] 0 foot wide stream
with a predominately cobble and gravel substrate. Brush Creek is classified as Class C,
trout.
Existing channel morphology will be maintained upstream and downstream of the bridge.
Riparian vegetation will be reestablished along disturbed areas associated with the
project. Stormwater will be diverted through grass-lined ditches or vegetated buffers
prior to entering streains.
No effect on federally listed species (threatened or endangered) or their habitats will
occur.
As a part of the 401 Certification process, the project was processed through the DOT
Programmatic Agreement for Minor Project as required by Section 106 of the National
Historic Preservation Act of 1966 and GS 121-12(a). No Historic Resources will be
affected.
Division Thirteen Office Post Office Box 3279 Asheville, NC 28802
Phone: [phone] OfEice of the Division Engineer Fax: [phone]
www.ncdot. gov/d oh/ope ra ti ons/d ivisionl3

Ms. Lori Beckwith
Page —2 Bridge 235, Yancey County
April 30, 2014
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.
By copy of this letter, we are asking the Area Roadside Field Operations Engineer, to
comment on the above project. Brush Creek is classified as C, trout. The project will not
require a trout buffer variance.
By copy of this letter, I am forwarding one electronic copy of the application package to
Sonia Carillo, NC Division of Water Quality, Transportation Permitting Unit with cc to
Kevin Barnett, NC DWQ Transportation Permitting Unit for review and comment.
Please charge the application fee of $240.00 to WBS element #17BP.13.R.109. 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 [phone].
Sincerely,
�� p ,�,�-
Roger D. Bryan
Division 13 Environmental Officer
Endosures
cc: J.J. Swain, Jr., P.E.
Ben DeWit, CPESC
Kevin Barnett
Sonia Carillo
Marla Chambers
Eileen Fuchs
Eleni Riggs

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Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the X Section 404 Permit ❑ Section 10 Permit
Corps:
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? X Yes ❑ No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
X 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑ Yes X No ❑ Yes X No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes X No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h ❑ Yes X No
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes X No
2. Project Information
2a. Name of project: Bridge 235, SR 1317
2b. County: Yancey
2c. Nearest municipality / town: Burnsville
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state 176P.13.R.109
project no:
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 N/A
applicable):
3d. Street address: N/A
3e. City, state, zip: N/A
3f. Telephone no.: N/A
3g. Fax no.: N/A
3h. Email address: N/A
Page 1 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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 N.C. Department of Transportation
(if applicable):
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: rdbrvan(a�ncdot.gov
5. AgenUConsultant Information (if applicable)
5a. Name: N/A
Sb. Business name N�A
(if applicable):
5c. Streetaddress: N/A
5d. City, state, zip: N/A
5e. Telephone no.: N/A
5f. Fax no.: N/A
5g. Email address: N/A
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitude: 35.97566° N Longitude: - 82.23064° W
1c. Propertysize: 0.1 acres
2. Surtace Waters
2a. Name of nearest body of water (stream, river, etc.) to grush Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: C, Trout
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 bridge on SR 1317 surrounded by low density residential area and forested land.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
100
3d. Explain the purpose of the proposed project:
Replace existing 18' bridge with a single span 40' bridge at the existing location.
3e. Describe the overall project in detail, including the type of equipment to be used:
A permanent impact to 67 linear feet of Brush Creek will be necessary for rip rap scour protection of the new
abutments. An additional temporary impact of 10 linear feet will be necessary for access during bridge construction
and demolition. The new bridge abutments are above ordinary high water. Equipment used will include excavator,
crane, and trucks.
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 X No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): N/A Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.3 December 10, 2008 Version

Proposed impacts Inventory
1. Impacts Summary
1 a. 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 questi�n for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem orar T
W� � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
WZ � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W5 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3 b. 3c. 3d. 3 e. 3f. 3 g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ — non-404, Width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ❑ P X T Bridge Access Brush Creek X PER X Corps 10 10
❑ INT ❑ DWQ
S1 X P❑ T Rip Rap Brush Creek X PER X Corps 10 67
❑ INT ❑ DWQ
S2 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S2 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S3 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
SS ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacts 77
3i. Comments:67 feet of permanent impacts for scour protection, 10 feet of temporary impacts
Page 4 of 10

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 individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number — (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tem orar T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
Si. Expected pond surtace 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 an im acts re uire miti ation, 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 Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem orar T im act re uired?
B1 ❑P❑T ❑Yes
❑ No
B2 ❑P❑T ❑Yes
❑ No
63 ❑P�T ❑Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10

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.
Replacement of bridge with longer span with less impact on stream channel.
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 ❑ Yes X No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
project? ❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
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
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ❑ Yes X No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private miligation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 10

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 � Yes X No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Mana ement 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:
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 governmenYs jurisdiction is this project? N/A
❑ Phasell
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ Water Supply Watershed
X Other: N/A
3c. Has the approved Stormwater Management Plan with proof of approval been N/A
attached?
4. DWQ Stormwater Pro ram Review
❑ Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply � ORW
(check all that apply): ❑ Session Law 2006-246
X Other: N/A
4b. Has the approved Stormwater Management Plan with proof of approval been
altached? N/A
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? N/A
5b. Have all of the 401 Unit submittal requirements been met? N/A
Page 8 of 10
PCN Form — Version 1.3 December 10, 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?
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)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 26 .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.
N/A
Page 9 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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
Sc. 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 of the project area and evaluation of current distribution data.
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: Project will not impact water passage or flood zone beyond existing
conditions
Sc. What source(s) did you use to make the floodplain determination? Current FEMA Maps
Roger D. Bryan n/1 4I30/2014
!� �� �
ApplicanUAgenPs Printed Name ApplicanUAg Ys Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.
Page 10 of 10

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Figure 1. Bridge 990235, SR 1317, Brush Creek, Yancey County, NC.
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INCOMPLETE PLANS
DO NOT USE FOR R/W ACQUISITION
DO NOT USE FOR CONSTRUCTION
PRELIMINARY PLANS
N S R S 2007
NA
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STATE STATE PROJECT REFERENCE NO.
STATE PROJ. NO.F. A. PROJ. NO.DESCRIPTION
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PROJECT LENGTH
LETTING DATE:
DIVISION OF HIGHWAYS
PROJECT ENGINEER
PROJECT DESIGN ENGINEER
FOR
CONTRACTOR :
SIGNATURE:
SIGNATURE:
P.E.
P.E.
RIGHT OF WAY DATE:
1-888-521-4455 OR 919-878-9560
NC LICENSE NO. F-0112
RALEIGH, NORTH CAROLINA 27609
900 RIDGEFIELD DRIVE, SUITE 350
RUMMEL, KLEPPER & KAHL, LLP
30 0.069 mi
0.008 mi
0.061 mi
C
2
0
3
3
1
4
TOTAL LENGTH TIP PROJECT 990235...............
LENGTH STRUCTURE TIP PROJECT 990235.......
LENGTH ROADWAY TIP PROJECT 990235........
6
APRIL 16, 2013
PROFILE (HORIZONTAL)
GRAPHIC SCALES
PLANS
PROFILE (VERTICAL)
100
100
50 0 50
50 0 50
2010010
APRIL 16, 2013
2012 STANDARD SPECIFICATIONS
=
=
B. Keith Skinner, P.E.
%
DIVISION OF HIGHWAYS
STATE OF NORTH CAROLINA
B
R
I
D
G
E

9
9
0
2
3
5
LOCATION:
TYPE OF WORK:
VICINITY MAP
Bridge No. 990235
4
ENGINEER
DESIGN
ROADWAY
ENGINEER
HYDRAULICS
BRIDGE NO. 990235
17BP.13.R.109
17 BP 13.R.109
YANCEY COUNTY
MPH
FUNC CLASS =
LOCAL
RURAL
Brandon McInnis, P.E.
NCDOT CONTACT: Virginia Mabry
PRIORITY PROJECTS OFFICE MANAGER
* TTST = 3%
* DUAL = 3%
AND RESURFACING
GRADING, DRAINAGE, PAVING, STRUCTURES
SUB REGIONAL TIER
100 VPD
2. THIS PROJECT IS NOT WITHIN ANY MUNICIPAL BOUNDARIES.
THE TOE OF SLOPE WITH NO GRUBBING.
LIMITS ESTABLISHED BY METHOD II WITH CLEARING EXTENDING 5’ BEYOND
1.CLEARING AND GRUBBING ON THIS PROJECT SHALL BE PERFORMED TO THE
NOTES:
SR 1317
-L- STA. 11+25.00
BEGIN PROJECT
-L- POT STA. 13+34.00
END BRIDGE
-L- POT STA. 12+91.40
BEGIN BRIDGE
-L-
SR 1317 (BIG BRUSH CREEK RD)
BRIDGE NO. 990235 OVER BRUSH CREEK ON
CREEK RD.BIG BRUSH
SR 1317
Big Brush Creek Rd.
SR
1308
B
rush C
reek R
d.
S
R 13
1
8
Charlie
Deyton
Rd.
SR 1313Ridge Rd.OFFSITE DETOUR
M
IT
C
H
E
L
L
C
O
.
Y
A
N
C
E
Y
C
O
.
Brush Creek
MITCHELL CO.
Brush Creek
TO MITCHELL CO.
TO NC 80
-L- STA. 14+90.00
END PROJECT
BRIDGE LENGTHENED 5 FT. TO KEEP THE WINGWALL OUT OF THE CHANNEL IN THE SOUTHWEST CORNER.
DESIGN EXCEPTION NEEDED FOR BRIDGE WIDTH AND HORIZONTAL SSD.
NOTES:
WETLAND AND STREAM IMPACTS SHEET 1 OF 4
PERMIT DRAWING

T
15" CMP
1
8
"
C
M
P
GR
DRI
VE
SR 1317 16’ BST
BIG BRUSH CREEK ROAD
POSSIBLE U/G TELE
6" PVC
EXISTING R/W
EXISTING R/W
NL
EIP
6
0
.
0
0
’
6’ WW
DB 575 PG 33
TRUE NORTH EQUITIES LLC
SUSAN W SMITH
DB PG UNKNOWN
WOODS
NICKI J FINK JOLE
EUGENE W &
DB PG UNKNOWN
LOUIE M & DELORIS ROBERSON
DB PG UNKNOWN
SAMUEL JEFF GRINDSTAFF
DB 367 PG 544
ELEV=2569.87’
8.29’ RT
-BL- STA 7+45.28
BM#1
WOODS
HW
CONCBARN
6
0.
0
0
’
EXISTING R/W
EXISTING R/W
HW
CONC
GRDRIVE
NL
SURFACE WATER
IMPACTS IN
S S SURFACE WATER
DENOTES IMPACTS IN
-L- POT STA. 12+80.40
BEGIN APPROACH SLAB
-L- POT STA. 13+45.00
END APPROACH SLAB
9
’
9
’
1’-
11
"
1’-
11
"
F
-
F
-L- POT STA. 13+34.00
END BRIDGE
-L- POT STA. 12+91.40
BEGIN BRIDGE
.
0
2
5
.
0
2
5
EXISTING BRIDGE
REMOVE
2
1
’-
10
"
STA. 13+42.50
END SBG
E
XI
S
T
0
6
0
4
0
6
0
5
0
4
0
3
0
2
0
1
0
0
0
1
0
2
0
2
0
2
0
1
0
0
0
1
0
4
0
2
0
3
0
2
E
XI
S
T
0
2
5
0
2
5
0
40
3
0
2
5
0
2
0
2
0
2
5
0
2
5
0
2
5
PLANS PREPARED BY :
900 RIDGEFIELD DRIVE SUITE 350
RALEIGH, NORTH CAROLINA 27609-3960
RUMMEL, KLEPPER & KAHL, LLP
NC LICENSE NO. F-0112 [phone]
8
/
1
7
/
9
9
4
/
7
/
2
0
1
4
R
:
\
H
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d
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i
c
s
\
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R
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9
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2
.
d
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s
ENGINEER
ROADWAY DESIGN
R/W SHEET NO.
ENGINEER
HYDRAULICS
SHEET NO.PROJECT REFERENCE NO.
NAD
83 (N SR S 2007)
16+0015+0014+0013+0012+0011+00
4
17+00
-L-
990235
10+00
2,590
2,580
2,570
2,560
2,550
2,590
2,580
2,570
2,560
2,550
DIV13B - BRIDGE 990235 - YANCEY COUNTY
SKETCH SHOWING ROADWAY IN RELATION TO PROPOSED STRUCTURE
TYPE-III TYPE-III
TYPE-IIISHOP CURVED
TYPE-III
AT-1 TYPE TL-2
GRAU 350
TYPE TL-2
GRAU 350 TYPE TL-2
GRAU 350
-L- STA. 14+50.00 TO STA. 14+90.00
-L- STA. 11+25.00 TO STA. 11+50.00
MILLING LIMITS:
RR SPIKE IN 10" CHERRY TREE
-L- STA. 13+20.58 (17.53’ RT)
BM#1 EL. = 2569.87’
2576.4’
25-YR2577.3’
100-YR
OUT OF THE CHANNEL IN THE SOUTHWEST CORNER.
BRIDGE LENGTHENED 5 FT. TO KEEP THE WINGWALL
DESIGN EXCEPTION NEEDED FOR BRIDGE WIDTH AND HORIZONTAL SSD.
NOTE:
MCF OUTLET DATA
DRAINAGE AREA
Q10
V10
0.04 ac
0.2 cfs
5.1 ft/s
Length
STREAM IMPACTS
Permanent
Temporary
Type DescriptionArea
529 sf
61 sf
67 ft.
10 ft.
NOTES:
WITH NO GRUBBING.
WITH CLEARING EXTENDING 5’ BEYOND THE TOE OF SLOPE
PERFORMED TO THE LIMITS ESTABLISHED BY METHOD II
3. CLEARING AND GRUBBING ON THIS PROJECT SHALL BE
2. PROPOSED BRIDGE SHALL HAVE NO DECK DRAINS.
BASIN, WHICH HAS NO BUFFER ZONES AT THIS LOCATION.
1. BRUSH CREEK IS IN THE FRENCH BROAD RIVER
21" CORED SLAB UNITS
PROPOSED BRIDGE DIMENSIONS - 1@40’-0", 60 DEG. SKEW;
TIMBER FLOOR ON TIMBER JOISTS
EXISTING BRIDGE DIMENSIONS - 1@18’-6", 45 DEG. SKEW;
END OF APPROACH SLAB TO -L- STA. 13+42.50 LT
SHOULDER BERM GUTTER:
SHEET 2 OF 4
PERMIT DRAWING
1"=50’
SCALE
and Remove Existing Abutment
Work Area to Install Rip Rap
and Remove Existing Abutment
Install Rip Rap Scour Protection
of the existing abutmet along the stream.
along the proposed end bent and removal
For installation of rip rap scour protection
abutment along the stream.
scour protection and remove the existing
For construction access to install rip rap
CABLES IN-PLACE
SPLICE TELEPHONE
TO REMOVE PED AND
FRONTIER TELEPHONE
1
5
2569.6’
NWS
DS = 39 mph
DS = 40 mph
ELEV. = 2,581.37’
-L- STA. 11+25.00
BEGIN GRADE
PI = 11+65.00
EL = 2,579.50’
(-)
4
.6700
%
VC = 70’
K = 64
PI = 12+35.00
EL = 2,577.00’
(
-
)3
.5755
%
VC = 70’
K = 172
PI = 13+95.00
EL = 2,570.63’
(-)
3
.9825
%
(-)
5.
6416
%
VC = 70’
K = 42
PI = 14+60.00
EL = 2,566.96’
(-)
5.3
0
0
0%DS = 62 mph
DS = 68 mph
VC = 60’
ELEV. = 2,565.37’
-L- STA 14+90.00
END GRADE
K = 176
-L- STA. 12+91.40
BEGIN BRIDGE
(-
)3
.9825
%
-L- STA. 13+34.00
END BRIDGE
BRIDGE HYDRAULIC DATA
100 YEAR FREQUENCY
= 2
= 100 YRS
= 2571.3
= 2575.0
= 10+
STR #990235 Sta. 13+12.70 -L-
DESIGN FREQUENCY
DESIGN DISCHARGE
DESIGN HW ELEVATION
100 YEAR DISCHARGE
100 YEAR HW ELEVATION
OVERTOPPING FREQUENCY
OVERTOPPING ELEVATION
OVERTOPPING DISCHARGE
YRS
CFS
FT
CFS
FT
YRS
CFS
FT
= 130
= 650
= 2577.09
= 420
NORMAL WATER SURFACE ELEV = 2569.6 FT
NWS SURVEY 9/3/2013
F
C
C
F
F
F
F
F
F
F
87
15"
REMOVE
R
E
T
AI
N
MCF
5 SY GEO FAB
RIP RAP W/
1 TON CL B
5 SY GEO FAB
RIP RAP W/
1 TON CL B
0401
0402
15" CMP
F
F
F
MCF
IN SURFACE WATER
TEMPORARY IMPACTS
TS TS
IMPACTS IN SURFACE WATER
DENOTES TEMPORARY
BRUSH CREEK
2555
25
6
0
2560 2560
2565
25652565
2565
2570
2570
257025
7
0
25
7
0
2575
2575
257
5
25
75
2575
2580
2580
25802580
2580
2
5
8
0
2580
2585
2585
2585
25852585
2
5
8
5
2
5
8
5
25
8
5
2590
2590
2590
25
90
25
9
0
25902595
2595 2595
2595
26
0
0
2600 2600
2600
2605
2605
2610
T
15" CMP
1
8
"
C
M
P
GR
DRI
VE
SR 1317 16’ BST
BIG BRUSH CREEK ROAD
POSSIBLE U/G TELE
6" PVC
EXISTING R/W
EXISTING R/W
NL
EIP
6
0
.
0
0
’
6’ WW
DB 575 PG 33
TRUE NORTH EQUITIES LLC
SUSAN W SMITH
DB PG UNKNOWN
WOODS
NICKI J FINK JOLE
EUGENE W &
DB PG UNKNOWN
LOUIE M & DELORIS ROBERSON
DB PG UNKNOWN
SAMUEL JEFF GRINDSTAFF
DB 367 PG 544
ELEV=2569.87’
8.29’ RT
-BL- STA 7+45.28
BM#1
WOODS
HW
CONCBARN
6
0.
0
0
’
EXISTING R/W
EXISTING R/W
HW
CONC
GRDRIVE
NL
SURFACE WATER
IMPACTS IN
S S SURFACE WATER
DENOTES IMPACTS IN
25702575
-L- POT STA. 12+80.40
BEGIN APPROACH SLAB
-L- POT STA. 13+45.00
END APPROACH SLAB
9
’
9
’
1’-
11
"
1’-
11
"
F
-
F
-L- POT STA. 13+34.00
END BRIDGE
-L- POT STA. 12+91.40
BEGIN BRIDGE
.
0
2
5
.
0
2
5
EXISTING BRIDGE
REMOVE
2
1
’-
10
"
STA. 13+42.50
END SBG
E
XI
S
T
0
6
0
4
0
6
0
5
0
4
0
3
0
2
0
1
0
0
0
1
0
2
0
2
0
2
0
1
0
0
0
1
0
4
0
2
0
3
0
2
E
XI
S
T
0
2
5
0
2
5
0
40
3
0
2
5
0
2
0
2
0
2
5
0
2
5
0
2
5
PLANS PREPARED BY :
900 RIDGEFIELD DRIVE SUITE 350
RALEIGH, NORTH CAROLINA 27609-3960
RUMMEL, KLEPPER & KAHL, LLP
NC LICENSE NO. F-0112 [phone]
8
/
1
7
/
9
9
4
/
7
/
2
0
1
4
R
:
\
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2
3
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_
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o
n
_
0
3
.
d
g
n
e
r
i
g
g
s
ENGINEER
ROADWAY DESIGN
R/W SHEET NO.
ENGINEER
HYDRAULICS
SHEET NO.PROJECT REFERENCE NO.
NAD
83 (N SR S 2007)
16+0015+0014+0013+0012+0011+00
4
17+00
-L-
990235
10+00
2,590
2,580
2,570
2,560
2,550
2,590
2,580
2,570
2,560
2,550
DIV13B - BRIDGE 990235 - YANCEY COUNTY
SKETCH SHOWING ROADWAY IN RELATION TO PROPOSED STRUCTURE
TYPE-III TYPE-III
TYPE-IIISHOP CURVED
TYPE-III
AT-1 TYPE TL-2
GRAU 350
TYPE TL-2
GRAU 350 TYPE TL-2
GRAU 350
-L- STA. 14+50.00 TO STA. 14+90.00
-L- STA. 11+25.00 TO STA. 11+50.00
MILLING LIMITS:
RR SPIKE IN 10" CHERRY TREE
-L- STA. 13+20.58 (17.53’ RT)
BM#1 EL. = 2569.87’
2576.4’
25-YR2577.3’
100-YR
OUT OF THE CHANNEL IN THE SOUTHWEST CORNER.
BRIDGE LENGTHENED 5 FT. TO KEEP THE WINGWALL
DESIGN EXCEPTION NEEDED FOR BRIDGE WIDTH AND HORIZONTAL SSD.
NOTE:
MCF OUTLET DATA
DRAINAGE AREA
Q10
V10
0.04 ac
0.2 cfs
5.1 ft/s
Length
STREAM IMPACTS
Permanent
Temporary
Type DescriptionArea
529 sf
61 sf
67 ft.
10 ft.
NOTES:
WITH NO GRUBBING.
WITH CLEARING EXTENDING 5’ BEYOND THE TOE OF SLOPE
PERFORMED TO THE LIMITS ESTABLISHED BY METHOD II
3. CLEARING AND GRUBBING ON THIS PROJECT SHALL BE
2. PROPOSED BRIDGE SHALL HAVE NO DECK DRAINS.
BASIN, WHICH HAS NO BUFFER ZONES AT THIS LOCATION.
1. BRUSH CREEK IS IN THE FRENCH BROAD RIVER
21" CORED SLAB UNITS
PROPOSED BRIDGE DIMENSIONS - 1@40’-0", 60 DEG. SKEW;
TIMBER FLOOR ON TIMBER JOISTS
EXISTING BRIDGE DIMENSIONS - 1@18’-6", 45 DEG. SKEW;
END OF APPROACH SLAB TO -L- STA. 13+42.50 LT
SHOULDER BERM GUTTER:
SHEET 3 OF 4
PERMIT DRAWING
1"=50’
SCALE
and Remove Existing Abutment
Work Area to Install Rip Rap
and Remove Existing Abutment
Install Rip Rap Scour Protection
of the existing abutmet along the stream.
along the proposed end bent and removal
For installation of rip rap scour protection
abutment along the stream.
scour protection and remove the existing
For construction access to install rip rap
CABLES IN-PLACE
SPLICE TELEPHONE
TO REMOVE PED AND
FRONTIER TELEPHONE
1
5
2569.6’
NWS
DS = 39 mph
DS = 40 mph
ELEV. = 2,581.37’
-L- STA. 11+25.00
BEGIN GRADE
PI = 11+65.00
EL = 2,579.50’
(-)
4
.6700
%
VC = 70’
K = 64
PI = 12+35.00
EL = 2,577.00’
(
-
)3
.5755
%
VC = 70’
K = 172
PI = 13+95.00
EL = 2,570.63’
(-)
3
.9825
%
(-)
5.
6416
%
VC = 70’
K = 42
PI = 14+60.00
EL = 2,566.96’
(-)
5.3
0
0
0%DS = 62 mph
DS = 68 mph
VC = 60’
ELEV. = 2,565.37’
-L- STA 14+90.00
END GRADE
K = 176
-L- STA. 12+91.40
BEGIN BRIDGE
(-
)3
.9825
%
-L- STA. 13+34.00
END BRIDGE
BRIDGE HYDRAULIC DATA
100 YEAR FREQUENCY
= 2
= 100 YRS
= 2571.3
= 2575.0
= 10+
STR #990235 Sta. 13+12.70 -L-
DESIGN FREQUENCY
DESIGN DISCHARGE
DESIGN HW ELEVATION
100 YEAR DISCHARGE
100 YEAR HW ELEVATION
OVERTOPPING FREQUENCY
OVERTOPPING ELEVATION
OVERTOPPING DISCHARGE
YRS
CFS
FT
CFS
FT
YRS
CFS
FT
= 130
= 650
= 2577.09
= 420
NORMAL WATER SURFACE ELEV = 2569.6 FT
NWS SURVEY 9/3/2013
F
C
C
F
F
F
F
F
F
F
87
15"
REMOVE
R
E
T
AI
N
MCF
5 SY GEO FAB
RIP RAP W/
1 TON CL B
5 SY GEO FAB
RIP RAP W/
1 TON CL B
0401
0402
15" CMP
F
F
F
MCF
IN SURFACE WATER
TEMPORARY IMPACTS
TS TS
IMPACTS IN SURFACE WATER
DENOTES TEMPORARY
BRUSH CREEK
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4

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers

This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.

SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):

B. DISTRICT OFFICE, FILE NAME, AND NUMBER:

C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: NC County/parish/borough: Yancey City: Burnsville
Center coordinates of site (lat/long in degree decimal format): Lat. 35.97566° N, Long. -82.23064° W.
Universal Transverse Mercator:
Name of nearest waterbody: Brush Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: French Broad River
Name of watershed or Hydrologic Unit Code (HUC): 06010105
Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
Check if other sites (e.g., offsite mitigation sites, disposal sites, etc…) are associated with this action and are recorded on a
different JD form.

D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
Office (Desk) Determination. Date:
Field Determination. Date(s): April 28, 2014

SECTION II: 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 co mmerce.
Explain: .

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): 1
TNWs, including territorial seas
Wetlands adjacent to TNWs
Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
Non-RPWs that flow directly or indirectly into TNWs
Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into 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: 100 linear feet: 10 width (ft) and/or acres.
Wetlands: acres.

c. Limits (boundaries) of jurisdiction based on: Established by OHWM.
Elevation of established OHWM (if known): .

2. Non-regulated waters/wetlands (check if applicable):3
Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain: .

1 Boxes checked below shall be supported by completing the appropriate sections in Section III below.
2 For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least “seasonally”
(e.g., typically 3 months).
3 Supporting documentation is presented in Section III.F.

SECTION III: CWA ANALYSIS

A. TNWs AND WETLANDS ADJACENT TO TNWs

The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.

1. TNW
Identify TNW: .

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 ex istence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.

If the waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.C below.

1. Characteristics of non-TNWs that flow directly or indirectly into TNW

(i) General Area Conditions:
Watershed size: Pick List
Drainage area: Pick List
Average annual rainfall: inches
Average annual snowfall: inches

(ii) Physical Characteristics:
(a) Relationship with TNW:
Tributary flows directly into TNW.
Tributary flows through Pick List tributaries before entering TNW.

Project waters are Pick List river miles from TNW.
Project waters are Pick List river miles from RPW.
Project waters are Pick List aerial (straight) miles from TNW.
Project waters are Pick List aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain: .

Identify flow route to TNW5: .
Tributary stream order, if known: .

4 Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional featur es generally and in the arid
West.
5 Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

(b) General Tributary Characteristics (check all that apply):
Tributary is: Natural
Artificial (man-made). Explain: .
Manipulated (man-altered). Explain: .

Tributary properties with respect to top of bank (estimate):
Average width: feet
Average depth: feet
Average side slopes: Pick List.

Primary tributary substrate composition (check all that apply):
Silts Sands Concrete
Cobbles Gravel Muck
Bedrock Vegetation. Type/% cover:
Other. Explain: .

Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain: .
Presence of run/riffle/pool complexes. Explain: .
Tributary geometry: Pick List
Tributary gradient (approximate average slope): %

(c) Flow:
Tributary provides for: Pick List
Estimate average number of flow events in review area/year: Pick List
Describe flow regime: .
Other information on duration and volume: .

Surface flow is: Pick List. Characteristics: .

Subsurface flow: Pick List. Explain findings: .
Dye (or other) test performed: .

Tributary has (check all that apply):
Bed and banks
OHWM6 (check all indicators that apply):
clear, natural line impressed on the bank 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/characteristics 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: .
Identify specific pollutants, if known: .

6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody’s flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
7Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
Riparian corridor. Characteristics (type, average width): .
Wetland fringe. Characteristics: .
Habitat for:
Federally Listed species. Explain findings: .
Fish/spawn areas. Explain findings: .
Other environmentally-sensitive species. Explain findings: .
Aquatic/wildlife diversity. Explain findings: .

2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW

(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain: .
Wetland quality. Explain: .
Project wetlands cross or serve as state boundaries. Explain: .

(b) General Flow Relationship with Non-TNW:
Flow is: Pick List. Explain: .

Surface flow is: Pick List
Characteristics: .

Subsurface flow: Pick List. Explain findings: .
Dye (or other) test performed: .

(c) Wetland Adjacency Determination with Non-TNW:
Directly abutting
Not directly abutting
Discrete wetland hydrologic connection. Explain: .
Ecological connection. Explain: .
Separated by berm/barrier. Explain: .

(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the Pick List floodplain.

(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 known: .

(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 wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:

Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)

Summarize overall biological, chemical and physical functions being performed: .

C. SIGNIFICANT NEXUS DETERMINATION

A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions per formed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological in tegrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of i ts 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. bet ween 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 c arbon that
support downstream foodwebs?
 Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, o r
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 TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D: .

2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D: .

3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D: .

D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):

1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
TNWs: linear feet width (ft), Or, acres.
Wetlands adjacent to TNWs: acres.

2. RPWs that flow directly or indirectly into TNWs.
Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: Brush Creek has prominent bed/bank features, fish, and aquatic insects.
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 rat ionale indicating that tributary flows
seasonally: .

Provide estimates for jurisdictional waters in the review area (check all that apply):
Tributary waters: 100 linear feet 10 width (ft).
Other non-wetland waters: acres.
Identify type(s) of waters: .

3. Non-RPWs8 that flow directly or indirectly into TNWs.
Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.

Provide estimates for jurisdictional waters within the review area (check all that apply):
Tributary waters: linear feet width (ft).
Other non-wetland waters: acres.
Identify type(s) of waters: .

4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW: .

Wetlands directly abutting an RPW where tributaries typically flow “seasonally.” Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW: .

Provide acreage estimates for jurisdictional wetlands in the review area: acres.

5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section III.C.

Provide acreage estimates for jurisdictional wetlands in the review area: acres.

6. Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.

Provide estimates for jurisdictional wetlands in the review area: acres.

7. Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
Demonstrate that impoundment was created from “waters of the U.S.,” or
Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
Demonstrate that water is isolated with a nexus to commerce (see E below).

E. ISOLATED [INTERSTATE OR INTRA-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: .

8See Footnote # 3.
9 To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

Provide estimates for jurisdictional waters in the review area (check all that apply):
Tributary waters: linear feet width (ft).
Other non-wetland waters: acres.
Identify type(s) of waters: .
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 Engine ers
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 be st 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” stand ard, 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:1:24000, Micaville Quadrangle.
USDA Natural Resources Conservation Service Soil Survey. Citation: .
National wetlands inventory map(s). Cite name: .
State/Local wetland inventory map(s): .
FEMA/FIRM maps:NC Floodplain Mapping Program.
100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
Photographs: Aerial (Name & Date): .
or Other (Name & Date):Stream photos in NWP Application, April 30, 2014.
Previous determination(s). File no. and date of response letter: .
Applicable/supporting case law: .
Applicable/supporting scientific literature: .
Other information (please specify): .

B. ADDITIONAL COMMENTS TO SUPPORT JD: .