20080792 Ver 1_Application_20150220

Corps Submittal Cover Sheet
Please provide the follow�ing info:
1. Project Name: SR 1521A—Mountain Grove Road (O��iou Mountaiu Road) - Reapplic�tion
2. Namc of Property Owuer/Applicant:_North Carolina Departu�eut of Ti•ansportation (NCDOT)
3. Name of Co��sultauUAgeut: N/A _
'Agent nutliorizntion nceds to be auaclied.
4. Related/Yrevious Action ID mmiber(s): SAW-2008-2253; (DWQ Project No. 080792)
Site Address:
5. Sttbdivision Name: N/A
G City:
7. Cow�ty:
8. Lat: 35.2212 N Long: -83.2654_W (Decimal De�rees Plense)
9. Quadraugle Name: _Corbin Knob (35083-B3-TF-024)
10. Water���ay: UT's to Falls Brauch (DWR Class: C)
1 I. Watershed: Little Tennessee River (HCU: 06010202)
12. Requested Action:
X Natioinvide Permit # 14
Gener�l Permit #
Ju�isdictional Determination Request
Pre-Applicatiou Reqiiest
The follow�ing iuform�tiai will be completed by Coips office:
AID:
Prepare File'Folder Assigu number in ORM Begin Date
Autliorization: Section 10 Section 404
Project Descriptioi�/ Nature of Activity/ Project Purpose:
Site/Waters Name:
Key�vords:

PAT' McCaoa��
Govr:e�oa
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STATG OF NORTH CAROLINA
DEPART`MENT OF TRANSPORTATION
Pebrua�}� 20, 2015
Ms. Lori Beck���itli, NCDOT Regulatory Project Manager
U.S. Army Corps of Engiueers
151 Patton Avenue, Room 208
Aslieville, NC 28801-2714
ANTHONY J. TATA
Srcarr.�av
SuUject: Nationwide 14 Peruiit Application —Reapplicatiou Request
SR 1521-A — Mowitain Grove Road — Umtamed Tribtitaries to FTlls Braucl�
Macon County
State Project No. 14C.056106 (DWR Minoj• Pe�•�uit ree �240)
Dear Ms. Beck�vitl�:
The North Carolina Department of Transportation (NCDOT) is proposing to widen, grade, drain
aud pave tlie remainder of the subject ro�d to meet current NCDOT secondaiy road staudards. A
Natiomvide Permit 14 and 401 Water Qualit�� Certifieation were issued to NCDOT in 2008
(Actiau ID No.: SAW-2008-2253, DWQ Praject No. 080792), but tlie project could not be
completed due to a lack of fimdiiig. In 2011, a reauthorization of the 404 Permit was requested
aud i•eceived fi�oui your office via email, but only a few of the culvei t sites were completed (Sites
8-11). The project was again stopped due to funding issues. The 404/401 permits have espired
and since new Nationwide Permits and Regional Conditions were authorized in Marcl� 2012,
NCDOT is reqiiesting new permits to complete tlie project. Punds are ct�rrently available to
complete the work ii1 this fiscal year. The proposed stream impacts that remain (Sites 3-7) have
uot chauged since they were originally permitled iu 2008.
I am eiiclosing a PCN applicatioii, Rapanos Jurisdictional Form, SHPO forms, plan slieets
sho�viug the proposed work, a marked county map, a USGS topograpl�ic ma�� and photographs.
Mitigatian for stream impacts was paid ta NCEEP back in 2008 and is nat required.
Tl�e U.S. Pish and Wildlife Se�vice (USFWS) list 57 species for Macon County that have federTl
status. The North Carolina Natw•aI Heritage Database was checked for records of tlu•eatened and
endangered species. The species in the database include the sickletin redhorse (d�Ioxostann
sp.2), a candidate species for listiug, aild the bog hirtle (Gl��pteiir��s inaJrlenbergii), which is listed
as tlu�eatened due to similarity of appearance to the listed northern bog hirtle. Seveu species,
Carolina nortliern flying squirrel (Glauconry.s snbrrna�s coloi•nitrs), spottin chub (Erinronn.z
moirnchus), Appalachian elktoe (A/nsmirlmvn rati�eneli�ura), little�viug pearlymussel (Pegins
fabida), small whorled pogonia (Isoh•ia nredeoloides), Virginia spiraea (Spri•nen i�irginirntn) and
rock gnome liclien (G��m�rodw•��io linem•e), are listed as eitlier threatened or endangered.
Fourteenth Division ORice
Tcicphone: (32S) 53G-2141 253 \1'ebater Ruad Sylva, Nu�h Carolinn 2R779 Fae (R2S) SS6-4043

SR 1521-A, Macon County Page 2 FeUrua�y 20, 2015
Additionally, the U.S. Fish aud Wildlife Seivice coi�sider Macon Connty to l�ave potential for the
Indiana bat (II�I��olis sodalis). The bald eagle (Haliaeelus le�rcocephnlrrs), which is protected
under the B�Id and Golden Eagle Protectiou Act, is also luiown from Macon County.
However, t�ere ara no records for these species in the Elijap Creek waterslied. StceTms in tlie
project area are too small 1nd/or cold to support mussels and fish. These species are found in the
Little Temiessee River below Lake Emory Dam. The project should have "no effect" on these
species since the project area is over 15 tniles upstream of the Little Temiessee River and Emory
Dam aud there will only be miniuial stream disturbances from the 5 calvert extensions.
As with aquatic species, the project should have "no efPect" on the listed pl�nts that are kvo�vu
froru eurrent records in Macon Connty. The project area is too low in elevation and lacks tlie
damp rock faces that may support rock gnome lichen (Gymnoderinn Irnenre). There are no rock
bars or scoured stream baiilcs at the ctdvert sites that could sti}>port Viiginia spiraea (Spirnen
i�i�•giiriann).
Tlie only potential habitat for listed species withiu the project area may be a few saitable roost
trees aud foraging areas for Indiana bats (1LI��olis sepienh•ronnlis) and the proposed for listing
northern long-cared bat (�l�tyolis septenh�ronalis), wl�ich may be listed �s endangered in the spring
of 2015. The nearest uuderground niines are over one inile from the project area and it is
uiilcnown whether tliey aie even still open and se�viug as hibernacula for bats. Regardless, tliis
projeet �vill not require blasting or additional tree removal (trees were cut along right of way
during consU uction activities in 2010). Por these reasons, we believe that a determination of "no
effect" on bat species sliould apply to this project.
Tl�is project �vas ceviewed by NCDOT's Humau Euviroiwient Unit in 2003. Surveys were
conducted for historic �rchitecture aud archaeology. As � result of the survey work, it was
determined that tliere would be "uo effecP' o�i cultui'al resources (see attaclied SHPO forms).
The best mauagemeut practices will be used to minimize and conU�ol sedimentation and erosion
on this project. We propose to install new culvei�ts slightly below the existiug streambed
elevations where bedrock is not encountered to minimize impacts to aquatic habitats and allo���
tlie esisting stream gradients to remain as unchanged as physically possible. The construction
foreman will rcview all erosion conteol measures daily to ensure sedimentafion and erosion is
being effectively controlled. If the planned devices are not fimctioning as intended, they will be
iuimediately replaced �vith better devices.
Impacts to Waters of the United States
The unuamed tributary of Palls Brauch at site 5 is shown on the USGS topographic map as a
perennial stream. Tl�e uimamed tributaries of Falls Branch at sites 3, 4, 6 1nd 7 are not sho�a�n on
the USGS topographic map. All the streams are small biit have defined channels. T�e nmiamed
tributaries of Falls Brancli (DWQ Class C) at sites 3, 4, 6 aud 7 flow into tlie unnamed tributary
of Falls Branch froin site 5 within approximately 1360 feet (rauges from 585-1360 feet) of tlie
road. The main unnamed tributaiy fi•av site 5 then flo�vs approximatel}� 650 feet to Falls Branch.

SR 1521-A, Macon County Page 3 February 20, 2015
Falls Branch flo�vs approsimately 0.4 miles to North Prong L'llijay Creek. From the conflueuce
of these stre�ms, North Prong Ellijay Creek flows appro�imately 2.0 miles where it discharges to
Bllijay Creek. From tliis confluence, Ellijay Creek flows approximately 2.7 uiiles to the
Cullasaja River. The CullasTja River at tl�e confluence with Elliiay Creek meets the definition of
a Tr�ditional Navigable Water. For tl�e reasons stated above, we believe that the uimamed
tribut�ries of Falls Br�ucl� meet the defluition of Relativcly Yermaneut Waters and are under the
iurisdiction of the U.S. Army Corps of Bngineers. In order to construct the projeet iu accordance
�vith our current secaidary road staudards, it will be necessaiy to impact waters of the United
States i�� the Little Te�messee River Basin (HUC 06010202). Listed belo�v is a stmunary of the
proposed impacts; the sites �h•eady completed are marked tIu•ougl� aud I�igliligl�ted (Sites
8-11).
Site No. �iisting Conditim� Proposed Condition Net Impacts
Site 3 50' x 24" CMP 50' x 24" CMP 0'
Site 3A Free Flo�ving Channel Impei•vious Dike & Flo�>> Diversion 75'
Site 4 30' s 24" CMP 40' 124" CMP 10'
Site 4A Free Flo�>>ing Chaimel lnipervious Dike & Flow Diversion 75'
Site 5 25' � 48" CMP — Perched 40' s 48" CMP — Perched llue to 15'
Duc to To �o ra �LV To o ra �h �
Site SA Free Flo�ving Chaunel Impei•��ious Dike & Flow Diversion 75'
Site 6 25' x 18" CMP 40' s 24" CMP 15'
Site 6A Free Flowing Chamiel Impeivious Dike & Flow Diversion 75'
Site 7 30' � 18" CMP 40' s 24" CMP 10'
Site 7A Free Flowing Channel Impervious Dike & Flow Diversion 75'
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c'� -,T'—r� .i c � �.� ?'�^� �$
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C;� if 7' �.�r�r � � .`" �� D �
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c'� �!1 `.�Ax'r� �>o�o--c�vr�r �6H@
c.•�i. � r,.o ri,....:.,,, r-t,.,.,.,ot i.,,..o...:,..... n:t,o .e. ri,.... n:. ., �
Tot�l Stre:�m Impacts for Cuh�ert I'sxtensions (Rem�iuing Sites) 50'
Total Tempoi�a��� Streau� I�upacts foi• Iutpe�l�ious llilces and Flo�ti� Diversim�s 375'

SR 1521-A, Macon County Page 4 Pebruaiy 20, 2015
Permits Requested
NCDOT is hereby requesting autliorization undei• Seclioii 404 of the Clcaii Water Act to proceed
with tl�e construction project outlined above. By copy of tl�is letter, I am asking Mrs. Marla
Chambers, Westeni NCDOT Coordinator �vith the North C�rolina Wildlife Resources
Commission (NCWRC), to conunent directly to you coucerniug the 404 Natiomvide Periuit
request.
Also, by copy of this letler, T ain reqi�esting authorizatio�i tmder Section 401 of tlie Clean Water
Act from the North Carolina Department of Enviromnent and Natl�rat Resources (DENR),
Division of Water Resources (DWR). In addition, I am asking Ms. Chambers and Mr. Beu
DeWit, EI, Roadside Enviromuental Field Operations Engiueer (NCDOT), to corument directly
to me concerniug this permit request.
If yoii have any questions or necd additional information, please coutact ine at [phone].
Your early review and consideration ���ill Ue greatly appreciated.
Sincerel}',
�
/7 /
j�l�/�/`� /i� l7i�/�7-��
Mark S. Davis,
Division 14 Enviroiunental Supervisor
Euclosures
cc: Ms. Amy Cl�apmaii, Division of Water Resources, DENR, Raleigh
Mr. Keviu Barnett, Division of Water Resources, DENR, Asheville
Mrs. Marla Cl�ambers, Western NCDOT Coordinator, NCWRC, Ablernarle
Mr. Jason Mays, Biologist, US Fish and Wildlife Seivice, Asheville
Mr. Adam Dockery, County Maintenance Engineer, NCDOT, Audrews
Mr. Ben DeWit, El, Roadside Eiivirotmiefital Field Operltions Engineer, NCDOT

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Office Use Only:
Corps aclion ID no.
DWQ project no.
Fomi Version 1.3 Dec 10 2008
Pre-Consh•uction Noti�cation (PCI� Form
A. Applicaut Iusoruiation
1. Processinc�
1 a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: NW 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ❑ Yes � No
1 d. Type(s) of approval sought from the DWQ (check all lhat apply):
� 401 Water Qualily CeAification – Regular ❑ Non-404 Jurisdictional General Pennil
❑ 401 Water Quality Certification – Express ❑ Riparian Buffer Authorizalion
1 e. Is this notification solely for ihe record For the record only for DWQ 401 For the record only for Corps Permit:
because wrilten approval is not required? Certification:
❑ Yes � No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigalion � Yes ❑ No
of impacls? If so, attach the acceptance lelter from mitigation bank or in-lieu
fee program. NCEEP payment made when project first permitted in 2008.
1 g. Is the project located in any of NC's twenty coas[al counlies. If yes, answer 1 h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concem (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: SR 1521A - Mounlain Grove Road (Onion Mountain Road)
2b. Counry: Macon
2c. Nearest municipality / town: Franklin
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or State WgS No. 14C.056106
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 Mark S. Davis, Division Environmental Supervisor
applicable):
3d. Street address: 253 Webster Road
3e. City, state, zip: Sylva, NC 28779
3f. Telephone no.: 828-586-2141
3g. Fax no.: 828-586-4030
3h. Email address: markdavis(a�ncdot.qov
Page 1 of 11
PCN Form – Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑ Olher, specify:
4b. Name: N/A
4c. Business name N/A
(if applicable):
4d. Street address: N/A
4e. City, slate, zip: N/A
4f. Telephone no.: N/A
4g. Fax no.: N/A
4h. Email address: N/A
5. Ac�enUConsuitant Information (if applicable)
5a. Name: N/A
5b. Business name N/A
(if applicable):
5c. Street address: N/A
5d. Ciry, state, zip: N/A
5e. Telephone no.: N/A
5f. Fax no.: N/A
5g. Email address: N/A
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Icientification
1a. Properly identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitude: 352212 Longitude: -832654
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Falls Branch
proposed project:
2b. Water Quality Classification of nearest receiving water: DWR Class: C
2c. River basin: Liltle Tennessee (HUC 06010202)
3. Project Description
3a. Describe the existing condilions on the site and the general land use in the vicinily of the project at lhe lime of this
applicalion:
The overall landscape in the area is prirnarily small farms, residences, and timberlands. The immediate vicinity of the
project includes lhe roadway, pastures, and wooded areas.
3b. List the total eslirnated acreage of all exisling wetlands on the property:
N/A
3a List lhe lotal estimated linear feet of all existing streams (intermiltent and perennial) on the property:
N/A
3d. Explain lhe purpose of the proposed project:
To improve fhe last seclion of SR 1521, Section A, to meet current NCDOT design standards and improve safety.
3e. Describe the overall project in detail, including lhe type of equipment to be used:
NCDOT will widen, grade, drain and pave SR 1521-A. This will require extending/replacing culverts in streams at Sites 3-
7; Sites 8-11 were completed after the project was permitted earlier. Track hoes, dump trucks, bulldozers, graders,
paving equipment, water pumps, sandbags, and various hand tools will be used to accomplish the work.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or sfream determinations by the
Corps or State been requested or obtained for this properly / � Yes � No ❑ Unknown
project (including all prior phases) in lhe pas[?
Comments:
4b. If the Corps made lhe jurisdictional determinalion, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated lhe jurisdictional areas? Agency/Consultant Company: N/A
Name (if known): N/A Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and altach documentation.
N/A
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes ❑ No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Action ID No. SAW-2007-1082-356 and DWQ Project No. 070487 were issued for SR 1521 B and C, Onion Mountain
Road in 2007. Permits for SR 1521A (Mountain Grove Road) were issued in 2008 (Action ID No. SAW-2008-2253, and
DWQ Project No. 080792) and the NWP was reauthorized in 2011 by the USACE via email. Only Sites 8-11 were
completed due to funding issues. NCDOT was granted additional funding to complete lhe road project in February 2012.
Permit Sites 3-7 need to be permilted under lhe new NWP's and Regional Conditions, which were issued/renewed in
March of 2012.
Page 3 of 11
PCN Forrn — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project?
� Yes ❑ No
6b. If yes, explain.
The remainder of the SR 1571A project will be consVucted and completed during the 2015 construction season. The SR
15216&C, as well as, part of SR 1521A have already been completed. No olher permits will be required.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all lhat apply):
❑ Wetlands � Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Consiruction
2. Wetland Impacls
If there are weUand impacts proposed on the site, lhen complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number — Type of impact Type of wefland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem orar T
W1 ❑ P❑ T N/A N/A ❑ Yes ❑ Corps N/A
❑ No ❑ DWQ
W2 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total �cetland impacts N/A
2h. Comments: N/A
3. Strearn Impacts
If lhere are perennial or intermiltent stream impacts (including temporary impacts) proposed on lhe site, lhen complete this
question for all stream sites impacted.
3 a. 3 b. 3 c. 3 d. 3 e. 3 f. 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, widlh (linear
Temporary (T) (INT)? other) (feet) feet)
S3 � P❑ T Culvert UT Falls Branch � PER � Corps 1 0
Replacement ❑ INT � DWQ
S3A ❑ P� T Temporary Dike UT Falls Branch � PER � Corps 2 �5
Flow Diversion ❑ INT � DWQ
S4 � P❑ T Culvert Extension UT Falls Branch � PER � Corps 2 10
❑ INT � DWQ
S4A ❑ P� T Temporary Dike UT Falls Branch � PER � Corps 2 �5
Flow Diversion ❑ INT � DWQ
S5 � P❑ T Culvert Extension UT Falls Branch � PER � Corps Z 15
Perched ❑ INT � DWQ
Ternporary Dike � PER � Corps
S5A ❑ P� T Flow Diversion UT Falls Branch � INT � DWQ 2 75
S6 � P❑ T Culvert Extension UT Falls Branch � PER � Corps 1 15
❑ INT � DWQ
S6A ❑ P� T Temporary Dike UT Falls Branch � PER � Corps � 75
Flow Diversion ❑ INT � DWQ
S7 � P❑ T Culvert Extension UT Falls Branch � PER � Corps 2 10
❑ INT � DWQ
S7A ❑ P� T Temporary Dike UT Falls Branch � PER � Corps � 75
Flow Diversion ❑ INT � DWQ
3h.
Total Permanent Stream and Tributary Impacts for Culvert Extensions 50'
Total Ternporary Stream Impacts for Impervious Dikes and Flow Diversions 375'
3i. Coinments:
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the AUantic Ocean, or any other open water of
the U.S. lhen individually list all open water irnpacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number— (if applicable) Type of impact Waterbody type Area of impacl (acres)
Permanent (P) or
Tem orar T
01 ❑P❑T N/A
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Totnl open water impacls N/A
4g. Comments: N/A
5. Pond or Lake Construction
If ond or lake conslruction ro osed, then com lete the chart below.
5a. 5b. Sc. 5d. 5e.
Welland Impacts (acres) Stream Impacts (feet) Upland
Pond ID proposed use or purpose (acres)
number of pond
flooded Filled Excavated Flooded Filled Excavated Flooded
P1 N/A N/A N/A N/A N/A N/A N/A N/A
P2
Sf. Total N/A N/A N/A N/A N/A N/A N/A
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no: N/A
5i. Expected pond surface area (acres): N/A
Sj. Size of pond walershed (acres): N/A
5k. Method of construction: N/A
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 impacts require mitigalion, lhen you MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Bufferimpact
number— Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem ora T im act re uired?
B1 ❑ P❑ T N/A N/A ❑ Nos N/A N/A
62 ❑P❑T ❑Yes
❑ No
B3 ❑P❑T ❑Yes
❑ No
6h. Total buffer impacts N/A N/A
6i. Comments: N/A
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance ancl Minimiaation
1 a. Specifically describe measures taken to avoid or minimize lhe proposed impacts in designing project.
Only the minimum culvert lenglhs needed to meet design standards will be installed in the streams. The road is improved on
its current location and its wiQlh is the minimum needed to meet ciurent NCDOT design standards.
1 b. Specifically describe measures taken to avoid or minimize lhe proposed impacts through construclion techniques.
Instream excavation and fill work will be completed in a"dry" (temporarily dewatered stream channel) to minimize potential
impacts to downstream aquatic resources.
2. Compensatory Mitiyation for Impacts to Waters of the U.S. or Waters of the State
2a. Does lhe project require Compensatory Miligation for � Yes ❑ No
impacts to Waters of the U.S. or Waters of the Slate? NCEEP payment made when project first permitted in
2008.
26. If yes, mitigntiou is required by (check all ihat apply): ❑ DWQ � Co�ps
2c. If yes, which mitigation option will be used for this ❑ Mitigation bank
project? NCEEP payment made when project was � Payment to in-lieu fee program
first permitted in 2008.
❑ Permiltee Responsible Mitigation
3. Complete if Usinc� a Mitigation Bank
3a. Name of Miligation Bank: N/A
3b. Credits Purchased (attach receipt and lelter) Type N/A Quantity N/A
3c. Comments: N/A
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is altached. ❑ Yes
4b. SUeam mitigation requested: N/A linear feet
4c. If using stream mitigation, stream temperature: ❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): N/A square feet
4e. Riparian wetland mitigation requesled: N/A acres
4f. Non-riparian wetland mitigation requested: N/A acres
4g. Coastal (tidaq weUand miligation requested: N/A acres
4h. Comments: N/A
5. Complete if Usiny a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of lhe proposed mitigation plan.
N/A
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the projec[ result in an impact wilhin a protected riparian buffer that reyuires ❑ Yes � No
buffer miligation?
6b. If yes, then identify the square feet of impact to each zone of lhe riparian buffer that requires mitiyation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Lone Reason for impact Total impact Multiplier Required mitigalion
(square feet) (square feet)
Zone 1 N/A N/A 3(2 for Catawba) N/A
Zone 2 1.5
6f. Total buffer mitiyation required: N/A
6g. If buffer mitigation is reyuired, discuss what type of mitigalion is proposed (e.g, payment to private mi[igation bank,
permiltee responsible riparian buffer restoration, payinent into an approved in-lieu fee fund).
N/A
6h. Comments: N/A
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (reyuired by DWQ)
1. Diffuse Flow Plan
1a. Does ihe project include or is it acljacent to protected riparian buffers idenfified � Yes � 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.
Comments: N/A ❑ Yes ❑ No
2. Stormwater Manac�ement Plan
2a. What is lhe overall percent imperviousness of this project? N/A %
2b. Does this projec[ require a Stormwater Management Plan? � Yes ❑ No
2c. If lhis project DOES NOT require a Slormwater 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 is covered by individual NPDES Permit No. NCS000250.
❑ Certified Local Government
2e. Who will be responsible for the review of the Slormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local governinent's jurisdiction is this project? N/A
❑ Phase II
3b. Which of the following locally-implemented stonnwater management programs ❑ NSW
appty (check all lhat apply):
❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has lhe approved Slormwater Managernent Plan with proof of approval been ❑ Yes ❑ No
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
❑ Olher:
4b. Has the approved Stormwater Management Plan with proof of approval been
atlached? ❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does lhe Stormwater Management Plan meet the appropriate requirements? ❑ yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No
Page 9 of 11
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?
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 Slate ❑ Yes � No
(Norih 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, atlach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes � No
Comments: N/A
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Welland 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 afler-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 lhe
most recent DWQ policy. If you answered "no," provide a short narrative description. This project is an upgrade of
existing infrastnicture wilhout an increase in capacily (no additional lanes), so it will not facilitate secondary or cumulative
development.
4. Sewage Disposal (DWQ Reyuirement)
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 facilily.
N/A
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will lhis project occur in or near an area with federally protected species or � Yes � No
habitat?
5b. Have you checked with lhe 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 Designaled Crilical
Habitat?
Norih Carolina Natural Heritage data and onsite investigations.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this projecl occur in or near an area designaled as essential fish habitat? ❑ Yes � No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
N/A—There are no marine or estuarine communifies wilhin the Blue Ridge Physiographic Province
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will lhis project occur in or near an area that lhe state, federal or tribal
govemmenls have designated as having historic or cultural preservation � yes � No
status (e.g., National Historic Tnist designation or properties significant in
North Carolina history and archaeology)?
7b. What dala sources did you use to determine whether your sile would impact historic or archeological resources?
This projec[ was reviewed by NCDOT's Human Environment Unit in 2003. Surveys were conducted for bolh Historic
Architecture and Archaeology. It was determined thal there would be "no effect" to cultural resources (see atlached
SHPO forms).
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: N/A
Sc. What source(s) did you use to make the floodplain determination? NC Floodplain Mapping Program
Mark S. Davis
Division 14 Environmental Supeivisor ����� �v,��� �'�2�-��/
ApplicanUAgenPs Signature Date
ApplicanUAgenPs Printed Name (AgenCs signature is valid only if an aulhorization letter from the
applicantis provided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

�ou�{ �� : r�ACON
SR. 1J0. - CPS:
1521-A
�• N�� MT. GROVE RD.
PIPE STA. qz+00 °
51Tp 1�D. 3
OLD ' �
CL
- Lo�� `^`� ` .
�� ¢�� �� �� ti �
,� �� \�� �� '�
`�� � . ,.�-�
,
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RIP RAP ENDV7ALL �
� +i n�
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`i
1 ��
wvl�
TEMP.SILT FENCE
� ROCi: BERM %
35 ° 13 � 3� N. DEC.35.226
� � n
B3 15 59 u• DEC.83.266
N OTE : '
ISI'^� � 1 d SIT� # 2 I
ri m m� p
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CHBCK DAMS AS REO.
�� ROCK SEDIMEr.�T DAM
Ti'PE B 1 5' X3' X2'
,� ��
SPRING HEA
SPRING BO};
�'
��\
�
�_ � CHECK DAMS AS REO.
�� SILT BASIN TYPE B
12'Y,3'X2'

wunr�:_.Ni�CON _�5 ° 13 35 N DEC.35.226
GPS:
SR. N0. GR_15�1-�
RD• NAME: MT. GROVE RD, o ' "
PIPE STA. a�+�� g3 16 02 N. DEC.83.267
SITE tio. 4
OLD CL � ��
� �
TEMP. SILT
FENCE & —
Rocx sExr�
RIP RAP END�VALL
. _. . �` r✓ A`'_i„ � '6�
� � NORTH
�
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SR. it0� ��':'
—L5�1 _�,
�' N�' � !40UNTAIN GROVE RD
PIP� STA. 48+25
SITE l�o. 5
SILT FENCE
& ---
ROCK BERMS
RIP RAP
END jJALL
, ��
�� .
SILT FENCE
8 —
ROCK BERMS
_ 35° 13 32 �� ��. DEC.35.2Z6
83�� 16 09 u. DEC. B3.269
� MAG �.,s
OLD � ^inRmg�'"
,�
�;. . �
/� � � /
� / tQEW CL
/�
/ �� CHECK DAMS
/: � f SPACE AS
� � / / REO.
� � j,���
J tG
RSD TYPE B
�7+� ���,��-•�� I 15X 3Y21
; ,( �/
� ��I � ��^RTP RAP
X�4�' J, _ ����� q� HE:4D V7ALL
I �
� �� E4CT. 25'X48" CMP
I ' � REPLACE WITH
� � i ao�xaa�� c��p
� I �`��_CHECP. OAMS
�% AS REO.
� � ��SILT B?�SIN
t TIPE B
1� � � 1 OY.3K2
I-f- ,--� �-i; ,-i-�-� �-----�-�-�-� �—I-�- 1� �
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a
� i���i:

l.Utriin'_ n_i�'nia p � �� '
"SP.. 1�0. CPS: _ 35 13 33 N DEC.35.226
1 521 -A
�. H�:�SJNTTAN C;RCIVF Rn R�� 16_ 18 u. DEC.83.272
PiPE STA'. 52+20 °
SITE No. � ,
OLD � _ SSLT 8?�SIN
& �„ TYPE B �
NEW 1 OX3X2 N�75�C
CL `-�` — — � � ���`. CHECK'DA�95 O��'IY�
~ \ � �
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� \ . � ` '
\ /
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TEMP. SZLT FEN. E\�� �� 15}:3X2
ROCK BERMS
1'
` �.
RIP RAP
END WAI;L
TEMP.SILT FENCE
&
Rocx aERn�s
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n
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/
11
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REPLACE j�,TTH
40' x24" ea7p
CHECK DAMS AS REO.
SILT BASIN
TYPE B
1 OY.3X2
a
� i i i i � � i I I� I i i I I I I I I� i i i I I I i; . i I I I i i I I I � I I � I i � I I I� I i I i�l I I I
I I I I I I i I � i i I i �� � I 1 i i I I I I . I i i i I. i i

COUtiTY:_ n1t�CON i�
CPS: °
SR. t70. 1 521 -A 35 1 3� 31 ��DEC. 35. 225
RD. NA2fL: NiT. GROVE R�. n � �i
PIPH ST�._ ss+qn 83 16 24 u. DEC. B3.273
sITE No. �
�
\ �A'
��� � ��R�F�
� � �
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OLD \�� \\ � \, TYPE A
CL � \� � lOX3X2
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FENCE r � ` � ���.
s
ROCK BERMS ��,, � \, < , RIP RAP
L�;,�; i ��� �r_^ HE.ADWALL
� �;
' _ ' �" 3 0 X11 8 '
. �- ` . �.--, 2
, ' � i '� ���
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USE STACKED GABIAN' I
BASKETS FOR SHOULDER � �' 1{ /
& ENDPIALL I ✓
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TEMP. SILT FENCE r �I
& 41 �
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T � � •
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AS REn.
SILT B8SI7.V
TYPE B
1 0}:3X2
WITH
ap�YZa�� �Mp
n
� � ��� ����,;

SR 1521-A
Site 3 Inlet
Site 3 Outlet

SR 1521-A
Site 4 Inlet
Site 4 Outlet

SR 1521-A
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Site 5 Inlet
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Site 5- steep channel downstream of outlet.

SR 1521-A
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Site 6 Inlet
Site 6 Outlet
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L7

F7:ZiF7��ise�
Site 7lnlet
Site 7 Outlet

Co�urty Macon NCDOT Divisia� # 14 Distrrct # 3
CONCL]RR�NCE FORM TOR PROP�RTIES NOT ELIGIBL� TOR T'EIE NATIONAL
R�GIST�R OT HISTORIC PLACCS,
FOR STATE FUNDF.D SF('OTVDARY ROAD PRO iT TS O S'
Projecr Descripriat: Widen. �ade draui and pave SR 1521 (Onion Mountain Rd 1
On 5/]3/2003, representatives ofthe
� North Carolina Depamnent of Transportation (NCDOT)
� North Caroluia State Historic Preservation Office (HPO)
❑ Other
Reviewed the subject project at
�❑ a scopin� meetin�
photogaph revie�v session/consultation
❑ other
All parties present a�reed
f
. ;�,!"y'��.�
l,l �
A/(�ZDO.+
There are no properties over fifty years old within [he projecPs Federal Pemiit Site's (or Sites') area (or
areas) of po[ential effects (APE).
�/There are no properties less [han fifty years old that are considered to mee[ Cri[erion Considera[ion G
within the projec['s Federal Permi[ Site's (or si[es') area (or areas) of potential effects.
�There are properties over fifty years old (list attached) wi[hin [he projecYs Federal Permit Si[e's (or Sites')
area (or areas) of poten[ial effects, bu[ based on the historical information available and [he photographs of
each property, properties iden[ified as Mountain Grove Baptist Church (MA 202) are considered not
eligible for the National Register and no further evaluation is necessary.
�7'here are no National Register or Study-Lis[ed properties loca[ed within the secondaq� road projecPs area
of potential effects.
�There are ��o historic properties affected by Ihis project. (AtlaclJ airy notes or doc+unen(s as nee�ler�
Signed:
�
Representative, HPO �
Ir�o.�v=c,� �/�,.o-�-�
State Historic Preservation Ofticer
Date
�j � 3 0
Date
,� �� ,
4
- ��6 a
Date
If a survey report is prepared, a final copy of this form and the attached list will be included.

� .:���
���
Ga .,
North Carolina Department of Cultural Resources
State Historic Prese►•vation Office
David L. S. Brook, Administrator
Michael F. Easley, Govemor
Lisbe�h C. Evans, Secrelary
]effrey l. Cro�v, Deputy Secretmy
January 17, 2003
MEMORANDUM
TO: Mr. M1tt Wilkerson
P'ROM:
SUBJECT:
�,�%
Division of Historical Resources
David J. Olson, Director
Acchaeology Supetvisoi
NC Depaemient of Transpoitation
David Btook ��%L �{ 1-x-L(,�-GL ��!l��L
Accl�aeological Sun/Cy Repoct, SR 152] Oiuon Mountain Road, Macon County �R
029G59
Tl�ank you fot youc lettec December 17, 2002 of uai�snutung the ucl�aeological sutvey repoxt by
Paul Mohlex fox the above pxojcct.
During die couese of die survey, (no ) sites �vece loc�ted �vitlun die pxoject aren. Paul Mohler has
xecommended tl�at no £uither nrchleological investigation be conducted 'ui connecuon with this
pioject. We concuc widi tlus xeconunendation since the pxoject will not involve significant
archacologicnl resources.
The above comments ace tnnde pursaant to Sectio�i ]O6 of d�e Nauonal Histoxic Pceservation Act
aud the Advisory Council on Histocic Yceseivatiou's IZegula[ions fox Compliance with Section 706
codificd at 36 CFR Paxt 800.
Thanlc pou foi your coopecauon a�id considecldon. If you have quesuons concexning d�e above
conunent, contact Renee Gledliill-Encley, envixonmental xeview cooxdinatoc, at 919/733-4763. In all
futuxe cotrunutucnUon concexrw�g tlus pcojcct, please cite tlie above reEexenced teacking nutnUet.
cc: Snedeker, USDA PS
Locntion Mniling Address Telcphone/Rax
Administrntlon 507 N. Blount S�, Rnleigh, NC 4617 Mail Service Centcr, Rnleigh 27699-4617 [phone] •733-8G53
Restornflon 515 N. Blount S�, Raleigh , NC 4613 Mail Scrvice Ccnter, Rnleigh 27699-46IJ (919j 733-6547 •715-4801
Sw�rey & Plnnning 515 N. 8lount St, Raleigh, NC 4618 Mnil Service Center, Raleigh 27699�4618 [phone] •715-4801

APPROVED JURISDIC'PIONAL DE'fL;R�11NA'I'10� ['ORVI
U.S. Army Cm�ps of Cnginecrs
'I�his forin should be complele� by Collo�ving the instructions provided in Seciion IV of O�e JD Forni Instructional Guidebook.
SECTION 1: BACI<CROUND IN�ORNATION
A. REPORT CODIPLCTION DATP: P'OR APPROVCD JURISDIC'I'IO�AL DCT�R\IINATION (JD):
B. DISTI2IC'I' OFRICE, FILE NA11[E, AND NUDIBCR:
C. PROJGCT LOCATION ANU 13ACI<GILOUYD 1NROR1IATION: SR 1521-A, n4ounlain Grove Koad
S���e:NC Counly/parish/borough:ldacon Ci�y: Crmiklin
Center coordinates ol site (IaUlon� in degrcc dcciinal forinat): LnL 35.2213° N, Long. 83.25�8° \5'.
Universnl Trnnsrerse Nlerca�or:
Name of nearest �rnterbody: wu�amcA �ributnries of P�IIs I3rnnch (Class C)
Nmne of nearest Trnditional Navignble AVn�cr (TNN) Into �chich �he aquntie resource flo�vs: Cullasajn 2i��er
Nanre of �vatecshed or Hydrolo�ic Unil Code (HUC): 06010202030030
� Check if map/dingrnm ofrcaic�r nren nnd/or potentiel lurisdictionel nreas is/are nvnilablc upon rcqucst.
❑ Check if other sites (e.g., oftsile mitigalion sites, disposal sites, ete...) are associated �vith this nc�ion nnd are recorded on n
ditl�crent 1D fornt �
D. RG\'IG\1' PCRfORD16D �OR SITC C�S\LUA'1'IOY (CHECK ALL TH.\T APPLI'):
� Office (Desk) Determina�tion. Date: Iune I R, 2008
❑ Pield De�ermination. Da�e(s):
SCCTION II: SU\I�IARI' OR RINDINGS
A. RHA SECTION ]0 DETERDIINATION OI' JURISDICTION.
There Are no "nnrigable n�aiers oJ dre US." �cithin Rivers nnd I Inrbors Ac� (RI IA) I��risdiction (ns dctincd by 33 CCR part 329) in the
revie��� m�en. [2equire�(�
❑ 1Vaters subject to the ebb and �lo�v of the tidc.
❑\Vaters are presently used, or harc becn uscA in tlic p�st. or nmr be suscep�ible tor usc ro transport interstate or Corzign commerce.
Cxpinin:
B. CNA SCCTION d0a DE'I'ER�IIN.\'I'ION OP dURISDICTION.
'I liere Are "�ra�ers of0�e U.S." within Clean Watzr Act (CR'A) I��risdiction (as dclined by 33 CF2 part 328) in tlie revie�c area. [2eqi�iredJ
1. AA'aters of the U.S.
n. Indicnte presence oPwnters of U.S. in reriew nren (check all that apply): �
❑ 7N\Vs, includine ten�i�orial scas
❑ NeU�nds ndjacei�t to'INWs
� Relatively pennnnen� �vaters� (RPAA's) thnt Flo�v directly or indirectly iNO TNIVs
❑ Non-RPIVs thnt Floo° directly or indirecUy intu TNVVs
❑ 11'ctlmids directly nbutting RPN�s Ihal Iloo� directly or indirectly into "fNNs
❑ AVetlands ucilacent to but not directly abutting RPAVs that �1o�a directly or indirectly into'fNVVs
❑ Netlands adjacent ro non-RPVA's �hnt tlow directly or indirectip into "CN�Vs
❑ hnpoundnren�sofjurisAiclionnl�vnlers
❑ Isolated (intcrstnte or intrastnte) �cnters, including isolated �cetlands
b. [dentiPy (rstimnte) size of wntcrs o( the U.S. in the reriew area:
Non-���etlanA �rnters: �00 linear teeC I-2 �cid�h (fQ and/or ncres.
Nctlands: ncres.
c. Limits (boundaries) ofjurisdiction based on: Esfablished by OIIR'11.
8levntion of cs�ablishcd OHVVM (if kno�vn): .
2. Non-regulatedwatersAvetlnnds(el�ecl<i(npplicnble):''
❑ Polentiallyjurisdictional �vaters and/or �rctlnnds «�ere nssesscd �eithin 8ic rcrie�v area and detenuined to be notjurisdictio�ml.
Gspinin: .
� I3oses checked belo�c shall ha suppotleJ by eomple�in� the nppmpriate szc�ions in Sec�ion III below.
' Fnr purposcs of this fomi, m� RP\5' is dzfined as a �cibWnq� �hnt is no� a TN\1' and �ha� h�pically �o�ca yznrround or has conlinuoir [lo�c al Irast `sc�son�ll}"
(c.e., typicnlly 3 monlhs).
' Supporting documznlalion is pccxntzd in Scction IILP.

SECTION Ill: C\VA ANr1L1'SIS
A. TNR's ANU \VETLANDS ADJACGNT TO'PNR's
'I'he agencies �vill �ssert jw�isdiction ovcr l'NR's �nd �retlnnds ndjnceut ro TN�Vs. If the nquntic resow�cc is n TN�V, compictc
Section III.A.1 mid Section III.D.I. oniy; if the nquntic resom�ce is a wetlnnd ndjnccnt to n TMV, completc Sections III.A.1 nnd 2
nnd Section III.D.1.; otherwisq sec Secfion III.Q below.
I. TN�V
Idcntifi�'IN\V:
Summnriz_e rutionale suppurting detenninntion:
2. \\'etlnnd ndjnccnt to TN�V
Summarizc rntionale supporting condusion tha� ���etland is "ndjncent":
6. CHAIiACTERISTICS OP TRIItUTARI' ('1'HAT IS NOT A TN\V) AND ITS ADJACCNT \\'CTLANDS Q� AN]'):
This seetion sununnrizes infm�mation regarding chnrncteristics of tlie tributnry nnd its ndjacent wetlnnds, i(any, mid it helps
detcrmine �rhethcr or not the standords for jw�isdiction estnblished under �7npanas have been met.
"fhe ngencies will nssertjurisdiction orer non-nnvignble h�ibutnries of TN\Vs ���here �he tribufnrics m�c "rclntively permnnen[
wnters" (RI'11's), i.e. tributnries thot lypicnlly Ilow ycm�-round or hm�e continuous ilow at least seasonally (e.g., typically J
months). A�re[Innd thnt direclly nbuts nn RPA1' is aiso jurisdietional. ICtlie nqunlic resow�ce is not n TN1V, but hns yem�-romid
(perenniol) Oo�e, sl<ip to Section llI.D.2. If the nquatic resource is a weHand directly nbidting n tribidnry wiH� perenninl ilo���,
skip to Section III.D.4.
A a�eH:ind tl�nt is ndjncent to buf lhnt does imt directly nbut mi RPR' requires n significnnt nesus evnluntimi. Corps districts nnd
EPA regions o�ill inchide in fhe record nny nvnilnble infm�mntion thnt doruments the ezistence of a signilicant nexus 6ehveen a
relntivclv permnnent tributarr th�t is not peremiinl (nnd its adjncent wetlands i(any) and a h�oditional novignble �r�iter, eren
though a significant ne�us finding is not required os m m�tter of Imv.
If thc wnterbod�' is not nn RPR', a� n wednnd directly abutting an RP�V, a JD �rill require additional data to determine if Ihe
�rnter6ody has o signifennt nesus wifh n TNN. If the tributnry hns odjncent wetlnnds, ihe significnnt neuis evnlunfion must
mnsider the tributnry in combinntion �rith all of its nAjncent wetlnnds. This significnnt necus evnluntion Ihnt combines, for
nnnlyticnl purposes, the tributnry and nll of its ndjacent wetlnnds is used whether the review nren identi(ied in the JD requcst is
the tributnry, m� ils ndjncenf �cetlnnds, m� both. ICtlie JD covers n h�ibutm�y with ndjncent wetlnnds, cmnplete Section III.B.1 for
fhe tributary, Section I11.B.2 for ouy onsite �vetlnnds, nnd Section 111.13.3 (or all wetlands adjacent to th:it tributary, both onsite
nnd affsite. The determinnfion �r6efhcr n siguifiennt neuis esists is determined in Section III.0 bclow.
1. Chm�ncteristics of non 'CNVVs thot ilo�r directly m� indirectlp into TNVV
(i) Cencrnl Aren Conditions:
�Yatershed size: Picle Lisf
Drninaec nren: Pick List
A��emge annual rainfall: inches
Averaee annual snowfnll: inches
(ii) Plq�sical Characteristics:
(n) Relutio�uhip �vi�h TNVV:
❑ Tributan� flo«�s dircctly inlo TN�\'.
❑'I'ributnq� ilo�vs Uvough Piek List tributaries before enlering "fNVV.
Prqjecl waters are Pick List rircr miles Gom TNR�.
Project �catcrs nrc Pick List rirer miles �iom RPN.
Prolec[ �vnters nre Pick List azrial (s�rnight) miles Gom'IT'\V.
Project �vnters are Pick List aerial (strnight) iniles from RPAV.
Prolect �raters cross or servc ns state boundaries. Esplain:
Idcntih� Flo�r route to'I'N\P`:
Tributnry strenm order. if known:
' notz Iha� tl�e Instruclional Guidehook cunlains additionnl informa�ion regarding s�cales, �itches, �c:uhcs, mid crosional Icawrzs gcncrally nnd in thz urid
R'est.
' Flow roulz enn be Aescribed b}' idenlilying, eg., Ieibulary� q which �o��s �h�ough Ihe reeie�c area, lo Ilmc into I�ibulnq� b, �chieh then Oo��� into TN\\'.

(b) General Tribularv Ch�rneterislics (check all �hat auulr):
Tributnry is: ❑ \alival
❑ Artifcial (man-madc). Gxpl�in:
❑ Manipulaled (mm�-nitered). hapluin:
Tributnrr propedies �vith respec� to top of bank (estimate):
A��erage �cidth: tcet
r\verage depth: feet
Avemge sidc slopes: Pick Lisf.
Priivaq� tribWary subs�rate composition (chcck all thnt apply):
❑ Silts ❑ Snnds ❑ Concre�c
❑ Cobbles ❑ Grnvel ❑ Muck
❑ Bedrock ❑ \'egetation. Typd%covcr:
❑ Otlier. Esplain: .
Tributnry condition/s�ubility [e.g., highly eroAing. sloughing banks]. Eaplain:
Prese.nce of nm/rifile/pool compleses. Esplain: .
Tributmy geonretry: Picl< List
'I'ributaq� gradienl (appro�imnte average slope): %
(c) flow:
Tribu[nry provides for: Pick List
H;slimale a��eraee number of Flo�c eren�s in rzvie��� area/ycar. Piek List
Describe Flo�v regime: .
O�her informalion on duration and volume: .
SurCace ilo��� is: Pick LisL Characteristics:
SubsurCace Ilow: Pick List F,splain tindines:
❑ Dye (or o�hcr) �cst performed: .
'I'ribu�ary has (check all �hnt apply):
❑ Bcd and bnnks
❑ OI IR��46 (check nll indicntors Ihat apply):
❑ clear, nalural linc impressed on tlie bank
❑ changes in the chtiracter olsoil
❑ shelving
❑��ege�mion nmtted doo�n, bent, or absent
❑ IcaClitter Aisturbed or aashed away
❑ seAiment deposilion
❑ ���ater stainine
❑ othcr (list):
❑ Discontinuuus OH\V\4.' Explain:
■
■
■
■
■
■
■
thc prescncc of littcr and debris
destrucfiun of tertestrial vege�aiion
the presence ol wrnck linc
sediment sorting
scour
mulliple observed or prcdicted Flon° even�s
abnipt changc in pinnt communiq�
[Clactors other than �he OHVVNI �rerc used to delermine la�eral e�tent of CAA'Ajurisdiction (chcek nll thnt lpply):
❑ High'1'ide I.ine indicated by: ❑ Mean High Nater b[ark indicatcd bp:
❑ oil or scum line along shore objec�s ❑ sun�ay ro nrnilablc Aa�um;
❑ tuio shcll or debris deposits (toreshore) ❑ physical markings;
❑ physical markings/characteristics ❑��eee�alion linec/changes in vcgc�ation q�pes.
❑ tidnl gnuges
❑ other (list):
(iii) Chemic�l Chnrneteristics:
Chaeacterize �ributnq� (e.g., �rater color is clenr, discolored, oily film: �valer quality; general �vatershed ehnrncteris�ics, ete.).
Gxpinin:
Iden�iCy specitic pollulants, if kno�rn: .
`A natuml or man-made discunlinuily in thc OI I1VN1 does not nccessncily szvcr I���isdicfion (e.g., n�herz tlie slrenm tempo�a�ily Oo��s undz�gmund. or �chece
�he OI IN��I ha hetn �emoved by dzvelopmenl or aericulturol p�ncticzs). \Vhere �here is a break in Ihe OH WM Ihnt is unrelmzd to the �vn[erbody's �ow
regime (e.g., Ilow over n rock oulcrop or �hruue�Ji a culvzn), the agencies �cill look for in4icn�oes oC Ilo�c nbore nnA belo�v Ihe break.
'Ibid.

(ir) 6iological Characteristics. Ciiannel supporfs (checic nll thnt �pply):
❑ Ripaaian corriAoc Char�cteristics (type, nveragc ���idth): .
❑ \Vetland liinge. Chnr2cteris�ics: .
❑ Ii.ibitnt foc
❑ Pederalle Lis�ed species. Esplain fmdings: .
❑ PislJspn�vn nrcais. E�plain �indings: .
❑ Other environmentally-saisi�ire species Esplain lindings:
❑ AqunticAvildlife divarsity. 6spinin findines: .
2. Characteristics of �retlnnds ndjncenl to non-TN�V tlint flow directly m� indirectly iuto TN�\'
(i) Physicnl Chnrnctcristics:
(a) Genernl VVctl�nd Characteris�ics:
Propcities:
1Vetland size: ncres
\Vetland q�pe. 8splain: .
\VeOmid qualily. B�plain: .
Project �retlnnds cross or sen�e as s(nfe boundaries. F,�plain:
(b) Gcncrnl Plow Relntionehiu with Non=1NVV:
Plo�v is: Pick List. 8�plain: .
Sudacc tlo«° is: Pick List
Charnc�cris�ics:
Subsurface Ilo�v: Picl: List Esplain findings:
❑ Dye (or other) test pertormed: .
(c) We�land Adiacenev Determinution with Non-TNVV:
❑ Dircctlp nbutting
❑ 1�ot direc�ly abutting
❑ Discrete �setland hydroloeic connec�ion. Cxpinin:
❑ Bcologicnl connec�ion. 8spinin: .
❑ Sepanued by berm/bnrrier. �splain: .
(d) Pro�imiri� (Relntionshipl lo TN\V
Project «°eUands- are Yick List river miles from 7`NVA'.
Project �caters are Pick List uerial (straight) miles from'IN1V.
Clow is irom: Picl< Lisf.
F,stimate approsinmlc locntion of �cetland as «�ithin the Pick List Floodplain.
(ii) Chemicnl Chnrncferistics:
Chnrneterize �cetlan� system (c.g.. �cnter color is clear, bro�vn, oil fihn on surfnce', wuter yualiq; geneeal �vatershcA
cliaracteris�ics; ctc.). F,splain: .
IdentiCy specific pollu�nnts, if kno�vn: .
(iii) Biological Chnrncteristics. AVetlaud supports (ciiecl< all thal apply):
❑ Riparian buffec Chnnicleristics (q�pe. nvernge �t�idth): .
❑ Ve�e�ation type/percenl cover. Gsplain: .
❑ Hnbitntfor.
❑ Fedemll�� Listed species. Esplain �indings: .
❑ Pish/spa�vn nre�s. E�plain �indings: .
❑ Other environmentnlly-sensitire spccies. F.xpluin findings:
❑ Aquntic/wildlifa diversity. H�plein fndines: .
3. Chnrneteristics of nll �vetlands adjncent to the h�ibutnry (if nny)
All ���e�land(s) bcing considered in the cumnla�ive analysis: Pick List
Approximn[ely ( ) acres in [otnl nre being considered in [hc cumidntive nnalysis.

Cor cnch �setland, specity Ihc follo���ing:
Directh� abuts? (YMl Size (in acrosl Directh� abuts? (YM1 Sizc (in ncresl
Summarize o��erall biologienl, chemical and physical tiine�ions being performed: .
C. SIGNIrICANT NGXUS UCTER1llNATION
A significant nesus nunlysis �rill nssess the Oo�r charnc�erisfics end Puncfions oPtlie tributary itself nnd the Punctions performed
by any �retlnnds ndjncent to the tributnry to determine i(ther signi(iennHy nt@et the chemicnl, physicnl, nnd biologieal integrity
of n'I'N\V. For enrh of ihe follo���ing situntions, n significnnt nesus exisfs if the tribufnry, in combinntion with nll of ifs adjacent
wetlnnds, hns mm�c thnn n speculntive m� insubstnntiai effeet on tl�e el�eiuicnl, physicnl nnd/or biological integrity of a TNVV.
Considerntions �rhen eraluating significnnt necus include, bid nre not limited to the volume, dw�ntion, and frequency of the ilow
of e�nter in the tribufmy nnd its procimity to n TNR', miA the functions per(ormed by the tributnry nnd nll its ndjncent
�reflmids. It is not npproprinte to determine significnnt necus bnsed solely on an}• specife tlu�eshold of distnnce (c.g. behveen :�
tributnry nnd its ndjncent wetland m� behreen n tributnrr and Hie TMV). Similnrly, the fncf nn ndjncent wetland lies within m�
outside of n �oodpl�in is not solelp dcterminntive oPsignificnnt nesus.
Drnw conneetions between Ihe fcatm�es documented nnd �he c((ects on the'fNVV, as identified in the Rnpmms Guidnnce and
discussed in ihe Instructional Guidebook. �nctors to consider include, for example:
• Does ihe Iribwaq�, in combinntion �vith its adjacent �setlands (if nny), hnve the ct�pacity io carq� pollutan�s or tlood wnters to
'iN1A's, or to reduce tha amoun� of pollutanu or flood �vntcrs rcnching n'IN1A'?
• Does �hc tribu�nq�, in combinn�ion �vith its ndln�ent �vetlands (if any), provide habitnt nnd lifecycle support Cunctions for flish anA
other species, sucli as feeding. nesting spa�cning. o� renring young tor species ihnt nre prtsen� in Ihe TNIY?
• Does the �ribu�nry. in combination �vi�h its ndjacent ���e�lands (if any), have �he enpaeiq� to �rnnsfer nu�rien�s mid oreanic carbon thnt
support do�cns�ream food�ccbs?
. Does the tribWaq�, in combinntion �vilh i�s aAlaeent �cetlnnds (iGmy), have otlier relatimiships lo the physical, chemical, or
biological integrig� of �he'ITVV?
Note: the nbove list of considerations is not inclusive and other functions observed or I<nown to occur shoidd be documented
bclow:
l. Significnnt nesus findings Por uon-RP�V tiint h�s no ndjncent �vetlauds nnd (lo�vs directly m� indirecHy into TN\5's. Gsploin
❑ndings of presence or absence of signifiennt nesus belo�r, based on �he tributnq° itself, Ihen go to Seclion II7.D: .
2. Significnnt necus findings far non-RP�V and its adjacent �retlmids, where �he non-RP\1' ilo�rs directiy or indirectly into
TN�Vs. F.splain Gndings of presence or absence ol signiliemit ne�us belo�c, based on tl�e tribwary in combination �vith nIl of i�s
adjnccnf �vetlan�s, then go �o Section III.D: .
3. Siguificnnl necus findings fm� wetlands ndjacent to an RP\5' but thnt do not directl,y nbut the RYR'. Esplain �Tndings of
presence or absence of significnnt nexus belo���, based on the tributaq� in combinalion �vith all of i�s ndjaeent �vetlnnds, then go lo
Section III.D: .
D. DE'I'LR\IINATIONS O!' JURISDICTIONAL FINDINGS. THC SUBJECT �5'ATCRS/R'CTLANDS ARE (CHECK ALL
THA'1' APPLY):
L TNVVs nnd Adjncent VVetinnds. Check nll ihat apply and providc siu estimntes in rerie�r area:
❑'I'v�Vs: linear Icc[ �vi�th (ft), Or, �cres.
❑ VA'etlnnds adjxent to'I`N\Vs: acres.
2. RP�Vs tlmt tlow directly m� indirec�ly into TN\Vs.
�"fribularies of'ITNs �chere Iribu�aries typieaily flo�v yenrround nre lurisdictional. Proride data and rntionnle indicaling �hnt
tributaq� is perenniah There are deGned channcls nnd Flo�r has heen present on several site visi�s..
❑ Tributarics of TT'\V �vhere Iribumrics hnve continuous ilo�c °sensonally" (e.g., q�pienlly �hree months e.ich }'ear) are
jurisdictionnl. Data supponing this conclusion is provided at Section III.I3. Provide rutionale indicating tlmt tributaq� tlows
seasonally: .

Provide es�imntes iorjurisdic�ionnl �cnters in the revie�c area (check nll thn� apply):
❑ TribWnq� wnters: 500 linear Re� L2 �cidth (ti).
❑ Other non-�se�lancl �va�ers: acres.
Identif}� lype(s) of �vnters: .
3. Non-ItP\1'sa tliat ilow directh� or indirectiv into TN1\'s.
❑ 1Vn�erbody �hat is not a Ti ]AV or an RP\V, but tlo�as directly or indirectlp into n TNV1', and it has a signil7cant ne�us �vi(h n
TNN isjurisdictional. Data supporting this conelusion is provided al Sec�ion IILC.
Provide estimates lor jurisdictional wnters �vi�hin the revie�c area (check �dl �hal applr):
❑ Tributnn� �cnters: linenr feet �t�idtl� (il).
❑ O�her non-�vetland wuters: acres.
Identify type(s) o(waters: .
J. AVetlnnds directly nbu�ting nn RP�V that Oo�v direetly m� indirectly into TN�Vs.
❑ Netlands AirecUy nbut RP�V and (hus are jurisdictional as adjacen� �ve�lands.
❑VVctlnnds Airec�ly nbuttine an RP\V �vhere iribwaries q�pically Oow yearround. Provide da�a and rationale
indicnling that tributary is perennial in Section III.D?, abore Providc rationnle indicating tha� �retland is
directly abiming an RPIV: .
❑ Netlnnds diree�ly abutting nn RP1V �chert Iributaries typically Oo��� ..seasonally." I'rovide dulf� indicaling Ihat tributaq� is
sensonnl in Sec�ion III.f3 and rationale in Section III.D.2, abo��e. Provide rn�ionale indica�ing that wetland is dimetly
abuttin� an RPN: .
Provide aereaee estimates for I��risdic�ionnl �ceUan�s in the revie�e area: acres.
5. \1'etlnnds adjscent [o but not direcNy nbutting mi RP�V thnt Oow directl}� or indirectly into TN�Vs.
❑ lVeUnnds �hn� do not directly abut nn RPN, bul �chen eonsidered in combiimtion ���i�h the tributary to �vhich they are adjacent
and �sith similady simated adjnecnt �cetlnnds, hnve n significnnt nesus �vith n"INV1' nre jurisidictionnl. Dntn supporting this
conelusion is provided nt Section III.C.
Provide acreage estimates t'orjurisdictional �retlnnAs in the revie�v nren: nerzs.
G \Vetlnndsndjncent to non-RP�Vs tliat Oo�r direetly or indirectly in[o TN�Vs.
❑ lVellands adjnecn[ to such �vnters, �nd have �chen considered in combination with �he trihwary to �vhich �hey are acijacent and
�vi�h similnrip siluated acfjacent �retlands, hare a significnnt nesus ���ilh n"I'uN arejurisdictional. D�ta supponing �his
conclusion is providcd a� Scc�ion IILC.
Provide es�imntes For I�����sdictionul weUands in the revie�v area: acres.
7. Impoundments o(jurisdictional waters.'
As n genernl rule, ihz impoundment of ajurisdictional �ributnq� rcmnins jurisdictionnl.
❑ Demonstrnte thn� impowidment �vns erea�ed from "�cater, of the U.S.,'� or
❑ Demons�rnto that �vakr inccts the critcria for one of Ihe ca�egories prtsenled above ( I-6), or
❑ Demons�rate thnt �cater is isolated �vi�h a nesus ro commerca (see 8 belo�r).
B. ISOLATED �I\TERSTATE OR IN"PRMS'PATE� \VATCRS, INCLUDING ISOLATCD �1'ETLAYDS, THC USE,
DEGRAUA'fION OR DCSTRUCTION OF \5'HICII COULD A�f CCT INTERSTATC CODI�IERCC, INCLUDING A�l'
SUCH R'ATERS (CHCCK ALL TIIAT APPLI'):10
❑���hich nre or could bc uscd by intcrstnte or Poreign travelers for recreational or uther purpos-es.
❑ ti�om �vhich flsh or shclltish are or could be tnken �nd sold in interstate a foreign commeree.
❑�vhich arc or could be used for industrial purposes by industries in in�erlate commerce.
❑ Interstale isolated waters. Esplain: .
❑ Other factors. Gxplain: .
Identify ��•ntcr body nnd sununnrize rntionale supporting determination:
"See Footnole d 3.
' 7'o complete �he,malysis afer lo tlie key in Scetion III.D.6 of [he Ins�metional Guidebook.
'" Prior to assrrling m� Jeclining CR'A jw�isdiclim� bnsed solely on Ihis cafegorp, Corps Uistriefs �cill rlecNC Ihr netion lo Cm�ps nnd liPA IlQ for
rcric�c consislent ��ilh the pincess describecl in Ihe Corps/F.P.\ Dle�uormuhun Regrvding CII:I ArlJurisdiNiai Faflairing Rnpnnos.

Provide estimn�es for jurisdie�ionnl �vnlers in �he revie�c area (check all Ihnt apply):
❑ 'I'ributary �caters: linear feel �cidth (fQ.
❑ Olher non-�vetland �va�zr.,: acres.
Identilj'type(s) ol �vaters: .
❑ VVetlands: acres.
F. NON-JURISDICTIONAL R'ATCRS, INCLUDINC �VGTLANDS (CHCCK ALL THAT APPLY):
❑ If poten�inl �vetlnnds ���erz a�ssessed �rithin the revie�v area, these areas did no� mee� �he cri�eria in �he 1987 Corps of Gnginecrs
\VeUtind Delinention �danual and/or appropriale Regional Siipplements.
❑ Revie��� area included isolated �vaters �vith no subs�nn�inl nesus to intcrstate (or foreion) commeree.
❑ Prior lo thc Jan 2001 Suprcme Coun decision in "SII;dNCC," thc rcvicn° nrca would hnae bcen mgulated based solelv on the
"n4igra�oq� Bird 2ulc" (bIB2).
❑\Vn�crs Ao not meet the "Significnnt Nexus' slt�ndm�d, �chere such n finding is required forjurisdiction. Esplain: .
❑ Other. (esplain, ifno� coverad above): .
Provide acreage es�imates 1'or non-jurisdictional �va�ces in Iha mcie�c area, �ehere the sole potenlial basis ofjurisdiction is the MBR
li�ciors (i.c., presencc of migra�ory birds, presencc of endnngerzd spzcics, usc of wn�cr for irrigatcd agricultare), usine bes� prolessional
judgmcnl (check �II thal npply):
❑ Nun-�vetland �raterss (i.e.. rivers, streams): linear lcet �vidlh (li).
❑ Lakevponds: acres.
❑ Othcr non-�cdland ���atcrs: acres. List �ype of nquntic resourcc: .
❑ N'ctlands: acres.
Provide acreaoe esiimates for non-jurisdictianal wnters in �hc reri��v nrea Ihat do not mee� the "Signifcant Nesus' s�andard, wliere such
a lindine is required torjurisdiction (check nll that npply): ,
❑�on-���etland �v.aers (i.e., rivers, strenms): linear Icet, width (ft).
❑ Lakes/ponds: acres.
❑ Othor non-���c�lnnd «�nlcrs: acres. I,ist type of aquatic resourcr. .
❑ \VeUands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Dnfn rc��iewed (or JD (check all that apply - checked items shnll be included in cnsc tilc and, �nc�rc chcckcd
amd requested, appropriatal�� reference sources belo�v):
� D4aps. plans. pbts or pint submitted by or on beha�lf of the npplirnnt/considtant: .
❑ D��a shects prepnred/submitted by or on behalf of �he applicant/consultnnt.
❑ Office concurs �citli deta sheets/delineation report.
❑ Olficc does not wucur ���ith dntn sheets/delinention rzpor�.
❑ Dnta sheels prepnred by Ihe Corps: .
❑ Corps navigable �raters' study: .
❑ U.S. Geological Sun�ey Hydrologic A�las: .
❑ USGS 1JHD dntn. .
❑ USGS R and 12 digit HUC maps.
� U.S Geulogital Sun�e}' map(s). Cite scale @, quad name:Corbin Knob 12dk.
❑ USDA Natural Resources Conscrvation Scrvice Soil Sun�cy. Ci�a�ion: .
❑ Na�ionnl �cctl�nds inventoq� map(s). Cite nnme: .
❑ Stnte/I.ocul wetland inventory map(s): .
❑ FEMA/FIR�4 maps: .
❑ 100-year Floodplain 81eva[ion is: (Nnlionnl Gcodectic Vcrtical Dntum of 1929)
� Photogrnphs: ❑ Acrinl (Name R Dnte): .
or � Olher (Name fi Dnte):Culvect Sites Peb 2015.
❑ Prz��ious determination(s). File no. and date oCrespwise letter: .
❑ Applicable/suppoding case la�v: .
❑ Applicnble/supportine scientific liternture: .
❑ Other informetion (please specil'y): .
B. ADDITIONAL CODIIIENTS TO SUPPORT JD: 'I his form covers 5 impact sites for strenms. �I he strenms nre of similar size and
Inndscnpc posi[ion and nre tributaries lo Fulls Qranch.