20150411 Ver 1_Application_20150428

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
PAT L. MCCRORY
GOVFRNOR
April 28, 2015
Mr. Steve Kichefski
Asheville Regulatory Field Office
US Arxny Corp of Engineers
151 Patton Avenue
Asheville, NC 28801-5006
SUB7ECT: Pipe Replacement on SR ]324 (Talley Street), Iredell County
Dear Mr. Kichefski:
ANTHONYJ.TATA
SECRF.TARY
The North Cazolina Deparhnent of Transportation (NCDOT) requests authorizafion to replace a
deteriorating perched pipe on SR 1324 (Talley Street) in Iredell County. NCDOT proposes to replace the
existing perched 43.5 foot, 24" CMP with a 44-foot, 24" pipe. To provide some aquatic passage and to
prevent further downstream scour, the new pipe inlet will be placed at the existing streambed elevation
and the outlet will remain perched, with a 5 foot long 'rock ladder' constructed Yo reconnect the outlet
invert to the downstream bed elevation. A Yemporary cofferdam pumping system will be used to divert
the stream around the construction site as needed. Due to the site conditions, NCDOT request a waiver
from the Regional Conditions 2(b)(e) permit depth specification for the conetruction of thie project.
A temporary cofferdam pumping system will be used to divert the stream around the construcYion site as
needed. All areas affected by temporary cofferdam system will be restored to pre-project conditions.
The scope of the work involves UT to Hicks Creek, which is classified as Class WS-IV Waters by the
Division of Water Resources.
The project is noT located within '/z mile of any critical watershed area nor is SR 1324 a rural or urban
arterial; therefore, hazardous spill basins are not required. Enclosed is the hazardous spill basin checklist.
This office has conducted a GIS and field survey for the project for historical sites and
threaYened/endangered species sites. No sites listed on the National Register of Historic Places are
located in the vicittiYy of the project nor did fhere appear to be any eligible structures The federally listed
species for Iredell County (USFWS lisTed dated April 2, 2015) include the Dwarf-flowered Heartleaf
(Hexastylis nan�ora)- Threatened, Northern L,ong Eared Baf (Myotis septentrionalis)-Threatened, and
the Bog Turtle (Clemmys nsuhlenbergiz)- T/SA, Threafzned due to SimilariYy of Appearance. Natural
Heritage Program records document the nearest Dwarf-flowered Heartleaf locafion approximately 73.5
miles northwest of the proposed project area. The heartleaf is usually fotimd in acidic soils along bluffs
and adjacent slopes, in boggy areas next to streams and creek heads, and along the slopes of nearby
hillsides and ravities. The project area is a roadway and powerline ROW and adjacenY wooded and
pasture areas. There is little potential habitat within the proposed project area and no species were
observed during the site visiY. No impact on fhis species is anticipated.

SR 1324, Talley Street
Page 2
Apri128, 2015
Natural Heritage Program xecords document the nearest NorYhern Long Eared Bat locaTion approximately
40 miles west of the proposed project uea. During summer, northern long-eared bats roost singly or in
colonies anderneath bark, in cavities, or in crevices of both live and dead trees. They may also roosY in
cooler places, like caves and mines. Tree species may be used based on suitability to retain bark or
provide cavities or crevices. It has also been found, rarely, roosting in structures like barns and sheds.
Northern long-eared bats spend winter hibernating in humid caves and mines. No suitable roosting trees
will be impacted by the proposed project and the closest known underground mine location (per NIIP
database) is 5 miles west of the project area. Natural Heritage program records document the nearest bog
turtle location approximately 0..5 miles northeast of the proposed project area. Bog turtles are typically
found in bogs, marshes, and wet pastures. There is no suitable habitat located within Yhe project footprint.
T/SA species are not subject to Section 7 consultation; however, no impact on this species is anticipated.
I have enclosed a pre-construction notification for a NW#3, sketches of planned activities and location
map relative to the project.
Project information for the 401 Automated Payment Procedure is as follows:
• Work order number: 150461-55120005-12.204911-3126
• TIP#: NA
• Project CaYegory: $2A0.00 Fee
if you have any questions or concerns please feel free to contact me at [phone]. Thank you for
your time and considerarion on this matter.
Respectfully yours,
Reuben D. Chandler, P.E.
Division Engineer
Twelfth Division
BY: `
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Trish Beam
Division 12 Envuonmental Supervisor
Enclosures

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. A licant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 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 that apply):
� 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1e. 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 � Na ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes � No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: SR 1324 (Talley Street)
2b. County: Iredell
2c. Nearest municipality / town: Troutman
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state 12.204911
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: NC DOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Party (for LLC i f
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Infoemation (if different from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name: Reuben Chandler
4c. Busines s name N.C. Department of Transportation, Division 12
(if applicable):
4d. Street address: 1710 East Marion Street
4e. City, state, zip: Shelby, NC 28151
4f. Telephone no.: 704-480-9020
4g. Fax no.: 704-480-5401
4h. Email address: [e-mail]
5. AgenUConsultant Information (if applicable)
5a. Name: Trish Beam
Sb. Business name N.C. Department of Transportation, Division 12
(if applicable):
5c. Street address: 1710 East Marion Street
Sd. City, state, zip: Shelby, NC 28151
5e. Telepho�e no.: 704-480-9044
5f. Fax no.: 704-480-5401
5g. Email address: [e-mail]
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): NA
Latitude:35.694358 Longitude: -
1b. Site coordinates (in decimal degrees): 81.919857
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: <.10 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Ut to Hicks Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-IV
2c. River basin: Catawba
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:
Pipe on paved secondary road. Landuse is mostly residential/wooded.
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 feet
3d. Explain the purpose of the proposed project:
The purpose of the proposed work is to replace the deteriorating pipe for the safety of the travelling public.
3e. Describe the overall project in detail, including the type of equipment to be used:
The North Carolina Department of Transportation requests authorization to replace a deteriorating pipe on SR 1324
(Talley Street) in Iredell County. NCDOT proposes to replace the existing perched 43.5 foot, 24" CMP with a 44-foot, 24"
pipe. To provide some aquatic passage and to prevent further downstream scour, the new pipe inlet will be placed at the
existing streambed elevation and the outlet will remain perched, with a 5 foot long 'rock ladder' constructed to reconnect
the outlet invert to the downstream bed elevation. A temporary cofferdam pumping system will be used to divert the
stream around the construction site as needed. All areas affected by temporary cofferdam system will be restored to pre-
project canditions.
The Project will be constructed using typical heavy equipment (trackhoe, backhoe, etc.)
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ❑ Yes � No ❑ Unknown
Comments: Jurisdictional stream determination made by
Division 12 DEO.
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): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Project History
Sa. 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 fle" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes � No
6b. If yes, explain.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands � Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type ofjurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem ora T
W1 ❑ P 0 T ❑ �'es ❑ Corps
❑ No ❑ DWQ
WZ � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P ❑ T ❑ �'es ❑ Corps
❑ No ❑ DWQ
W4 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
WS ❑ P❑ T ❑ �'es ❑ 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.
3 a. 3 b. 3c. 3d. 3e. 3f. 3 g.
Stream impact Type of impact Stream name Perennial Type ofjurisdiction 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❑ T Additional pipe Ut to Hicks Creek � PER � Corps 2 0.5
length � INT � DWQ
S2 � P❑ T Rock ladder Ut to Hicks Creek � PER � Corps 2 5
� INT � DWQ
Temporary ❑ pER � Corps
S3 ❑ P� T cofferdam bypass Ut to Goble Creek � �NT � DWQ 2 60
pumping
S4 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P � T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacts
3i. Comments: 'Permanent Impacts= 5.5 feet: Permanent impacts contained within temporary dewatering impacts.
Page 5 of 11
PCN Farm — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number — (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tem ora 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
Sf. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
Si. Expected pond surface area (acres):
Sj. 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 require 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 ora T im act re uired?
61 ❑P❑T ❑Yes
❑ No
B2 ❑P❑T ❑Yes
❑ No
B3 ❑P❑T ❑Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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.
Inlet invert at streambed elevation and outlet invert to remain perched to mi�imize stream further scouring and to provide
limited aquatic passage.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Minimization of impacts by installing appropriate erosion control measures.
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 � No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is xequiced by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigat ion 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 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 project result in an impact within a protected riparian buffer that requires ❑ Yes � 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., payme�t to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 � 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: ❑ Yes ❑ No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? 0%
2b. Does this project require a Stormwater Management Plan? ❑ Yes � No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Complies with NCDOT's individual
NPDES permit NCS000250.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Govemment Stormwater Review
3a. In which local governmenYs jurisdiction is this project? NA
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management 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
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No
Page 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?
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 2B .0200)?
2b. Is this an after-the-fact permit application? ❑ Yes � No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in � Yes � No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a shoR narrative description.
The project is a minimum criteria project which has low potential for cumulative/indirect impacts and will not result in
additional development which could impact water quality.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater ge�erated from
the proposed project, or available capacity of the subject facility.
No wastewater generated from project.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or � Yes � No
habitat?
Sb. Have you checked with the USFWS concerning Endangered Species Act � Yes � No
impacts?
❑ Raleigh
Sc. If yes, ind icate the USFWS Field Office you have contacted.
❑ Asheville
Sd. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program database and feld survey.
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?
No salt marshes, oyster reefs, or seagrass beds located in vicinity of project.
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?
The State Historic Preservation office resources and the National Register of Historic Places were reviewed for historic
sites in the vicinity of the project; however, the pipe replacement project occurs within a previously impacted area
(NCDOT Right of Way).
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:
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM panal number: 3710472100J
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�, �- �h`�n�/.vs � ` � L, �:�$' ��-.
Applicant/AgenPs Printed Name ApplicanUAgents Signature Date
(AgenYs signature is valid onty if an authorization letter from the appiicant
is rovided.
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

Pipe Replacement
Talley Street (SR 1324)
Iredell County
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APPROVED JURISD1CT10NAL DETERMINATION FORM
U.S. Army Corps of Engineers
This forrn should be wmpleted by following the instructions provided i� Section N of the SD Form Instrncfional Guidebook.
SECTION I: BACKGROOND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JUffiSDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC CounTy/padsh/boiough: Iredell CiCy: Troutrnan
Ce�ter coordinates of site (laUlong i¢ degree decimal fonnat): Lat. 35.69A358° l�, Lo�g. 809198�7° l3'.
Universal Transverse Mercator:
Name of nearest watexbody:
Nazne of nearest Traditional Navigable Water (TN1� lnto which the aq�atic cesoucce flows: Hicks Creek
Name of watershed or Hydxologic Uuit Code (HUC): 03050101150040
� Check if map/diagram of review azea and/or potential jurisdictional azeas is/aze available upon req�est.
,_-�'� Check if other sites (e.g., offsitemit�igation sites, disposal sites, etc...) are associaLed with this action and aze cecorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPL1�:
� Ofrce(Desk)Determination. Date:4/27/15
,� Field Determination. Date(s):
SECTION II: SUIVI�VIARY OF FINDINGS
A. RIIA SECTION 10 DETERMINATION OF .TIJRISDICTION.
There Are�nd "navigab[e waters of ihe US" within Riveis and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in tt�e
review azea. [ReguiredJ
[( Waters subject to the ebb and flow of the tide.
Q W aters are presently used, or have bee� used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There AC�e "waters of the US" within Clean Wafex Act (CWA) jurisdiction (as defined by 33 CFRpart 328) in the review azea [Xequired�
1. Waters of the U.S.
a IndicaYe presence of watere of II.S. iu review area (check all that apply): �
�� TNWs, including territorial seas
[] Wetlacids adjacent to TNWs
� Relatively permanent waters� (RPWs) that flow directly or indvectly into TNW s
j� Non-RPW s that flow directly or indixectly into TNWs
� Wetla�ds directly abutting RPWs that flow diceetly or indirectly into TNWs
� Weelands adjaeent to but not directly abutting RPWs that flow dueetly oc ind'uectly into 7'NWs
� Wetlauds adjace�t to non-RPWs that flow directly or iodireetly into TNWs
�] Impoundments ofjurisdictional waters
� TsolaCed (interstate or intrastate) waters, including isolated wetlands
b. Ideutify (estimate) size of waters of the U.S. in the review area:
Non-weLle�id waters: L00 linear feet: 2 width (ft) and/or acres.
Weflands: NA accos.
c. Limits (bouudaries) ofjurisdiction based on. Est�blished byf3L9W&1;
Elevation of established OHWM (if Imown): .
2. Non-regulaYed waEers/wetlands (check if applieable):'
� Potenrially jurisdictiooal waters and/or wetlands were assessed within the review erea a�id determined to be not jurisdictiooal.
Explain:
� Boxes checked below shali be supported by wmpleting tlie eppxopriate sections in Section III below.
'' Fox pueposes ofthis fonn, an RPW is defined as a tcibutary that is not a TNW and fl�at typically flows year-round or has continuous Ylow at least"seasonally'
(e.g., typically 3 mon9�s).
' Supporting documenta[ion is pcesented m SecSon III.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacenk to TNWs. If the aquatic resource is a TNW, complete
Section IIl.A1 and Section IiI.D1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A1 and 2
aud SecYion III.D1.; otherwise, see Section IILB below.
1. TNW
IdentifyTNW: NA.
Summarize rationale supporti¢g detecmination:
2. WetlandadjaceottoTil'W
Summazize �ationale supporting conclasion that wetland is "adjacenP':
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJAC&NT 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 Yne etandards for jurisdiction established under Rapaooshave been meY.
The agencies will assert jurisdiction over nomnavigabie 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 aquaYic resource is not a TNW, but has year-round
(perennial) flow, skip Yo Sectiou III.D.2. If the aqaatic resource is a wetlaud direcNy abutting a tributary with perenuial flow,
skip to Section III.D.4.
A wetland that is adjacent Yo but that does not directly abut an RPW requires a signi£canY nexoe evaluation. Corps districts and
EPA regions will include in the record any available iuformatiou Chat documents the e�stence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacenY wetlands if any) and a traditional navigable water, eve�
though a significant nexus finding is not required as a matter of law.
If the waterbody° is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary hae 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 adjaceut wetlands, completa Section III.B.1 for
the tributary, Section IR.B.2 for any onsiYe wetlands, and Section IlI.B.3 for all wetlands adjacent Yo that tribuYary, both onsite
and offsite. The deYermination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non-TNWs thaY flow directly or indirectly into TNW
(i) General Area Conditions:
_..._._..__.___..
Watershed size 03 §quar¢iriilcs
Drainage area� 03 agqai'etnil'es�
Average annual rainfall: 46 inches
Average annual snowfall: 5 inches
(ii) Physical Characteristies:
(a) Relationship with TNW:
❑ Tributazy flows directly ioto TN W.
❑ Tributary flows through3�'tributaries before entering TNW.
Project waters aro 1, �ur.3asa� river miles from TN W.
Project waters are 1-2 river miles from RPW.
Project waYers aze -�_� aerial (stcaight) miles from TNW.
Project waters aze 1(aY LesS� aerial (straight) miles from RPW.
Pxoject wate�s cross or serve as 5tate boundaries. Explain:
Identify flow ioute to TN Ws: Onnamed tributary to Hicks Creelc to Lake Norman .
Tributary stream order, if known: ]s` order.
' Note [hat the lnstcuc[ional Guidebook contauis additional infomiation reg�ding swales, ditches, wuhes, and erwional fcalures generally and �i the azid
West.
' Plow route can be described by identifying, e.g, fributazy a, which flows tluough ttie review are� W flow into [rbutary b, whicli then flows in[o TNW.

culveR
(b) General Triboearv Chazacterisrics (check all that applyZ
Tributary is: ❑ Natural
❑ Artificial (man-made). Explain: .
� Manipulated (man-altered). Explain: Upstream and downstream of road c�lvert.
Tributary pxoperties with respect to top of bank (esYimate):
Average width: 2 feet
Average depth: 25 feet
Average side slopes 2:2��,.
Primary tributary sobstrate composirion (check all that appLy):
� Silts � Sands ❑ Concrete
❑ Cobbles � Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/%covcr:
❑ Other. Explain: .
Tcibutary condiCion/stabiliry [e.g., highly eroding, sloughing banks]. Explain_ Fairly stable except for scour at end of
Presence of ron/riffle/pool complexes. F,kplain: Mi�or sotting inCO riPfle/pools evideut.
Tributazy geometry: R8lativg�.q sYrsigLt
Tributary gradient (approximate average slope): 7%
(c) Flow:
Tributazy provides for: Zater.fjiMutkent 6qf trat seaspnai _Ilow
Estimate average number of flow events in review area/yeaz� 6=�(�
Describe flow regime: .
Othec information on duraCion and volume: .
Surface flow is: i3yerland s1i�Ei;flUt�, Characteristics:
Subsurface flow: Y�s. Explain findings:
❑ Dye (or other) test performed:
Tributary has (c6ec1< all that apply):
� Bed and banks
� OHWM6 (check all indicators that apply):
� clear, natural line impressed on the bank �
❑ changes in the character of soil �
❑ shelving �
❑ vegetation matCed down, bent, or absent �
� leaf litter disturbed or washed away �
� sediment deposition ❑
� water staining ❑
❑ other (list):
❑ Discontinuous OHW�R.' �xplain: .
ihe prescnce of litter and debris
destruction oFterrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
If factors oiher 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 ox scum line along shoce objects ❑ survey to available dat�m;
❑ fine shell or debris deposits (foreshore) ❑ physical mazkings;
❑ physical madcings/characterisfics ❑ vegetarioo ]ines/chaages in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical CharacEeristics:
Characterize tribatary (e.g, water color is clear, discolored, oily film; water qualiry; general watershed chacacterisUCS, ete.).
Explain: Relafivety clear water, some �filamentous.
Identify specific pollutants, if known: .
`A natural or man-made discon[inuity in the O11WM does nM necessarily severjurisdiction (e.g., where the shean tempoxarily flows undecground, ox where
the OHWM has been removed by de�lopment or agricuPoaral practices). Where there is abreak in the OHWM that is ur¢elated to ttie waterbody's flow
regime (e.g., flow ovee a mck outerop oc through a oulvert), the agemies will loolc foe indicators of flow above andbelow the brealc.
�ibid.

(iv) Biological Characteristics. Channel supports (check all thaY apply):
� Ripaziau coRidor. Characteristics (type, averagewidth): .
❑ Wetlandfringe. Characteristics: .
❑ }�labitatfor:
❑ Federally Listed species. Explain findings: .
❑ Pish/spawn areas. Explain findings: .
❑ Other emironmentatty-sensitive species. Explain findings: .
� Aquatic/wildlife diversiry. Explain findings: None obscrvcd, but assumcd present..
2. Characteristics of wetlaods adjacent to non-TNW that flow directly or indirecYly inYo TNW
(i) Physical Characteristica:
(a) Genecal Wetlaod Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain: .
Wetland qualiry. �xplain: .
Project wetlands cioss or serve as state boundazies. Explain:
(b) General Flow Relationship with Non-TNW:
Flow �s. p"ickT,isf. Explain: .
Surface flow is: P.iGk List
Chazacterisrics: � .
Subsurfaceflow:PiCk�,is�. Explainfindings:
❑ Dye (or other) test performed: .
(c) Wetland Adjacency Determination with Non-TTIW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connecrion. Explain:
❑ Ecologicalconnecfion. Explain: .
❑ Separated by berm/barrier. Explain: .
(d) Proacimity (Relafio�shi�) to TNW
Pxoject wetlands are �eh.Y:c�' river miles from TNW.
_.:
Project waters aze PtqkLi's� aerial (straight) miles from TNW.
Flow is from. EiCk�L9st.
Estimate approximate location of wetland as within the Pick�,±i9t floodplain.
(u) Chemical Characterietics:
Chazacterize wetland sysCem (e.g., water color is cleaz, brown, oil film on surface; water qualiry; general watecshed
characterisrics; ete.). Explain: .
Identify specific pollutants, if known: .
(iii) Biological Characteristics. WeNaud supports (cheek all thaY apply):
❑ Ripariac� buffer. CharacterisCics (type, average width): .
❑ Vegetation Type/percent cover. Eacplain: .
❑ Habitat for:
❑ Federally Listed species. ExpLain findings: .
❑ Fish/spawn areas. Explain findings: .
❑ OEher environmentally-sensitive species. Explain findirigs:
❑ Aquafic/wildlife diversiTy. Explain fndings: .
3. Characteristics of all wetlands adjaeent to the tributary (if any)_ _..
All wetland(s) being considered io the cumulative analysis:'�ie� GisE
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directiv abuts7 (Y/N� Size (in acces) Directly abutsP (Y/N) Size (in acres)
Summazize overatl biological, chemical and physical functions being performcd: .
C. SIGNIFICANT NEXUS DETERMINATION
A siguiTicant nexus analysis will assess the flow characteristics and functions ofthe tribut�ry itself and the functions performed
by any wetla�ds adjacent to the tributary to determine if they eignificantly affect the chemical, physical, aud biological integriTy
of a TNW. For each of the following situations, a significant nexus exists ifthe tributary, in combination with all of its adjacent
wetlands, has more than a spec�lative or insubstantial effect on Yhe chemical, physical and/or biological integriTy of a TiVW.
Considerations when evaluating significant nexus indude, but are uot 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
weYlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact au adjacent wetland lies within or
outside of a floodplain is not solely determinative of signi£cant nexus.
Draw conuections beYween the features documented and the effects on the TNW, as identified in theRapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlends (if any), have the capaciCy Co carry pollutants or flood waters to
'PN W s, or to reduce the amount of pollutants or flood waters reaching a TTIW7
• Does the tcibutary, 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 reazing young for species that ue present inthe TNW?
• Does the tributary, in combinarion with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstrcam foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemieal, oc
biological inCegriYy of the TNW?
Note: the above list of considerations is not inclusive aud other funetions observed or knowu to occur should be dowmented
below:
1. Significant nexus Sndiugs for non-RPW that has no adjacent we8ands and flows directly or indirectty into TNWs. Explain
fiodings of presence or absence of significant nexus below, based on the tributary itseif, then go to Section IILD: .
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
T1VWs. Explain findings of presence or absence of significant nexus below, based on the tcibutary in combination with all of its
adjacent weClands, then go to Section III.D: .
3. Significant nexus Sndings for wetlands adjacent to an RPW but that do not direetly abut the RPW. Explain findings of
presence or absence of significa�t nexus below, based on the tributary in combinatiou with all of its adjacent wetlands, then go to
Section III.D: .
D. DETERMINATIONS OF JURISDICTIONAL FL�'DINGS. THE SUBJECT WATERS/WETLANDS AR� (CHECK ALL
THAT APPLI�:
1. TNWs and Adjacent WeHands. Check ail that apply end provide size estimates in review area:
�} TNWs: li near feet width (ft) , Or, acres.
[]'�.. Wetlands adjacent to TNWs: acres.
2. RPWs Yhat flow directly or indiractly into TNWs.
�' Tributaries of T1VWs where tributaries rypically flow yeaz-round aze jurisdictional. Pcovide data and rationalc indiearing that
tributary is perennial: .
,'� Tributaries of TNW where tributaries have continuous flow "sea.sonalLy' (e.g., typically three months each year) are
jurisdictionaL Data supportiug this conelusion is provided at Seetion III.B. Provide xationale indieativg that riibutazy flows
seasonally: .

Provide estimates for jurisdicrional waters in the review azea (check all that apply):
�, Tributary waters: 100 linear feet 2 width (fr).
� Other non-wetland waters: a cres.
� Identify rype(s) of waters: .
3. Non-RPWsa that flow directly or indirectly into TNWa.
� Waterbody that is not a TNW or an RPW, but flows direcUy or indirectly into a TNW, and it has a significant nexus with a
�� TNW is jurisdictional. Data supporting this conclusion is pcovided at Section IILC.
Provide estimates forjurisdictional waters within the ieview azea (check all that apply):
� Tributary waters: Iviear feet width (ft).
[� Other non-wetland watcrs: acres.
� � Identify type(s) of waters: .
4. Wetlands directly abutting an RPW that flow directly or indirectly into T1VWs.
�� Wetlauds directly abut RPW and thus aze jarisdictional as adjacent wetlands.
�� �� � Wetlands d'uectly abuteing an RPW where tributazies typically flow year-rou�d. Provide data and rakionale
�� indicating Yhat tributary is perennial in Secfion III.D.2, above. Provide raCionaLe indicating that wetland is
directly abutting an RPW: .
� Wetlands directly abutting an RPW where tributazies typically flow "seasonally" Provide data indicati�g that tributary is
seasonal in Section III.B and rarionale in Secrion III.D.2, above. Provide ra5onale indicating that wetlend is directly
abutting an RPW: .
Provide acreage estimates foc jurisdietional wetlends in the review azea: acres.
5. Wetlands adjacent to but not directly abufting an RPW that flow directly or indirectly into TNWs.
� WeYlands that do not directly abut an RVW, but when considered in combination with the tcibutary to which they aze adjacent
��� � and with similacly situated adjacentwetlands, have a significant neavs with a TNW are jurisidictional. Data supportiog this
conclusion is provided at Section III.C.
Provide acreage estimates for jurisdictio�al wetla�ds in the review area: acres.
6. WeUands adjacent to non-RPWs that flow directly or indirectly into TNWs.
�' WeYlands adjacent to sueh waters, and have when considered in combination with the tcibutary to whieh they aze adjacent and
with similady situated adjacent wetlands, have a significant neacus with a TNW are jurisdictional. Data supporting this
conclusion is pcovided at Secrion III.C.
Provide estimates forjurisdictional wetlands in the review azea: acres.
Z ImpoundmentsofjurisdicYionalwaters.'
As a ge�eral rule, the impoundmeut of ajurisdictional trbutary remains jurisdictional.
� Demonstrate that impouodment wes created �From "waters of the U.S.," oi
}� Dcmonstrate that water meets fhe criteria for one of the categories presented above (I-�, or
Q Demonstrate t�hat water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE� WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATLON OR DESTRUCTION OF WAICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCA WATERS (CHECK ALL THAT APPLY):10
� which are or coold be �sed by interstate or foreign travelers for recreational oc otlier purposes.
� from which fish or sliellfish aze or could be ta.l<en and sotd in interstaee or �£oreign conunerce.
[] which azc or could be used for indusirial purposes by industries in intcrstate commerce.
[� lnterstate isolated waters. Explain: .
[]'�. Other factors. �xplain: .
Identify water body aud summarize rationale supporting determination:
eSee Footnote # 3.
9 To complete the aialysis refzr m the key in Section III.D.6 of the Ins[ructional Guidebook.
10 Prior Yo aseer[ing or decliniug CR'A juristliction based solely on this category, Corps Districts will eicvatc thc acfion N Corps and EPA HQ for
review consistcntwith the process described in the Corps/EPA Memorandum Regnrding CWA Ac1 Jurisrttcdon Fo/lowingRapnnos.

Provide esrimates for jurisdicfional waters in tY�e review aren (check al] that apply):
[� Tributary waters: linear feet widt h(Pt).
� Other non-weUand waters: acres.
� �� � Idenlify rype(s) of waters: .
Q', Wetlands: acres.
F. NON-JiJRISDICTIONAL WATERS, 1NCLUDING WETLANDS (CAECKALL THAT APPLY):
� If potential wetlands were assessed within the review azea, these azeas did not meet the criteria in the 1987 Corps of Engineers
WeUand Delineation Manval and/or appropriate Regional Supplements.
� Review azea included isolated waters with uo substantial nexus to interstate (or foreign) commerce.
���� ❑ Pxior to the Jan 2001 Supreme Court decisiw in "SWANCC," the review azea woald have been regulated based soleLv on tLie
"Migratory Bird Rule" (MBR).
� Waters do not meet the "Significant Nexus" seendard, where such a finding is required forjurisdictiou. Explain: .
[� Other. (explain, if not covered above): .
Piovide acreage estimates Por non-jurisdictional waters in the review azea, where the so e potential basis oFjurisdiction is the MBR
factors (i.e., presence of migratory bicds, preseoee of endange�ed species, use of water for irrigated agciculture), using best professional
j�dgment (check all that apply):
� Non-wetland waters (i.e., rivers, streams): li neaz feet width (ft).
�{ Lakes/ponds: acres.
� Other non-weCland waters: acres. List type of aquatic resource: .
[� Wetlands: acres.
Provide acreage estimates for non jurisdictionaL waters in the review azea that do not meet the "SigoificantNexus" standazd, where sucL
a finding is �equieed for jurisdiction (check all that apply):
� Non-weYland waters (i.e., riveis, streams): li near feet width (�fi).
Q Lakes/ponds: acres.
� Other non-wctland waters: acrea List type of aquatic cesource: .
[f'�, Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall be incl�ded in case file and, where checked
and requested, appropriately refi'erence sources below):
� Maps, plans, plots or plat submitted by or on behalf of the applieanUconsultant: .
�{ Data sheets prepaxed/submitted by or oo behalf of the applicanUconsultanC.
❑ Offico coneucs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation eeport.
[;�'���.. Data sheets prepared by the Corps: .
[�� Corps uavigable waters' study: .
� U.S. Geological Survey Hydrologic Atlas: .
❑ USGS NHD data.
❑ USGS 8 and 12 digit HLJC maps.
� D.S. Geotogical Survey map(s). Cite scale & quad name: .
Q USDA Natural Resourees Conservation Service Soi] Survey. Citation: .
� Nariooal wetla�ds imentory map(s). Cite name: .
� State/L.ocal wetland inventory map(s): .
�;] FEMA/FIRM maps: .
� 100-year Floodplain Elevation is: (National Geodectic Vertica] Datum of 1929)
� Yhotographs: ❑ Aerial (Name & Date): .
or ❑ Other (Name & Date): .
� Previous determinatioa(s). File no. and date of response letter: .
�, Appliceble/supporting case law: .
� Applicable/supportiug scientific literature: .
� Other informatio� (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD:

NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 1 �. County: Tredell Project ID: 12.204911
River Basin: _ Catawba Bridge No: NA
Route: SR 1324
Water Quality Criteria:
Stream: Ut to Hicks Creek
Stream Crossing Blue Line On USGS
ORW
WSI
WS II,III OR IV, Crossing Within O.Smi of W.S. Critical Area
Roadwav Criteria:
Route Designation-
Additional Site Information:
Yes No
Arterial Urban 3� �
Arterial Rural �` �
Yes No
Is a Hazardous Spill Basin Required? � �
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
Yes No
�` �
�` �
r' r�
� �