20150404 Ver 1_401 Application_20150415

t.Lear ater
C1earWater Environmental Consultants, Inc.
April 24, 2015 www.cwenv.com
Mr. David Brown
US Army Corps of Engineers
Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, North Carolina 28801 -2638
Ms. Jennifer Burdette
NC DWR, 401 & Buffer Permitting Unit
512 North Salisbury Street, 9h Floor
Raleigh, North Carolina 27604
RE: Ingles - Waynesville
Nationwide Permit 3 - Culvert Replacement
Haywood County, North Carolina
Dear Mr. Brown and Ms. Burdette,
2 0 1 5 0 4 0 4
The attached Pre - Construction Notification (PCN) is being submitted on behalf of Ingles Markets
Inc. represented by Mr. Preston Kendall. The project site is located off Russ Avenue (US -276) in
Haywood County, North Carolina. Ingles Markets Inc. is requesting a Nationwide Permit 3 for
the replacement of an existing culvert.
Please do not hesitate to contact me at 828 -698 -9800 if you have questions regarding the attached
PCN and supplemental information. A copy of this package has been sent to Ms. Andrea Leslie
of the NC Wildlife Resources Commission and Mr. Bryan Tompkins of the US Fish and Wildlife
Service for review. A copy of this application has also been submitted to Mr. Ed Williams of the
NC Division of Water Resources, Asheville Regional Office.
Respectfully,
Kevin Mitchell
Biologist
Copy Furnished:
NC Wildlife Resources Commission — Andrea Leslie
US Fish and Wildlife Service — Bryan Tompkins
NC Division of Water Resources — Ed Williams
224 South Grove Street, Suite F
Hendersonville, NC 28792
828 - 698 -9800 Tel
828- 698 -9003 Fax
-R. Clement Riddle, S
Principal

Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name: Ingles - Waynesville — Culvert Replacement
2. Name of Property Owner /Applicant: Ingles Markets Inc.
3. Name of Consultant/Agent: ClearWater Environmental Consultants, Inc.
*Agent authorization needs to be attached
4. Related/previous Action ID numbers(s): n/a
5. Site Address: 201 Barber Blvd.
6. Subdivision Name: n/a
7. City: Wayneville
8. County: Haywood
9. Lat: 35.504299N Long: - 82.987109W (Decimal Degrees Please
10. Quadrangle Name: Clyde
11. Waterway: UT to Richland Creek
12. Watershed: French Broad 06010106
13. Requested Action:
X Nationwide Permit # 3
General Permit #
Jurisdictional Determination Request
Pre- Application Request
The following information will be completed by the Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/Nature of Activity/Project Purpose:
Site/Waters Name:
Keywords:

CLearWater
Department of the Army NCDENR
Wilmington District, Corps of Engineers NC DWR, Webscape Unit
Attn: Scott McLendon, Chief Regulatory Division Attn: Karen Higgins
PO Box 1890 512 North Salisbury Street
Wilmington, NC 28402 -1890 Raleigh, North Carolina 27604
I, the current landowner /managing partner of the property identified below, hereby
authorize ClearWater Environmental Consultants, Inc. (CEC) to act on my behalf as my
agent during the processing of jurisdictional determination requests and permits to impact
Wetlands and Water of the US subject to Federal jurisdiction under Section 404 of the
Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. CEC is
authorized to provide supplemental information as needed at the request of the USACE
or DWR.
Additionally, I authorize representatives of the Wilmington District, US Army Corps of
Engineers to enter upon the property herein described for the purposes of conducting on-
site investigations and issuing a determination associated with Wetlands and Waters of
the US subject to Federal jurisdiction under Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act of 1899.
Property Owner of Record: T N6,L45 fAk L)(L-I 5 1AJC.
Property Owner of Address: ?r . 0. G o%, 610L,
%Ni-evzt.ct: , .�JL asc6 tla
Phone Number: 25-25 - -2GS- MI 2
Property Location: 9AR66C 1 VA I�tJM.vrSJr�lt- UL a$)6G
Owner/Managing Partner
Printed Name: RC ST On/ KE,V -OA _L Z,Vw"r-s'"441'rr
Owner/Managing Partner Signature:`
Date: 3 _ -� - 15
224 South Grove Street, Suite F
Hendersonville, NC 28792
Phone: 828 - 698 -9800
www.cwcnv.com

Parcel Information

4!232015
Printed: 22 APR 2015 - by 0
Page: 1
CARD 1 OF 1
Tax Year : 2015
Description
Parcel : 8616 -22 -7311 RUSS AVE
WAYNESVILLE
maps. haywoodnc .nettprcl8616227311_1.txt
Haywood County NC Property Record Card
Tax Districts
C15 TOWN OF
------ ---- - - - - - -- OWNER INFORMATION ------------ - - - - -- I --- - - - - -- PROPERTY FACTORS ---- - - - - --
-- - - - --- SALES INFORMATION -- - - - - --
I I
ACCT: 40373 INGLES MARKETS INC I Topography
I Date Sales Price Vld Bk /Pg
P 0 BOX 98309 I R ROLLING
10/14/83 1,350,000 M 345/459
ATLANTA, GA 30359 I
(
I Land Mkt Adj Streets /Roads
I
I I P PAVED
--- ---- - - -
- -- MISCELLANEOUS INFORMATION --------
- - - - -- I - - - - - -- ENTRANCE INFORMATION -- - - - - --
I ---- - - - -
-- VALUE SUMMARY ---- - - - - --
I
I
Township
15 TOWN OF WAYNESVILLE
I Date Type Source Appraiser
I
Assessed Current
Address :
RUSS AVE
1 01/28/11 8 RSM
I Land
750,700 750,700
Land Use
1 07/08/10 1 FHB
I Bldg
7,600 7,600
Nbrhood
15C011 RUSS AVE COM /IND
I
I Tot Appr
758,300 758,300
Map
8616.18
I
I Defer
0 0
Class
R1 RESIDENTIAL 1
I
I Net Taxable : 758,300 758,300
Remarks:
No Remarks on file
- -- LAND DATA - --
# MTH TYPE
TAX
1 A CP COMMERCIAL PRIMA
472,500
2 A CS COMMERCIAL SECON
247,500
httpJ/ maps. twywoodnc .neuprc /8616227311_1.txt
UNIT
SIZE PRICE GRADE
1.50 350,000
1.00 275,000
--- -- - - - --- V A L U E S- - - - - --
%AD7 APPR DEFER
T -10 472,500 0
T -10 247,500 0
1/3

4/23/2015
maps.haywoodnc.neWc /8616323480 1.1x1
Printed: 22 APR 2815 - by 0
Haywood County NC Property Record Card
Page:
1
CARD 1 OF 1
Tax Year
2015
Description
Tax Districts
Parcel : 8616 -32 -3480 135 BARBER BLVD
C15 TOWN OF WAYNESVILLE
----------- - - - - -- OWNER INFORMATION ------------
- - - - -- --- - - - - -- PROPERTY FACTORS ---- - - - - -- -- - - - - -- SALES INFORMATION - - - - --
ACCT: 40373 INGLES MARKETS INC
Topography Date Sales
Price Vld
Bk /Pg
P O BOX 98309
F FLAT 10/e2/92
5,724,000 N
430/646
ATLANTA, GA 30359
( 10/14/83
1,350,000 M
345/459
Land Mkt Adj Streets /Roads
P PAVED
------- - - - - -- MISCELLANEOUS INFORMATION -------- - - - - -- - - - - - -- ENTRANCE INFORMATION -- - - - - -- ---- - - - - --
VALUE SUMMARY -- - - - - --
Township 15 TOWN OF WAYNESVILLE
Date Type Source Appraiser
Assessed
Current
Address 135 BARBER BLVD
01/28/11 8 RSM Land
1,129,6ee
1,129,600
Land Use
07/08/10 1 Tenant ]HB Bldg
1,828,100
1,828,180
Nbrhood 15C011 RUSS AVE COM /IND
Tot Appr
: 2,957,7ee
2,957,700
Map 8616.18
Defer
0
0
Class RI RESIDENTIAL 1
Net Taxable 2,957,700
2,957,700
Remarks:
No Remarks on file
- -- LAND DATA - --
UNIT ----------- V A L U E S----- - - - - --
# MTH TYPE SIZE
PRICE GRADE %AD1 APPR DEFER TAX
1 A CP COMMERCIAL PRIMA 3.86
350,090 1,050,000 a 1,eS8,ee0
2 A CR COMMERCIAL RESID 0.91
87,508 79,608 0 79,600
Total Acres : 3.91
Land Totals 1,129,608 a 1,129,6ee
- -- OUTBUILDINGS - --
YEAR EFF YR
BLDG# TYPE MTH DESCRIPTION
REMARKS %COMP STORIES AREA GRD BUILT BUILT COND PHYS
FUNC ECON TAX
VALUE
2 PVC 0 PAVING, CONCRETE
CONC IN FRONT OF LD 188 0.0 1,980 + + +■
25
2,2ee
3 PVA 0 PAVING, ASPHALT
-CONC IN FRONT OF 8 lee e.0 S7,858 •••+
25
37,400
4 PVA 0 PAVING, ASPHALT
PAVING LEFT OF BLDG 180 0.0 18,624 +'••
25
15,7e0
5 CLF 0 CHAIN LINK FENCE
lee e.0 57 +• ►+
25
300
6 LMT 0 LIGHTING, MULTI
lee 0.0 7 *'••
25
5,300
60,900
End of Page 1
httpJ/maps,haywoodnc.net/prc/8616323480-1 Ix t
CARD 1 OUTBUILDING VALUE
1/2

4=015
Printed: 22 APR 2015 - by 0
Page: 1
CARD 1 OF 1
Tax Year : 2015
Description
Parcel : 8616 -32 -8401 201 BARBER BLVD
WAYNESVILLE
231 BARBER BLVD
255 BARBER BLVD
261 BARBER BLVD
267 BARBER BLVD
277 BARBER BLVD
287 BARBER BLVD
maps. haywoodnc .neVprc /8616328401_l.bct
Haywood County NC Property Record Card
Tax Districts
C15 TOWN OF
-- ------- --
- - - - -- OWNER INFORMATION ------------
- - - - -- ( --- - - - - -- PROPERTY FACTORS ---- - - - - --
-- - - - - --
SALES INFORMATION -- - - - - --
I
I
ACCT: 40373
INGLES MARKETS INC
I Topography
I Date
Sales Price Vld Bk /Pg
P 0 BOX 98309
I F FLAT
i 10/02/92
5,724,000 N 430/646
ATLANTA, GA 30359
I
I
I Land Mkt Adj
Streets /Roads
I
P PAVED
- -- MISCELLANEOUS INFORMATION --------
- - - - -- ( - - - - - -- ENTRANCE INFORMATION -- - - - - --
- ------ - - -
I - --- - - - -
-- VALUE SUMMARY ---- - - - - --
I
I
Township
15 TOWN OF WAYNESVILLE
I Date Type
Source Appraiser
I
Assessed Current
Address
201 BARBER BLVD
1 01/28/11 8
RSM
I Land
2,840,700 2,840,700
Land Use
1 07/09/10 1
Tenant GWW
I Bldg
4,108,000 4,108,000
Nbrhood
15C0ll RUSS AVE COM /IND
I Tot Appr
: 6,948,700 6,948,700
Map
8616.18
I Defer
0 0
Class
R1 RESIDENTIAL 1
I Net Taxable : 6,948,700 6,948,700
Remarks:
LAND ADJUSTMENT FOR RESIDUAL = SIZE /EASEMENT /TOPO /ETC
INGLES /FORMER GOODYS & OTHERS
- -- LAND DATA - --
UNIT ----- - - - - -- V A L U E S-- - - - - --
http. // maps. haywoodnc .net/prc/8616328401_1.td 1/4

oC'0� W ArE9OG
T_
1 1 > y
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre - Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit ❑Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1 c. 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
1 e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
If. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or In -lieu
fee program.
❑Yes
® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
Ingles — Waynesville — Culvert Replacement
2b. County:
Haywood
2c. Nearest municipality / town:
Waynesville
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state
project no:
N/A D
3. Owner Information
3a. Name(s) on Recorded Deed:
Ingles Market Inc. APR 2
3b. Deed Book and Page No.
3451459; 430/646
3c. Responsible Party (for LLC if
applicable):
Preston Kendall 401$ BUFFER RE-S-0---J
URCES
ERMITT�NG
3d. Street address:
PO Box 6676
3e. City, state, zip:
Asheville, NC 28816
3f. Telephone no.:
828 - 768 -3992
3g. Fax no.:
N/A
3h. Email address:
N/A
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
R. Clement Riddle
5b. Business name
(if applicable):
ClearWater Environmental Consultants, Inc.
5c. Street address:
224 South Grove Street, Suite F
5d. City, state, zip:
Hendersonville, North Carolina 28792
5e. Telephone no.:
828 -698 -9800
5f. Fax no.:
n/a
5g. Email address:
clement @cwenv.com
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):
8616 -22 -7311; 8616 -32 -8401; 8616 -32 -3480
1b. Site coordinates (in decimal degrees):
Latitude: 35.504299N Longitude: - 82.987109W
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
+/_ 29 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
UT Richland Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
B
2c. River basin:
French Broad 06010106
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application: Existing conditions on site include two commercial buildings and parking for an Ingles grocery store. Land
use in the vicinity includes commercial and residential.
3b. List the total estimated acreage of all existing wetlands on the property:
There are no wetlands within the project area.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
There are approximately 332 linear feet of open stream on -site. The remaining streams are in culverts.
3d. Explain the purpose of the proposed project:
The purpose of the project is to replace approximately 1,200 linear feet of an existing failing 60 inch culvert.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project includes the replacement of an existing 60 inch culvert. Typical construction and earth moving equipment
will be used (i.e. backhoe). This project is constrained by existing drop boxes and elevation changes and significant
depth of fill slopes over the proposed culvert (see sheet C -115 for profile). The applicant Is reconfiguring the alignment;
however, due to the existing fill pad the drainage system will maintain several drop boxes. Per our conversation with Mr.
David Brown on March 31, 2015 regarding the site constraints with the existing culvert and fill pad, the applicant is
requesting a waiver from regional condition 3.6.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
❑ Yes ® No ❑ Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
❑ Preliminary Final
of determination was made?
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.
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.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑P ❑T
El Yes
El Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) ) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
Culvert
UT Richland
® PER
® Corps
5
1,200
Replacement
Creek
❑ INT
® DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P [:IT
❑ PER
❑ Corps
❑ INT
❑ DWQ
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
1,200
3i. Comments:
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 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
Temporary T
01 ❑P ❑T
02 ❑ PEI T
03 ❑P ❑T
04 ❑P ❑T
4L Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction Dr000sed. then complete the chart below.
5a.
Pond ID
number
15c.
Wetland Impacts (acres)
Proposed use or purpose
of pond
5d. 5e.
Stream Impacts (feet) I Upland
Flooded I Filled I Excavated I Flooded I Filled I Excavated I Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar - Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number— Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
B1 ❑P ❑T ❑Yes
❑ No
B2 ❑P ❑T ❑Yes
❑ No
133 ❑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
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Impacts associated with this project are the minimum necessary to replace the existing culvert.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All work will be conducted from high ground.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ® No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
E:1 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
buffer mitigation?
❑ Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private 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
1a. 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.
❑ Yes No
❑
Comments:
2. Stormwater Management 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: This project does not include the addition
of impervious surfaces to the site.
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 Government Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ Phase II
3b. Which of the following locally - implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other.
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
4a. Which of the following state - implemented stormwater management programs apply
❑ HQW
❑ 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 9of11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes ® No
use of public (federal /state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "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 short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non- discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Wastewater will not be generated as a result of this project.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will thi project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑Yes ®No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS county database and Natural Hertage Program data.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
South Atlantic Habitat and Ecosystem IMS. Impact will not occur in a marine system.
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?
National Register of Historic Places records maintained by the NC State Historic Preservation Office (SHPO) and
available on SHPO's HPOWEB GIS Service. The project site is located within close proximity (1,000 feet) to the Phillips -
Palmer House (SHPO# HW0163) and 0.5 miles to the Spread Out Historic District (SHPO# HW0181). It is the opinion of
CEC, that the culvert replacement will not threaten the integrity of these sites.
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 Map Service Center. This area is outside of a
designated FEMA floodplain. FEMA Panel No. 8616J Map No. 3700861600J Effective Date April 3, 2012.
R. Clement Riddle
O'Z
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
Is provided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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SURVEY PREPARED BY:
J. RANDY HERRON, P L.S L -3202
Herron Surveying, PC
134 MT.11er Street Waynesville, NC 28786
(828) 456 — 5761
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a C811 before you dig.
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PROPERTY INFORMATION:
TAX MAP NUMB13L 5616.22.1311
REFERENCE DJL 8 PG: SK 313, M 48
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ADDITIONAL NO. at"44 o
6516024011
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PERMIT DATE:
SID DATE:
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201 BARBER BLVD.
WAYNESVILLE, NC
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JOB NUBEIL 617.1
STORNWATER
PLAN AND PROFILE
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Haywood County, ESRI (2011)
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224 South Grove Street, Suite F
liendmonville, North Carolina 28792 Figure 4

Jurisdictional Determination Information

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County /parish/borough: Haywood City: Waynesville
Center coordinates of site (lat/long in degree decimal format): Lat. 35.5042990 [I, Long. - 82.987109° j.
Universal Transverse Mercator: NAD 83
Name of nearest waterbody: UT to Richland Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Pigeon River
Name of watershed or Hydrologic Unit Code (HUC): French Broad 06010106
® Check if map /diagram of review area and/or potential jurisdictional areas is/are available upon request.
Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
® Office (Desk) Determination. Date:
® Field Determination. Date(s):
SECTION 11: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There 110 "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required)
® Waters subject to the ebb and flow of the tide.
® Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There AM "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required)
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply):
® TNWs, including territorial seas
Wetlands adjacent to TNWs
rlRelatively permanent waters'' (RPWs) that flow directly or indirectly into TNWs
Non -RPWs that flow directly or indirectly into TNWs
Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
ON Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
Impoundments of jurisdictional waters
:12 Isolated (interstate or intrastate) waters, including isolated wetlands
t. Identify (estimate) size of waters of the U.S. In the review area:
Non - wetland waters: 332 linear feet: 4 width (ft) and/or acres.
Wetlands: acres.
Limits (boundaries) of jurisdiction based on: �a ab 6edby PRA,
Elevation of established OHWM (if known):
Non - regulated waters /wetlands (check if applicable):3
91 Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
Boxes checked below shall be supported by completing the appropriate sections in Section 111 below.
Z For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year -round or has continuous flow at least "seasonally"
,e.g, typically 3 months)
3 Supporting documentation is presented in Section Ill F

SECTION 111: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section 111.13 below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent ":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non - navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year -round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year -round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available Information that documents the existence of a significant nexus between a
relatively permanent tributary that Is not perennial (and Its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody° is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area Identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: SMEM
Drainage area: +
Average annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
❑ Tributary flows through�kEM tributaries before entering TNW.
Project waters are iK- lils"t river miles from TNW.
Project waters are P'Ieli: river miles from RPW.
Project waters are , &Mit aerial (straight) miles from TNW.
Project waters are PleJcl.let aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW':
Tributary stream order, if known:
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
` Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW

(b) General Tributary Characteristics (check all that apply):
Tributary is: ❑ Natural
❑ Artificial (man- made). Explain:
❑ Manipulated (man - altered). Explain.
Tributary properties with respect to top of bank (estimate):
Average width: feet
Average depth: feet
Average side slopes: fiekc'�Xht.
Primary tributary substrate composition (check all that apply):
❑ Silts ❑ Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover.
❑ Other. Explain:
Tributary condition/stability (e.g., highly eroding, sloughing banks]. Explain:
Presence of run/nfile/pool complexes. Explain:
Tributary geometry: PROWITA
Tributary gradient (approximate average slope): %
(c) Flow.
Tributary provides for:
Estimate average number of flow events in review area/year: fteRLIkI
Describe flow regime:
Other information on duration and volume:
Surface flow is: Lfrr . Characteristics:
Subsurface flow: . Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
❑ Bed and banks
❑ OHWM6 (check all indicators that apply):
❑ clear, natural line impressed on the bank
❑
❑ changes in the character of soil
❑
❑ shelving
❑
❑ vegetation matted down, bent, or absent
❑
❑ leaf litter disturbed or washed away
❑
❑ sediment deposition
❑
❑ water staining
❑
❑ other (list):
❑ Discontinuous OHWM.' Explain:
If factors other than the OHWM were used to determ
® High Tide Line indicated by:
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings/characteristics
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
SCOUT
multiple observed or predicted flow events
abrupt change in plant community
ine lateral extent of CWA jurisdiction (check all that apply):
Mean High Water Mark indicated by:
❑ survey to available datum;
❑ physical markings;
❑ vegetation lines /changes in vegetation types.
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
6A natural or man -made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g, where the stream temporarily flows underground, or where
the OHWM has been removed by development or agncultural practices) Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e g , flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break
']bid.

(iv) Biological Characteristics. Channel supports (check all that apply):
❑ Riparian corridor. Characteristics (type, average width):
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings.
❑ Fish /spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aquatictwild life diversity. Explain findings:
2. Characteristics of wetlands adjacent to non -TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain:
Wetland quality. Explain:
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non -TNW:
Flow is: Md. Explain:
Surface flow is: L 1
Characteristics:
Subsurface flow: just. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non -TNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by bernJbarrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are MUM river miles from TNW.
Project waters are 7 aerial (straight) miles from TNW.
Flow is from: ,
Estimate approximate location of wetland as within the floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. Explain:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis:
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed In the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
Significant nexus findings for non -RPW that bas no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
Significant nexus findings for non -RPW and Its adjacent wetlands, where the non -RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
® TNWs: linear feet width (ft), Or, acres.
® Wetlands adjacent to TNWs: acres.
RPWs that flow directly or indirectly into TNWs.
® Tributaries of TNWs where tributaries typically flow year -round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: Tributary has strong bed and bank, substrate sorting, and strong base flow.
Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section II1.B. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 332 linear feet 4 width (ft).
® Other non - wetland waters: acres.
Identify type(s) of waters:
Non -RPWss that flow directly or indirectly into TNWs.
® Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
® Tributary waters: linear feet width (ft).
® Other non - wetland waters: acres.
Identify type(s) of waters:
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
Q Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Wetlands directly abutting an RPW where tributaries typically flow year- round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
® Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section 111.13 and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
® Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section II1.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs.
© Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section II1.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
0 Demonstrate that impoundment was created from "waters of the U.S.," or
10 Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
19 Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA - STATE) WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
® which are or could be used by interstate or foreign travelers for recreational or other purposes.
® from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
t� which are or could be used for industrial purposes by industries in interstate commerce.
® Interstate isolated waters. Explain:
® Other factors. Explain:
Identify water body and summarize rationale supporting determination:
°See Footnote # 3
9 To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Acr.Jurisdiction Following Rapanos.

Provide estimates for jurisdictional waters in the review area (check all that apply):
Q Tributary waters: linear feet width (ft).
® Other non - wetland waters: acres.
Identify type(s) of waters:
® Wetlands: acres.
F. NON - JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
Q If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
® Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
Other: (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
€ Non - wetland waters (i.e., rivers, streams): linear feet width (ft).
® Lakes/ponds: acres.
® Other non - wetland waters: acres. List type of aquatic resource:
Q Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
® Non - wetland waters (i.e., rivers, streams): linear feet, width (ft).
® Lakes/ponds: acres.
® Other non - wetland waters: acres. List type of aquatic resource:
Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall be included in case file and, where checked
and requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant:
® Data sheets prepared/submitted by or on behalf of the applicant/consultant.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report.
® Data sheets prepared by the Corps:
® Corps navigable waters' study:
U.S. Geological Survey Hydrologic Atlas:
❑ USGS N1-ID data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: 1:24K; Clyde.
® USDA Natural Resources Conservation Service Soil Survey. Citation:
❑® National wetlands inventory map(s). Cite name:
State /Local wetland inventory map(s):
FEMA/FIRM maps:
® 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date):ESRI, 2011.
or ❑ Other (Name & Date):
® Previous determination(s). File no. and date of response letter:
® Applicable/supporting case law:
® Applicable/supporting scientific literature:
Q Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD: