20160172 Ver 1_401 Application_20160216

Letter of Transmittal
S&ME, Inc.
*S&ME
9751 Southern Pine Blvd.
DESCRIPTION
Charlotte, NC 28273
[phone]
Nationwide Permit No. 3 for Pre -Construction Notification and request for
[phone] fax
2.8.2016
N.C. Division of Water Resources
512 North Salisbury Street
Raleigh, North Carolina, 27604
WE ARE SENDING YOU
❑ Shop drawings
❑ Copy of letter
2 0 1 60 1 72
DATE: February 11, 2016 JOB NO: 4335-16-015
ATTENTION: Ms. Karen Higgins
RE: 3129 Riley Ave Culvert Improvement Project
D
►tib 22 2. 01 6"
i
® Attached ❑ Under separate cover via
❑ Prints ❑ Plans ❑ Draft
® Report
the foUovli, q
❑ Specifications
COPIES
DATE
NO
DESCRIPTION
Nationwide Permit No. 3 for Pre -Construction Notification and request for
5
2.8.2016
1
Jurisdictional Determination (with Design Plans)
1
2.11.2016
2
Check No. 025885 in the amount of $570.00 (Processing fee)
THESE ARE TRANSMITTED AS CHECKED BELOW:
® For approval ❑ For your record
❑ As requested ❑ For review and comment ❑
❑ FORBIDS DUE: _/_/_ ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS: Attached please find the above. Please let Erin Turner (CMSWS) or myself know if you have questions, Thank you.
- Darrin Peine
SIGN:
Dc" Afpt�4_�
COPY TO: File, USACE, CMSWS, NC SHPO
IF ENCLOSURES ARE NOT AS NOTED, PLEASE NOTIFY US AT ONCE.
This Letter of Transmittal and the documents accompanying this Letter of Transmittal contain information from S&ME, Inc., which is confidential and legally
privileged. The information is intended only for use of the individual or entity named on this Letter of Transmittal. If you are not the intended recipient, you
are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on these documents is strictly prohibited.
S&ME SFG-001
(Rev. 04/04)

Pre -Construction Notification and Request for
Preliminary jurisdictional Determination
3129 Riley Avenue Culvert Improvements Project
Mecklenburg County, North Carolina
S&ME Project No. 4335-16-015
•
Prepared for:
Charlotte -Mecklenburg Storm Water Services
600 E. Fourth Street
Charlotte, North Carolina
Prepared by:
S&ME, Inc.
9751 Southern Pine Boulevard
Charlotte, NC 28273
February 8, 2016

•
February 8, 2016
U.S. Army Corps of Engineers
Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
Attention: Ms. Crystal Amschler
N.C. Division of Water Resources
401 and Buffer Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attention: Ms. Karen Higgins
Reference: Pre -Construction Notification: NWP No. 3 / WQC No. 3883
3129 Riley Avenue Culvert Improvements Project
Charlotte, Mecklenburg County, North Carolina
S&ME Project No. 4335-16-015 Phase 001
Dear Ms. Amschler and Ms. Higgins:
On behalf of Charlotte -Mecklenburg Storm Water Services (CMSWS), S&ME, Inc. (S&ME) is submitting this
Pre -Construction Notification (PCN) for impacts to waters of the U.S. in accordance with Department of
the Army Nationwide Permit (NWP) 3 (Maintenance) along With supporting, documentation for
preliminary jurisdictional determination of the on-site jurisdictional boundaries. The proposed project will
involve 70 linear feet (If) of temporary impact for construction equipment access, also 53 If of permanent
impact (with no loss of waters) due to re-routing and permanent bank matting, and 81 If of permanent
impact (with loss of waters) due to channel realignment and riprap outfall installation. Two unnamed
tributaries were identified within the project area. The intermittent stream channel (Sl) is an unnamed
tributary to the perennial stream channel (S2), both of which are tributaries of Irwin Creek in Charlotte,
North Carolina. The proposed bed and bank reshaping and matting placement is for appropriate culvert
elevation transitions and, though a permanent impact, will result in no loss of Waters of the U.S.. The
proposed riprap apron will be keyed into the bed of the channel and will result in loss of Waters.
CMSWS is requesting written authorization under NWP 3 as the proposed stream channel modification
has been limited to the minimum necessary for the rehabilitation and replacement of the culvert. The
project described herein also requires written authorization under North Carolina Division of Water
Resources (DWR) Water Quality Certification (WQC) No. 3883 because proposed impacts are greater than
40 If of additional stream impact.
S&ME, Inc. 19751 Southern Pine Boulevard I Charlotte, NC 29273 1 p 704.523.4726 1 f 704.525.3953 1 www.smeinc.com

Pre -Construction Notification: NWP No. 12 / WQC No. 3883
3129 Riley Avenue Culvert Improvements Project
S&MECharlotte, Mecklenburg County, North Carolina
S&ME Project No. 4335-16-015 Phase 001
The location of the project area is depicted on the Site Vicinity map (Figure 1), the appropriate portions of
the Derita, N.C. (1993) USGS Topographic Map (Figure 2), the 2015 aerial photograph (Figure 3), and on
the Approximate Waters of the U.S. / Proposed Project Impacts map (Figure 4).
In support of this application, please find enclosed the following:
s Figures: Site Vicinity (Figure 1), USGS Topographic Map (Figure 2); 2015 Aerial Photograph (Figure
3), Approximate Waters of the U.S. / Proposed Impacts (Figure 4);
♦ Appendix I: Pre -Construction Notification (PCN);
♦ Appendix II: Site Photographs;
♦ Appendix III: Engineering Plans;
Appendix IV: Preliminary Jurisdictional Determination Request Form;
♦ Appendix V: N.C. Division of Water Quality (DWQ) Stream Identification Form;
♦ Appendix VI: Wetland Determination Data Form.
•'• Field Observations
On January 18, 2016, Mr. Darrin Peine of S&ME visited the site to verify the location and classification of
jurisdictional waters and note site conditions along the drainage system where disturbance associated
with the project is proposed. Stream and wetland assessments were conducted in accordance with DWR
and USACE guidelines. Results of the assessment are depicted on Figure 4 and representative
photographs of the project area are included in Appendix II.
Proposed Project Impacts
Proposed jurisdictional impacts associated with this project are detailed in the project plans and depicted
on Figure 4 — Approximate Waters of the U.S. / Proposed Project Impacts.
The purpose of this project is to replace existing storm water culverts that do not meet city design
standards and minimize erosion and potential flooding. The proposed project will involve the following:
Removing 40 If of existing 18 -inch -diameter reinforced concrete pipe (RCP) under Riley Avenue;
install 27 If of 36 -inch -diameter RCP and 22 If of 42 -inch -diameter RCP; Stream 1 temporary
impact of 6 If for construction equipment access, with 26 If of permanent impact (Stream 1) due
to re-routing and permanent bank matting for erosion, and 22 If of permanent impact due to
channel realignment and riprap outfall installation.
Removing 90 If of two existing 18 -inch -diameter RCP under Riley Avenue; install 48 If of 72 -inch -
diameter and 42 -inch -diameter RCP pipes; Stream 2 temporary impact of 32 If for construction
equipment access, with 27 If of permanent impact (Stream 2) due to permanent bank matting,
and 59 If of permanent impact due to channel realignment and riprap outfall installation.
In total, the proposed project will result in 70 If of temporary impact and 134 If of permanent impact, 81 If
of which is considered a permanent loss of waters.
February 8, 2016

Protected Species
Pre -Construction Notification: NWP No. 12 / WQC No. 3883
3129 Riley Avenue Culvert Improvements Project
Charlotte, Mecklenburg County, North Carolina
S&ME Project No. 4335-16-015 Phase 001
S&ME's consideration of potential protected species habitat began with a review of existing records
obtained from federal and state sources. The U.S. Fish & Wildlife Service (USFWS) list of federally -
protected species (updated April 2, 2015) was consulted for a listing of protected species documented
within Mecklenburg County, North Carolina. This review identified four plant species and three animal
species. Listed fauna and flora and their federal status are identified in Table 1.
Table 1: Federally -Protected Flora and Fauna Summary
Species,
Status
Habitat Present
Helianthus schweinitzii
Endangered
Current
No
Schweinitz's sunflower (vascular plant)
Rhus michauxii
Endangered
Current
No
Michaux's sumac (vascular plant)
Echinacea laevigata
Endangered
Current
No
Smooth Coneflower (vascular plant)
Symphyotrichum georgianum
Candidate
Current
No
Georgia aster (vascular plant)
Lasmigona decorata
Carolina heelsplitter (invertebrate
Endangered
Current
No
animal)
Haliaeetus leucocephalus
BGPA
Current
No
Bald eagle (vertebrate animal)
Myotis septentrionalis
Northern Long-eared Bat (vertebrate
Threatened
Probable/Potential
Yes
animal)
As part of the protected species review, S&ME also reviewed the North Carolina Natural Heritage Program
(NCNHP) Geographic Information Systems (GIS) files of Element Occurrence (EO) and Natural Heritage
Areas available from NC OneMap. This review found no extant EOs of protected species on record within
a one -mile radius of the project area.
S&ME completed a field reconnaissance of the project area on January 18, 2016. The project area consists
of maintained lawn and roadside along with a narrow, lightly wooded riparian corridor upstream and
downstream of Riley Avenue. Riparian corridors are not the preferred habitat for the plant species of
concern, and none of the listed plant species were observed. The waters to be impacted are borderline
intermittent/perennial and of poor habitat due to surrounding urbanization; these streams should
therefore be considered unsuitable for Carolina heelsplitter. The activity will not significantly change the
overall nature and function of the local forested habitat, therefore the project may affect, but is not likely
to adversely affect the northern long-eared bat. Based on the level of continued maintenance and
disturbance observed, the project area was not considered to provide suitable habitat for protected
species with a likelihood of occurring in Mecklenburg County.
February 8, 2016

Pre -Construction Notification: NWP No. 12 / WQC No. 3883
S&ME 3129 Riley Avenue Culvert Improvements Project
Charlotte, Mecklenburg County, North Carolina
"` S&ME Project No. 4335-16-015 Phase 001
Cultural Resources
A digital copy of this PCN will be provided to the North Carolina State Historic Preservation Office (SHPO),
requesting that they review their records regarding cultural, archaeological, or historical resources in or
near the project area and to provide written comments regarding the interests of their agency. A review
of the SHPO's "HPOWEB" GIS Web Service indicated that there were no properties currently listed or
determined eligible for listing in the National Register of Historic Places within a half -mile radius of the
project.
❖ Avoidance and Minimization
Impacts have been avoided and minimized to the extent practicable and have been limited to the areas
necessary to meet current design standards and accommodate the installation of properly sized culverts.
To prevent sedimentation of downstream portions of the affected streams, construction will be conducted
in the dry through the use of cofferdams and pump-arounds. Temporary erosion and sediment control
measures placed in waters will be removed and the original grade restored upon completion of the
project. Banks affected by culvert installation work will be matted, re -seeded, and restored to stable bank
conditions.
❖ Additional Regulatory Considerations
Efforts have been made to meet the conditions of NWP 3 as well as the regional conditions of the NWP
and conditions associated with WQC 3883. Materials will not be placed in excess of that which is required
to meet erosion protection needs. The proposed riprap apron is designed to be keyed into the channel
bed.
Appropriate erosion and sediment control practices will be implemented to meet water quality turbidity
standards. Best Management Practices employed for the project will be in compliance with the most
recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual," and
the local governing authority. Impacts have been avoided and minimized, and appropriate measures will
be taken during construction to allow flow and circulation patterns of waters of the U.S. to remain
unaffected. Following construction, disturbed areas adjacent to the work site will be restored to a stable
grade and disturbed areas will be appropriately seeded and restored. The proposed project will not result
in additional impervious surface.
•••• Mitigation
Based on conversations with the USACE for similar projects, we anticipate that mitigation will not be
required for this project as total permanent impacts will remain less than 150 If, resulting in 81 If of
permanent loss of channel bed, and reflect appropriate avoidance and minimization procedures that have
been implemented during the design phase of the project. Therefore, no further mitigation measures are
proposed in association with these activities.
February 8, 2016 4

Pre -Construction Notification: NWP No. 12 / WQC No. 3883
'
S&ME 3129 Riley Avenue Culvert Improvements Project
Charlotte, Mecklenburg County, North Carolina
S&ME Project No. 4335-16-015 Phase 001
:° Closing
By copy of this correspondence and completed PCN, we are requesting your written concurrence with
authorization of this project under NWP 3. If you have questions or require additional information, please
feel free to contact Erin Turner at [phone] or [e-mail].
Sincerely,
S&ME, Inc.
IBJ G.w._ /�• �?.t.�.c� � _..�
Darrin M. Peine, QEP Kristy Smedley
Project Manager Senior Natural Resources Professional
Reviewed and Authorized by:
Erin Turner
Wetland Specialist
Charlotte -Mecklenburg Storm Water Services
Attachments:
Figures
Appendix I: Pre -Construction Notification (PCN)
Appendix II: Site Photographs
Appendix III: Engineering Plans
Appendix IV: Preliminary Jurisdictional Determination Request Form
Appendix V: N.C. Division of Water Quality (DWQ) Stream Identification Form
Appendix VI: Wetland Determination Data Form
February 8, 2016 5

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0 1 2 "IREFERIENCE:
GIS BASE MAPPING WAS OBTAINED FROM ESRI STREET MAP DATASET THIS MAP ISFOR
mgzz;;Wmmmmm� INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED ARE APPROXIMATED.
Miles THEYARE NOT BASED ON CIVIL SURVEY INFORMATION, UNLESS STATED OTHERWISE.
SCALE: 1 1 miles FIGURE NO.
DATE: 02-02-16SITE VICINITY
DRAWN BY: DDH *S&ME 3129 Riley Avenue
PROJECT NO: Culvert Improvements Project
4335-16-015 PH 001 Charlotte, North Carolina

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REFERENCE: 1993 DERITA [NC] 1:24,000 USGS QUAD SHEET MAP A Ilk r' !
THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS
DISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY
INFORMATION, UNLESS STATED OTHERWISE. ,� - r- • Project Location
d
SCALE:1 „ 0 2 000 , FIGURE NO.
DATE:02-02-16 ftS&ME
USGS TOPOGRAPHIC MAP
DRAWN BY: 3129 Riley Avenue 2
PROJECT NO: DDH Culvert Improvements Project
L 4335-16-015 PH 001 Charlotte, North Carolina

N
€�a g 27 LF of Permanent Impact
No Loss of Waters
6 LF of Temporary Impact
( )
P y Pa .' to Stream 2 (Perennial RPW)
to Stream 1 (Seasonal RPW) ��' .,_•
f;?� i due Permanent Bank Matting
for Construction Equipment Access ,� +� �„
3� €
a A � '• \ _ rte„ / � / Y'
`-'�-. !� : '•, ��' � W� � n�Upland
26 LF of Permanent Impact x bPotI' ifa`�•v
(No Loss of Waters)
to Stream 1 (Seasonal RPW)
due to Re-Routing and
Permanent Bank Matting 714
i J
Stream 1
56 LF of P_erennialRPW i 'ter `' f`� 7• § qv
Within Proposed Work Area ` 'I
j .' � � � Stream 2 -�
,Irc _� �a - 1+1Z LF of Perennial RPW,_
/ew ? '
l �" , . Within Proposed Work Aseara '
`.�•41'
22 LF of Permanent Impact
(with Loss of Waters), , f! �', 32 LF of Temporary Impact
to Stream 1 (Perennial RPW)�3 !� to Stream 2 (Perennial RPW)
due to Channel Realignment # �Y for Construction Equipment Access
and Riprap Outfall InstallationRw
/ as
sg
f
59 LF of Permanent Impact � ,>,('• M
(with Loss of Waters) i •,F f
to Stream 2 (Perennial RPW) jY.rk't 'akr
i�p -
"` due to Channel Realignment I';p
and Riprap Outfall Installation
Approximate Proposed Work
i Area (0.28 Acres)
• > - - -> Stream Centerline
�x J
' Existing Stream Banks
Existing Storm Sewer Culvert
Proposed Permanent Stream
Impact (With Channel Loss)
Proposed Permanent Stream
0 25 50 Impact (No Channel Loss)
(IN FEET) Proposed Temporary Stream
Impact
REFERENCE:
DESIGN PLANS PROVIDED BY CHARLOTTE MECKLENBURG STORM WATER SERVICES. THIS MAP IS
FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED ARE APPROXIMATED. '�Y Photo Locations
THEYARE NOT BASED ON CIVIL SURVEY INFORMATION, UNLESS STATED OTHERWISE.
SCALE: 1 " = 25' APPROXIMATE WATERS OF THE U.S. / FIGURE NO.
DATE: 02-02-16��� PROPOSED PROJECT IMPACTS
DRAWN BY: DDH 3129 Riley Avenue 4
PROJECT NO: Culvert Improvements Project
4335-16-015 PH 001 Charlotte, North Carolina

Appendix I - Pre -Construction Notification (PCN)

O�O'� W A TF'9
� f
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 El 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
1d. 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
1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
3129 Riley Ave Culvert Improvement Project
2b. County:
Mecklenburg
2c. Nearest municipality / town:
Charlotte
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state
project no:
N/A
3. Owner Information
3a. Name(s) on Recorded Deed:
Multiple Owners
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
N/A
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 12
PCN Form —Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: Charlotte -Mecklenburg Storm Water Services
4b. Name:
Erin Turner
4c. Business name
(if applicable):
Charlotte -Mecklenburg Storm Water Services
4d. Street address:
600 East Fourth Street
4e. City, state, zip:
Charlotte, NC 28202
4f. Telephone no.:
704-336-3927
4g. Fax no.:
704-336-6586
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
Darrin Peine
5b. Business name
(if applicable):
S&ME, Inc.
5c. Street address:
9751 Southern Pine Blvd.
5d. City, state, zip:
Charlotte, NC 28273
5e. Telephone no.:
704-523-4726
5f. Fax no.:
704-525-3953
5g. Email address:
[e-mail]
Page 2 of 12
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):
Multiple Parcels
1 b. Site coordinates (in decimal degrees):
Latitude: 35.2782 Longitude: - 80.8377
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
Work Area = 0.28 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Irwin Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
Irwin Creek, Class C
2c. River basin:
Lower Catawba River Basin (WBD HUC 03050103)
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:
The project area is composed entirely of lawns and yards within high density residential development
3b. List the total estimated acreage of all existing wetlands on the property:
None.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
172
3d. Explain the purpose of the proposed project:
The purpose of this project is to replace existing storm water culverts that do not meet city design standards and minimize
erosion and potential flooding.
3e. Describe the overall project in detail, including the type of equipment to be used:
The proposed project will involve 70 linear feet (If) of temporary impact for construction equipment access, also 53 If of
permanent impact (with no loss of waters) due to re-routing and permanent bank matting, and 81 If of permanent impact
(with loss of waters) due to channel realignment and riprap outfall installation. Worts will be performed from within
CMSWS's existing storm drainage easement, and within a temporary work easement that allows equipment access. Work
will be conducted in the dry through the use of cofferdams and pump-arounds. Upland areas disturbed due to work will
be reseeded, and disturbed trees and shrubs within the upland areas will be replaced. Typical construction equipment will
be used, including backhoes and dump trucks.
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 12
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 12
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 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
❑ No
❑ Corps
❑ DWQ
W2 ❑ P [--IT
❑ Yes
❑ No
❑ Corps
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
2g. Total wetland impacts
2h. Comments: No wetlands were observed within the project area.
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
matting and riprap
Stream 1 (UT to
Irwin Cr.)
❑ PER
® INT
® Corps
® DWQ
2
54
S2 ®P ®T
matting and riprap
Stream 2
® PER
❑ INT
® Corps
® DWQ
3
118
S3 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and
tributary impacts
172
3i. Comments: S1 Temporary Impact of 6 If and Permanent Impact of 48 If
S2 Temporary Impact of 32 If and Permanent Impact of 86 If
Page 5 of 12
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 ❑P❑T
03 ❑P❑T
04 ❑ PEI T
4E Total open water impacts
4g. Comments: No open waters are located within the project area.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
number
of pond
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 El Tar -Pamlico El 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)
T
impact
required?
—Temporary
❑Yes
61 ❑P❑T
❑ No
❑ Yes
B2 ❑ P ❑ T
❑ No
El Yes
B3 ❑P❑T
❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 12
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 have been avoided and minimized to the extent practicable and have been limited to the areas necessary to meet
current design standards and accommodate the installation of properly sized culverts.
To prevent sedimentation of downstream portions of the affected streams, construction will be conducted in the dry through
the use of cofferdams and pump-arounds. Temporary erosion and sediment control measures placed in waters will be
removed and the original grade restored upon completion of the project. Banks affected by culvert installation work will be
matted, re -seeded and restored to stable bank conditions.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
To prevent sedimentation of downstream portions of the affected streams, construction will be conducted in the dry through
the use of coffer dams and pump-arounds. Temporary erosion and sediment control measures placed in waters will be
removed and the original grade restored upon completion of the project.
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
El 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 12
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 12
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.
❑ 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: The proposed project is a culvert
improvement project being undertaken by a municipal stormwater authority.
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?
City of Charlotte
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
El 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
❑ 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
El Yes El No
attached?
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 12
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)?
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
❑ Yes ❑ No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑ Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
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.
The project is not considered a "growth -inducing" project as the proposed culvert improvements are necessary to meet
current design standards and accommodate the installation of properly sized culverts.
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.
The proposed project will not generate wastewater.
Page 10 of 12
PCN Form —Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Field review of the project area did not indicate the presence of protected species or their habitat for species listed for
Mecklenburg County. The project area and vicinity are not located in a Designated Critical Habitat. Review of Element
Occurrences on the North Carolina Natural Heritage Program Geographic Information Systems (GIS) files found that
there were no known extant occurences of threatened or endangered species within a 2 -mile radius of the proposed
project.
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?
hftp://ocean.floridamarine.org/efh—coral/ims/viewer.htm
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?
A digital copy of this application will be provided to the North Carolina State Historic Preservation Office (SHPO). A
review of the HPOWEB GIS Web Service indicated that there were no properties currently listed or determined eligible for
listing in the National Register of Historic Places within a mile of the project area.
B. 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? The proposed project will be constructed outside of the
100 -year FEMA floodplain. http://polaris.mecklenburgcountync.gov
Erin Turner
2.8.2016
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 11 of 12
PCN Form —Version 1.3 December 10, 2008 Version

Appendix II — Site Photographs

�'''S&ME City of Charlotte — 3129 Riley Avenue Maintenance Project S&ME Project No. 4335-16-015
<,._ , Mecklenburg County, North Carolina Taken by: DMP I Date Taken: 1/18/2016

*S&ME City of Charlotte — 3129 Riley Avenue Maintenance Project S&ME Project No. 4335-16-015
Mecklenburg County, North Carolina Taken by: DMP I Date Taken: 1/18/2016

Appendix III - Engineering Plans

PROFfT m pill. RADII NOTES-.
1. EXISTING CONTOURS SHOWN ON PLW
AN INCLUDE SURVEYED TOPOGRAPHY AND RILEY WOODS
SUBDIVISION PROPOSED GRADES TO BE CONSTRUCTED SUBSEQUENT TO SURVEY FOR THIS PROJECT. AS
A RESULT,CON TOURS PROPOSED FOR THIS PROJECT ARE SHOWN CONNECTING TO RILEY WOODS
CONTOURS SOUTH OF RILEY AVENUE, WHICH WILL BE CONSTRUCTED PRIOR TO CONSTRUCTION FOR THIS
PROJECT, IN AREAS OUTSIDE OF RILEY WOODS WORK NORTH OF RILEY AVENUE. CONTOURS PROPOSED
FOR THIS PROJECT ARE SHOWN CONNECTING TO SURVEYED CONTOURS
2. EXISTING SIDEWALK AND BAC( OF CURB (DOC) ELEVATIONS AND LOCATIONS INDICATED ON PLAN ARE
BASED ON AN EXISTING RILEY WOWS SUBOIVMON DESIGN, APPROVED BY CITY OF CHARLOTTE ON
5/22/2008. WHICH WILL BE CONSTRUCTED PRIOR TO NIS PROJECT. SOME ELEVATIONS ARE
INTERPOLATIONS BETWEEN DESIGN PANTS. UNE WORK SHOULD BE CONSIDERED APPROXIMATE AND
VERIFIED IN THE FIELD PRIOR TO CONSTRUCTION.
AW
P R TIC�TFS
:
1. CONTRACTOR IS FULLY RESPONSIBLE FOR CONTACTING APPROPRIATE PARTIES AND ASSURING NAT
EXISTING UTILITIES ARE LOCATED PRIOR TO BEGINNING CONSTRUCIIM.
2, CONTRACTOR IS RESPONSIBLE FOR PLACING ALL TRAFFIC CONTROL DEVICES AND SIAL CONFORM TO
THE REODREMQITS OF THE CHARLOTTE DEPT. OF TRANSPORTATION (COOT) WORT( AREA TRAFFIC CONTROL
HANDBOOK (W.A.T.C.H.).
3. ALL RPE JOINTS ARE TO BE WRAPPED PER PIPE WRAP DETAIL ON SHEET 2.
4. ANY SHRUBS OR TREES REMOVED IN ORDER TO INSTALL DRAINAGE ITEMS SHALL BE REPLACED.
YARDS SHALL BE RE -SEEDED IN AREAS DISTURBED WRING CONSTRUCTION.
5. STORM PIPE INSTALLATION SHALL BE IN ACCORDANCE WITH NWOT STANDARD DETAIL 300.0,
6. ALL STORM WATER PIPE LENGTHS SHOWN ARE FROM CENTER OF STRUCTURE TO CENTER OF
STRUCTURE.
.W71S
'AUL D. HARTON
DB 3711/PG 945
1129 RILEY AVENUE
1 EXXITWD6•WATER _
II' 71 SWNTORBMNI
REMOVE AND REFUGE
IN KIw H'CONCRETE
CURBND TT
AGUER (65 LF.)
IN wN0
KTATCH EMSTING ASP HALT
LEVATONSANO GRADES
)APER ASPHALTOVER IO LPPROPOSED CHARLOTTE
_�WATEREASEMENTEDP 750.83d1T7ERTPROP09EDCATCHBASIN,
NODDY STD. 310.0,
R3•CURB BOC.761.15•
7%
741
74,
- - -
aoB Bf0. eDa
W O=K
g
BE AB
BE ABANOOIED(3B LF •I-)
CONED IN
NINA' - - - __ X51 •B
\ \ f
f 11 I '
/
}1129 RIL AVENUE
2 7
SYMBOL
S AIIETY RAX.
UE
NORTH AMERICAN GREEN
PROPOSED
SEOTION(SE
w�
'�
SAFETY RAL
�ff
'm
I!lBIHf1 CO1FTGMMBmd
PBOPOlE0 IT 1NFEM% GaNmm
'
_
ON CHANNEL FLOOR (W YO*)
I Q
PLANS Mfm"YI000l61SOILA1011 TECIRPRO
` I
��
RBlY oueowlY1lW
I
f
I f W
CONCRETE aRl AND
GUTTER 92 LF s)
¢)
1
HW -2
BTA, 1.13
1 W' NCDOT SOD. M.
TON 750
Q
PROPOSED COMC. ENDWALL NV41
REMOVE AND REPLACE
EX*TlwCAlCHBAIN
-. _ _
CIUNIEL LIN: T4A]5
ABIN MGTW
I I
TOW14 TD. 553.10
TO
SW 7566
- - - -"
I
if
f
'-�
f If
�� /
CHANNEL CEMEP
E TO EXIST.
\ CHANNEL
\ CHANNEL
/ P0.0POBEOGTOM BASINi�- "`
\
2-12•RCPMV:74&Q5
J
E%. BOC
PROP03E0 RILEY N000.5 JJ NCODr BTD.Ba.al
BOC:76130
I
EXISTING GRADE
751.50
SUBDIVISION LOT LINE(TYP)
INV IN: 14 3.25
!
I
INV OUT:145.15
i
'EM. MH
ECASEMENT
I
q
SEWER�`� F
S�ANLT ARY
qAUD
20
_ --- E / POE
5r is lr lv
W
-
AR®DdW
C
RV
/Ew5nN
/
ESOP ]SCIS-
_
_
�'RRl!L511DOIVPIEE@w
P (1LF•
;..RWwATERLP!
BOC 51..30-
E
/ IMOVE EXISTING
-� 1IWAXP(Ri0q..)
I
PR22LFAz
E
r
/
nRCP 02aL
tp_�/- 747
PLAN FOR REALIGNMENT/
-�-! CLDS BTD. SO .M
748
- - -
LOCATION
SAFETY RAIL Ib LF7
RIP RM CHANNEL (ISO TOMB)
050=fC7; B
OnHR1 • 11' ,7 _
APRON NICKRE99. 21' 7
CROWN AT ,LOW
POINT ]STYO
TXW
REMOVEAT
1B RCP (2 AT lF EA.)
15LF
CONSTRUCT tY HIGH SILLS AT EACH
BOC 15,.62
PROPOSED CANNEL CENTER
�....�_p1
L'
72" RCP PROFILE
CRCWN 131.35
k
U
1r BELO CHAUN
INVERT ,2' BELOW CHHANNEL INVERT.
INERTD
NAIVE STREAM MATERIAL WA t. FlLL
�K
CHANNEL GRADE
HORIL SCALE: tti1D
-
46--
CROWN ]51.116
21'
112. HW -1
'L
oo.6W
A
PR 4B �IT
UVJ
RCP O
9%
,'
QUT
751.4:
TME 1B RC PIPPA NO LP •A
TREE TO BE REMOVED I&I K N 2- IXI8LF -
f n
I
E%. EO 751.50
TOTAL))
POE
MOVE 6003y COIILF�E
BOC ML10
90EWNKR
-':_
TEMPORA
SW 752 26ASPHALT
lII
�E6IS
PAVEMENT
CONSTRUCTION
EASEMENT(TYP)
fII
'II
(BE TON
J
III
MATCH'ISTNO
ASPHALTEUEVATION S
HOMES-NC, LC.
232
AND GRAOSS0410423
12RILEY
- _
I1
TAPER -T4 J
WETS IDLE
CASTINGSIOEWALK'CLIRBANDOUTERLOCATIONS
ARE BASED ON RI LEY w00DS SUBOIVBION DESIGN
/
f
ANO'NERE CONSTRUCTED W RING 7X18 DESIGN
PROCESS THIS INFORM TION HAS NOT BEEN
I /�
SURVEY LOCATED VERIFYHOR2.ANDVERT.
LOCATION PFUOR TO CONSTRUCTION AND MEAT
ENGINEER OF ANY DISCREPANCIES OR POTENTIA
CONFLICTS.
PROFfT m pill. RADII NOTES-.
1. EXISTING CONTOURS SHOWN ON PLW
AN INCLUDE SURVEYED TOPOGRAPHY AND RILEY WOODS
SUBDIVISION PROPOSED GRADES TO BE CONSTRUCTED SUBSEQUENT TO SURVEY FOR THIS PROJECT. AS
A RESULT,CON TOURS PROPOSED FOR THIS PROJECT ARE SHOWN CONNECTING TO RILEY WOODS
CONTOURS SOUTH OF RILEY AVENUE, WHICH WILL BE CONSTRUCTED PRIOR TO CONSTRUCTION FOR THIS
PROJECT, IN AREAS OUTSIDE OF RILEY WOODS WORK NORTH OF RILEY AVENUE. CONTOURS PROPOSED
FOR THIS PROJECT ARE SHOWN CONNECTING TO SURVEYED CONTOURS
2. EXISTING SIDEWALK AND BAC( OF CURB (DOC) ELEVATIONS AND LOCATIONS INDICATED ON PLAN ARE
BASED ON AN EXISTING RILEY WOWS SUBOIVMON DESIGN, APPROVED BY CITY OF CHARLOTTE ON
5/22/2008. WHICH WILL BE CONSTRUCTED PRIOR TO NIS PROJECT. SOME ELEVATIONS ARE
INTERPOLATIONS BETWEEN DESIGN PANTS. UNE WORK SHOULD BE CONSIDERED APPROXIMATE AND
VERIFIED IN THE FIELD PRIOR TO CONSTRUCTION.
AW
P R TIC�TFS
:
1. CONTRACTOR IS FULLY RESPONSIBLE FOR CONTACTING APPROPRIATE PARTIES AND ASSURING NAT
EXISTING UTILITIES ARE LOCATED PRIOR TO BEGINNING CONSTRUCIIM.
2, CONTRACTOR IS RESPONSIBLE FOR PLACING ALL TRAFFIC CONTROL DEVICES AND SIAL CONFORM TO
THE REODREMQITS OF THE CHARLOTTE DEPT. OF TRANSPORTATION (COOT) WORT( AREA TRAFFIC CONTROL
HANDBOOK (W.A.T.C.H.).
3. ALL RPE JOINTS ARE TO BE WRAPPED PER PIPE WRAP DETAIL ON SHEET 2.
4. ANY SHRUBS OR TREES REMOVED IN ORDER TO INSTALL DRAINAGE ITEMS SHALL BE REPLACED.
YARDS SHALL BE RE -SEEDED IN AREAS DISTURBED WRING CONSTRUCTION.
5. STORM PIPE INSTALLATION SHALL BE IN ACCORDANCE WITH NWOT STANDARD DETAIL 300.0,
6. ALL STORM WATER PIPE LENGTHS SHOWN ARE FROM CENTER OF STRUCTURE TO CENTER OF
STRUCTURE.
.W71S
'AUL D. HARTON
DB 3711/PG 945
1129 RILEY AVENUE
1 EXXITWD6•WATER _
II' 71 SWNTORBMNI
REMOVE AND REFUGE
IN KIw H'CONCRETE
CURBND TT
AGUER (65 LF.)
IN wN0
KTATCH EMSTING ASP HALT
LEVATONSANO GRADES
)APER ASPHALTOVER IO LPPROPOSED CHARLOTTE
_�WATEREASEMENTEDP 750.83d1T7ERTPROP09EDCATCHBASIN,
NODDY STD. 310.0,
R3•CURB BOC.761.15•
7%
741
74,
740
739
0+00
-"(A5
- - -
aoB Bf0. eDa
W O=K
g
BE AB
BE ABANOOIED(3B LF •I-)
CONED IN
$GEM
PAU_L(LPN^•E NARTON
6J 945
BTD.50.01
/
}1129 RIL AVENUE
2 7
SYMBOL
S AIIETY RAX.
UE
NORTH AMERICAN GREEN
PROPOSED
SEOTION(SE
,�
BHOPEAM(MATTMGOR
ENGINEERAPPROIEDEOWL
SAFETY RAL
OE --
ON pW WEL 610E SLOPES
ONLY DO NOT PUCE MATTING
NAME
ON CHANNEL FLOOR (W YO*)
1. W'
DETAIL)PROP08E0
WIC, ENGVALL MYI
PROPOSED 6P STANDARD
F
CONCRETE aRl AND
GUTTER 92 LF s)
CL06 BTD. 5001
1
HW -2
BTA, 1.13
1 W' NCDOT SOD. M.
TON 750
PROPOSED COMC. ENDWALL NV41
T2 PCP IMV: 745.20
STA: 0.70
-. _ _
CIUNIEL LIN: T4A]5
TOW14 TD. 553.10
TO
I2' RCP INV: ]u.75
RCP
CHANNEL INN 743.75
�� /
CHANNEL CEMEP
E TO EXIST.
\ CHANNEL
\ CHANNEL
2-12•RCPMV:74&Q5
RA
CIMNNELGRADE
EXISTING GRADE
-
/Ew5nN
;..RWwATERLP!
LOCATION PER ESP. BEE
/
PLAN FOR REALIGNMENT/
LOCATION
Tri
TXW
REMOVEAT
1B RCP (2 AT lF EA.)
15LF
CONSTRUCT tY HIGH SILLS AT EACH
PROPOSED CANNEL CENTER
72" RCP PROFILE
OF PIPE
LME ORAD@ TIE TO.111
1r BELO CHAUN
INVERT ,2' BELOW CHHANNEL INVERT.
INERTD
NAIVE STREAM MATERIAL WA t. FlLL
CHANNEL GRADE
HORIL SCALE: tti1D
INVERT. IEEE DEThIL)
VERT.6GLE: P•2
740
739
0+00
-"(A5
- - -
N ANN)
W O=K
n
1 )126
BE AB
BE ABANOOIED(3B LF •I-)
CONED IN
PROPOSED MATTING
PAU_L(LPN^•E NARTON
6J 945
RPRAP
/
}1129 RIL AVENUE
2 7
SYMBOL
TREE BARANI
UE
NORTH AMERICAN GREEN
X
STORM DRNNACE MANHOLE
BHOPEAM(MATTMGOR
ENGINEERAPPROIEDEOWL
CATCH BASH
OE --
ON pW WEL 610E SLOPES
ONLY DO NOT PUCE MATTING
NAME
ON CHANNEL FLOOR (W YO*)
BOC 1.
PROPOSED 6P STANDARD
F
CONCRETE aRl AND
GUTTER 92 LF s)
CL06 BTD. 5001
1
HW -2
SAFETY PAL (40 UF)
.10 11 `45•BENO
TAPER 3' CURB FACE
HBGHT TO P OVERT LF
/5' SEND \ ,
/ TEMPORARY
CONSTRUCTION
EABEMENT(TYP)
4
R 01T07T0HAR5
PAULRIE D. 'ON
DB 250/PC 32
3119 RILEY AVENUE
iDE--
`-E� BOATER
MAIN TO REMAIN
CONSTRUCTIONjF E3 .
1. PUCE ALL TEMPORARY EROSION CONTROL MEASURES REQUIRED FOR
PROJECT.
2. CONSTRUCT WATER UNE REALIGNMENT. PRIOR TO CONSTRUCTION,
CONTACT BILL DEAL (CITY OF CHARLOTTE UTILITY ENGINEERING DEPT,
701-391-5150). WATER LME REALIGNMENT TO BE PERFORMED TO
MINIMIZE WATER OUTAGE FOR RESIDENTS DOWNSTREAM OF WORK.
RESIDENTS TO BE ALERTED ON WATER OUTAGE PRIOR TO CONSTRUCTION.
3. BEAN CONSTRUCTION OF PROPOSED SOUTH LANE AND ASSOCIATED
STORMDRAINAGE, FILL SLOPE AND HEADWALL ON SOUTH SIDE OF RILEY
AVENUE UTILIZE EXISTING NORTH LANE AS TEMPORARY DETOUR.
PROVIDE TEMPORARY GUARD RAIL AT TOP OF FILL SLOPES AS NECESSARY
TO INSURE TRAFFIC SAFETY.
4 ONCE A TEMPORARY LANE IS CONSTRUCTED ON SOUTH SIDE OF RILEY
AVENUE THAT IS ADEOUATE AND SAFE FOR VEHICULAR AND EMERGENCY
TRAFFIC. BEGIN CONSTRUCTION OF NORTH SIDE OF PROJECT.
EXIBTMOP ERTV UNE
0+50
APPUCATION FOR PERMIT FOR WATER MAIN EXTENSION
PROJECT NAME: 3119 RILEY AVENUE DRAINAGE IMPROVEMENTS
LF
- IN REL2EA__
CMU PROJECT N0.:
PROIECF DESCwPNON: PRO D106LF.OFS" WATER MAIN RELOCATION TO ACCOMMODATE
MM naical P EP E
1+00
DESIGNED BY: FIRM: CHARLOTTE MECKLENBURG STORM WATER SERVICES
ENGINEER: - ROBERT FROST P.C.
ADORES& SM EASF4TH STREET
CHARIOTTc RC m2@
PHONE: (701) 353 OM"
THIS APPLICATION IS MADE UNDER AND IN FULL ACCORD WITH THE PROVISIONS OF CHAPTER 130A-317 OF THE
P RELATED TO PUBLIC WATER SYSTEMS.
NORTH TTE WATER
HAS SE STATUTES, AU HORN OTME STARES AS
CHARLOTTE WATER HAS BEEN GRANTED AUTHORITYTOISSUE PERMITS CH NG EOR DE IA WATER FROM THE
PURSUANT
TODSAICAC TIONS01. THE APPLICANT AGREES THAT VASIGNIFICANT CHANGEORDEVIATION FROMTHEND
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APPROVAL OF CHARLOTTE WATER OR RS AUTHORIZED MITASATEM T PROFESSIONAL ENGINEER TCDNSEO TO
PRACTICE IN THE STATE OF NORTH COMPLETION
SUBMITASTATEMENTREFLECTING THAT ADEQUATE
OBSERVATIONS DURING AND UPON COMPLETION OF INSTRUCTION INDICATES THAT CONSTRUCTION WAS
COMPLETED IN ACCORDANCE WITH APPROVED PIANS AND SPECIFICATIONS.
PERMIT MD. --
AP AD __ __.._.- DATE
JOSEPH C WILSON, PE. CHIEF ENGINEER
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Appendix IV - Preliminary Jurisdictional Determination
Request Form

Jurisdictional Determination Request
le�il
�S:Army `EbrPs
of-Eeglneers F
NVIIRlnutcdAl3uiki
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
to the appropriate Corps Field Office (or project manager, if known) via mail, electronic mail, or
facsimile. A current list of county assignments by Field Office and project manager can be
found on-line at: http://www.saw.usace.aM.mil/Missions/Reg_ulatoD PermitProgram.aspx , by
telephoning: 910-251-4633, or by contacting any of the field offices listed below:
ASHEVILLE REGULATORY FIELD OFFICE
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
Version: December 2013 Page 1

Jurisdictional Determination Request
INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E and F.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part G.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that all JD
requests must include the current property owner authorization for the Corps to proceed with the
determination, which may include inspection of the property when necessary. This form must be
signed by the current property owner to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for JD
requests associated with North Carolina Department of Transportation (NCDOT) projects will be
conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD may not
be valid for the wetland conservation provisions of the Food Security Act of 1985. If you or
your tenant are USDA Program participants, or anticipate participation in USDA programs, you
should also request a certified wetland determination from the local office of the Natural
Resources Conservation Service, prior to starting work.
Version: December 2013 Page 2

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: 3129 Riley Avenue
City, State: Charlotte, North Carolina
County: Mecklenburg
Directions: see Figure 1 and 2
Parcel Index Number(s) (PIN):
B. REQUESTOR INFORMATION
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address'
04107128, 04104237, 04104247
Erin Turner (CMSWS) / Darrin Peine (S&ME)
600 East Fourth Street, Charlotte, NC 28202
704-336-3927/704-523-4726
[e-mail] / [e-mail]
Select one:
❑ I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultant
❑ Interested Buyer or Under Contract to Purchase
❑✓ Other, please explain.
Ms. Turner is a representative of Charlotte -Mecklenburg Storm Water Services
(CMSWS) which owns the storm drainage easements throughout the project area.
Mr. Peine is an authorized agent assistina CMSWS.
C. PROPERTY OWNER INFORMATION
Name:
Mailing Address:
Charlotte -Mecklenburg Storm Water Services
600 East Fourth Street
Charlotte, NC 28202
Telephone Number: 704-336-3927
Electronic Mail Address 3: [e-mail]
❑ Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
1 If available
2 Must attach completed Agent Authorization Form
3 If available
Version: December 2013 Page 3

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Erin Turner
February 8, 2016
Property Owner (please print) Date
Q. -,—
Property Owner Signature
E. JURISDICTIONAL DETERNIINATION TYPE
Select One:
❑v I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
❑ I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
❑ I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUS5 and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
❑ I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an approved JD (this may or may not include a survey plat).
I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
4 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
5 Waters of the United States
Version: December 2013 Page 4

Jurisdictional Determination Request
F. ALL REQUESTS
❑� Map of Property or Project Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.
❑✓ Size of Property or Project Area Project Area = 0.28 acres
n✓ I verify that the property (or project) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.
G. JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests:
❑✓ Completed and signed Preliminary Jurisdictional Determination Form6.
❑✓ Project Coordinates: 35.278271'N Latitude -80.837749°W Longitude
Maps (no larger than 11x17) with Project Boundary Overlay:
WlLarge and small scale maps that depict, at minimum: streets, intersections, towns
❑✓ Aerial Photography of the project area
USGS Topographic Map
❑ Soil Survey Map
FOther Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
6 See Appendix A of this Form. From Regulatory Guidance Letter No. 08-02, dated June 26, 2008
Version: December 2013 Page 5

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
❑ Wetland Data Sheets$
Tributaries:
❑ USACE Assessment Forms
❑III/ Upland Data Sheets ❑ll/ Other Assessment Forms
(when appropriate)
❑I✓ Landscape Photos, if taken
Field Sketch overlain on legible Map that includes:
■ All aquatic resources (for sites with multiple resources, label and identify)
■ Locations of wetland data points and/or tributary assessment reaches
■ Locations of photo stations
■ Approximate acreage/linear footage of aquatic resources
(2) Approved JDs including Verification of a Delineation:
❑ Project Coordinates:
Latitude
Longitude
Maps (no larger than 11x17) with Project Boundary Overlay:
❑ Large and small scale maps that depict, at minimum: streets, intersections, towns
❑ Aerial Photography of the project area
❑ USGS Topographic Map
❑ Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
1987 Manual Regional Supplements and Data forms can be found at:
http://www.usace.army.mi[/Missions/CivilWorks/ReguIatoryProgramandPermits/reg supp.aspx
Wetland and Stream Assessment Methodologies can be found at:
http://Portal.ncdenr.org/c/document library/get file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&groupld=38364 and,
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/publicnotices/2013/NCSAM Draft User Manual 130318.0df
8 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 6

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
❑ Wetland Data Sheets9
Tributaries:
❑ USACE Assessment Forms
❑ Upland Data Sheets ❑ Other Assessment Forms
(when appropriate)
❑ Landscape Photos, if taken
❑ Field Sketch overlain on legible Map that includes:
• All aquatic resources (for sites with multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
• Approximate acreage/linear footage of aquatic resources
Supporting Jurisdictional Information (for Approved JDs only)
❑ Approved Jurisdictional Determination Form(s) (also known as "Rapanos
Form(s)")
❑ Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc. to navigable waters.
9 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 7

Jurisdictional Determination Request
I. REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT
Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps project manager for
review.
Due to storage limitations of our administrative records, the Corps requires that all hard-
copy submittals include at least one original Plat (to scale) that is no larger than 11"x17"
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11"x17", may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Document Format (PDF) file. Upon verification, the Corps can electronically sign these
plats and return them via e-mail to the requestor.
(1) PLATS SUBMITTED FOR APPROVAL
❑ Must be sealed and signed by a licensed professional land surveyor
Must be to scale (all maps must include both a graphic scale and a verbal scale)
❑ Must be legible
Must include a North Arrow, Scale(s), Title, Property Information
❑ Must include a legible WoUS Delineation Table of distances and bearings/metes
and bounds/GPS coordinates of all surveyed delineation points
❑ Must clearly depict surveyed property or project boundaries
❑ Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)
When wetlands are depicted:
• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system
Version: December 2013 Page 8

Jurisdictional Determination Request
❑ When tributaries are depicted:
• Must include either a surveyed, approximate. centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) of tributary
• Must identify each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area (using approximate
widths or surveyed OHWM)
• Must include name of tributary (based on the most recent USGS topographic
map) or, when no USGS name exists, identify as "unnamed tributary"
❑ all depicted WoUS (wetland polygons and tributary lines) must intersect or tie -to
surveyed project/property boundaries
Must include the location of wetland data points and/or tributary assessment
reaches
Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. "isolated wetlands", "non -
jurisdictional waters"). NOTE: An approved JD must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.
F1Must include and survey all existing conveyances (pipes, culverts, etc.) that
transport WoUS
Version: December 2013 Page 9

Jurisdictional Determination Request
(2) CERTIFICATION LANGUAGE
When the entire actual Jurisdictional Boundary is depicted:
include the following Corps Certification language:
"This certifies that this copy of this plat accurately depicts the boundary of the jurisdiction
of Section 404 of the Clean Water Act as determined by the undersigned on this date.
Unless there is a change in the law or our published regulations, the determination of
Section 404 jurisdiction may be relied upon for a period not to exceed five (5) years from
this date. The undersigned completed this determination utilizing the appropriate Regional
Supplement to the 1987 U.S. Army Corps of Engineers Wetlands Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
FWhen uplands may be present within a depicted Jurisdictional Boundary:
include the following Corps Certification language:
"This certifies that this copy of this plat identifies all areas of waters of the United States
regulated pursuant to Section 404 of the Clean Water Act as determined by the
undersigned on this date. Unless there is change in the law or our published regulations,
this determination of Section 404 jurisdiction may be relied upon for a period not to exceed
five years from this date. The undersigned completed this determination utilizing the
appropriate Regional Supplement to the 1987 U.S. Army Corps of Engineers Wetlands
Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
Version: December 2013 Page 10

Jurisdictional Determination Request
(3) GPS SURVEYS
For Surveys prepared using a Global Positioning System (GPS), the Survey must include
all of the above, as well as:
❑ be at sub -meter accuracy at each survey point.
❑ include an accuracy verification:
One or more known points (property corner, monument) shall be located with the
GPS and cross-referenced with the existing traditional property survey (metes and
bounds).
Rinclude a brief description of the GPS equipment utilized.
Version: December 2013 Page 11

ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD): February 8, 2016
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Erin Turner (CMSWS)
600 East Fourth Street, Charlotte, NC 28202
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
3129 Riley Ave
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES AT DIFFERENT
SITES)
State: NC
County/parish/borough: Mecklenburg
City. Charlotte
Center coordinates of site (lat/long in degree decimal format):
Lat. 35.278271°N °N; Long. -80.837749°W
Universal Transverse Mercator: NA
Name of nearest waterbody: Irwin creek
°W.
Identify (estimate) amount of waters in the review area:
Non -wetland waters:
173 linear feet: 3 width (ft) and/or acres.
Cowardin Class: R3
Stream Flow: Perennial
Wetlands: 0 acres.
Cowardin Class:
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal:
Non -Tidal:
1

E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
❑ Office (Desk) Determination. Date:
❑✓ Field Determination. Date(s): 1/18/2016
SUPPORTING DATA. Data reviewed for preliminary JD
(check all that apply - checked items should be included in case file and,
where checked and requested, appropriately reference sources below):
Ft/]Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant: SWE
❑✓ Data sheets prepared/submitted by or on behalf of the
app is nt/consultant.
Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data
❑ USGS 8 and 12 digit HUC maps
❑✓ U.S. Geological Survey map(s). Cite scale & quad name: Derita 1993 [NC] 1:24,000
❑ USDA Natural Resources Conservation Service Soil Survey.
Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
01
100 -year Floodplain Elevation is:
(National Geodectic Vertical Datum of 1929)
❑✓ Photographs: ❑✓ Aerial (Name & Date): Mecklenburg county, 2015
0 Other (Name & Date): site Photographs, 1/18/2016
❑ Previous determination(s). File no. and date of response letter:
Other information (please specify): NC cwR stream Identification Form
2
or

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre -construction notification" (PCN), or requests verification for a non -reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.
3

This preliminary JD finds that there "may be" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified by the Corps and should not be relied upon for
later jurisdictional determinations.
Signature and date of
Regulatory Project Manager
(REQUIRED)
4
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)

Appendix V - N.C. Division of Water Quality (DWQ) Stream
Identification Form

NC Division of Water Quality -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC DWO Stream Identification Form Version 4.11
Date:1/18/2016
Projectisite: 3129 Riley Ave / S1
Latitude: °N 35.278243
Evaluator: Darrin Peine (S&ME, Inc.)
County: Mecklenburg
Longitude: °W -80.837786
Total Points:
Stream is least intermittent 23.75Derita
Stream Determination (circle one)
Other
at
Intermittent
e.g. Quad Name:
ifZl9or erennialif>_30*
20
30
A. Geomorphology (Subtotal = 11 j
Absent
Weak
Moderate
Strong
1' Continuity of channel bed and bank
0
1 0
2 •)
3
2. Sinuosity of channel along thalweg
0
1 .;
20
30
3. In -channel structure: ex. rife -pool, step -pool,
ripple -pool sequence
00
1 D
20
30
4. Particle size of stream substrate
0 C)
1 ••
2 ®
3
5. Active/relict floodplain
00
10
2•
30
6. Depositional bars or benches
0
1 •;
2
3
7. ,Recent alluvial deposits
00
1
20
3
8. Headcuts
0
1
2 •,
3
9. Grade control
0 •1
0.
10
1.50
10. Natural valley
0 _
0.50
1 •
1.50
11. Second or greater order channel
No = 0 •
Yes = 3
a artificial ditches are not rated; see discussions in manual
R_ Hvdroloov (Subtotal= 8 1
12. Presence of Baseflow
00
10
20
3
13. Iron oxidizing bacteria
0 •_
1
20
3
14. Leaf litter
1.50
1 •.
0.
0
15. Sediment on plants or debris
00
0.5@
10
1.5
16. Organic debris lines or piles
00 1
0.5 •1
10
1.5
17. Soil -based evidence of high water table?
No = 0
,
Yes = 3
0
C. Bioloav (Subtotal = 4.75 )
18. Fibrous roots in streambed
3
2•
1
00
19. Rooted upland plants in streambed
3
2 •
1
0
20. Macrobenthos (note diversity and abundance)
O(•?
1
2Q
3
21. Aquatic Mollusks
0 •
1
2
3
22. Fish
0 .
0.5
10
1.5
23. Crayfish
00
0.50
10
1.5 ,_
24. Amphibians
0 •
0.50
10
1.5
25. Algae
0 0
0.50
10
1.50_
26. Wetland plants in streambed
FACW = 0.7500BL = 1.500ther = 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
41

NC Division of Water Quality -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC DWQ Stream Identification Form Version 4.11
Date: 1/18/2016
Project/Site: 3129 Riley Ave / S2
Latitude: °N 35.278239
Evaluator: Darrin Peine (S&ME, Inc.)
county: Mecklenburg
Longitude: °W -80.837713
Total Points:
Stream is at least intermittent 30.25
Stream Determination (circle one)
Other Derita
if 2:19 orperennial if -e 30*
Perennial
e.g. Quad Name:
A. Geomorphology (Subtotal = 17 )
Absent
Weak
Moderate
Strong
1a. Continuity of channel bed and bank
0
10
20
3 t)
2. Sinuosity of channel along thalweg
0
1
2 •
3 Q
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
00
10
2(D
30
4. Particle size of stream substrate
0
10
2 0
3 (E)
5. Active/relict floodplain
00
10
2•
30
6. Depositional bars or benches
0
1 •
2
3
7. Recent alluvial deposits
0 D
1
2 ,>
30
8. Headcuts
0
1 )
2•
30
9. Grade control
00
0.50
1 0
1.50
10. Natural valley
00
0.
1 • 1
1.50
11. Second or greater order channel
No = 00
Yes = 3
0
artificial ditches are not rated; see discussions in manual
B. Hvdroloav (Subtotal = 8.5 1
12. Presence of Baseflow
00
10
20
3
13. Iron oxidizing bacteria
0 •
1
2
3 ,
14. Leaf litter
1. •
10
0.50
0
15. Sediment on plants or debris
0 _
0.5 •
10
1.5 __
16. Organic debris lines or piles
00
0.5 •j
1
1.5
17. Soil -based evidence of high water table?
No = 00
0.5
Yes = 3 0
1.5
C. Bioloav (Subtotal = 4.75 )
18. Fibrous roots in streambed
30
2 •)
1
0
19. Rooted upland plants in streambed
3
2 @
1
00
20. Macrobenthos (note diversity and abundance)
0 •
in
20
3
21. Aquatic Mollusks
0
10
2 .'
3
22. Fish
00
0.50
1
1.5 ,
23. Crayfish
00
0.5
1
1.5
24. Amphibians
0e)
0.50
10
1.5
25. Algae
00
-0.50
10
1.5
26. Wetland plants in streambed
FACW = 0.7500BL = 1.500ther = 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
41

Appendix VI - Wetland Determination Data Form

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: 3129 Riley Ave /between S1 and S2 city/county: Charlotte/Mecklenburg Sampling Date: 1/18/2016
Applicant/Owner: City of Charlotte State: NC Sampling Point:
Investigator(s): Darrin Peine (S&ME, Inc.) Section, Township, Range:
Slope (%): 1
DP1 (upland)
Landform (hillslope, terrace, etc.): floodplain
Local relief (concave, convex, none): convex
Subregion (LRR or MLRA): MLRA 136 Lat: 35.278271 Long: -80.837749 Datum:
Soil Map Unit Name: Cecil sandy clay loam NWI classification:
Are climatic/ hydrolo is conditions on the site typi I f his time of year? Yes ✓ No (If no, explain in Remarks.)
Are Vegetation = Soil �, or Hydrology significantly disturbed?=Are "Normal Circumstances" present? Yes= No =
Are Vegetation = Soil or Hydrology= naturally problematic? =(If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes= No 0✓ Is the Sampled Area /
Hydric Soil Present? Yes= No 0 within a Wetland? Yes No
Wetland Hydrology Present? Yes= No=
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of twoSecondarindicators (minimum of two required)
[�Surface
Primary Indicators (minimum of one is required: all that apply)
Soil Cracks (136)
1=1sparsely Vegetated Concave Surface (138)
=Surface Water (Al) =True Aquatic Plants (1314)
=High Water Table (A2) =Hydrogen Sulfide Odor (C1)
[�Drainage Patterns (1310)
=Saturation (A3) =Oxidized Rhizospheres on Living Roots (C3)
=Moss Trim Lines (616)
=Water Marks (B1) =Presence of Reduced Iron (C4)
=Dry -Season Water Table (C2)
=Sediment Deposits (132) =Recent Iron Reduction in Tilled Soils (C6)
=Crayfish Burrows (C8)
=Drift Deposits (133) =Thin Muck Surface (C7)
=Saturation Visible on Aerial Imagery (C9)
=Algal Mat or Crust (134) =Other (Explain in Remarks)
=Stunted or Stressed Plants (D1)
=Iron Deposits (135)
=Geomorphic Position (D2)
=Inundation Visible on Aerial Imagery (137)
=Shallow Aquitard (D3)
=Water -Stained Leaves (139)
=Microtopographic Relief (D4)
=Aquatic Fauna (1313)
=FAC -Neutral Test (D5)
Field Observations:
Surface Water Present? Yes= No= Depth (inches):
Water Table Present? Yes= No= Depth (inches):
Saturation Present? Yes= No= Depth (inches):
Wetland Hydrology Present? Yes= No I ZI
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont —Version 2.0

VEGETATION (Five Strata) — Use scientific names of plants.
Sampling Point: DP1 (upland)
Absolute Dominant Indicator Dominance Test worksheet:
Tree Stratum (Plot size: 30 -ft ) % Cover Species? Status Number of Dominant Species
1. Liquidambar styraciflua 30 yes FAC That Are OBL, FACW, or FAC: 5
7.
Total % Cover of:
Multiply by:
OBL species
30
= Total Cover
Sapling Stratum (Plot size: 15 -ft
)
x 2 =
1. Cornus florida
40
yes FACU
2.
70
x4= 280
3.
0
x 5 =
4.
120
(A) 430
5.
6.
7.
40
= Total Cover
Shrub Stratum (Plot size: 15 -ft
1. Ligustrum sinense
20
yes FACU
2. Cornus florida
10
yes FACU
3.
4.
5.
6.
7.
30
= Total Cover
Herb Stratum (Plot size: 5 -ft )
1. Lonicera japonica
5
yes FAC
2. Smilax rotundifolia
5
yes FAC
3 Toxicodendron radicans
5
yes FAC
4 Vitis rotundifolia
5
yes FAC
6.
7.
8.
9.
10
11
12
Woody Vine Stratum (Plot size: 30 -ft
1.
5
Remarks: (Include photo
20
or on a separate sheet.)
= Total Cover
= Total Cover
Total Number of Dominant 8
Species Across All Strata: _
Percent of Dominant Species
That Are OBL, FACW, or FAC: 62.5
Prevalence Index worksheet:
Total % Cover of:
Multiply by:
OBL species
0
x 1 =
FACW species
0
x 2 =
FAC species
50
x 3 = 150
FACU species
70
x4= 280
UPL species
0
x 5 =
Column Totals:
120
(A) 430
Prevalence Index = B/A = 3.5
(A)
(B)
(A/B)
(B)
Hydrophytic Vegetation Indicators:
Q 1 -Rapid Test for Hydrophytic Vegetation
02 - Dominance Test is >50%
03 - Prevalence Index is 53.0'
Q4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Five Vegetation Strata:
Tree — Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and 3 in.
(7.6 cm) or larger in diameter at breast height (DBH).
Sapling —Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and less
than 3 in. (7.6 cm) DBH.
Shrub — Woody plants, excluding woody vines,
approximately 3 to 20 ft (1 to 6 m) in height.
Herb —All herbaceous (non -woody) plants, including
herbaceous vines, regardless of size, and woody
plants, except woody vines, less than approximately 3
ft (1 m) in height.
Woody vine —All woody vines, regardless of height.
Hydrophytic
Vegetation
Present? Yes= No �✓
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

A
SOIL
Profile
depth needed to document the indicator or confirm the absence of
Sampling Point: DP1 (upland
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loc Texture Remarks
0-15 7.5YR 4/4 95 7.5YR 6/6 5 C M loamy/cla, soil void after 15 inches
'Type: C=Concentration
Hvdric Soil Indicators:
U Histosol (A1)
=Histic Epipedon (A2)
=Black Histic (A3)
=Hydrogen Sulfide (A4)
=Stratified Layers (A5)
=2 cm Muck (A10) (LRR N)
=Depleted Below Dark Surface (A11)
=Thick Dark Surface (Al2)
=Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
=Sandy Gleyed Matrix (S4)
=Sandy Redox (S5)
=Stripped Matrix (S6)
Restrictive Layer (if observed):
Type:
Depth (inches):
MS=Masked Sand
=Dark Surface (S7)
=Polyvalue Below Surface (S8) (MLRA 147, 148)
=Thin Dark Surface (S9) (MLRA 147,148)
=Loamy Gleyed Matrix (F2)
=Depleted Matrix (F3)
=Redox Dark Surface (F6)
=Depleted Dark Surface (F7)
= Redox Depressions (F8)
=Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
=Umbric Surface (F13) (MLRA 136, 122)
=Piedmont Floodplain Soils (F19) (MLRA 148)
r_JRed Parent Material (1721) (MLRA 127, 147)
:ion: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric So
=2 cm Muck (A10) (MLRA 147)
=Coast Prairie Redox (A16)
(MLRA 147, 148)
=Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
=Very Shallow Dark Surface (TF12)
=Other (Explain in Remarks)
3Indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes= No E
US Army Corps of Engineers Eastern Mountains and Piedmont —Version 2.0