20080155 Ver 1_Application_20080122

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STATE OF NORTH CAROLINEI'"
DEPART~~N'T OF TRANSPORTATION
~ MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
~ ~ January 7, 2008
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v Mr. David Baker, NCDOT Regulatory Project Manager
~ U.S. Army Corps of Engineers p ~ ~ ~ ~~ ~ D
~, 151 Patton Avenue, Room 208
~ Asheville, NC 28801-2714 JAN 2 2 2008
~- Subject: Nationwide 13 Permit Application DENq _ yypTER QUAIITY
SR 1105 -Mill Creek Road -Hyde MiII Creek yyETUwDS AND STORMyVA7ER BRANCH
Graham County
State Project No. 14.202811
Dear Mr. Baker:
The North Carolina Department of Transportation (NCDOT) is proposing to stabilize 60 linear
feet of streambank along the shoulder of Mill Creek Road. Hyde Mill Creek is eroding the
shoulder of the roadway and will eventually undermine the roadbed. The proposed streambank
stabilization is necessary for maintenance and safety of the existing roadway. Attached is a site
map and digital photo of the site. Funds have been allocated for this project, and NCDOT would
like to perform these activities as soon as possible.
NCDOT will install large shot rock along the streambank in order to rebuild and stabilize the
shoulder. Minimal excavation of the streambank may be necessary in order to install the rock.
The majority of the shot rock will be placed above the ordinary high water mark. Sandbags will
be used to prevent water from entering the work area. The best management practices will be
used to minimize and control sedimentation and erosion on this project. The construction
foreman will review all erosion control measures daily to ensure sedimentation and erosion is
effectively controlled.
The North Carolina Natural Heritage Database was checked for records of federally threatened
and endangered species. There are no records of threatened or endangered species listed for the
Hyde Mill Creek watershed. There is a pre-1981 record for the Appalachian elktoe (Alasmidonta
raveneliana) approximately two miles downstream of the project site in Tulula Creek. There
have been no observations of the Appalachian elktoe in recent years from Tulula Creek. Hyde
Mill Creek is not of sufficient size to support mussels. The impacts from this bank stabilization
will be very minimal. For these reasons, we believe there will be "no effect" on threatened and
endangered species.

Impacts to Waters of the United States
Hyde Mill Creek is shown as a perennial stream on the USGS topographic map. The stream is at
least a third order stream and has awell-defined channel composed of cobble, gravel and sand.
The channel lacks vegetation. Hyde Mill Creek has sufFcient flow to support fish. The stream
has had flow even during an extraordinary drought. Hyde Mill Creek flows to Tulula Creek
approximately 0.4 miles below the project site. Tulula Creek and Sweetwater Creek flow
together to form the Cheoah River approximately 2.4 miles below the confluence of Hyde Mill
Creek and Tulula Creek. The Cheoah River is navigable in fact and would be considered a
Traditional Navigable Water. For these reasons, we believe that Hyde Mill Creek is a Relatively
Permanent Water and is under the jurisdiction of the U. S. Army Corps of Engineers. In order to
conduct the necessary repairs, it will be necessary to impact waters of the United States in the
Little Tennessee River Basin. Specifically, NCDOT is proposing to stabilize 60 linear feet of
streambank of Hyde Mill Creek along the shoulder of SR 1105. Listed below is a summary of
the impacts.
Site No. Existing Condition Proposed Condition Net Impacts
Site 1 Unstable streambank Stabilize 60 linear feet of 60'
encroachin into roadbed streambank with shot rock
Site 1 6 foot wide free flowing 2 ft wide x 70 ft long 70'
open channel sandbag coffer dam w/ 4 Temporary
foot wide o en channel
Total Permanent Impact 60 feet
Temporary Impacts from Sandbag Coffer Dam 70 feet
Permits Requested
NCDOT is hereby requesting authorization under Section 404 of the Clean Water Act to proceed
with the construction project outlined above. By copy of this letter, I am asking Mr. David
McHenry, Mountain Region Coordinator of the North Carolina Wildlife Resources Commission
(NCWRC), to comment directly to you concerning the 404 Nationwide Permit request.
Also, by copy of this letter, I am asking Mr. McHenry and Mr. Ed Ingle, Roadside
Environmental Field Operations Engineer of NCDOT, to comment directly to me concerning this
permit request.
If you have any questions or need additional information, please contact me at [phone].
Sincerely,
~~~ ~~
Steven M. Buchanan
County Maintenance Engineer
cc: Mr. Mike Parker, DWQ, DENR, Asheville (1 Courtesy Copy}
Mr. David McHenry, Mountain Region Coordinator, NCWRC
Mr. Troy Wilson, Biologist, U.S. Fish and Wildlife Service
Mr. Joel Setzer, P.E., Division Engineer, NCDOT
Mr. Mark Davis, Division Environmental Officer, NCDOT
Mr. E. L. Ingle, Roadside Environmental Field Operations Engineer, NCDOT

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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401 General Water Quality
Certifications, and Riparian Buffer and Watershed Buffer Rules
SR 1105 Mill Creek Road
Graham County
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NCDOT Division 14, District 111
Prepared by: Steven M. Buchanan
County Maintenance Engineer
Cherokee $~ Graham County

Office Use Only: Form Version March OS
20080155
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
^ 401 Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 13
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ^
If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ^
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation (NCDOT)
Mailing Address: 191 Robbinsville Road
Andrews NC 28901
Attn: Steven Buchanan
Telephone Number: 828.321.4105 Fax Number: 828.321.3228
E-mail Address: sbuchananndot.state.nc.us
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
III. Project Information
Page 1 of 9

Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps maybe included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: SR 1105 -Mill Creek Road -Bank Stabilization
2. T.I.P. Project Number or State Project Number (NCDOT Only): 14.203811
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Graham Nearest Town: Robbinsville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): From Robbinsville at the
intersection of US 129 & NC 143 ~o south on US 129. Trave12.10 mile to SR 1105 and take
a right on to SR 1105. Site is 0.10 mile on the right.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 35.29289°N 83.78701°W
6. Property size (acres): N/A
7. Name of nearest receiving body of water: Hyde Mill Creek (WS-III)
8. River Basin: Little Tennessee
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: residential, forest
Page 2 of 9

r
10. Describe the overall project in detail, including the type of equipment to be used: NCDOT
proposes to stabilize 60 linear feet of eroded streambank on Hvde Mill Creek by installing
lame shot rock and backfillin~ in order to rebuild the road shoulder along SR 1105. A
trackhoe, dump truck, sandba~;s and various hand tools will be used during construction.
11. Explain the purpose of the proposed work: To maintain safety and integrity of the road.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N/A
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
None anticipated
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs maybe included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: The streambank/road shoulder will
be excavated to provide sufficient room to install large shot rock along the 60-foot section of
eroding streambank to provide long term stability.
Page 3 of 9

2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)
N/A N/A N/A N/A N/A N/A

Total Wetland Impact (acres) N/A
3. List the total acreage (estimated) of all existing wetlands on the property: N/A
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
indicate on ma
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Im act Impact
Length
linear feet Area of
Impact
acres
Site 1 Hyde Mill Creek Bank Stabilization P 6 60 N/A
Site 1 Hyde Mill Creek Sandbag Coffer
Dam P 2 (Coffer
Dam 70 .00321

Total Stream Impact (by length and acreage) 60 N/A
Total Temporary Impact Coffer Dam 70 .00321
Page 4 of 9

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact

Site Number
(indicate on ma
Name of Waterbody
(if applicable)

Type of Impact Type of Waterbody

(lake, pond, estuary, sound, bay,
ocean, etc. Area of

Impact
(acres
N/A N/A N/A N/A N/A

Total Open Water Impact (acres) N/A
6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Im act (acres): 0
Wetland Irri act (acres : N/A
O en Water Im act (acres): N/A
Total Im act to Waters of the U.S. acres 0
Total Stream Im act (linear feet): 60
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes ®No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
N/A
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ^ uplands ^ stream ^ wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Current land use in the vicinity of the pond: N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
Page 5 of 9

were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. The stream is adjacent to the
road and is underminin eroding the fill slope and road shoulder. The impacts will be minimized
by excavating the shoulder/streambank and installing shot rock along the toe of the
streambank. This will stabilize the streambank and prevent further undermining of the shoulder.
Sandbags will be used to prevent water from entering the work area during construction. The
sandbags will be removed following stabilization of the bank.
VIII.. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that maybe appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable. in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http: //h2o. enr.state.nc.us/ncwetlands/strm~ide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
Page 6 of 9

2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount ofNon-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ® No ^
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ^ No
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ^ No ^
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify N/A )? Yes ^ No
Page 7 of 9

2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* Impact
s uare feet Multiplier Required
Miti ation
1 3 (2 for Catawba)
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additiona120 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. N/A
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Is this anafter-the-fact permit application? Yes ^ No
Page 8 of 9

XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
This project involves an eroding streambank along a roadside. The project will not change the
existin tg ransportation infrastructure but only make the existing road safer and reduce adverse
impacts to surface waters and aquatic habitat.
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
N/A
1 / is ~ goo
~icant/Agent's signature Date
signature is valid only if an authorization letter from the applicant is provided.)
Page 9 of 9

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section [V 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: Graham City: Robbinsville
Center coordinates of site (lat/long in degree decimal format): Lat. 35.2932° N, Long. 83.7871 ° 1i .
Universal Transverse Mercator:
Name of nearest waterbody: Hyde Mill Creek (WS-III)
Name of nearest Traditional Navigable Water (TNW) Into which the aquatic resource flows: Cheoah River (Santeetlah Lake)
Name of watershed or Hydrologic Unit Code (HUC): 06010204010010
(~ 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: Dec 19, 2007
Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are uo "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 Arc "waters of the U.S" within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
I. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): t
^ TNWs, including territorial seas
^ Wetlands adjacent to TNWs
® Relatively permanent watersz (RPWs) that flow directly or indirectly into TNWs
^ Non-RPWs that flow directly or indirectly into TNWs
^ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
^ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
^ Impoundments of jurisdictional waters
Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non-wetland waters: 300 linear feet: 6 width (ft) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: Established by OHWM.
Elevation of established OHWM (if known):Unknown.
2. Non-regulated waters/wetlands (check if applicable):3
[~ Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
~ Boxes checked below shall be supported by completing the appropriate sections in Section Ill below.
z For purposes of this form, an RPW is defined as a tributary that is not a TN W and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
Supporting documentation is presented in Section IILF.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section IQ.D.1.; otherwise, see Section IILB below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non-navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section IILD.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 waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.C below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: Pick List
Drainage area: Pick List
Average annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
^ Tributary flows directly inter TNW.
^ Tributary flows through Yick List tributaries before entering TNW.
Project waters are Piek List river miles from TNW.
Project waters are >1'lek List river miles from RPW.
Project waters are Pick List aerial (straight) miles from TNW.
Project waters are Pick List aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain: N/A.
Identify flow route to TNWS:
Tributary stream order, if known:
° Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the arid
West.
s 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 applyl:
Tributary is: ^ Natural
^ Artificial (man-made). Explain:
^ Manipulated (man-altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: feet
Average depth: feet
Average side slopes: Pick List.
Primary tributary substrate composition (check all that apply):
^ Silts ^ Sands ^ Concrete
^ Cobbles ^ Gravel ^ Muck
^ Bedrock ^ Vegetation. Type1% cover:
^ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain:
Presence of run/riffle/pool complexes. Explain:
Tributary geometry: Pick Lis).
Tributary gradient (approximate average slope):
(c) Flow:
Tributary provides for: Yick List
Estimate average number of Clow events in review area/year: Pick List
Describe flow regime: Perennial.
Other information on duration and volume:
Surface flow is: PIck List. Characteristics:
Subsurface flow: Pick List. Explain findings:
^ Dye (or otherl 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):
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
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.
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices).. Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.

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

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/Nl 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:
I. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section IILD:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLl7:
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: The stream at the project area has a watershed of approximately 951 acres and is a 3rd order stream.
The stream at the impact site has had flow on two visits during an extraordinary drought..
Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
] Tributary waters: linear feet width (ft).
^ Other non-wetland waters: acres.
Identify type(s) of waters:
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 IILC.
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:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
^ Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
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 IILC.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
Q 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 IILC.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters 9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
^ Demonstrate that impoundment was created from "waters of the U.S.," or
^ Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
Q Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
^ which are or could be used by interstate or foreign travelers for recreational or other purposes.
'^ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
^ which are or could be used for industrial purposes by industries in interstate commerce.
^ Interstate isolated waters. Explain:
Other factors. Explain:
BSee Footnote # 3.
v To complete the analysis refer to the key in Section III. D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
^ Tributary waters: linear feet width (ft).
^ Other non-wetland waters: acres.
Wetlands
acres.
F. NON-JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLE:
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
udgment (check all that apply):
Non-wetland waters (i.e., rivers, streams): linear feet width (ft).
^ Lakes/ponds: acres.
^ Other non-wetland waters: acres. List type of aquatic resource:
^ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" 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 NHD data.
^ USGS 8 and 12 digit HUC maps.
U.S. Geological Survey map(s). Cite scale & quad name:
^ 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):
or ^ Other (Name & Date):
^ Previous determination(s). File no. and date of response letter:
^ Applicable/supporting case law:
^ Applicable/supporting scientific literature:
Other information (please specify):Photographs.
Identify type(s) of waters:
B. ADDITIONAL COMMENTS TO SUPPORT JD:

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