20160635 Ver 1_401 Application_20160616

Charlotte -Mecklenburg
STORM "11
Charlotte Storm Water Services
WATER 600E Fourth St, 2- Floor
Charlotte, NC 28202-2844
Services
June 27, 2016
N.0 Division of Water Resources
401 8 BUFFER PERMITTING
Attention: Karen Higgins D @ �'l Li
401 & Buffer Permitting Unit ,J L' D
1617 Mail Service Center
Raleigh, N.C. 27699-1617 JUL " X 2016 1
Subject: Submittal of Pre -Construction Notification Package for 9804
Circle Maintenance Project- Permit Fee Payment
Dear Ms. Higgins:
Charlotte -Mecklenburg Storm Water Services (CMSWS) is hereby submitting payment for the
permit application associated with the 9804 Woodland Circle Maintenance Project. Application
materials were mailed to your office on 6/22/16.
If you have any questions, please feel free to contact me.
Sincerely,
Erin Turner
Wetland Specialist
City of Charlotte Storm Water Services Division
Desk phone [phone]
[e-mail]
To report drainage problems: 704 -336 -RAIN hftp://stormwater.charmeck.org

Charlotte -Mecklenburg
STORMCharlotte Storm Water Services
WATER 600E Fourth , Floor
2
Charlotte, NC 28202-2- 2844
Services —'
June 22, 2016
N.0 Division of Water Resources
Attention: Karen Higgins
401 & Buffer Permitting Unit 20 1 6 0 6,35
1650 Mail Service Center
Raleigh, N.C. 27699-1650
Subject: Submittal of Pre -Construction Notification Package for 9804 Woodland
Circle Maintenance Project
Dear Ms. Higgins:
Charlotte -Mecklenburg Storm Water Services (CMSWS) is hereby submitting a Pre -Construction
Notification package pursuant to Nationwide Permit No. 3/ WQC 3883 for approval to the
NCDWR for the 9804 Woodland Circle Maintenance Project.
The project primarily consists of replacing a 41 LF culvert with a larger culvert on a linear foot-
for- linear foot basis to pass the 10 and 25 -year storm events and prevent road flooding. Currently
the channel grade drops about 4 vertical feet over a short distance on the downstream side of the
culvert. To repair this headcut and prevent a new one from forming, we are proposing to install
in -stream structures on the upstream side of the new culvert to control the grade. A series of 5
cross vanes with maximum 6 -inch drops will be installed upstream of the road crossing and a
constructed riffle with log sills will set the grade downstream of the crossing.
I have enclosed the following for your review: PCN form, Project Area Maps and Photos, Project
Plans, and Preliminary Jurisdictional Determination Form. Payment will be mailed separately. If
you need any additional information or have any questions concerning this project and its
associated impacts, feel free to contact me by phone or via email.
Sincerely,
Q_"�
Erin Turner
Wetland Specialist
City of Charlotte Storm Water Services Division
Desk phone [phone]
[e-mail]
cc: Crystal Amschler, USACE
enclosed: 4 copies of PCN package, 4 half size plan sets
To report drainage problems: 704 -336 -RAIN hUp://stormwater.charmeck.org

Office Use Only
Corps action ID no
DWQ project no.
Form Version 14 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1b Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1d. Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑X No
For the record only for Corps Permit:
❑ Yes ❑X 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 ❑X No
1 g
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below
❑ Yes ❑X No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a. Name of project
9804 Woodland Circle Maintenance Project
2b. County-
Mecklenburg
2c.
Nearest municipality / town:
Charlotte
2d
Subdivision name-
N/A
2e
NCDOT only, T.I P or state project no:
,/O
Al
3.
Owner Information y�
3a
Name(s) on Recorded Deed.
multiple parcels q F
3b
Deed Book and Page No.
OV
3c.
Responsible Party (for LLC if
applicable):
S
City of Charlotte (Storm Drainage Easement)
3d. Street address
9804, 9813, 9723 Woodland Circle
3e
City, state, zip:
Charlotte, NC 28216
3f
Telephone no.
3g
Fax no.:
3h. Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a
Applicant is.
❑ Agent ❑X Other, specify CMSWS; Ms. Erin Turner
4b. Name:
Erin Turner
4c.
Business name
(if applicable)
City of Charlotte, Charlotte -Mecklenburg Storm Water Services
4d
Street address:
600 E. 4th Street
4e
City, state, zip:
Charlotte, NC 28202
4f
Telephone no.:
704-336-3927
4g. Fax no.:
4h.
Email address
[e-mail] nc.us
5.
Agent/Consultant Information (if applicable)
5a. Name -
5b. Business name
(if applicable) -
5c.
Street address:
5d
City, state, zip:
5e
Telephone no..
5f.
Fax no.:
5g
Email address.
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a Property identification no. (tax PIN or parcel ID): —T62510611,02510520
1b. Site coordinates (in decimal degrees):
Latitude: 35.354627 Longitude- -80.86421
1c. Property size.
0.1 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Dixon Branch (Trib to Long Creek)
2b. Water Quality Classification of nearest receiving water:
Class C
2c River basin
Upper Catawba (03050101)
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
Elliptical culvert crossing Woodland Circle is perched, road floods in 10 and 25 year storms Land use is residential, maintained lawns Nearby
interstates and commercial developments
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 160
3d Explain the purpose of the proposed project.
Project proposes upsizing existing perched pipe under Woodland circle to alleviate road flooding and stabilize a headcut Grade control structures will
3e. Describe the overall project in detail, including the type of equipment to be used:
Dual elliptical concrete pipes under Woodland Circle will be replaced with an 8'x 6' RCBC buried 12" with a 3' by 3" baseflow channel and graded floor
D
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
❑ Yes ❑X No ❑ Unknown
Comments:
4b If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known)
Agency/Consultant Company:
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
this project (including all prior phases) in the past?
❑ Yes ❑X No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑X No
6b. If yes, explain
Page 3 of 10
PCN Form – Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑X 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.
Wetland impact
number
Permanent (P) or
Temporary
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1
Choose one
Choose one
Yes/No
-
W2
Choose one
Choose one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6 -
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a
Stream impact
number
Permanent (P) or
Temporary (T)
3b
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
Intermittent (INT)?
3e.
Type of
jurisdiction
3f
Average
stream
width
(feet)
3g
Impact
length
(linear
feet)
S1 P
Fill
Tnb to Dixon Branch
INT
Corps
2
42
S2 P
Fill
Tnb to Dixon Branch
PER
Corps
3
71
S3 T
Culvert
Tnb to Dixon Branch
Corps
25
41
S4
Choose one
-
S5 -
Choose one
_
S6 -
Choose one
3h. Total stream and tributary impacts
113
3i. Comments.
Culvert replacement is linear foot- for- linear foot, no net impacts
Page 4 of 10
PCN Form — Version 1 4 January 2009

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
Open water
impact number
Permanent (P) or
Temporary
4b
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04 -
Choose one
Choose
4f Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f Total:
5g. Comments
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
51. 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. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b.
Buffer Impact
number —
Permanent (P) or
Temporary T
6c
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
131
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h Total Buffer Impacts:
61 Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Culvert is being replaced on a foot -for -foot basis and grade control structures are minimized to maximum extent practicable to accommodate new,
larger culvert and arrest an existing headcut. Structure drops are no larger than 6 inches to WSE and logs are used where appropriate to minimize
hard structure
1b. Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques.
Proper sediment and erosion control techniques will be employed to minimize sediment loss to downstream waters Coffer dams and pump around
method will be used to conduct work in -the -dry.
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 ❑X 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: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity.
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
Choose one
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 6 of 10
PCN Form — Version 1.4 January 2009

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 X 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 7 of 10

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 ❑X 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
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:
Storm water repair project will not result in an increase in existing impervious surface cover
2d If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which localgovernment's jurisdiction is thisproject?
❑ Phase II
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program Review
❑Coastal counties
❑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
❑ Yes ❑ 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 8 of 10
PCN Form — Version 14 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑x Yes
❑ No
use of public (federal/state) land?
lb 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
❑X No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.)
❑ Yes
❑ No
Comments
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes
No
or Riparian Buffer Rules (15A NCAC 2B.0200)?
2b Is this an after -the -fact permit application?
❑ Yes
❑X 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
❑X No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis In accordance with the
most recent DWQ policy If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Storm water protect will not generate wastewater during construction
Page 9 of 10
PCN Form — Version 14 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ X Yes El No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ❑X No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
-
5d. What data sources did you use to determine whether your site would Impact Endangered Species or Designated Critical
Habitat?
Field assessment determined no suitable or critical habitat exists for listed or endangered species Northern Long -Eared Bat Final 4d Rule key was
used to determine no USFWS consult was necessary
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat
No essential fish habitat in this region
I
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. WIII this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ❑X 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?
NC State Historic Preservation Office HPOWEB GIS Service No significant landmarks or historic places listed within -0 5 miles of protect area
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination?
Mecklenburg County GIS
Digitally signed Ey Enn Tumer -
E ri n T u rn e r D N ct Enn Tumer, o=City of Char Otte,
fou -Storm Water Sernces
Erin Turner ,
I- Nmer®a charlotte nc us c=US
--oats 2018 06 22 08 55 47-04'00
06-22-2016
!
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

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ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD): 6/14/16
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Charlotte -Mecklenburg Storm Water Services, Erin Turner
600 E 4th Street, Charlotte, NC 28202
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
Asheville Regulatory Field Office
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
9804 Woodland Circle, Charlotte, NC 28216
(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 354627 °N; Long. 60 66421 oW
Universal Transverse Mercator:
Name of nearest waterbody: Dixon Branch, Long Creek
Identify (estimate) amount of waters in the review area:
Non -wetland waters:
160 linear feet: 3 width (ft) and/or acres.
Cowardin Class:
Stream Flow: Intermittent above culvert, perennial below
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): 6/14/16
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):
✓❑ Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant:
❑✓ Data sheets prepared/submitted by or on behalf of the
appl*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:
❑ USDA Natural Resources Conservation Service Soil Survey.
Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
u
100 -year Floodplain Elevation is:
(National Geodectic Vertical Datum of 1929)
❑✓ Photographs: ❑ Aerial (Name & Date):
Other (Name & Date): see Figure 4 of PCN
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
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.

This preliminary JD finds that there "maybe" 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)
N
Digitally byErin Turner
DN cn=ErinTurner,o=Crty ofErin
Charlotte, ou=Storm Water
Services,
Turner email=erin turner@cl charlotte nc
us, c=us
Date 2016 06 22 09 0438 -04'00'
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)

SAMPLE
Estimated
Site
Cowardin
amount of
Class of
number
Latitude
Longitude
Class
aquatic
aquatic
resource in
resource
review area
1
0.1 acre
Non -section 10
— non -wetland
2
100 linear feet
Non-section10
— wetland
3
15 square feet
Non -section 10
— wetland
4
0.01 acre
Non -section 10
— non -wetland

1/Y'5T�EA'�'
NC DWQ Stream Identification Form Version 4.11
Date: Z% i.o
Project/Site: 01 r
Latitude:
Evaluator: C-'pT
County: IOV1r-
Longitude:
Total Points:
Stream Determ circle one)
Other
Stream is at least Intermittent
if z 19 or erennlal if Z 30"
Ephemeral 1 ermitten Perennial
e.g. Quad Name:
A. Geomorphology Subtotal =_W2.j
Absent
Weak
Moderate
Strong
iB Continuity of channel bed and bank
0
1
2
0 0 1 1.5
2. Sinuosity of channel along thalweg
0
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
�
3
4 Particle size of stream substrate
0
1
CL23
15
5. Active/relict floodplain
0
0.5
2
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0
0.5
FACW = 0.75; OBL = 1.5
2
3
8. Headcuts
0
1
2
3
9. Grade control
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
e�cy4-
Ao 79-1)
Yes = 3
- artificial ditches are not rated; see discussions in manual
B. Hvdroloav (Subtotal = � )
12. Presence of Baseflow
1 2 3
13 Iron oxidizing bacteria
1 2 3
14 Leaf litter
1. 1 0.5 0
15. Sediment on plants or debris
0 0.5 1.5
16. Organic debris lines or piles
0 0 1 1.5
17. Soil -based evidence of high water table?
No = 0 Yes = 3
C. Bioloav (Subtotal = "1 .S )
18. Fibrous roots in streambed
2
1
0
19. Rooted upland plants in streambed
2
1
0
20. Macrobenthos (note diversity and abundance)
0
1
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
1
15
23. Crayfish
0
0.5
1
1.5
•24. Amphibians
0
0.5
1
1.5
25. Algae
26. Wetland plants in streambed
0
0.5
FACW = 0.75; OBL = 1.5
1
Other = 0
1.5
`perennial streams may also be Identifled using other methods. See p. 35 of manual
Notes:
ketch:)
Sketch:-
Z)
e�cy4-
-
�
M

r
Dhws J P�_14W
lva� M Vl1 Q+-.- Trinn*ifinatinn Fnrm Varcinn A 11
Date: W ' (,y
Project/Site: la
Latitude:
Evaluator:
County:
Longitude:
Total Points:
1:30 "
Stream Determination (ci e o
Other
Stream is at least Intermittent
Ephemeral Intermitten Perennia
a g. Quad Name:
if? 19 orperennial if z 30*
2
3
A. Geomorphology (Subtotal =)
Absent
'Weak
Moderate
Strong
1a• Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
0.5
2
3
4. Particle size of stream substrate
0
1
1
3
5. Active/relict floodplain
0
1
2
3
6. Depositional bars or benches
0
CJ
1
3
7. Recent alluvial deposits
0
1
1
3
8 Headcuts
0
1
`' 2
3
9. Grade control
0
0.5
1
1 5
10. Natural valley
00
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
Sketch:
"artificial ditches are not rated, see disc ssions in manual
R. Hvdroloov (Subtotal = 1
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
0
r 1
2
3
14. Leaf litter
1 5
1
0.5
0
15. Sediment on plants or debris
0
0.5
2
1.5
16. Organic debris lines or piles
0
0.5
1
1.5
17 Soil -based evidence of high water table?
No = 0
Y_es = 3
1.5
C. Bioloav (Subtotal = 75 LS 1
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
15
23. Crayfish
0.5
1
1.5
24 Amphibians
0
0.5 <=
1
15
25. Algae
0
0-5:?
1
1.5
26. Wetland plants In streambed
FA
_=0. 7 6; OBL = 1.5
ther =
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
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SWDES 00551 Munis Code: 807020 0009