20160957 Ver 1_401 Application_20161003

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
PAT MCCRORY
GOVERNOR
October 3, 2016
U. S. Army Corps of Engineers
Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, NC 28403
Attention: Ms. Crystal Amschler
NCDOT Coordinator
ANTHONY 7. TATA
SECRETARY
Subject: Application for Section 404 Nationwide Permit 14 and Section 401 Water Quality
Certifcation 3886, for the Replacement of Bridge No. 152 on Austin Road (SR 2156) over
Adams Branch in Union County, North Carolina. State Project No. 17BP.10.R.66, Division 10.
Dear Ms. Amschler:
Please find enclosed the Pre-Construction Notification (PCN) form, Stormwater Management Plan, permit
drawings, and half-size roadway design plans for the subject project. The North Carolina Department of
Transportation (NCDOT) proposes to replace Bridge No. 152 over Adams Branch on Austin Road (SR 2156)
between SR 2139 and SR 2152 in Union County. The proposed project consists of removing the functionally
obsolete bridge (Sufficiency Rating of 23.67) built in 1957 and replacing it with a double 12 x 9-foot
Reinforced Concrete Box Culvert (RCBC). The project length is approximately 0.097 miles.
A copy of this permit application will be posted on the NCDOT website at:
http://www.ncdot.or /g doh/preconstruct/pe/neu/permit.html. Thank you for your time and assistance with this
project. If you have any questions or need additional information, please contact Larry Thompson at
[e-mail] or [phone].
Sincerely,
Larry Thompson, PWS, LSS
Division Environmental Officer
Cc: NCDOT Permit Application Standard Distribution List
716 W. Main Street, Albemarle, NC 28001 * Telephone [phone] * Fax [phone]
North Carolina Division of Highways — I Oth Division

Mitiqation Services
ENVIRONMENTAL OUALITY
PAT MCCRORY
Goreruor
DONALD R.. VAN DER VAART
Secrerm�,-
September 29, 2016
Mr. Larry Thompson
NCDOT Division 10
North Carolina Department of Transportation
716 West Main Street
Albemarle, North Carolina 28001
Dear Mr. Thompson:
Subject: EEP Mitigation Acceptance Letter:
Division 10 Project, Replace Bridge 152 on SR 2156 over Adams Branch, Union County; WBS
Element 17BP.10.R.66
The purpose of this letter is to notify you that the Division of Mitigation Services (DMS) will provide the
compensatory stream mitigation for the subject project. Based on the information received from you on September
29, 2016, the impacts are located in CU 03040105 of the Yadkin River basin in the Southern Piedmont (SP) Eco-
Region, and are as follows:
Yadkin
03040105
Sp Cold
Impacts O
feet/acres)
Stream
Cool � Warm
0 25.0
Wetlands
�p�,i� Non- Coastal
Riparian Marsh
Buffer (Sq. Ft.)
Zone 1 I Zone 2
This impact and associated mitigation need were under projected by the NCDOT in the 2016 impact data.
DMS will commit to implement sufficient compensatory stream mitigation credits to offset the impacts associated
with this project as detemuned by the regulatory agencies using the delivery timeline listed in Section F.3.c.iii of the
In-Lieu Fee Instrument dated July 28, 2010. If the above referenced impact amounts are revised, then this
mitigation acceptance letter will no longer be valid and a new mitigation acceptance letter will be required from
DMS.
If you have any questions or need additional information, please contact Ms. Beth Harmon at 919-707-
8420.
Sincerely,
,
James B. tanfill
Credit nagement Supervisor
cc: Ms. Crystal Amschler, USACE Asheville Regulatory Field Office
Ms. Amy Chapman, NCDWR
Ms. Linda Fitzpatrick, NCDOT — PDEA
File: SR 2156 — Bridge 152 — Division 10
State of North Carolina Environmental Quality Mitigation Services
1652 Mail Service Center � 217 W. Jones Street, Suite 3000 � Raleigh, NC 27609-1652
919 707 8976 T

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps: ❑X Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes ❑X No
1 d. 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
1 e. Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 Certification:
❑ Yes ❑X No ❑ 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 � Yes ❑X No
or in-lieu fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h � Yes ❑X No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ❑X No
2. Project Information
2a. Name of project: Replacement of Bridge No. 152 on SR 2156 (Austin Road) over Adams Branch
2b. County: Union
2c. Nearest municipality / town: Monroe
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if N/A
applicable):
3d. Street address: 716 W. Main Street
3e. City, state, zip: Albemarle, NC 28001
3f. Telephone no.: 704-983-4400
3g. Fax no.: 704-982-3146
3h. Email address: [e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name: N/A
4c. Business name
(if applicable):
4d. Street address:
4e, City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: N/A
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): N/A
1 b. Site coordinates (in decimal degrees): Latitude: 34.893294 Longitude: -80.560731
1 c. Property size: acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Adams Branch
2b. Water Quality Classification of nearest receiving water: WS-IV
2c. River basin: Yadkin-Pee Dee
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:
Land use in the project vicinity consists primarily of agriculture, forest, and low density residential.
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:
To replace a functionally obsolete bridge. The bridge was built in 1957 and has a Sufficiency Rating of 23.67.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project will replace Bridge No. 152 with a double 12'x9' RCBC. Standard road building equipment will be used including trucks, dozers, and cranes
0
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the � Yes ❑X No ❑ Unknown
Corps or State been requested or obtained for this property /
pro'ect includin 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 ❑X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes OX 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. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora T
W 1 - Choose one Choose one Yes/No -
�/2 - 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 -
Wg - Choose one Choose one Yes/No -
2g. Total Wetland Impacts: 0
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 P Culvert Adams Branch PER Corps 10 25
$2 T Benches Adams Branch PER Corps 10 131
S3 - Choose one - -
S4 - Choose one - -
S5 - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts 156
3i. Comments:
The project will replace the existing bridge with a 12'x9' reinforced concrete box culvert (RCBC). Impacts include 25 feet of permanent channel impacts
for the culvert and 131 feet of temporary impacts for creation of the benches and open cut installation for waterline relocation.
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 individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Tem ora T
01 - Choose one Choose
O2 - Choose one Choose
03 - Choose one Choose
04 - Choose one Choose
4f. Total open water impacts o
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (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:
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 an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse � Tar-Pamlico � Catawba � Randleman ❑ Other:
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number — mitigation impact impact
Permanent (P) or required? (square (square
Tem ora T feet feet
B� - Yes/No
g2 - Yes/No
B3 - Yes/No
B4 - Yes/No
B5 - Yes/No
gg - Yes/No
6h. Total Buffer Impacts: o 0
6i. 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.
The project is a bridge replacement. There will not be any on site detours to avoid additional impacts and the bridge will be replaced at its existing
location.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
NCDOT Best Management Practices for Bridge Demolition, Removal, and Construction will be followed as well as those for Sedimentation and
Erosion Control.
2. Compensato Miti ation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑X Yes ❑ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑X DWQ ❑X Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this ❑X Payment to in-lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Complete if Makin a Pa ment to In-lieu Fee Pro ram
4a. Approval letter from in-lieu fee program is attached. ❑X Yes
4b. Stream mitigation requested: 25 linear feet
4c. If using stream mitigation, stream temperature: warm
4d. Buffer mitigation requested (DWQ only): 0 square feet
4e. Riparian wetland mitigation requested: 0 acres
4f. Non-riparian wetland mitigation requested: 0 acres
4g. Coastal (tidal) wetland mitigation requested: 0 acres
4h. COmments: Stream mitigation is requested for the 25 linear feet of permanent impacts.
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 � Yes ❑X No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., 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
1a. Does the project include or is it adjacent to protected riparian buffers identified � Yes ❑X No
within one of the NC Ri arian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes � No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? p o�o
2b. Does this ro'ect re uire a Stormwater Mana ement Plan? ❑x Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached Stormwater Management Plan.
2e. Who will be responsible for the review of the Stormwater Management Plan? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local overnmenYs 'urisdiction is this ro'ect? N/A
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
� Water Supply Watershed
� Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No
attached?
4. DWQ Stormwater Pro ram Review
�Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply �ORW
(check all that apply):
❑Session Law 2006-246
DOther: NCS000250
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 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the 0 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 ❑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.) N�q ❑ 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 ❑X 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.
Due to the minimal transportation impact resulting from the bridge replacement, this project will neither influence nearby
land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study is not necessary.
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.
N/A
Page 9 of 10
PCN Form — Version 1.4 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 � Yes ❑X 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?
USFWS County List, NCNHP Database, and field reviews in 2014.
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?
EFH Mapper
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?
NCDOT Project Review is currently underway to determine whether surveys are required.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑X Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
It has been designed to meet the MOA criteria. The proposed design does not increase base flood elevations.
8c. What source(s) did you use to make the floodplain determination?
NC Floodmaps
Larry Thompson October 3, 2016
Applicant/Agent's Printed Name ApplicanUAgenYs Signature Date
(AgenYs signature is valid only if an authorization
letter from the a licant is rovided.
Page 10 of 10

APPROVED JURISDiCTIONAL DETERMiNATION FORM
U.S. Army Corps of Engineers
This farm should be completed by following the inshuctions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State: NC County/parish/borough: Union City: Monroe
Center coardinates of site (lat/long in degree decimal format): Lat. 34.893° N, Long. -80.560° W.
Universal Transverse Mercator: 17
Name of nearest waterbody: Adams Branch
Name of nearest Traditional Navigable Water (TN W) lnto which the aquatic resource flows: Yadkin-Pee Dee River
Name of watershed ar Hydrologic Unit Code (HUC): 030401050504
� Check if map/diagram of review area and/ar 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 recarded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
� Office (Desk) Determination. Date: 12/12/2014
� Field Determination. Date(s): 12/21/2014
SECTION IL• SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Appear to be no "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.
❑ Watcrs are presently uscd, or havc becn used in thc past, or may be susccptiblc for usc to transport intcrstate or foreign commercc.
Explain: .
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Reguired]
l. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): i
❑ TNWs, including tcrritorial seas
❑ Wctlands adjaccnt to TNWs
� Rclativcly permancnt waters� (RPWs) that flow directly or indircctly into TNWs
❑ Non-RPWs that ilow dircctly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly ar 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 jwisdictional waters
❑ Isolated (interstatc or intrastatc) waters, including isolatcd wctlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non-wctland watcrs: 150 lincar fcct: 10 width (ft) and/or 0.03 acres.
Wetlands:0 acres.
c. Limits (boundaries) of jurisdiction based on: Established by OHWM.
Elevation of established OHWM (if known): .
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 111 below.
z For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or ]las continuous flow at least "seasonally"
(e.g., typically 3 months).
' Supporting documentation is presented in Section III.F.

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 IILD.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections IILA.1 and 2
and SecYion IILD1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacenY':
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 IILD.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody° is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section IILB1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section [li.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section IILC below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watcrshed sizc Pick List
Drainage area: Pick List
Average am�ual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Rclationship with TNW:
❑ Tributary flows directly into TNW.
❑ Tributary flows through Pick List tributarics bcforc cntcring TNW.
Project waters are Pick List river miles from TNW.
Project waters are Pick 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:
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.
` Flow route can be described by identifying, e.g., hibutary a, which flows through the review area, to flow into hibutary b, whicli then flows into TNW.

(b) General Tributary Characteristics (check all that a�plv):
Tributary is: ❑ Natural
❑ Artificial (inan-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. Type/% cover:
❑ Other. Explain: .
Trib�itary condition/stability [e.g., highly eroding, sloughing banks]. Explain:
Presence of run/riffle/pool complexes. Explain: .
Tributary geometry: Pick List
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for: Pick List
Estimate average number of flow events in review area/year: Pick List
Describe flow regime: .
Other information on duration and volume: .
Surface flow is: Pick List. Characteristics:
Substuface flow: Pick List. Explain findings:
❑ Dye (or other) test performed: .
Tributary has (check all that apply):
❑ Bed and banks
❑ OHWM6 (check all indicators that apply):
❑ clear, natural Linc impressed on the bank ❑
❑ changcs in thc charactcr of soil ❑
❑ shclving ❑
❑ vegetation matted down, bent, or absent ❑
❑ leaf litter disturbed or washed away ❑
❑ sediment deposition ❑
❑ water staining ❑
❑ other (list):
❑ Discontinuous OHWM.� Explain: .
thc presence of litter and dcbris
destruction of terrestrial vcgetation
thc presence of wrack line
scdimcnt sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
If factors other than the OHWM were used to detennine lateral extent of CWA jurisdiction (check all that apply):
❑ High Tidc Linc indicated by: ❑ Mcan High Watcr Mark indicatcd by:
❑ oil or scum linc along sharc objccts ❑ survcy to availablc datum;
❑ finc shcll or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation rypes.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterizc h-ibutary (e.g., water color is clear, discolored, oily film; watcr quality; gencral watershed characteristics, etc.).
Explain: .
Identify specific pollutants, if knowil: .
�A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows undergrotmd, or where
tl�e OH WM has been removed by development or agricultural practices). Where there is a break in the OH WM that is unrelated to the waterbody's flow
regime (e.g., flow over a rocl< outcrop or through a culvert), the agencies will look for indicators of flow above and below the breal<.
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
❑ Riparian corridor. Cl�aracteristics (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 ar serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Pick List. Explain: .
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed: .
(c) Wetland Adjacency Determination with Non-TNW:
❑ Dircctly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain: .
❑ Separated by berm/barrier. Explain: .
(d) Proximity (Relationship) to TNW
Projcct wctlands arc Pick List river miles from TNW.
Projcct watcrs arc Pick List acrial (st�-aight) �nilcs fiom TNW.
Flow is from: Pick List.
Estimatc approximatc location of wetland as within thc Pick List floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water colar is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain: .
Identify spccific pollutants, if known: .
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffcr. Charactcristics (type, avcragc width): .
❑ Vegetation rype/percent cover. Explain: .
❑ Habitat for:
❑ Federally Listed species. Explain findings: .
❑ Fish/spawn areas. Explain findings: .
❑ Othcr environmcntally-scnsitivc specics. 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 curnulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directiv abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres�
Summarize overall biological, chemical and physical functions being performed: .
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/ar 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 TN�. 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 I�structional 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 far fish and
other species, such as feeding, nesting, spawning, or rearing young far 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 T'NW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
Significant nexus findings for non-RPW that has no adjacent wetlands and tlows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section IILD: .
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
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 APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet width (ft), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
2. 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: NCDWR's Methodology far Identification of Intermittent and Perennial SYream and Their Origins
(Version 4.11) was used to assess the tributary. An evaluation of the existing geomorphology, hydrology, and biological
characteristics determined this tributary to e�ibit perennial flow. .
❑ TribuYaries of 1'NW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section IILB. Provide rationale indicating thaY 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: .
3. Non-RPWs$ that flow directly or indirectly into TNWs.
❑ Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non-wetland waters: acres.
Identify type(s) of waters: .
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ 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 IILD.2, above. Provide rationale indicating that wetland is directly
abutting an RPW: .
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
5. 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 T'NW 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.
❑ 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 T'NW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.
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
❑ 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 APPLI�:Io
❑ 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: .
$See Footnote # 3.
9 To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

Idenrify water body and summarize rationale supporting determination:
Provide estimates far 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:
�] Wetlands: acres.
F. NON-JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
Q If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solelv 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 far irrigated agriculture), using best professional
judgment (check all that apply):
❑ Non-wetland waters (i.e., rivers, streams): linear feet width (ft).
❑ Lakes/ponds: acres.
❑ Other non-wetland waters: acres. List type of aquatic resource: .
� 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:
Q Data sheets prepared/submitted by ar on behalf of the applicant/consultant.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concw 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: Monroe 24K Quadrangle.
❑
❑
❑
❑
❑
�
■
■
■
■
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):Bing Aerials.
ar� Other (Name & DaYe): Field Photographs 12/21/2014.
Previous deternunation(s). File no. and date of response letter: .
Applicable/supporting case law: .
Applicable/supporting scientific literature:
Other information (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD:

l �i�;iltiti El�' North Carolina Department of Transportation
Str�t'i15�vc7�� Highway Stormwater Program
i� I
STORMWATER MANAGEMENT PLAN __-
(Version 1.2; Released September 2011) FOR LINEAR ROADWAY PROJECTS
Project/TIP No.: 17BP.10.R.66 County(ies): Union Page 1 of 2
General Project Information
Project No.: 17BP.10.R.66 Project Type: Bridge Replacement Date: 12/10/2013
NCDOT Contact: Paul Fisher Contractor / Designer: HDR Engineering
Address: 1020 Birch Ridge Road Address: 3733 National Drive, Suite 207
Raleigh, NC 27612
Phone: [phone] Phone: [phone]
Email: pfisher@ncdot. ov Email: [e-mail]
City/Town: Monroe, NC County(ies : Union
River Basin(s): Yadkin-Pee Dee CAMA County? No
Primary Receiving Water: Adams Branch NCDWQ Stream Index No.: 13-17-36-2
NCDWQ Surface Water Classification for Primary Receiving Water Primary: Water Suppl IV WS-IV
Supplemental:
Other Stream Classification:
303(d) Impairments: None
Buffer Rules in Effect N/A
Project Description
Project Length (lin. Miles or feet): 0.10 mi. Surrounding Land Use: Residential-Rural
Proposed Project Existing Site
Project Built-Upon Area (ac.) 0.23 ac. 0.21 ac.
Typical Cross Section Description: Roadway -(2) 10' travel lanes with 4' shoulders. Culvert- Roadway -(2) 9' lanes with 1' shoulders.
(2) 10' travel lanes 28' outside to outside. Bridge- (2) 9' Travel Lanes 22.33' outside to outside.
Average Daily Traffic (veh/hr/day): Design/Future: 1,480 (2025 Existing: 740 2012)
General Project Narrative: Replace bridge #152 on SR 2156 (Austin Road) over Adams Branch with a Double 12' X 9' RCBC buried 1' with a 2.5' sill in barrel 2.
References

HE� 'hWa North Carolina Department of Transportation
�SfOYY1�"1WateY
„«,..��.,, Highway Stormwater Program �
STORMWATER MANAGEMENT PLAN _.
(Version 1.2; Released September 2011) FOR LINEAR ROADWAY PROJECTS
Project/TIP No.: 17BP.10.R.66 County ies): Union Page 2 of 2
Project Environmental Summary
Surface Water Impacts
Sheet Station Feature Water / Wetland / Receiving Surface NRTR Map NCDWQ Stream NCDWQ Surface 303(d) Type of Existing Proposed
No. (From / To Impacted Buffer Type Water Name ID Index Water Classification Impairments Impact SCM SCM
4 12+79 Stream Perennial Adams Branch 13-17-36-2 WS-IV None Culvert N/A N/A
13+19
' List all stream and surface water impact locations regardless of jurisdiction or size.
Equalizer Pipes to be noted as a minimization of impacts.
All proposed SCMs listed must also be listed under Swales, Preformed Sour Holes and other Energy Dissipators, or Other Stormwater Control Measures.
Description of Minimization of Impacts or Mitigation
References

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WETLAND PERMIT IMPACT SUMMARY
WETLAND IMPACTS SURFACE WATER IMPACTS
Hand Existing Existing
Permanent Temp. Excavation Mechanized Clearing Permanent Temp. Channel Channel Natural
Site Station Structure Fillln Fillln in Clearing in SW SW Impacts Impacts Stream
No. (From/To) Size / Type Wetlands Wetlands Wetlands in Wetlands Wetlands impacts impacts Permanent Temp. Design
(ac) (ac) (ac) (ac) (ac) (ac) (ac) (ft) (ft) (ft)
1 12+43 to 13+37 -L- Culvert <0.01 25
Bench / Waterline 0.02 131
TOTALS: <0.01 0.03 25 131
Revised 3/31/05