20170276 Ver 1_401 Application_20170317

ENVIRONMENTAL SERVICES, INC
4901 TRADEMARK DRIVE
RALEIGH, NC 27610
[phone] • FAX [phone]
environmentalseryicesinc. com
March 7, 2017
NCDWR-401 & Buffer Permitting
Attn: Karen Higgins
1617 Mail Service Center
Raleigh, NC 27699-1617
A I u
Re: 401 Request for Town of Nashville
Stony Creek Sewer Outfall
Nash County, NC
2 0 1 70 2 7 6
o C �120WE
MAR 0 2017��
DEQ -WATER RESOURCES
401 & BUFFER PERMITTING
Ms. Higgin:
Enclosed please find the application that ESI has prepared on behalf of the Town of Nashville.
The contact for the Town is Brian Hassell(brian.hassellgtownofnashvillenc.gov) and the project
engineer is Kevin Varnell (kvarnellkstocksengineering com) of Stocks Engineering.
The Town of Nashville is proposing construction of a new sewer outfall paralleling Stony Creek
in Nash County, NC. ESI has completed the field delineation, obtained a PJD from the Army
Corps, and is currently requesting NCDWR approval via a General Water Quality Certification
for 0.29 acre of wetland impacts (i.e., land clearing for the sewer line).
Please contact me at 919-805-4208 or jharbourkesinc.cc if you have any questions or need
additional information. Thank you for your assistance.
Sincerely,
Environmenta Services, Inc.
J Harbour, PWS

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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
E11A ion 10 Permi
1b.
Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number: 111AH © <i 2017
1c.
1 d.
Has the NWP or GP number been verified by the Corps? ❑ Yes DEQ_ A
Type(s) of approval sought from the DWQ (check all that apply): UFFER PERMITTIN
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑X Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑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.
❑X Yes ❑ 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:
Nashville Stony Creek Sewer Outfall
2b.
County:
Nash
2c.
Nearest municipality / town:
Nashville
2d.
Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
See attachment
3b.
Deed Book and Page No.
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
3e. City, state, zip:
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009
1

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
Town of Nashville c/o Brian Hassell
4c. Business name
(if applicable):
4d. Street address:
801 East Washington Street, PO Box 1108
4e. City, state, zip:
Nashville, NC 27856
4f. Telephone no.:
252-459-8196
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Jeff Harbour
5b. Business name
(if applicable):
Environmental Services, Inc.
5c. Street address:
4901 Trademark Drive
5d. City, state, zip:
Raleigh, NC 27610
5e. Telephone no.:
919-212-1760
5f. Fax no.:
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
See Attachment A
1b. Site coordinates (in decimal degrees):
ILatitude: 35.97861 Longitude: -77.96594
1c. Property size:
16 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Stony Creek
2b. Water Quality Classification of nearest receiving water:
C; NSW
2c. River basin:
Tar -Pamlico
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The project study area and vicinity consist of residential areas and undeveloped forested communities.
3b. List the total estimated acreage of all existing wetlands on the property: 10
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 700
3d. Explain the purpose of the proposed project:
This project proposes construction of a new section of sewer outfall so the Town can abandon an existing lift station on Elm Street
3e. Describe the overall project in detail, including the type of equipment to be used:
The Town is proposing a new sewer outfall. Typical construction equipment will be used for installation of the pipe.
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?
❑X Yes ❑ No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
Eg Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): K. Murphrey, J. Harbour
Agency/Consultant Company: Environmental Services, Inc.
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
March 2,2016 - SAW -2015-02655
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):
❑X Wetlands ❑ Streams — tributaries ❑X 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 P
Land Clearing
Bottomland Hardwood Forest
No
Corps
0.07
W2 P
Land Clearing
Bottomland Hardwood Forest
Yes
Corps
0.05
W3 P
Land Clearing
Bottomland Hardwood Forest
Yes
Corps
0.01
W4 P
Land Clearing
Bottomland Hardwood Forest
Yes
Corps
0.02
W5 P
Land Clearing
Bottomland Hardwood Forest
Yes
Corps
0.07
W6 P
Land Clearing
Bottomland Hardwood Forest
Yes
Corps
0.07
2g. Total Wetland Impacts:
0.29
2h. Comments:
There will be a 20 -foot wide permanent easement left in place after construction. This easement will be returned to pre -construction contours so any
wetland impacts will be temporary. Wetland Impact 1 (0.07 acre) is an area that is already a maintained easement for a power line. No wetland
conversion will occur in this area. Total amount of conversion is 0.22 acre
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 -
Choose one
-
S2 -
Choose one
-
-
S3 -
Choose one
-
S4 -
Choose one
-
S5 -
Choose one
-
S6 -
Choose one
-
3h. Total stream and tributary impacts
0
3i. Comments:
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 indivi ually 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)
O1 -
Choose one
Choose
O2 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
0
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. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) 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:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑X Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet
6g.
Zone 2
impact
(square
feet
61 T
Land Clearing
Stony Creek
No
1,252
3,239
B2 T
Land Clearing
Stony Creek
No
0
1,249
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
1,252
4,488
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.
Wetlands have been avoided where possible. Streams have been avoided. The construction corridor has been minimized to reduce land clearing.
The engineer has reduced overall impacts as a result of USACE concerns and mitigation requirements.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All necessary sediment and erosion control BMPs will be installed and maintained through construction. Disturbed ground will be restored and
stabilized with permanent vegetative cover.
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
❑X 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:
0.22 acres
4f. Non-riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments: Approval letter from NCDMS forthcoming.
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 QX 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 7of10

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
❑x Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
No impervious surface associated with this project
❑ Yes ❑X No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑X 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:
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 this ro'ect?
❑ Phase II
❑ NSW
3b. Which of the following locally -implemented stormwater management programs
USMP❑
❑
apply (check all that apply):
Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑X 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 ❑X 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
El 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
❑Yes
❑ No
letter.)
Comments:
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes
❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
El Yes
No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes
No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4.
Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
No wastewater will be produced as a result of this project.
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 pX No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
Yes No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
North Carolina Natural Heritage Program data (updated 2016) and on site evaluations
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes QX No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
National Oceanic and Atmospheric Administration 2009 List of EFH Species by Waterbody in North Carolina
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 MX 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?
SHPO
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
Q Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
No fill in floodway. Engineer certified plans
8c. What source(s) did you use to make the floodplain determination?
www.ncfloodmaps.com
)eff1-1,44011A,
-7
Applicant/Agent's Printed Name
ppiicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10

Environmental Services, Inc.
NIGHT OF ENTRY AGREEMENT44e- 70-Wn Of
Q
UWe Pae—,". jA q . p, 4, the .e s) -of the (Owner gas
Name) property commonly identified as
(street)
State of
(City/Town) (County)
hereby grant, freely and without coercion, the right of access and entry to said property to
Environmental Services, Inc., including but not Iimited to its employees, contractors,
subcontractors and any applicable regulatory agency personnel, for the purpose of
environmental, ecological or archaeological assessments.
This access agreement is effective upon signature and shall remain in effect until such
time as assessment activities are completed, including any ancillary activities associated
with said activities.
For the consideration and purposes set forth herein, I/We hereby acknowledge, accept
and agree to the terms of the Right of Entry Agreement as evidenced by my dated
signature below,
Signed this 00 day of�, 2015.
Print Name: 1, MMA4ei S
Signature:
Town of Nashville Stony Creek Sewer Outfall 3

Attachment A
Parcel owner information
• Town of Nashville: PO Box 987, Nashville, NC 27856
• PIN:380118425103,380118429142,381117029415
• Stallings Oil Company: 300S Wesleyan Blvd, Rocky Mount, NC 27804
PIN: 380114439182
• McKellar, Effie: 301 St. Agnes Rd, Uniondale, NY 11553
PIN:380118429147
• Williams, Sheila: 204 Vale Street, Nashville, NC 27856
• PIN: 380118429169, 380118429261
• McKellar, Harvey: 301 St. Agnes Rd, Uniondale, NY 11553
PIN: 380118429297
• Vaughan, Ross: 2425 Argyle Dr, Raleigh, NC 27609
PIN: 380100644117
• Vaughan, John: 6709 E Park Dr, Fort Worth, TX 76132
PIN: 380100740097
• Vick, Nina: 204 Golfers Ln, Nashville, NC 27856
PIN: 380100834249
• Nash County: 120W Washington St. STE 3072, Nashville, NC 27856
PIN: 381117115668

Stony Creek Outfall
Photo location 1: WA
(Liquidambar styraciflua, Ligustrum sinense)
Photo location 2: WD
(Liquidambar styraciflua, Acer rubrum, Ligustrum sinense)
Photo Sheet 1 of 3

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Photo location 5: "
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Photo location 6: WH
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Photo Sheet 3 of 3

COPY
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL DETERMINATION (JD): March 2.
2016
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Town of Nashville
Attn: Brian Hassell
801 East Washington St.
P.O. Box 1108
Nashville, NC 27856
Copy: ESI
Attn: Jeff Harbour
4901 Trademark Dr.
Raleigh, NC 27610
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, Stoney Creek Sewer Outfall/Nashville/Nash
County, SAW -2015-02655
D. PROJECT LOCATIONS) AND BACKGROUND INFORMATION: From Raleigh take Hwy 264 east towards
Rocky Mount take exit for NC -58 turn right onto W. Washington St and the study area starts behind the Waffle House.
Please see the attached mao and waters location table for iurisdictional waters within the review area.
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES AT DIFFERENT SITES)
State: NC County/parish/borough: Nash City: Nashville
Center coordinates of site (lat/long in degree decimal format): Lat. 35.9793024002402° N, Long. -77.9590420289682° W.
Universal Transverse Mercator:
Name of nearest water body: Stony Creek
Identify (estimate) amount of waters in the review area:
Non -wetland waters: 700 linear feet: width (ft) and/or acres.
Cowardin Class: Riverine
Stream Flow: Intermittent
Wetlands: 10 acres.
Cowardin Class: Forested
Name of any water bodies on the site that have been identified as Section 10 waters:
Tidal:
Non -Tidal:
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLIES):
® Office (Desk) Determination. Date: March 2, 2016
❑ Field Determination. Date(s):
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 N1VP 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 terns 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 terns 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(ax2)). I4 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 fords that there "may be" waters of the United States on the subject project site, and identifies all aquatic
features on the site that could be affected by the proposed activity, based on the following information:
SUPPORTING DATA. Data reviewed for preliminary JD (check all that apply - checked items should be included in can
file and, where checked and requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant:ESI.
® Data sheets prepared/submitted by or on behalf of the applicanticonsultant.
® 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: Nashville.
® USDA Natural Resources Conservation Service Soil Survey. Citation: Nash County 1989.
® National wetlands inventory map(s). Cite name: Simsuite NWI data set.
❑ State/Local wetland Inventory map(s):
® FEMA/FIRMmaps: SirnsuiteNFHL.
❑ 100 -year Floors lain Elevation is: (National Geodetic Vertical Datum of 1929)
® Photographs: Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE,• The information recorded on this form has not necessarily been verified by the Corps and should
not be relied upon for later iurisdictional determinations.
Sign and tial f
Regulatory Project Manager
(REQUIRED)
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining the signature is
Impracticable)

N,-OTIFTC,A` ION 01 ADNfINNISTRATIVF APPEAL, oP`rms >AND PROMs AND
'REQUE+STTOR APPEAL
Applicant: Town of Nashville Attn: Brian Hassell File Number: SAW -2015-02655
Attached is:
Date: March 2,201
See Section below
❑ PROFFERED PERMIT (Standard Permit or Letter of permission)
A
_INITIAL
PROFFERED PERMIT Standard Permit or Letter ofpermission)
B
I F-11 PERMIT DENIAL
C
APPROVED JURISDICTIONAL DETERMINATION
D
NJ PRELB41NARY JURISDICTIONAL DETERMINATION
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above der"ision.
Additional information may found at htp://y0ny.usaceam_mit/inet/fncwtion__cw/cecwo/reg or
_.y
Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SECTION IT - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division
Mr. Jason Steele, Administrative Appeal Review Officer
Raleigh Regulatory Field Office
CESAD-PDO
James Lastinger, Regulatory Specialist
U.S. Army Corps of Engineers, South Atlantic Division
3331 Heritage Trade Dr., suite 105
60 Forsyth Street, Room 1OM15
Wake Forest, NC 27587
Atlanta, Georgia 30303-8801
919-554-4884 ext 32Phone:
404 562-5137
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of an site investigation, and will have the o portunity to participate in all site investiations.
Date:
Telephone number:
Si ature of apEellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: , 69 Darlington Avenue, Wilmington, North Carolina
28403
For Permit denials, Proffered Permits and approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

Estimated
Site
Cowardin
amount of
Class of
number
Latitude
Longitude
Class
aquatic
aquatic
resource in
resource
review area
WA
35.97714
-77.96992
PFO
0.5
Section 404 -
wetland
WB
35.97735
-77.96931
PFO
0.2
Section 404 -
wetland
WC
35.98043
-77.96435
PFO
0.2
Section 404 -
wetland
WD
35.97987
-77.96453
PFO
1
Section 404 -
wetland
WE
35.97900
-77.96569
PFO
0.5
Section 404 -
wetland
WF
35.98113
-77.96266
PFO
4
Section 404 -
wetland
WH
35.98031
-77.95344
PFO
4
Section 404 -
wetland
WI
35.97939
-77.94977
PFO
0.5
Section 404 -
wetland
WJ
35.97918
-77.94953
PFO
0.2
Section 404 -
wetland
SA
35.9773
-77.9694
R2
200
Non -Section
10- non -tidal
SB
35.9805
-77.9643
R2
300
Non -Section
10- non -tidal
Sc
35.98039
-77.96425
R2
200
Non -Section
10- non -tidal

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— Stony Creek Outfall 205 410 820 1,230 1,60
Feet

She.
STONY CREEK SANITARY SEWER OUTFALL
Nashville, North Carolina
�' :.. FOR I glG1Y ME Pt�V41 NI.'rL FCR Yql, OECURS ME SDRO. PUNS TO PRt , YOU I NO' w-
TCl). PUNS TO pK ttXl ROPE M'p NTUTE. JFAEWAN 24 it

BEFORE YOU DIG,
CALL
o
NORTH CAROUNA
E CALL CENTER
—ncmc.9rq
PROFILE LEGEND
---iC'LEFT
— —NC rnouD
- - - -IV0' RIRiO1T
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(15,S !!EE/OY WIERGEPRN STA l61 G776
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STA 181+7589SiDVYI94R 53 W7FALL
A
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/\ 161 16> IJRB9
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rxaFPIIE ss oTNERwsF L: 0 50 100 125 150 T �
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_.
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19843
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CALL L -E= -(3E= -N 9Ec""`w0`FwPAWWNr
W "FILE " POIE
UK
PW POLYwlt CPACRIOE
OPE.NG COD CAST NOW OUMM CANE/ER
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ONE CALL CENTER &A. DFAMEMP
Ov PRO PROPOSEDSTA STATION
Sim LF WEAR FEE
ENCASEMENT LF
PPE FLOW LAC
GROOMED SAP 11,
ENCASEMENTSR. STATE ROAD
IR. YEAR
Ex -r.
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ma 2m
S.R. 1670 S70VYAm OREM OVWAU
STA 10+ 44
S R 1670 FIRS T s TREE r EXT AN IW 3989
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IMPACT 32.578 SF
ME puw
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PROFILE _�FNQ
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ALL PIPE CLASS B BEDDING
UNLESS OTHERWISE NOTED.
SCALE. 1" - 50'
Or 50 gam; 100 �125 150
Z'A
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SEAL
19843
('71A -X
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252+00 253+00 254+00 255+00 256+00 257+00 258+00
259+00 260+00
261+00 262+00 263+00 264+00
CE -06
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