20090091 Ver 1_401 Application_20090109

N A T?cgO
o
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Office Use Only:
Corps action ID no.
011__1_0091 DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing &PAID
1 a . Type(s) of approval sought from the
Corps: Section 404 Permit ? Section 10 Permit
1 b . Specify Nationwide Permit (N WP) number: or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ] Yes ? No
1 d . Type(s) of approval sought from the DWQ (check all that apply):
8401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ? No For the record only for Corps Permit:

? Yes ? No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes No
2. Project Information
2a. Name of project:
2b. County: 11*0
2c. Nearest municipality / town: LLE
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
?, i [... '.
a
3. Owner Information JAN 29
3a. Name(s) on Recorded Deed:
3b.
3c. Deed Book and Page No.
Responsible Party (for LLC if
applicable): WETLANDS AND STQftMwiATERP3WNC
3d. Street address: b k*A tT-
G
3e. City, state, zip:
3f. Telephone no.: 2 f
3g. Fax no.: 3 , • 30
3h. Email address:
Page 1 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
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:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip: -7
5e. Telephone no.: ` g'??,,// NCa • /
Qfa
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): 0 7 AJ - 11
1b. Site coordinates (in decimal degrees): Latitude:,07Z 31 W 'N Longitude: -7? , 96 IT ,
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 8 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
O
Mk
proposed project: ,
py2s F
2b. Water Quality Classification of nearest receiving water: G
2c. River basin: ,
3. Project Description
3a. Describe the existing conditions on the site and the general land use in )he vicinity of the project at the time of this
application: Fogz5v?-v VA-MAM`J ! k Uze 141 st;'tZ -0\}t?(J!'Iv?l ?
t6 hu h J?7N,3
3b. List the total estimated acreage of all existing wetlands on the property:
JR fJ\-n,- ,p fk-T k5- m -
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Csrnw?? rz?
AtT 6 F
3d. Explain the purpose of the proposed project:
PYL G`as
3e. Describe the overall project in detail, including the type of equipment to be used:
QJUNAD 6eossk
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
? Yes ®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? Agency/Consultant ompany:
Name (if known): ?V\VNI(\i Other: WM
4d. If yes, list the dates of the orps jurisdictional determinations or State determinations and attach documentation.
t? ?4
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ? Yes
No ? Unknown
5b. If yes, bxplain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? KI Yes ? No
6b. If yes, explain.
? F 6F ?? - lA0 ovrc,lp.

Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
L&Wetlands [5t Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 K P ? T
F ?WVWU'\"ii?? [!9 Yes ® Corps
) L1, ? No [R DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts ,t
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 Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent
DWQ -non-404,
width

ar
(linear
Temporary (T) (INT)? other) (feet) )

S1 P [I T 11??
PlY'?
-1SLCJ [&PER
? IINT Corps
EZDWQ q
1
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 E] P F1 T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts
3i. Comments:
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual) list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
0. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
131 ?P?T ?Yes
? No
B2 ? P ? T ? Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
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.
8EC ZM99t A 9fWYY S NN+ 456
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
s E-C WIN G
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank

El Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. [] Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool []cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ? No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 10
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ? No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 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 [8 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
Cn;}im -nts-
2. Stormwater Management Plan
2a . What is the overall r perviousness of this project? % S 2A-
2b . Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: 1J0 LUA&
2d . If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
? 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
4a. Which of the following state-implemented stormwater management programs apply [I HQW
? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ? No
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 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a . Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes K No
use of public (federal/state) land?
1 b . If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c . If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
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 ? 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
dditi ? Yes M No
a
onal 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.

Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or El Yes No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
i ? Yes No
mpacts?

5c. If yes, indicate the USFWS Field Office you have contacted. ?
Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat? Q??'}?
?
(G
,
l-
1,0 WJ
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes XNo
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
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
status (e.g., National Historic Trust designation or properties significant in
? Yes ? No
North Carolina history and archaeology)? QV*JWQ
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? El Yes ?.No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
C'Pl2 i5

Applicant/Agent's Printed Name Applicant/Agent's ignatu a Date
(Agent's signature is valid only if an authorization letter from the applicant
is rovided.)
Page 10 of 10
,wm;t
Wetland and Natural Resource
Consultants, Inc. ; %•?
January 7, 2009
US Army Corps of Engineers
Raleigh Regulatory Field Office
Attn: Mr. Andrew Williams
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Re: PCN - Lennox Woods
Guilford County
Dear Mr. Williams:
The purpose of this correspondence is to submit an application for a NWP14 for a road crossing
for the Lennox Woods Subdivision. The crossing will impact 90 linear feet of perennial channel
and 0.16 acres of wetland. The impact is associated with the final phase of the development.
Previous phases did not impact streams or wetlands. The impact will occur at the proposed
location to utilize an existing stub road.
Attached for your review are:
• Corps Submittal Cover Sheet
• Agent Authorization
• PCN Form
• USGS Topo
• Site Plans
• Impact Map
• Alternatives Discussion
• Wetland/Upland Dataforms
• JD Form
• Soil Map
Please contact me with any questions you may have.
Best regards,
Ll '
Chris Huysman
CC: Sue Homewood NCDENR-DWQ
JA N

Sparta Office
PO Box 1492
Sparta, NC 28675
Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name: Lennox Woods
2. Name of Property Owner/Applicant: Lennox Woods LLC
3. Name of Consultant/Agent: WNR
*Agent authorization attached.
4. Related/Previous Action ID number(s): n/a
5. Site Address: Cummings Dairy Road, Scalesville, NC
6. Subdivision Name:
7. City: Scalesville
8. County: Guildford
9. Lat: 36.23100 ° N Long:: 79.83195 ° W
10. Quadrangle Name: Lake Brandt
11. Waterway: UT to Mears Fork
12. Watershed: Haw River
13. Requested Action:
® Nationwide Permit # 14
? General Permit #
® Jurisdictional Determination Request
? Pre-Application Request
--------------------------------------------------------------------------•
The following information will be completed by Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description / Nature of Activity / Project Purpose:
Site/Waters Name:
Keywords:
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Yvr !a,yandNatural Resource
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FCC S-A i*-
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 14
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: , - L ..T
II. Applicant Information
1. Owne/Applicant
Lennox Woods LLCn="'`" rSo?S'`'s?rc?1
Mailing Address: 342 North Elm Street, Greensboro, NC 27401
Telephone Number: 336-230-1111 Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation: Wetland and Natural Resource Consultants
Mailing Address: 3674 Pine Swamp Road
P.O. Box 1492
Sparta, NC 28675
Telephone Number: 336-406-0906 Fax Number: 336-372-3455
E-mail Address: chris.huysmangwetland-consultants.com
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
Page 1 of 8
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Lennox Woods Subdivision
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN):
10-06-0360-0-0716-N -011
4. Location
County: Guilford Nearest Town: Scalesville
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, etc.):From Hwy 220 in
Summerfield, NC. Turn onto Scalesville Rd and travel east for approx 4 miles. Turn right
on Mabe Marshall Rd and travel 0.7 miles. Site is on left.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 36.23100°N 79.83195°W
6. Property size (acres): +/- 84 acres
7. Name of nearest receiving body of water: Mears Fork
8. River Basin: Cape Fear
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: This is the last phase of a residential development. Previous
phases are residential. Current phase is forested and agriculture. Surrounding land use is
forest, agriculture and residential.
Describe the overall project in detail, including the type of equipment to be used: The project
involves the installation of a culvert for a road crossing. Typical grading equipment will be
utilized to install culvert.
Page 2 of 8
Explain the purpose of the proposed work: Purpose of the work is to gain access highground
in the last phase of the subdivision.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules. This project is the last phase of a subdivision. Previous phases did not
require a permit.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
N/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
Provide a written description of the proposed impacts: The impacts will involve 90 linear feet of
impact for culvert installation on a perennial unnamed tributary to Mears Fork and 0 16 acres of
wetland impacts.
1. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact Type of Wetland Located within Distance to Area of
Site Number Type of Impact (e.g., forested, marsh, 100-year Nearest Impact
(indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres)
( es/no) (linear feet)
WL 1 Fill for road crossing Forested no 10 0.16
Page 3 of 8
Total Wetland Impact (acres) 10.16
2. List the total acreage (estimated) of all existing wetlands on the property:
3. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreaize. multiply length X width. then divide by 43.560.
Stream Impact
Number
(indicate on map)
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
I UT to Mears Fork Culvert/Fill Perennial 4 90 0.008

Total Stream Impact (by length and acreage) 90 0.008
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill. excavation. dredgino_ flooding- drninnoe hiilkhenrlc etc
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc.) Area of
Impact
(acres)

Total Open Water Impact (acres) 0
5. List the cumulative impact to all Waters of the U.S. resulti
Stream Impact (acres):
from the project:
0.008
Page 4 of 8
Wetland Impact (acres): 0.16
Open Water Impact (acres): 0
Total Impact to Waters of the U.S. (acres) 0.168
Total Stream Impact (linear feet): 90
6. Isolated Waters
Do any isolated waters exist on the property? ? Yes ® No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
N/A
7. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Current land use in the vicinity of the pond: N/A
Size of watershed draining to pond: N/A Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.The purpose of the impact is to
access hiPhPround for the last phase of an existing subdivision Access to the subdivision from
the west will also be established; however, for connectivity and need for multiple entrance and
exit points onto the subdivision the road crossing is necessary to connect phase to the rest of
subdivision. The previous phase of the subdivision avoided impacts to Waters of the US
Avoidance is accomplished by establishing only one road crossing connecting the phases as
opposed to multiple crossings. See attached alternative anal
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 5 of 8
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/stnngide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Mitigation is in the form of avoidance and minimization.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No
Page 6 of 8
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
213 .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identifyN/A)? Yes ? No
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* Impact Multiplier Required
(square feet) Mitieation
1 3 (2 for Catawba)
2 1.5
Total I N/A
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or.0244, or.0260. N/A
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
Page 7 of 8
demonstrating total proposed impervious level. Impervious acreage - 6 acres. Development
acreage - 84 acres. Percent Impervious - 7%
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
Septic will be the form of sewage disposal
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description: The
nature of the development will not facilitate further development and therefore will not result in
additional impacts to regulated waters.
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
N/A

Applicant[Agent's Sigiiature ` Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
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Impact Alternatives Analysis
WNR
January 1, 2009
Due to the need to utilize the existing stub road from the previous phase of the
development, limited alternatives were available for consideration. Two
alternatives were considered. Both alternatives impact varying amounts of the
same stream and wetland. An alternative that avoided all impacts to the wetland
and impacted only stream was not possible due to the location of the existing
stub road.
Alternative A, as can be seen on attached sheet, impacted 151 If of stream and
0.08 ac of wetland. Alternative B, as can be seen on attached sheet, impacted
90 If of stream and 0.16 ac of wetland.
Because Alternative B impacted fewer linear feet of stream, it was chosen as the
preferred alternative. Impacts to the wetland are greater in Alternative B,
however, because of the nature of the channel and wetland to be impacted, it
was considered a priority to minimize channel impacts over wetland impacts.

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DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Determination Manual)
Project / Site: Lennox Woods Date:
Applicant / Owner: Lennox Woods LLC County: Guilford
Investigator: Huysman State: North Carolina
Do normal circumstances exist on the site? Yes ® No[:] Community ID:Wetland
Is the site significantly disturbed (Atypical situation)? Yes El No ® Transect ID:
Is the area a potential problem area? Yes F] No Z Plot ID:WL1
(explain on reverse if needed)
VEGETATION
Dominant Plant Species Indicator Stratum Dominant Plant Species Indicator Stratum
1. Acer rubrum FAC tree 9.
2. Carex spp FACW . herb 10.
3. Woodwardia areolata OBL herb 11.
4. Juncus effusus FACW+ herb 12.
5. Microstegium vimineum FAC+ herb 13.
6. 14.
7. 15.
8. 16.
Percent of Dominant Species that are OBL, FACW, or FAC excluding FAC-). 100%
Remarks: Hydroph)jic vegetation present
HYDROLOGY
? Recorded Data (Describe In Remarks): Wetland Hydrology Indicators
? Stream, Lake, or Tide Gauge
? Aerial Photographs Primary Indicators:
? Other ? Inundated
0 Saturated in Upper 12"
? No Recorded Data Available ? Water Marks
? Drift Lines
Field Observations: ? Sediment Deposits
? Drainage Patterns in Wetlands
Depth of Surface Water: 0 (in.) Secondary Indicators:
Depth to Free Water in Pit:O (in.) 0 Oxidized Roots Channels in Upper 12"
® Water-Stained Leaves
Depth to Saturated Soil: 0 (in.) El Local Soil Survey Data
? FAC-Neutral Test
? Other (Explain in Remarks)
Remarks: Wetland hydrology present
SOILS
page 2 WL1
Map Unit Name
(Series and Phase): Madison Drainage Class: Well drained
Taxonomy (Subgroup): TYPIC KANHAPLUDULTS Confirm Mapped Type? Yes ? No
Profile Description:
Depth Matrix Colors Mottle Colors Mottle Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Abundance/Contrast Structure, etc.
0-8 A I OYR 5/2 /
8-12 B IOYR 4/1 7.5YR 515 /

Hydric Soil Indicators:
? Histosol ? Concretions
? Histic Epipedon ? High Organic Content in Surface Layer in Sandy Soils
? Sulfidic Odor ? Organic Streaking in Sandy Soils
? Aquic Moisture Regime ? Listed On Local Hydric Soils List
? Reducing Conditions ? Listed on National Hydric Soils List
® Gleyed or Low-Chroma Colors ? Other (Explain in Remarks)
Remarks: Hydric soil present
WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes ® No ?
Wetland Hydrology Present? Yes ® No ?
Hydric Soils Present? Yes ® No ?
Is the Sampling Point
Within a Wetland? Yes ® No ?
Remarks:
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Determination Manual)
Project / Site: Lennox Woods Date:
Applicant / Owner: Lennox Woods LLC County: Guilford
Investigator: Huysman State: North Carolina
Do normal circumstances exist on the site? Yes ® No E] Community ID:Upland
Is the site significantly disturbed (Atypical situation)? Yes ? No ® Transect ID:
Is the area a potential problem area? Yes E] No Z Plot ID:UPI
(explain on reverse if needed)
VEGETATION
Dominant Plant Species Indicator Stratum Dominant Plant Species Indicator Stratum
1. Acer rubnim FAC tree 9.
2. Lonicera japonica FAC- vine 10.
3. Microstegium vimineum FAC+ herb 11.
4. 12.
5. 13.
6. 14.
7. 15.
8. 16.
Percent of Dominant Species that are OBL, FACW, or FAC excluding FAC-). 66%
Remarks: Wetland plants present
HYDROLOGY
? Recorded Data (Describe In Remarks): Wetland Hydrology Indicators
? Stream, Lake, or Tide Gauge
? Aerial Photographs Primary Indicators:
? Other ? Inundated
? Saturated in Upper 12"
? No Recorded Data Available ? Water Marks
? Drift Lines
Field Observations: ? Sediment Deposits
? Drainage Patterns in Wetlands
Depth of Surface Water: (in.) Secondary Indicators:
Depth to Free Water in Pit: (in
) ? Oxidized Roots Channels in Upper 12"
. ? Water-Stained Leaves

Depth to Saturated Soil: (in.) ? Local Soil Survey Data
? FAC-Neutral Test
? Other (Explain in Remarks)
Remarks: No wetland h drology indicators
SOILS
page 2 UP 1
Map Unit Name
(Series and Phase): Madison Drainage Class: Well drained
Taxonomy (Subgroup): TYPIC KANHAPLUDULTS Confirm Mapped Type? Yes E] No
Profile Description:
Depth Matrix Colors Mottle Colors Mottle Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Abundance/Contrast Structure, etc.
0-12 A IOYR 5/4 / sandy clay loam

Hydric Soil Indicators:
? Histosol ? Concretions
? Histic Epipedon ? High Organic Content in Surface Layer in Sandy Soils
? Sulfidic Odor ? Organic Streaking in Sandy Soils
? Aquic Moisture Regime ? Listed On Local Hydric Soils List
? Reducing Conditions ? Listed on National Hydric Soils List
? Gleyed or Low-Chroma Colors ? Other (Explain in Remarks)
Remarks: No hydric soil indicators
WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes ® No ?
Wetland Hydrology Present? Yes ? No
Hydric Soils Present? Yes ? No
Is the Sampling Point
Within a Wetland? Yes ? No
Remarks:
APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD): UT Mears Fork
B. DISTRICT OFFICE, FILE NAME, AND NUMBER: Lennox Woods
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Guildford City: Greensboro
Center coordinates of site (lat/long in degree decimal format): Lat. 36.2310011 Long. 79.83195°W.
Universal Transverse Mercator:
Name of nearest waterbody: Mears Fork
Name of nearest Traditional Navigable Water (TN W) into which the aquatic resource flows: Haw River
Name of watershed or Hydrologic Unit Code (HUC): 03030002 Haw River
0 Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
? Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
? Office (Desk) Determination. Date:
Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are 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.
? Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters of the US." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply):
? TNWs, including territorial seas
? Wetlands adjacent to TNWs
® Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
? Non-RPWs that flow directly or indirectly into TNWs
® Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
? Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
? Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
? Impoundments of jurisdictional waters
? Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non-wetland waters: YYYlinear feet: YYY width (ft) and/or acres.
Wetlands: YYYY acres.
c. Limits (boundaries) of jurisdiction based on: 1987 Delineation Manual
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 III 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 has 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 III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; 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 "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non-navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section 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 waterbodya is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.C below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: square miles
Drainage area: acres
Average annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
? Tributary flows directly into TNW.
? Tributary flows through Pick List tributaries before entering 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 TNW':
Tributary stream order, if known:
a Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
' Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.
(b) General Tributary Characteristics (check all that apply):
Tributary is: ? Natural
? Artificial (man-made). Explain:
? Manipulated (man-altered). Explain: Ponds have been constructed on channel.
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:
Tributary 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: Flow is provided by discharge from pond.
Other information on duration and volume:
Surface flow is: Pick List. Characteristics:
Subsulial.G tlow: 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 line impressed on the bank ?
? changes in the character of soil ?
? shelving ?
? vegetation matted down, bent, or absent ?
? leaf litter disturbed or washed away ?
? sediment deposition ?
? water staining ?
? other (list):
? Discontinuous OHWM.' Explain:
If factors other than the OHWM were used to determ
High Tide Line indicated by:
? oil or scum line along shore objects
? fine shell or debris deposits (foreshore)
? physical markings/characteristics
? tidal gauges
? other (list):
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
ine lateral extent of CWA jurisdiction (check all that apply):
Mean High Water Mark indicated by:
? survey to available datum;
? physical markings;
? vegetation lines/changes in vegetation types.
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
`A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.
(iv) Biological Characteristics. Channel supports (check all that apply):
? Riparian corridor. Characteristics (type, average width):
? Wetland fringe. Characteristics:
? Habitat for:
? Federally Listed species. Explain findings:
? Fish/spawn areas. Explain findings:
? Other environmentally-sensitive species. Explain findings:
? Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain:
Wetland quality. Explain:
Project wetlands cross or serve as state boundaries. Explain:
(b) General 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:
? Directly abutting
? Not directly abutting
? Discrete wetland hydrologic connection. Explain:
? Ecological connection. Explain:
? Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the Pick List floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
? Riparian buffer. Characteristics (type, average width):
? Vegetation type/percent cover. Explain:
? Habitat for:
? Federally Listed species. Explain findings:
? Fish/spawn areas. Explain findings:
? Other environmentally-sensitive species. Explain findings:
? Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.
For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/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/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1. 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: observed flow.
? Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:
Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: YYY linear feet YYY width (ft).
? Other non-wetland waters: acres.
Identify type(s) of waters:
3. Non-RPWss that flow directly or indirectly into TNWs.
Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section 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: Visual assessment.
Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
se9110 1 r .ction 1I1.13 and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: YYY 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 TNW are jurisidictional. Data supporting this
conclusion is provided at Section III.C.
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 TNW 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 APPLY): 10
which are or could be used by interstate or foreign travelers for recreational or other purposes.
from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
which are or could be used for industrial purposes by industries in interstate commerce.
Interstate isolated waters. Explain:
? Other factors. Explain:
Identify water body and summarize rationale supporting determination:
'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.
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:
Wetlands: acres.
F. NON-JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
? Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
? Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
? Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
? Other: (explain, if not covered above):
Provide acreage estimates for non-jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
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:
?, Data sheets prepared/submitted by or on behalf of the applicant/consultant.
? Office concurs with data sheets/delineation report.
? Office does not concur with data sheets/delineation report.
Data sheets prepared by the Corps:
Corps navigable waters' study:
? U.S. Geological Survey Hydrologic Atlas:
? USGS NHD data.
? USGS 8 and 12 digit HUC maps.
U.S. Geological Survey map(s). Cite scale & quad name:
USDA Natural Resources Conservation Service Soil Survey. Citation:
National wetlands inventory map(s). Cite name:
?
? State/Local wetland inventory map(s):
FEMA/FIRM maps:
? 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
? Photographs: ? Aerial (Name & Date):
or ? Other (Name & Date):
Previous determination(s). File no. and date of response letter:
? Applicable/supporting case law:
? Applicable/supporting scientific literature:
? Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD:
Soil Map-Guilford County, North Carolina
(Lennox Woods Subdivision)
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Soil Map-Guilford County, North Carolina
Lennox Woods Subdivision
Map Unit Legend
Guilford County, North Carolina (NC081)
Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
ApB Appling sandy loam, 2 to 6 percent 5.4 2.9%
slopes
[Cc6 Cecil sandy loam, 2 to 6 percent slopes 50.2 27. 9/(
j CcC Cecil sandy loam, 6 to 10 percent slopes 16.7 I 9,2%
Ce62 Cecil sandy clay loam, 2 to 6 percent 26.7 14.6%o
slopes, eroded
[CeC2 Cecil sandy clay loam, 6 to 10 percent 3.9
slopes, 2,2% eroded
CrC Coronaca clay loam, 6 to 10 percent 11.5 6.3%
slopes
MaD Madison sandy loam, 10 to 15 percent 21.0 11.5%
slopes
McD2 Madison clay loam, 10 to 15 percent 7.1 I 3.9%
- slopes, eroded _ -- - - - _ _-,
McE2 Madison clay loam, 15 to 25 Percent 19.5 10.7%1
slopes, eroded
Wh Wehadkee silt loam 20.3 11.1%
--
Totals for Area of Interest 182.3 100.0% j
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Natural Resources Web Soil Survey 2.1
aii Conservation Service 12/4/2008
National Cooperative Soil Survey Page 3 of 3