20090575 Ver 1_401 Application_20090509

WITHERS _.° RAVENEL
ENGINEERS I PLANNERS I SURVEYORS
111 MacKenan Drive
CARY, NORTH CAROLINA, 27511
TEL: [phone]
FAX: [phone]
TO: NCDENR DWQ
2321 Crabtree Blvd
Raleigh
NC 27604
WE ARE SENDING YOU
? Shop Drawings
? Copy of Letter
? Specifications
COPIES DATE NO. DESCRIPTION
5 05/19/2009 1 Request for 404/401 Certification
1 05/18/2009 2 Check

9 2009
DENR - WLyE QUALITY
- - - ° -- •• ,.n.m cn CR DKPdAUM
THESE ARE TRANSMITTED as checked below:
® For approval ? Approved as submitted ? Resubmit copies for approval
? For your use ? Approved as noted ? Submit copies for distribution
? As requested ? Returned for corrections ? Return corrected prints
? For review and comment ? Other:
? FOR BIDS DUE ? PRINTS RETURNED AFTER LOAN TO US
REMARKS:
Received By:
COPY TO: File SIGNED: Todd Preuninger
I -I f' If [Fl? -11' 11 ZAI
DATE May 19, 2009 JOB NO. 2060096.20
ATTENTION Ms. Cyndi Karoly
PHONE #
RE: Lvnwood Lakes Sewer & Water Expansion
® Attached via Courier the following items:
? Prints ? Plans ? Samples
? Change order ? Diskette ?
if enclosures are not as noted, please notify us at once.
L YNWOOD LAKES
SEWER AND WATER EXPAN51ON
Lynwood Lakes Subdivision
Greensboro, Guilford County, /North Carolina
> E L4 D?O
MAY 1 9 2009
DENR - WATER QUALITY
WETLA14DS AND STORM RATER BRANCH
HIVITHERS
RAVEN EL
ENGINEERS I PLANNERS I SURVEYORS
09"0575
May 19, 2009
US Army Corps of Engineers NC-Division of Water Quality
Attn: Mr. Andy Williams Attn: Ms. Cyndi Karoly
3331 Heritage Trade Dr, Suite 1o5 2321 Crabtree Blvd.
Wake Forest, NC 27587 Raleigh, NC 27604
Re: Lynnwood Lakes Sewer and Water Improvements A I
Request for 404/401 Certification 40
W&R Project Number - 2o6oo96.20
Dear Mr. Williams and Ms. Karoly:
On behalf of the City of Greensboro, we are requesting authorization from the USACE
to use NWP 12 and NWP 18 for the construction of a sanitary sewer line. We are also
requesting 4o1-Certification from the NC-DWQ for the impacts to jurisdictional waters
and wetlands.
The proposed corridor is approximately 11,949 linear feet in length and is located
mainly around the perimeter of Lynwood Lake, just north of the intersection of
Lynnwood Road (SR 3466) and Liberty Road (SR 3549)• Latitude: 35.9987709°N and
Longitude: 79.7345663°W in Greensboro, Guilford County, North Carolina (Figure 1).
The site contains unnamed tributaries to Lynnwood Lake and is located in the Cape
Fear River Basin. The Water Quality Classification for these features is: WS-IV; NSW,
the Cataloging Unit for this site is: 03030002, and the Stream Index number is: 16-19-
3-3
Project History/Purpose and Need
Prior to design the applicant requested a detailed wetland delineation be completed
so impacts to wetlands and `waters' can be minimized. Wetlands were delineated by
Withers & Ravenel during June 2oo8. A site meeting was conducted with Mr. Andy
Williams, of the USACE on September 9, 2oo8. Mr. Williams agreed with our
delineation. JD forms in support of the delineation are included with the attachments.
The Lynwood Lakes Subdivision contains approximately 300 lots and was primarily
developed from 1959 to 1971. Currently, water service is provided by individual
privately owned wells. The majority of wastewater service is by privately owned septic
systems. However, in the late 9o's, sewer service was provided to approximately 65
lots along Lynwood Drive.
There are several property owners that are in need of a new water supply and it is
anticipated that septic system drain fields could be nearing the end of their life cycle.
The objectives of this project are to provide water and sewer services to the residents
iii MacKenan Drive i Cary, NC 27511 1 tel: [phone] fax: [phone]oo8 1 www.withersravenet.com
7040 Wrightsville Avenue i Suite 1o1 i Wilmington, NC 28403 1 tel: 91o.256.9277 1 fax: [phone]
Brunswick Surveying 1 1027 Sabbath Home Rd, SW i Supply, NC 28462 1 tel: 91o.842.9392 1 fax: 91o.842.8o19

of the Lynwood Lakes Subdivision with the least possible disruption. This will require
the installation of approximately 28,80o LF of gravity sewer line and approximately
• 25,20o LF of water line.
The proposed sewer consists of 8-inch DIP and and will ultimately be treated at the
T.Z. Osborne Water Reclamation Facility, and there is adequate capacity. Please note,
• the purpose of this sewer line is not to serve a new development, but will serve
existing homes and businesses (see attached aerial, Figure 3).

Proposed Impacts
The proposed temporary impacts include 0.071 acres of jurisdictional wetlands, 367
linear feet of perennial channel (228 LF temporary, 139 LF permanent), and 0.035
acres of open water (1,504 SF temp., 9SF permanent for a piling). The permanent
• stream impacts are necessary to allow for maintenance vehicles to access the line and
for access in the event of a line breakage or blockage. The access corridor is limited to
15 feet at wetland and stream crossings. At the stream crossings, this corridorwill
consist of pulling the banks back to a 3:1 slope and placing rip-rap below the invert of
• the stream, to allow for aquatic life passage (details are included with the
attachments). Following construction, all wetland areas will be returned to pre-
construction contours and re-seeded with a wetland seed mix. With the exception of
the permanently maintained corridor, stream crossings will also be returned to pre-
construction contours. The impacts are summarized on the overall impact map as well
as the PCN form. Please note that although some wetland areas on the map are
marked as permanent impacts, this is only for the purpose of determining whether
mitigation will be required. These areas will be returned to preconstruction contours,
• but will result in the conversion of forested wetlands to herbaceous wetlands, due to
periodic mowing. Mitigation is typically required if greater than o.1 acres of forested
wetland are converted to herbaceous wetlands.

Avoidance and Minimization

The original site plan proposed 229 linear feet of permanent stream impacts. In order
• to minimize stream impacts, the permanent maintenance corridor has been limited to
15 feet in width, rather than 25-35 feet (as in the original plans), reducing the
proposed stream impacts to 139 linear feet. Additionally, at several locations, the
line will be installed using jack and bore methods to eliminate impacts, and at 1
• location over the lake, an aerial crossing will be utilized. In addition, the majority of
the line was kept outside the 50400t stream and wetlands buffer established by 15A
NCAC SUBCHAPTER 02T for waters classified as WS-IV. We examined alternatives for
the crossing on Sheet 2, but the alignment of the sewer in this location is due to the
City of Greensboro requirements for sewer manhole separation from private wells. The
City of Greensboro requires that all manholes be greater than loo' from all existing
wells, and any realignment of the sewer in this location would cause several
homeowners to abandon their current well. On sheet 5, the alignment of the sewer in
this location was dictated to limit the impacts to the homeowners' garage and

Lynwood Lakes Sewer and Water Improvements
Greensboro, Guilford County, NC
W&R Project #02060096.20
May 19, 2009
Page 2

driveway in the rear of the house between MH K1 and MH A15. The sewer has also
been placed perpendicular to the stream, and temporary construction easements were
• reduced at the crossing locations to the greatest amount possible to help reduce
impacts. We examined the possibility of trenchless construction using bore and jack
at both the stream and wetland crossings for Sheet 9, however; the cost of directional
boring at this location would be too expensive and would restrict the construction
• space for the additional work to be completed on the existing sewer.
Moreover, we felt that there would be more land disturbing activity associated with
the use of a bore and jack rig (i.e. bore pits and waste areas), and that the potential
. for sediment loss was greater than just trenching the crossing in the dry and laying the
pipe in the trench. For sheet 11, the alignment of the sewer in this location is due to
the City of Greensboro requirements for sewer manhole separation from private
wells, as well as the location of existing houses. The City of Greensboro requires that
• all manholes be greater than loo' from all existing wells, and any realignment of the
sewer in this location would cause several homeowners to abandon their current well.
Coffer dams and pumps will be used so that work can be done in the dry. These
impacts are accounted for in our application and a detail for this work is included with
• the attachments.
Indirect and Cumulative Impact Analysis - DWQ

• We do not believe that this project will lead to additional development that will impact
downstream water quality. The purpose of this project is to provide existing homes
with water and sewer and is not driven by development but rather by the annexation
requirements placed on the City of Greensboro. The City is a delegated Phase II
• community; therefore, any future development that might occur in this area will be
required to comply with the current NC-DWQ Stormwater guidelines. Additionally
because this site is located in a water supply watershed, the City will require a 50-foot
buffer on either side of the stream channels, further reducing the risk of impacts to
water quality.
Mitigation

As per a recent conversation with Mr. Andy Williams, because the proposed
`permanent' impacts (i.e. areas converted from forested wetland to herbaceous) are
less than o.1 acres, and because all crossings will be returned to pre-construction
contours, mitigation will not be required for this project.

Please feel free to call if you have questions or require additional information.
Sincerely,
WITHERS & RAVENEL, Inc.
Todd Preuninger
Lynwood Lakes Sewer and Water Improvements
Greensboro, Guilford County, NC
Page 3
W&R Project #02060096.20
May 19, 2009
Attachments -
1) PCN Form
2) Site plans
3) Agent Authorization
4) USGS Quadrangle Map
5) Guilford County Soil Survey Map
6) Crossing Details
7) Details for coffer dam installation
Lynwood Lakes Sewer and Water Improvements
Greensboro, Guilford County, NC
W&R Project #02060096.20
May 19, 2009
Page 4
PRE-CONSTRUCTION NOTIFICATION FORM
-09^0575
o?o??W A 7?9
o Niii? <
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form IM M W

A. Applicant Information MIN
1. Processing
1a. Type(s) of approval sought from the

Corps:
FE
Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 12 and 18 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ® Yes ? No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® 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
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
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: Lynwood Lakes Sewer and Water Improvements
2b. County: Guilford County
2c. Nearest municipality / town: Greensboro
2d. Subdivision name: Lynwood Lakes Subdivision
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: See below
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 I of 13
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Municipality
4b. Name: City of Greensboro - Tony Kozuch
4c. Business name
(if applicable):
4d. Street address: P.O. Box 3136
4e. City, state, zip: Greensboro, NC 27402-3136
4f. Telephone no.: 336-373-2960
4g. Fax no.: 336-373-2338
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Todd Preuninger
5b. Business name
(if applicable): Withers and Ravenel
5c. Street address: 111 MacKenan Drive
5d. City, state, zip: Cary, NC 27511
5e. Telephone no.: 919-469-3340
5f. Fax no.: 919-467-6008
5g. Email address: [e-mail]
Page 2 of 13
PCN Form - Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): NA - Linear Project
1 b. Site coordinates (in decimal degrees): Latitude: 35.9987709 Longitude: - 79.7345663
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: NA - Linear Project
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to UT to Lynwood Lake
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-IV; NSW
2c. River basin: Cape Fear River Basin
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 site consists of an existing residential subdivision known as the Lynwood Lakes Subdivision. The land use in
the vicinity of the project site consists of residential development.
3b. List the total estimated acreage of all existing wetlands on the property:
NA - linear project
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
NA - Linear Project
3d. Explain the purpose of the proposed project:
The objective of this project is to provide water and sewer services to the residents of the Lynwood Lakes Subdivision.
3e. Describe the overall project in detail, including the type of equipment to be used:
The proposed project consists of the installation of approximately 28,800 If of gravity sewer line and approximately 25,200
If of water line to service the residents of the Lynwood Lakes Subdivision.
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: A Jurisdictional Determination of the onsite
wetlands and streams was conducted by Andy Williams of
the Corps of Engineers on September 9, 2008.
4b. If the Corps made the jurisdictional determination, what type
®Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Withers and Ravenel
Name (if known): Andy Williams - Corps of Engineers Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
September 9, 2008
5. Project History
5a. Have permits or certifications been requested or obtained for ? Yes ® No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
NA
Page 3 of 13
PCN Form - Version 1.3 December 10, 2008 Version
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 13
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - tributaries ® Buffers
® Open Waters ? Pond Construction
Page 5 of 13
PCN Form - Version 1.3 December 10, 2008 Version
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
P7 ®P ? T Conversion to Headwater ® Yes ® Corps 0
011 ac
Herb Wetlands ? No ® DWQ .
P9 ®P ? T Conversion to Headwater ® Yes ® Corps 0
017 ac
Herb Wetlands ? No ® DWQ .
P12 ® P ? T Conversion to Headwater ® Yes ® Corps 0
004 ac
Herb Wetlands ? No ® DWQ .
Total Permanent Wetland Impacts 0.032 ac

T9 ? P ®T Temp Const
Headwater ® Yes ® Corps
0
018 ac
Corridor ? No ® DWQ .

T11 ? P ®T Temp Const
Headwater ® Yes ® Corps
0
013 ac
Corridor ? No ® DWQ .

T12 ? P ®T Temp Const
Headwater ® Yes ® Corps
0
003 ac
Corridor ? No ® DWQ .
T14 ? P ®T Temp Const Headwater ® Yes ® Corps 0
005 ac
Corridor ? No ® DWQ .
Total Temporary Wetland Impacts 0.039 ac
2g. Total wetland impacts 0.071 ac
2h. Comments: ±0.032 acres of permanent impacts will occur from conversion of forested wetlands to herbaceous wetlands
as a result of periodic mowing and maintenance of an access corridor along the sewer line.
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 (linear
Temporary (T) (INT)? other) (feet) feet)
P1 ®P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±17' 24 If
rap in streambed Lake ? INT ® DWQ
P2 ®P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±g1 30 If
rap in streambed Lake ? INT ® DWQ
P3 ® P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±10' 15 If
rap in streambed Lake ? INT ® DWQ
P4 ® P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±9' 15 If
rap in streambed Lake ? INT ® DWQ
P5 ® P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±10' 17 If
rap in streambed Lake ? INT ® DWQ
P6 ®P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±13' 7 If
rap in streambed Lake ? INT ® DWQ
P8 ®P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±3' 15 If
rap in streambed Lake ? INT ® DWQ
P11 ®P ? T Placement of rip- UT to Lynwood ® PER ® Corps ±g, 16 If
rap in streambed Lake ? INT ® DWQ
Total Permanent Impacts 139 If
T1 ? P ®T Temp Const UT to Lynwood ® PER ® Corps ±24' 45 If
Corridor Lake ? INT ® DWQ
Page 6 of 13
PCN Form - Version 1.3 December 10, 2008 Version
T2 ? P ®T Temp Const UT to Lynwood ® PER ® Corps ±10' 14 If
Corridor Lake ? INT ® DWQ
T3 ? P ® T Temp Const UT to Lynwood ® PER ® Corps +8' 27 If
Corridor Lake ? INT ® DWQ
T4 ? P ® T Temp Const UT to Lynwood ® PER ® Corps ±10' 13 If
Corridor Lake ? INT ® DWQ
T5 ? P ® T Temp Const UT to Lynwood ® PER ® Corps ±10' 35 If
Corridor Lake ? INT ® DWQ
T6 ? P ® T Temp Const UT to Lynwood ® PER ® Corps ±10' 26 If
Corridor Lake ? INT ® DWQ
T7 ? P ®T Temp Const UT to Lynwood ® PER ® Corps ±11' 25 If
Corridor Lake ? INT ® DWQ
T8 ? P ® T Temp Const UT to Lynwood ® PER ® Corps ±10' 17 If
Corridor Lake ? INT ® DWQ
T10 ? P ® T Temp Const UT to Lynwood ® PER ® Corps ±2' 16 If
Corridor Lake ? INT ® DWQ
T13 ? P ® T Temp Const UT to Lynwood ® PER ® Corps '

Corridor
Lake
? INT
® DWQ ±3 5 If
T16 ? P ®T Temp Const UT to Lynwood ® PER ® Corps '

Corridor
Lake
? INT
® DWQ +8 5 If
Total Temporary Impacts 228 If
3h. Total stream and tributary impacts 367 If
3i. Comments: The 139 If of permanent stream impacts will result from the placement of rip-rap below the invert of the stream
to allow for permanent vehicular crossings for review and maintenance of the sewer line.
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 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
Tem ora T
P10 ®P ? T Lynwood Lake Installation of support pilings for
Lake
0.00 ac (9 sf)
aerial crossing
T15 ? P ® T Lynwood Lake Temp Const Corridor Lake 0.035 ac (1504 sf)
4f. Total open water impacts 0.035 ac (1513 sf)
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.

Pond ID
Proposed use or purpose Wetland Impacts (acres) Stream Impacts (feet) Upland

number (acres)
of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1 NA
P2 NA
K Total
5g. Comments: There are no proposed ponds.
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
Page 7 of 13
PCN Form - Version 1.3 December 10, 2008 Version
w
5i. Expected pond surface area (acres): NA
5j. Size of pond watershed (acres): NA
5k. Method of construction: NA
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: No Buffer impacts are proposed
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The original site plan proposed 229 linear feet of permanent stream impacts. In order to minimize stream impacts, the
permanent maintenance corridor has been limited to 15 feet in width, rather than 25-35 feet (as in the original plans), reducing
the proposed stream impacts to 139 linear feet. Additionally, at several locations, the line will be installed using jack and bore
methods to eliminate impacts, and at 1 location over the lake, an aerial crossing will be utilized. In addition, the majority of the
line was kept outside the 50-foot stream and wetlands buffer established by 15A NCAC SUBCHAPTER 02T for waters
classified as WS-IV. We examined alternatives for the crossing on Sheet 2, but the alignment of the sewer in this location is
due to the City of Greensboro requirements for sewer manhole separation from private wells. The City of Greensboro requires
that all manholes be greater than 100' from all existing wells, and any realignment of the sewer in this location would cause
several homeowners to abandon their current well. On sheet 5, the alignment of the sewer in this location was dictated to limit
the impacts to the homeowners' garage and driveway in the rear of the house between MH K1 and MH A15. The sewer has
also been placed perpendicular to the stream, and temporary construction easements were reduced at the crossing locations
to the greatest amount possible to help reduce impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
We examined the possibility of trenchless construction using bore and jack at both the stream and wetland crossings for Sheet
9, however; the cost of directional boring at this location would be too expensive and would restrict the construction space for
the additional work to be completed on the existing sewer. Moreover, we felt that there would be more land disturbing activity
associated with the use of a bore and jack rig (i.e. bore pits and waste areas), and that the potential for sediment loss was
greater than just trenching the crossing in the dry and laying the pipe in the trench. For sheet 11, the alignment of the sewer
in this location is due to the City of Greensboro requirements for sewer manhole separation from private wells, as well as
the location of existing houses. The City of Greensboro requires that all manholes be greater than 100' from all existing wells,
and any realignment of the sewer in this location would cause several homeowners to abandon their current well. Coffer
dams and pumps will be used so that work can be done in the dry. These impacts are accounted for in our application and a
detail for this work is included with the attachments.
Page 8 of 13
PCN Form - Version 1.3 December 10, 2008 Version

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: NA
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.
NA
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).
Page 9 of 13
PCN Form - Version 1.3 December 10, 2008 Version
6h. Comments:
Page 10 of 13
PCN Form - Version 1.3 December 10, 2008 Version
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 ® 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
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 0%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The proposed project consists of the
installation of sub-surface sewer and water lines and will not create any impervious surface or require stormwater
management.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
NA
? 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? City of Greensboro
® 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? NA
4. DWQ Stormwater Program Review
? Coastal counties

4a. Which of the following state-implemented stormwater management programs apply ? HQW
? ORW
(check all that apply):
? Session Law 2006-246
® Other: NA
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 11 of 13
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® 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 ? 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.
We do not believe that this project will lead to additional development that will impact downstream water quality. The purpose
of this project is to provide existing homes with water and sewer and is not driven by development but rather by the
annexation requirements placed on the City of Greensboro. The City is a delegated Phase II community; therefore, any future
development that might occur in this area will be required to comply with the current NC-DWQ Stormwater guidelines.
Additionally because this site is located in a water supply watershed, the City will require a 50-foot buffer on either side of the
stream channels, further reducing the risk of impacts to water quality.
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.
Upon approval of the proposed project, the ultimate treatment method and disposition of wastewater from the Lynwood
Lakes Subdivision will be sanitary sewer.
Page 12 of 13
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 ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
E] Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted. ? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
A review of the Natural Heritage Program database (http://www.ncnho.or-q/Pages/heritagedata.html) did not identify any
occurrences of threatened or endangered species within Ymile of the proposed project. Furthermore, no threatened or
endangered species were observed during numerous site visits.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Only estuarine and marine waters are designated as Essential Fish Habitat. The proposed project is located in the
Piedmont Region of NC, which does not contain waters designated as 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 ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
The proposed utility lines will be routed along existing roads within an existing subdivision, no historical structures were
observed during our field work.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: No fill will be placed within the FEMA floodplain
8c. What source(s) did you use to make the floodplain determination? FEMA Floodplain Maps
Todd Preuninger - Withers and
Ravenel /!ate
Applicant/Agent's Signature Date
Applicant/Agent's Printed Name (Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 13 of 13
PCN Form - Version 1.3 December 10, 2008 Version
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LYNWOOD LAKES
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T3 STREAM TEMPORARY 27 224 0.005
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LYNWOOD LAKES ENGINEERS 1 PLANNERS I SURVEYORS
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IMPACT TYPE TEMPORARY /
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T4 STREAM TEMPORARY 13 137 0.003
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Z TEMP. WETLAND IMPACT
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P4 STREAM PERMANENT 15 136 0.003
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IMPACT SUMMARY - SHEET 8
IMPACT TYPE TEMPORARY /
PERMANENT LF SF AC
T8 STREAM TEMPORARY 17 178 0.004
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LYNWOOD LAKES

WETLAND IMPACTS
SHEET 8 OF I I
JaTEMP. WETLAND IMPACT
PERM. WETLAND IMPACT
EJTEMP. STREAM IMPACT
PERM. STREAM IMPACT
WITHERS &' RAVENED.
SNOINISSS I PLANNOSS ISYSYSTORS
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IMPACT TYPE TEMPORARY /
PERMANENT LF SF AC
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T10 STREAM TEMPORARY 16 47 0.001
T11 WETLAND TEMPORARY N/A 567 0.013
P7 WETLAND PERMANENT N/A 497 0.011
P8 STREAM PERMANENT 15 48 0.001
P9 WETLAND PERMANENT N/A 727 0.017
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T13 STREAM TEMPORARY 5 17 0.000
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F
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Z TEMP. WETLAND IMPACT
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LYNWOOD LAKES ? RAVENEL
SHEET 9 OF 11 ENGINEERS 1 ?LANNERE 1 SURVEYORS ca, ,I N 11, C-4- 1? 1?
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T15 LAKE TEMPORARY N/A 1504 0.035
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®TEMP. WETLAND IMPACT
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LYNWOOD LAKES WITHERS &- RAVEN EL
SHEET 10 OF 11 ENGINEERS I PLANNERS 1 SURVEYORS
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IMPACT SUMMARY - SHEET 11
IMPACT TYPE TEMPORARY / LF SF AC
PERMANENT
P12 WETLAND PERMANENT N/A 189 0.004
®TEMP. WETLAND IMPACT
®PERM. WETLAND IMPACT
M TEMP. STREAM IMPACT
® PERM. STREAM IMPACT
WETLAND IMPACTS
LYNWOOD LAKES WITHERS &' RAVENEL
SHEET 11 OF 11 ENi1NEERt 1 PLANNERS i SURVEYORS
In
AGENT AUTHORIZATION
WITHERS
Site Access/Agent Authorization Form
4
? RAVEN EL
v A ,,
Project Name: 1:1. WWI) L AA&Cs W a}e' V 4 50V%JcV--
Property Owner/Contract Purchaser: C,;j!j re eq a6oro
Address: 2002 5. Elan - ?uq-cr?? S?
6recnsl?oro, NG 214o(o
Phone: 3'53 C., -41 7- -(c,5 I't
Fax: 33 (0 - q'12 - (4 3cls
Email: mc.lindA. k t1q AV-C4nslt"b - VIC. clcy
C
I hereby grant Withers and Ravenel, INC permission to conduct environmental
studies on the property described above. In addition, I authorize Withers and
Ravenel to act on my behalf as my agent when conducting site meetings and/or
correspondence (i.e. permit applications etc.) with the USACE and the NC - Division
of Water Quality, if necessary.
Property Owner: MC ?1 a ?. K" Date: 5. l8 .0
(Print Name)
(Signature)
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Proposed Sewer 4-
WITHERS L°o RAV E N E L FIGURE 1: US GS Drawn By: Scale: Figure No.:
ENGINEERS I P L A N N F R5 SU R VE YO RS TOPOGRAPHIC QUADRANGLE LT 12000'
111 MacKenan Drive Cary, North Carolina 27511 Lynwood Lake SeweriWater Study
Guilford County, North Carolina Date: Job Number:
tel:[phone] fax: [phone]
5-13-09 02060096.20
www.withersravenel.com Climax & McCleansville Quad Maps
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WITHERS RAV E N E L FIGURE 2: NRCS Drawn By Scale. Figure No
ENGINEER) 7E4NNE4i SURVEY'JRS SOIL SURVEY LT 1"= 1666' 2
Lynwood Lake SeweNWater Stud
111 MacKenan Drive Cary. North Carolina 27511 y
Guilford County, North Carolina Date: Job Number:
tel: [phone] lax: 919-467-6008
5-9-08 02060096.20
www.withersravenet.com
A
•
CROSSING DETAILS
20' PERM.
EASMENT (MIN,)
?10'?
Q --al
STREAM= ; .:-
'
FL ON
P OF BANK
cTO
TOB
IL
I I
NATURAL __J ?_
GROUND Q RIP-RAP
CROSSING TYPICAL
PIPE
SYNTHETIC FIL TER
FABRIC
PLAN
TOP OF BANK RIP RAP SHALL NOT
DRAINAGE DITCH EXTEND ABOVE NORMAL
OR SMALL STREAM NIGH WA TER MARK
--'-^? SYNTHETIC FIL TER
EX. INV. s , FABRIC (AS PER
CREEK S'?o ' ' ::: . `, -' -:- -s: I.' •' ~ '? NCDOT SPEC ,/1056,
F TYPE-2)
CROSSING PIPE
iB" CLASS I
RIP-RAP
SECTION A A
NOTES.
1) PERMANENT CROSSING FOR VEHICLE MAINTENANCE EOUIPMENT.
2) CLASS I RIP-RAP TO BE LAID MIN. 18 INCHES THICK OVER ENTIRE AREA OF DISTURBANCE
(AS DIRECTED BY ENGINEER).
3) CLASS II RIP-RAP USED IN LARGER STREAMS (AS DIRECTED BY ENGINEER).
4) AS PROJECT IS STABILIZED PLACE SYNTHETIC FILTER FABRIC 6 SPREAD ALL EXISTING
EROSION STONE INTO PERMANENT LINER AS SHOWN. ADD STONE AS NEEDED.
5) ANY REQUIRED ARMORING ABOVE NORMAL HIGH WATER MARK SHALL CONSIST OF
MATTING OR APPROVED VEGETATIVE COVER.
DETAILS FOR COFFER DAM INSTALLATION
PUMP
TEMP. CONSTRUCTION
STREAM
FLOW
TEMP.
24 " TO
42" CMP
CLASS "I "
RIP RAP
PROPOSED
EARTH BERM
(TYP.)
50' CONSTRUCTION EASEMEN
(SEE NOTE 5)
10' X 10 "
SEDIMENT TRAP
2' 1 SIDE SLOPE
OR SIL T BAG

U .

`
w
A

10 X 10
DEVATERING BASIN
2. 1 SIDE SLOPE
OR SIL T BAG.
PROPOSED
EARTH BERM
) PLAN
POLYETHYLENE FABRIC (TYP.
ON FACE (B HL. THICK)
TO I2
MIN TOP OF FROM
PUMP .
BANK PUMP

STRFAM
-
" TEMP.
-
IL ow 24 - TO
A f r? 4",. CMP -

MIN.
j EX. INV. TEMPORARY
- "' - CREEK STONE DAM

f \ POL YETHYLEA/E FABRIC
ON FACE (B ML. THICK)

g CROSSING
PIPE

N
a ?

,Q INSTALL SANDBAGS IN PIPE INVERT C FABRIC WHILE PUMPING
AROUND DURING CONSTRUCTION IN STREAM.
POL METHYLENE FABRIC
ON FACE (B ML. THICK) B REMOVE SANDBAGS C FABRIC TO ALLOW FLOW THROUGH
PIPE WHEN NOT PUMPING AROUND.
z
SECTION A -A
I OF 2
o C/ T Y O F G R E E N S B O R O
n
STANDARD TEMPORARY CREEK STD. NO. REV.
CROSSING DURING CONSTRUCTION 213 03-97 09-05
03-05
NO TES:
1) EROSION STONE TO BE -CLASS I- RIP-RAP UNLESS DESIGNATED DIFFERENTLY ON
CONSTRUCTION PLAN.
2) PIPE SIZE AND AMOUNT NEEDED TO BE DETERMINED BY ENGINEER ON CONSTRUCTION
PL AN.
3) TEMPORARY STREAM CROSSING TO BE CONVERTED TO COG f214 UPON PROJECT
CONSTRUCTION COMPLETION IF CALLED FOR ON THE CONSTRUCTION PLANS.
4) PUMP AND LINE SIZE TO BE DETERMINED BY THE CONTRACTOR USING THE BASE FLOW
SHOWN ON THE CONSTRUCTION PLANS.
5) WIDTH OF CONSTRUCTION EASEMENT SHALL BE MINIMIZED BASED UPON FIELD CONDITIONS.
ANY DISTURBANCE (S) EXCEEDING 40 ' MA Y REOUIRE ADDITIONAL WA TER DUAL I TY PERMITTING
OR MITIGATION.
CONSTRUCTION SEQUENCE FOR STREAM CROSSING
1) INSTALL PUMP AND LINE TO PUMP FLOW FROM AREA UPSTREAM OF TEMPORARY STREAM
CROSSING TO AREA DOWNSTREAM OF CONSTRUCTION AREA. BEGIN PUMPING AND
CONTINUING PUMPING WHILE WORKING WITHIN THE STREAM.
2) INSTALL UPSTREAM DAM, FIL TER FABRIC. AND TEMPORARY CMP. COVER PIPE INLET
WITH FABRIC AND SAND BAGS AS SHOWN IN INSET "A" WHILE WORKING IN THE STREAM.
ALLOW STREAM FLOW THROUGH CMP AS SHOWN IN INSET "B" WHEN NOT WORKING WITHIN
THE STREAM.
3) INSTALL DOWNSTREAM TEMPORARY STONE DAM AND FIL TER FABRIC TO PREVENT
BACK FLOW INTO CONSTRUCTION AREA.
4) INSTALL PROPOSED EARTH BERMS ALONG TOP OF BANK ON EACH SIDE OF THE
CONSTRUCTION AREA.
5) INSTALL DEWATERING BASIN OR SILT BAG AT TOP OF BANK. DEWATER CONSTRUCTION
AREA BETWEEN TEMPORARY DAM USING THIS BASIN.
6) INSTALL THE 10' X 10' SEDIMENT TRAP OR SIL T BAG.
7) UPON CONSTRUCTION COMPLETION, REMOVE TEMPORARY DAMS, FIL TER FABRIC, AND
TEMPORARY CMP. DEPRESS TEMPORARY DAM BOTTOMS INTO STREAM BED UNTIL TOP OF
RIP RAP IS LEVEL WITH STREAM BOTTOM. CONVERT TO COG STANDARD 0214 IF CALLED
FOR IN THE CONSTRUCTION PLANS.
B) UPON STABILIZATION OF CLEARED AREAS, REMOVE TEMPORARY EARTH BERM, SEDIMENT
TRAP, AND DENA TERING BASIN.
2OF2
C / T Y OF G R E E N S B O R O
STANDARD TEMPORARY CREEK STD. NO. REV.
01-9106-05
CROSSING DURING CONSTRUCTION 213 0
3- 09-05
031-05
JURISDICTIONAL DETERMINATION FORMS
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):
• B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
• State: NC County/parish/borough: Guilford City: Greensboro
• Center coordinates of site (lat/long in degree decimal format): Lat. 35.9987709° lY, Long. 79.7345663°?.
Universal Transverse Mercator:
• Name of nearest waterbody: Lynnwood Lakes
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Cape Fear
• Name of watershed or Hydrologic Unit Code (HUC): 03030002
® 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): September 9, 2008
SECTION 11: SUMMARY OF FINDINGS
• A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Appear to be no "navigable waters of the US." 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 U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): t
? TNWs, including territorial seas
? Wetlands adjacent to TNWs
® Relatively permanent waters' (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: -367 linear feet: 2-20 width (ft) and/or NA acres.
Wetlands: < I acres.
c. Limits (boundaries) of jurisdiction based on: W 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 111 below.
' 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 [II.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: NA.
• Summarize rationale supporting determination:
• 2. Wetland adjacent to TNW
• Summarize rationale supporting conclusion that wetland is "adjacent": NA.
• 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 I[I.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 waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
• waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
• consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
• the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section [[I.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: acres
Drainage area: acres
• Average annual rainfall: inches
Average annual snowfall: 10 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: NA.
•
•
•
•
•
Identify flow route to TNWs:
Tributary stream order, if known:
Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the 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:
• 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 Lis(
Estimate average number of flow events in review area/year: Pick List
• Describe flow regime:
Other information on duration and volume:
•
•
Surface flow is: Pick List. Characteristics:
Subsurface flow: Pick List. Explain findings:
? Dye (or other) test performed:
Tributary has (check all that apply):
? Bed and banks
? OHWM6 (check all indicators that apply):
? clear, natural 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):
? 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
? Discontinuous OHWM.7 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):
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:
• fiA 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.
7Ibid.
•
1
L
(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):
L 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: flowing during summer drought, and DWQ stream forms.
n 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:
•
0
0
0

Provide estimates for jurisdictional waters in the review area (check all that apply):
• Tributary waters: -367 linear feet 2-20 width (ft).
[] Other non-wetland waters: acres.
Identify type(s) of waters:
• 3. Non-RPWs8 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):
0 Tributary waters: linear feet width (ft).
• 0 Other non-wetland waters: acres.
Identify type(s) of waters:
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
• Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
• indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW: Wetlands tie to the channel as previously determined by Andy Williams during site
• meeting.
Q Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
• Provide acreage estimates for jurisdictional wetlands in the review area: < lacres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
• Q 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.
?Q 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 11-6), or
Q Demonstrate that water is isolated with a nexus to commerce (see E below).
• E. ISOLATED [INTERSTATE OR INTRA-STATEI WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
• SUCH WATERS (CHECK ALL THAT APPLY):"'
[Q which are or could be used by interstate or foreign travelers for recreational or other purposes.
Q 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.
0 Interstate isolated waters. Explain:
Q Other factors. Explain:
• "See Footnote # 3.
• ° To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
• review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.
•
•
•
• Identify water body and summarize rationale supporting determination:
• Provide estimates for jurisdictional waters in the review area (check all that apply):
? Tributary waters: linear feet width (ft).
• ? Other non-wetland waters: acres.
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: Quad.
• USDA Natural Resources Conservation Service Soil Survey. Citation: .
National wetlands inventory map(s). Cite name:
? State/Local wetland inventory map(s):
• ? FEMA/F[RM maps:
? I00-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
? Photographs: E] 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: This form is for impacts since they are all perennial channels and abutting wetlands.