20211347 Ver 1_401 Application_20210909

DWR
Division of Water Resources
la. Name of project:
3501 Moon Lindley Road
la. Who is the Primary Contact?
Michael and Allison Blanks
1b. Primary Contact Email:
[e-mail]
Site Coordinates
Latitude:
35.8329
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
Longitude:
-79.4117
lc. Primary Contact Phone:
[phone]
A. Processing Information
County (or Counties) where the project is located:
Chatham
Nearest Body of Water
Is this a NCDMS Project*
✓ Yes r- No
Is this project a public transportation project?
✓ Yes r• No
la. Type(s) of approval sought from the Corps:
17 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
I- Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
c Yes
r• No
1 b. What type(s) of permit(s) do you wish to seek authorization?
7 Nationwide Permit (NWP)
I— Regional General Permit (RGP)
I— Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
✓ Yes c No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
ld. Type(s) of approval sought from the DWR:
7 401 Water Quality Certification - Regular
I— Non-404 Jurisdictional General Permit
I— Individual 401 Water Quality Certification
Pre -Filing Meeting Information
Is the a courtesy copy notification?
✓ Yes r No
29 - Residential Developments
r 401 Water Quality Certification - Express
I— Riparian Buffer Authorization

le. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
1f. Is this an after -the -fact permit application?
✓ Yes r• No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
✓ Yes c No
1 h. Is the project located in any of NC's twenty coastal counties?
o Yes r- No
1j. Is the project located in a designated trout watershed?
a Yes r• No
• Yes 6- No
✓ Yes 6' No
B. Applicant Information
1d. Who is applying for the permit?
17 Owner r Applicant (other than
owner)
1e. Is there an Agent/Consultant for this project?*
6' Yes c No
2. Owner Information
2a. Name(s) on recorded deed:
Michael & Allison Blanks
2b. Deed book and page no.:
DB - 01359; PG - 0774
2c. Contact Person:
2d. Address
SVeet Address
98 Bridle Path
Address Line City
Pittsboro
Fbstal / Zp Code
27312
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Ian McMillan
4b. Business Name:
Sage Ecological Services, Inc.
4c. Address
SVeet Address
3707 Swift Drive
Address Line City
Raleigh
Fbstal / Zp Code
27606
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
State / Province / Regim
NC
Country
USA
2f. Fax Number:
State / Province / Regim
NC
Country
USA
4e. Fax Number:

C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
Of appropriate)
lc. Nearest municipality/town:
Snow Camp
2. Project Identification
2a. Property Identification Number:
8647 00 49 1257
2c. Project Address
SVeet Address
3501 Moon Lindley Road
Address Line City
Snow Camp
Fbstal / Zp Code
27612
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Mud Lick Creek
3b. Water Resources Classification of nearest receiving water:*
WSIII
3d. Please provide the 12-digit HUC in which the project is located.
030300030502
3c. What river basin(s) is your project located in?*
Cape Fear
4. Project Description and History
2b. Property size:
31.24 acres
State / Province / Regim
NC
Country
USA
4a. 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 Site is undeveloped, forested land. Hardwoods and pines are present throughout the Site. The site was recently logged so most of the trees on site are young and early
successional. The topography of the Site ranges from a low point of +/- 638 feet above mean sea level (msl) at the western property boundary, to a high point of +/- 670 feet msl at the
northeastern property corner.
Adjacent properties and those within close proximity are forested, farmed, or rural residential.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past? *
✓ Yes c No r Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0.447 acres
4g. List the total estimated linear feet of all existing streams on the property:
1,045 liner feet
4h. Explain the purpose of the proposed project:*
The purpose of the project is to development a single-family residence at the site. The proposed impacts result from the installation of a perpendicular driveway crossing of a
jurisdictional stream.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Only one residence is proposed to be built at the 31.24 acre Site. The driveway crossing was designed to cross perpendicular to jurisdictional features. There are 0.447 total acres of
on -site jurisdictional wetlands, of which none are proposed to be impacted. There are 1,045 liner feet of jurisdictional stream on -site of which only 54 linear feet are proposed to be
impacted. Construction fencing will be used to define the construction corridor and prevent any accidental additional impacts, while silt fencing will be installed to provide additional
protection from runoff.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
✓ Yes r No
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
✓ Preliminary r Approved r- Not Verified r Unknown r N/A
Corps AD Number:
o Unknown

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
o Yes
David Gainey
Sage Ecological Services, Inc.
6 No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
I— Wetlands
I— Open Waters
3. Stream Impacts
S1
3a. Reason for impact*(?)
driveway crossing
3b.Impact type *
Permanent
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
54
3i. Total stream and ditch impacts:
54
3j. Comments:
l Streams -tributaries
I Pond Construction
3c. Type of impact*
Culvert
3d. S. name*
Ut to Mud Lick Creek
r" Buffers
3e. Stream Type*
(?)
Perennial
3i. Total temporary stream impacts:
0
3f. Type of
Jurisdiction*
Both
3g. S. width *
4
Average (feet)
3h. Impact
length*
54
(linear feet)
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Only one residence is proposed to be built at the 31.24 acre Site. The road crossing was designed to cross perpendicular to the jurisdictional stream
and avoid adjacent wetlands. There are 0.447 total acres of on -site jurisdictional wetlands, of which none are proposed to be impacted. There are
1,045 liner feet of jurisdictional stream on -site of which only 54 linear feet are proposed to be impacted.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction fencing will be used to define the construction corridor and prevent any accidental additional impacts. The Project will be phased so as to
prevent large areas of land disturbance that could contribute to sediment runoff into the streams and wetlands.
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 r- No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
No wetlands are being impacted. Stream impacts have been minimized to 54 LF so no stream mitigation is proposed.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
• Yes r No

If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
✓ Yes r• No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
• Yes r No
Comments:
This site will classify as low density since there will be a single residence located on the 31.24-acre parcel.
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? *
✓ Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?*
• Yes 6 No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality? *
• Yes No
3b. If you answered "no," provide a short narrative description.
This is a stand alone single residence that does not introduce new utilities to the area. The construction of this project does not increase or decrease
the likelihood of future development in the area.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
6 Yes c No r N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated
at a treatment plant, list the capacity available at that plant.
Municipal water is available to the site and a septic system will be installed at the site.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat? *
✓ Yes rNo
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
✓ Yes r- No
5d. Is another Federal agency involved?*
✓ Yes
6 No c Unknown
5e. Is this a DOT project located within Division's 1-8?
c Yes r• No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
c Yes r No
5g. Does this project involve bridge maintenance or removal?
✓ Yes r- No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
✓ Yes r. No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
✓ Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*

The NCNHP was contacted and a search of their database on August 6, 2020, revealed there are no records for rare species, important natural
communities, natural areas, and/or conservation/managed areas within the proposed project boundary.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat? *
r Yes r- No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
NOAA Essential Fish Habitat Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status? *
cYes (zNo
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
A search of the NCSHPO database indicated there are only two properties within one -mile of the subject property. One is designated "Surveyed Only
Property" and the other is designated "Surveyed Only Property - Gone".
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
cYes (zNo
8c. What source(s) did you use to make the floodplain determination?*
FEMA F000dplain Mapper - Panel No. 3710876400K, dated November 17, 2017
Miscellaneous
Comments
Attachments:
Pre -construction Notification (PCN) Application Form
PCN Cover Letter
Agent Authorization Form
Figure 1-USGS Site Vicinity Map
Figure 2-Soil Survey Site Vicinity Map
Figure 3-PJD Wetland Sketch Map
Figure 4-NCSHPO Map
NCNHP Database Report
Impact Map
Preliminary ORM Data Entry Fields for New Actions
SAW JD Request (Jurisdictional Determination Request Form)
PJD Form
Property Tax Data
Data Forms
Site Photos
USACE ORM Spreadsheet
Signature
*
7 By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:*
Ian McMillan
Signature
Date
9/9/2021

DWR Pre -Filing Meeting Request Form
NORTH CA:iOLINA
6nvlronmerrtal Qualify
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Ian McMillan
[e-mail]
BLANKS MICHAEL J ETUXALLISON C
3501 Moon Lindley Road
Chatham
Owner Address:* Street Address
3501 Moon Lindley Road
Address Line 2
City State / Rovince / Region
Snow Camp NC
Fbstal / Zip Code Country
27312 Chatham
Is this a transportation project?* r Yes c: No
Type(s) of approval sought from the DWR:
l 401 Water Quality Certification - I— 401 Water Quality Certification -
Regular Express
I— Individual Permit I— Modification
I— Shoreline Stabilization
Does this project have an existing project ID#?*
(' Yes c: No
Do you know the name of the staff member you would like to request a meeting with?
No, first available, please.
Please give a brief project description below and include location information.*
Objective is to construct a single family residence on the property at
3501 Moon Lindley Road.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• !also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.

Signature *
Submittal Date 8/9/2021

September 9, 2021
US Army Corps of Engineers
Raleigh Regulatory Office
Attn: Mr. James Lastinger
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
Re: 3501 Moon Lindley Road
Request for NWP 29, GC 4526
Sage Project #2020.050
NC Division of Water Resources
401 & Buffer Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
On behalf of Michael and Allison Blanks (owners), please find attached a complete application and
supplemental information requesting written concurrence from the US Army Corps of Engineers
(USACE) that the activities associated with the proposed development of the 3501 Moon Lindley
Road (Project) may proceed under Nationwide Permit (NWP) 29 and General Certification 4256
(GC 4256).
Project Purpose and Location
The Project includes the construction of a single-family residence for the applicants. The +/-31.24-
acre parcel is located at 3501 Moon Lindley Road, south-southwest of Snow Camp, in Chatham
County, The coordinates of 35.832941 °N,-79.411744°W generally correspond to the center of the
Site.
Project Detail
The proposed Project consists of the construction of a single-family residence with associated
driveway and utilities. Municipal water and onsite septic are proposed for the development. The
impacts requiring approval are due to the installation of a single driveway crossing to connect the
proposed house site to Moon Lindley Road.
Access to the Site will be provided via Moon Lindley Road along the northern border. Water
services will be provided by a municipal waterline within Moon Lindley Road. Wastewater will be
treated by a proposed individual septic system. Heavy equipment typically used for utility
installation projects (e.g., backhoes, bulldozers, etc.) will be utilized.
No federally threatened or endangered species are listed to occur within 1 mile of the Project
according to the NC Natural Heritage Program (NHP) Database (see attached report dated August
6, 2020).
The Site itself is not listed as a historic property. There are two historic properties located within
1.0 mile of the Site based on a query of the North Carolina State Historic Preservation Office
(NCSHPO) database. One is listed as "Surveyed Only", and the other is listed as "Surveyed Only -
Gone". Figure 4 depicts the locations of these properties in relation to the Site. NCSHPO may have
comments during the permitting process but their comments should not prohibit the proposed
activities on the Site.
3501 Moon Lindley Road Page 1 of 2

Current Conditions and Project History
The site is primarily undeveloped and mostly wooded. Surrounding areas are rural with a mix of
farmland and undeveloped wooded areas. Mr. David Gainey of Sage Ecological Services, Inc.,
performed a wetland and stream delineation. Pre -Jurisdictional Determination (PJD) request
materials are attached to this application.
Avoidance and Minimization
Only one residence is proposed to be built at the 31.24-acre Site. The road crossing was designed
to cross perpendicular to the jurisdictional stream and avoid an adjacent wetland area. There are
0.447 total acres of on -site jurisdictional wetlands, of which none are proposed to be impacted.
There are 1,045 liner feet of jurisdictional stream on -site of which only 54 linear feet are proposed
to be impacted. Construction fencing will be used to define the construction corridor and prevent
any accidental additional impacts, while silt fencing will be installed to provide additional
protection from runoff.
Project Impacts
Permanent stream impacts total 54 linear feet of perennial stream for a single driveway crossing.
No other impacts are proposed.
Mitigation
No wetland impacts are proposed so no wetland mitigation is proposed. The proposed 54 linear
feet of stream impact has been minimized to the maximum extent and is below 150 LF therefore
no stream mitigation is proposed.
If you have any questions, please call me at [phone].
Respectfully submitted:
Sean Clark
Sage Ecological Services, Inc.
Attachments:
Pre -construction Notification (PCN) Application Form
Agent Authorization Form
Figure 1-USGS Site Vicinity Map
Figure 2-Soil Survey Site Vicinity Map
Figure 3-PJD Wetland Sketch Map
Figure 4-NCSHPO Map
NCNHP Database Report
Impact Maps (2 sheets)
PJD Form
Jurisdictional Determination Request
ORM Upload Sheets
yap.,_
Ian McMillan
Sage Ecological Services, Inc.
3501 Moon Lindley Road Page 2 of 2

Name:
Address:
Phone:
Email:
AGENT AUTHORIZATION FORM
Al! Blanks to Be Filled in By the Current Landowner or Legal Representative
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Project Name/Description: 3501 Moon Lindley Road
Sage Project # 2020.050
Date:
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
P.O. Box 1890
Wilmington, NC 28402
Attn: 'NI OWN N CW--
Field Office: „Ale r (It rJ G
Re: Wetlands and Streams Related Consulting and Permitting
To Whom It May Concern:
1, the undersigned, the owner or a duly authorized representative of record of the property/properties identified
herein, do authorize representatives of the U.S. Army Corps of Engineers (Corps) to enter upon the property herein
described for the purpose of conducting on -site investigations and issuing a deten-nination associated with Waters
of the U.S. subject to Federal jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers
and Harbors Act of 1899. l also hereby designate and authorize Sage Ecological Services to act on my behalf as my
agent in the processing of permit applications, to furnish upon request supplemental information in support of
applications, etc. from this day forward.
This notification supersedes any previous correspondence concerning the agent for this project.
Notice: This authorization, for liability and professional courtesy reasons, is valid only for government
officials to enter the property when accompanied by Sage staff. Please contact Sage to arrange a meeting
prior toi(tgt site.
v-5
BY:
Artj..kSSo A/ QGAll HY:
Print Name of Landowner or Signature of Landowner or
Legal Representative Legal Representative

/ -
/
Q Project Study Area
Map Location
ORANGE DURHAM
RANDOLPH CHATHAM
USGS Topo Map
3501 Moon Lindley Road
Sage Project # 2020.050
Crutchfield Crossroads, NC Quadrangle
USGS Topography, December 2013 N
Map Prepared by: Philip Beach
July 22, 2020
0 1,200 2,400
Feet
Figure 1
SAGE
ECOLOGICAL
SERVICES
EST. $ 2016
Sage Ecological Services, Inc.
Office: 919-335-6757
CeII: 919-559-1537

Map Location
JALAMANCE
ORANGE DURHAM
RANDOLPH CHATHAM
MOORE
HARNETT
Feature A
Feature B
NRCS Soils Map
3501 Moon Lindley Road
Sage Project # 2020.050
Chatham County Soil Survey 2006
Soil Sheet 2
Map Prepared by: Philip Beach
July 22, 2020
0 750 1,500
Feet
] Project Study Area
Figure 2
SAGE
ECOLOGICAL
SERVICES
Sage Ecological Services, Inc.
Office: 919-335-6757
CeII: 919-559-1537

All Features must be confirmed by
Chatham County and the USACE.
Map Location
GUILFORD
RANDOLPH
ALAMANCE
CHATHAM
ORANGE
NOTE: Location, shape and size of
depicted features on the evaluated
site are approximate and should be
surveyed by a licensed NC
surveyor for final site planning.
0 Data Point
— Perennial Stream - Jurisdictional Waters of the US; Subject to 100-Foot Chatham County Buffers
Wetlands - Jurisdictional Waters of the U.S.; Subject to 50-Foot Chatham County Buffers
Area Not Evaluated Due to Thick Vegetation
eroRV III!) IV'hlo and th- VI L!)5eP o mini
Wetland Sketch Map
3501 Moon Lindley Project
Sage Project # 2020.050
August 5, 2020
0 75 150
Feet
SAGE
ECOLOGICAL
SERVICES
Figure 3
Drawn By:
David Gainey
Sage Ecological Services, Inc.
Office: 919-335-6757
Cell: 919-559-1537

Map Preparer: P. Beach (Sage Ecological)
Data Source: NCSHPO GIS Shapefiles
Downloaded: August 8, 2019
https://www.ncdcr.gov
Tom Boggs Rd
%
0000
Keith Nunn Dr
Willie Hinshaw House
CH0614
QProject Study Area
1-Mile Project Buffer
❑ Surveyed Only Property
0 Surveyed Only Property - Gone
Gri Itin KO
0
0
U
t
2
ems
�5
�e`t
°
clack Rtl
moon Lindley Rd
Log House (Gone)
CH0412
Smith Harris Dr
G.'
Roland
Map Location
JALAMANCE
ORANGE DURHAM
RANDOLPH CHATHAM
WAKE
NCSHPO Map
3501 Moon Lindley Road
Sage Project # 2020.050
Map Prepared by: Philip Beach
July 22, 2020
Figure 4
SAGE
ECOLOGICAL
SERVICES
EST. $ 2016
LEE
MOORE
HARNETT
0 1,000 2,000
Feet
Sage Ecological Services, Inc.
Office: 919-335-6757
CeII: 919-559-1537

STAGE 1
1. CONTACT CHATHAM COUNTY WATERSHED MANAGER TO SET UP A
PRECONSTRUCTION MEETING AND TO DISCUSS PHASES AND FUTURE
MEETINGS FOR THIS PROJECT. GAIN APPROVAL BEFORE PROCEEDING.
2. CLEAR & INSTALL INITIAL S&EC MEASURES.
3. INSTALL ROADWAY AND DITCHLINES TO LOCATION AS SHOWN.
4. INSTALL STREAM CHECK DAM (SEE DETAILS)
4.1. WHEN INSTALLING STREAM CHECK DAM, BE SURE TO EXTEND
CHECK DAM FROM EMBANKMENT TO EMBANKMENT.
4.2. CHECK DAM SHALL BE CONSTRUCTED ON A 2:1 SLOPE, WITH A
4' FLAT TOP THAT IS EVEN IN ELEVATION.
4.3. CHECK DAM SHALL BE CONSTRUCTED OF ATLEAST CLASS B
RIP -RAP (POTENTIALLY CLASS A IF CONTRACTOR FEELS IT IS
NECESSARY) AND LINED ON THE FACE WITH BALLAST STONE
(2-3" STONE.
5. SEED/SOD AND STABILIZE ALL DENUDED AREAS ONCE ROADWAY
AND GRADING IS COMPLETED.
6. CHATHAM COUNTY STAFF MAY REQUIRE THAT TREE PROTECTION
FENCE BE INSTALLED WITH SILT FENCE IN BUFFER LIMTS. CHECK
WITH COUNTY STAFF BEFORE PROCEEDING.
STREAM BUFFER -EMITS
TO BE STAKED FLAGGED T0�
CHATHAM COUNTY SATISFACTION --------
STAGE 3
1. INSTALL ROADWAY ACROSS THE DRAINAGE SYSTEM, AND BEGIN CLEARING AND INSTALLING S&EC
MEASURES AS SHOWN ON PLANS.
2. REMOVE THE CHECK DAM SO THAT IT NO LONGER IMPEDES THE FLOW OF THE STREAM.
3. AS CONSTRUCTION TRAFFIC OCCURS ACROSS THE DRAINAGE SYSTEM FOR THE REMAINDER OF THE
PROJECT, THE CONTRACTOR SHALL CHECK THE DRAINAGE SYSTEM EVERY TWO WEEKS FOR DEFECTS
FROM VEHICULAR LOADING, SETTLING, OR OTHER DAMAGES.
4. ANY DAMAGES FOUND SHALL BE REPAIRED IMMEDIATELY.
5. INSTALL MATTING AND SEED OR SOD TO STABILIZE ALL BARE AREAS AND SLOPES ONCE GRADING IS
FINALIZED.
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/
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STREAM BUFFER LINTS
TO BE STAKED/FLAGGED TO
CFIATAM COUNTY SATISFACTION
PROP. GRAVEL
- DRIVE VAY
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Feet
STREAM BUFFER LI ITS
TO BE STAKED/FLAGGED TO
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1. INSTALL THE DOWNSTREAM HEADWALL.
1.1. BEGIN INSTALLING 4'X4' PRECAST CONCRETE BOX CULVERT. ALL COMPONENTS OF THE DRIVEWAY
CULVERT (INCLUDING THE WINGWALLS) SHOULD BE PER NCDOT STANDARDS AND STRUCTURALLY
SOUND. TO BE STRUCTURALLY DESIGNED BY PROVIDER OR OTHERS.
1.2. ITS SUGGESTED TO USE APPROPRIATE TECHNOLOGY DURING THE INSTALL TO MAINTAIN THE DESIGNED
SLOPE. WK ENVIRONMENTAL WILL NOT BE ACCOUNTABLE FOR ANY DAMAGES CAUSED BY A
IMPROPERLY INSTALLED DRAINAGE SYSTEM.
1.3. BE SURE TO BED ALL DRAINAGE SYSTEMS IN A MINIMUM OF 6" OF APPROPRIATE GRANULAR
MATERIAL.
1.4. CULVERT TRENCH SHALL BE COMPACTED AS MUCH AS PRACTICALLY ALLOWED BEFORE INSTALLING
BEDDING STONE AND PIPE.
1.5. CULVERT SHALL BE COMPACTED AROUND THE HAUNCHES PER MANUFACTURERS RECOMMENDATIONS.
1.6. CULVERT SHALL BE BACKFILLED WITH APPROPRIATE MATERIAL AND COMPACTION PER MANUFACTURERS
RECOMMENDATIONS.
1.7. ALL CULVERT CONNECTIONS SHALL BE WATER TIGHT. (SEAL ALL PLUG/LIFT HOLES BEFORE
BAC K FI LLI N G)
INSTALL UPSTREAM HEADWALL. (SEAL BOTH DOWNSTREAM AND UPSTREAM HEADWALL PIPE CONNECTIONS
TO REMOVE ANY VOIDS.)
INSTALL RIP RAP PADS ON UPSTREAM AND DOWNSTREAM END.
4. ALL SLOPES ARE TO BE MATTED AT STREAM CROSSING UPON COMPLETION OF GRADING.
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STAGE 4
ONCE CONSTRUCTION SITE IS COMPLETED, CONTRACTOR TO MAKE ONE FINAL INSPECTION OF THE
DRAINAGE SYSTEM FOR ANY FAULTS, FAILURES, OR POTENTIAL ISSUES AND IS TO REMEDY ALL ISSUES
APPROPRIATELY.
REMOVE ALL S&EC CONTROL MEASURES ONCE THE ENTIRE SITE IS COMPLETELY STABILIZED AND
CHATHAM COUNTY STAFF HAS APPROVED THE CONTRACTOR TO DO SO.
ALL SLOPES ARE TO BE MATTED AT STREAM CROSSING UPON COMPLETION OF GRADING.
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10)
SITE
BEFORE YOU DIG !
CALL 811 N.C. ONE -CALL CENTER
ITS THE LAW !
ALL RIGHTS RESERVED. THIS DRAWING IS THE
PROPERTY OF VVK ENVIRONMENTAL PLLC. AND
SHALL NOT BE REPRODUCED IN WHOLE OR IN
PART WITHOUT PERMISSION.
GENERAL SURVEY NOTES
1. MATTHEW S. JARRELL LAND SURVEYING, PLLC. PROVIDED THIS
BOUNDARY/EXISTING CONDITIONS SURVEY AS AN ELECTRIC COPY OF A
DRAWING ORIGINALLY CREATED BY MATTHEW S. JARRELL ON 8/19/2020 .
THIS DRAWING SHOWS BOUNDARY AND CONDITIONS OF THE SITE AT THE TIME
OF THE SURVEY. ALL TOPOGRAPHICAL DATA WAS DERIVED FROM COUNTY GIS
AND PROVIDED BY THE CLIENT, NO TOPOGRAPHY DATA WAS PROVIDED BY
THE SURVEYOR. IT IS RECOMMENDED THAT THE OWNER/CONTRACTOR VERIFY
ELEVATIONS AS GIS CONTOURS CAN BE RELEVANT WITH SOME ERROR.
2. THIS PROPERTY IS SUBJECT TO ANY EASEMENTS, AGREEMENTS, OR
RIGHTS -OF -WAY OF RECORD PRIOR TO THE DATE OF THIS MAP WHICH WERE
NOT APPARENT AT THE TIME OF THE INSPECTION. DECLARATION IS MADE TO
THE ORIGINAL PURCHASER OF THE SURVEY, IT IS NOT TRANSFERABLE TO
ADDITIONAL INSTITUTIONS OR OWNERS.
3. WK ENVIRONMENTAL PLLC, SHALL NOT BE HELD ACCOUNTABLE FOR ANY
DAMAGES OR HARM CAUSED BY THIS MAP THAT WAS PROVIDED BY OTHERS.
THIS MAP WAS PROVIDED BY THE OWNER AS AN EXISTING CONDITIONS SET.
STREAM BUFFER INFORMATION
PERMAN ENT STREAM IMPACT (DRAINAGE SYSTEM
AND HEADWALLS)
200 SF
ROAD CROSSING BUFFER IMPACT (GRAVEL
DRIVEWAY ONLY)
1,550 SF
RIP RAP PAD IMPACT (PERMANENT)
1,250 SF
TEMPORARY BUFFER IMPACT (INCLUDES ALL
FEATURES ABOVE AN DTEMPORARYGRADING
LIMITS)
11,500 SF
RIP -RAP CALCS
Outet pipe diameter, ID, On.)
Tailwater depth (in.)
Minimum/Maximum tailwater?
Discharge (cfs)
Velocity (ft.'s)
Minimum apron length, La (ft.)
Apron width at pipe outlet (ft.)
Apron shape
Apron width at outlet end (ft)
Max Stone Diameter, drnax (ft)
48
12
175
16.85
minimum TIN
Maximum TIN
38
8
42
Min im um
1 65
Min im um nv
2 475
12
STREAM CROSSING NOTES
4
Maximum TW
0
Maximum TW
0
CONTRACTOR IS RESPONSIBLE FOR SCHEDULING A PRECONSTRUCTION MEETING ON
SITE WITH THE WATERSHED MANAGER, FOR CHATHAM COUNTY, AND OBTAIN
AUTHORIZATION TO PROCEED.
CONTRACTOR SHALL PROVIDE AS MINIMAL OF AN IMPACT AS POSSIBLE TO THE
STREAM, AND THE WATER QUALITY OF THE STREAM.
AT NO POINT SHALL THE CONTRACTOR WORK OUTSIDE OF THE LIMITS OF
DISTURBANCE, UNLESS DOCUMENTED ALLOWANCE IS PROVIDED BY CHATHAM COUNTY
WATERSHED STAFF AND THE ENGINEER OF RECORD.
4. THE AREA BEING DISTURBED SHOULD ONLY HAVE NECESSARY CLEARING PERFORMED,
IN ORDER TO INSTALL THE FEATURES AS SHOWN ON THESE PLANS.
CONTRACTOR TO OBTAIN A CERTIFICATE OF COMPLIANCE THROUGH ON -SITE
INSPECTION BY EROSION CONTROL OFFICER FOR PROJECT.
IF APPROVED, CONTRACTOR MAY BEGIN CLEARING AND CRUBBING OF APPROVED
AREAS WITHIN BOUNDARIES OF THE CONSTRUCTION LIMITS. ROUGH GRADE ROADWAYS
AND PERMANENT ROADSIDE SWALES.
CONTRACTOR SHALL INSTALL CULVERTS WITHIN A 48 HOUR (72 HOUR MAXIMUM)
PERIOD OF DRY WEATHER USING A DITCH BLOCK (CHECK DAM) DOWN STREAM
WITHIN THE EXISTING CHANNEL.
7.1. IF NECESSARY, CONTRACTOR MAY UTILIZE A PUMP AROUND SYSTEM INSTEAD,
AND A COFFER DAM SHALL BE PLACED ON THE UPPER LIMIT OF THE STREAM
IMPACT (TO THE EAST, INSIDE THE LIMITS OF DISTURBANCE) AND PUMPED
AROUND THE SOUTH SIDE OF THE CROSSING, TO AN APPROPRIATE POINT.
FLOWS SHALL BE DISSIPATED APPROPRIATELY. (SEE PUMP AROUND DETAIL IF
THIS OPTION IS SELECTED).
. ALL PORTIONS OF THE CULVERT CROSSING OF THE STREAM, SHALL BE IN
COMPLETE COMPLIANCE WITH THE ARMY CORPS OF ENGINEERS NATIONWIDE PERMIT
29.
. APPROXIMATELY 1' OF NATURAL STREAM BED MATERIAL SHALL BE PLACED IN THE
BURRIED PORTION OF THE PIPE TO INSTILL A NATURAL CHANNEL BED THROUGHOUT
THE CULVERT.
10. FILL MATERIAL SHALL NOT CONSTRICT THE OVERALL FLOW DIMENSIONS AVAILABLE
BELOW 36"(h) X 48"(w).
11. CONTRACTOR IS RESPONSIBLE FOR FOLLOWING UP WITH CHATHAM COUNTY STAFF,
NCDEQ STAFF, AND ARMY CORPS OF ENGINEERS FOR ALL INSPECTIONS,
PRE -CONSTRUCTION MEETINGS, ETC.
**DIVERSION DITCHES ARE TO BE INSTALLED AT THE END OF EACH WORKING DAY AT
STREAM CROSSING TO ENSURE PROTECTION OF SURFACE WATERS. PER SECTION
Additional Stream Impact Table
US Rip -Rap Stream Impact- 20 LF
Drainage Culvert Stream Impact- 38 LF
DS Rip -Rap Stream Impact- 47 LF
Total LF of Stream Impact - 105 LF
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[e-mail]
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336-239-5
HELMSTETLER RD
LEXINGTON, NC
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DRAWN BY:WK
CHECKED BY:WK
DATE: 8/11/2021
PROJECT NO.:AB-1
JOB NO.:AB-1
SCALE: 1:20
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Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM n
1. Project Name [PCN Form A2a]: 3501 Moon Lindley Road
2. Work Type: ❑Private ❑Institutional ❑Government ❑ Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
Only one residence is proposed to be built at the 31.24 acre Site. The road crossing was designed to cross perpendicular to jurisdictional
features. There are 0.447 total acres of on -site jurisdictional wetlands, of which none are proposed to be impacted. There are 1,045 liner
feet of jurisdictional stream on -site of which only 54 linear feet are proposed to be impacted. Construction fencing will be used to
define the construction corridor and prevent any accidental additional impacts, while silt fencing will be installed to provide additional
protection from runoff.
4. Property Owner / Applicant [PCN Form A3 or A4]: CAVINESS RAYMOND N ETUX JANE B
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Sean Clark/Sage Ecological Services, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location — Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
35.8329, -79.4117 3501 Moon Lindley Road, Snow Camp, NC
8. Project Location — Tax Parcel ID [PCN Form Bla]: 8647 00 49 1257
9. Project Location — County [PCN Form A2b]: Chatham
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Snow Camp, NC
11. Project Information — Nearest Waterbody [PCN Form B2a]: Mud Lick Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]: 03030003
Authorization: Section 10 ❑ Section 404 ❑ Section 10 and 404 ❑
Regulatory Action Type:
❑ Standard Permit I Pre -Application Request
I
Nationwide Permit # I I Unauthorized Activity
Regional General Permit # n Compliance
Jurisdictional Determination Request fl No Permit Required
Revised 20150602

Jurisdictional Determination Request
US Army Corps
of Engineers.
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www. saw.usace. army.mil/Missions/RegulatoryPermitProgram/Contact/CountyLocator. aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Depaitiuent of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: 3501 Moon Lindley Road
City, State: Snow Camp
County: Chatham
Parcel Index Number(s) (PIN): 8647 00 49 1257
B. REQUESTOR INFORMATION
Name: Ian McMillan
Mailing Address: 3707 Swift Drive
Telephone Number:
Electronic Mail Address:
Select one:
o
❑
EI
o
Raleigh, NC 27606
919-559-1537
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION2
Name: CAVINESS RAYMOND N ETUX JANE
Mailing Address: 3501 Moon Lindley Road
Telephone Number:
Electronic Mail Address:
Snow Camp, NC 27312
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION3'4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
CAVINESS RAYMOND N ETUX JANE B
Print Name
Capacity: ❑ Owner fl Authorized Agents
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
n I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
n I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑ I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
n A Corps JD is required in order obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
n Other:
3 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
4 If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization faun/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
n
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
Size of Property or Review Area 31.24 acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017
Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
z
Project Coordinates (Decimal Degrees): Latitude: 35.8329
Longitude: -79.4117
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 11x 17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
• North Arrow
• Graphical Scale
• Boundary of Review Area
• Date
• Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
• Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
• Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
• Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
• Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
n
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Pro gram/Jurisdiction/
Version: May 2017
Page 5

Jurisdictional Determination Request
Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDs, please complete an Approved Jurisdictional Determination Forma
Vicinity Map
Aerial Photograph
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
Other Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/JD/RGL 08-02 App A Prelim JD Form fillable.pdf
s Please see http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Pro gram/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federaljurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: #CURRENT DATE TRADITIONAL#
B. NAME AND ADDRESS OF PERSON REQUESTING PJD:
Sage Ecological Services, Inc.
Attn: Ian McMillan
3707 Swift Drive
Raleigh, NC 27606
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Raleigh Regulatory Field Office
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: (USE THE
TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: North Carolina County/parish/borough: Chatham County City: Snow Camp
Center coordinates of site (lat/long in degree decimal format): Lat.: 35.8329,-79.4117
Universal Transverse Mercator: Zone 17 S 3966579.10 643456.91
Name of nearest waterbody: Mud Lick Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):

TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO
REGULATORY JURISDICTION.
Site Number
Latitude (decimal
degrees)
Longitude
(decimal degrees)
Estimated amount
of aquatic resources
in review area
(acreage and linear
feet, if applicable
Type of aquatic
resources (i.e.,
wetland vs. non -
wetland waters)
Geographic authority to
which the aquatic resource
"may be" subject (i.e.,
Section 404 or Section
10/404)
WA-1
35.833978°N
79.41 1521 °W
+/- 0.44 ac
Wetland
Section 404
WA-2
35.833743°N
79.411265°W
+/- 0.007 ac
Wetland
Section 404
Stream A
35.833792°N
79.41 1723°W
+/- 1,045 LF
Non -wetland
Section404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in the review area, and
the requestor of this PJD is hereby advised of his or her option to request and obtain an approved JD
(AJD) for that review area based on an informed decision after having discussed the various types of JDs
and their characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a Nationwide General
Permit (NWP) or other general permit verification requiring "pre- construction notification" (PCN), or
requests verification for a non -reporting NWP or other general permit, and the permit applicant has not
requested an AJD for the activity, the permit applicant is hereby made aware that: (1) the permit
applicant has elected to seek a permit authorization based on a PJD, which does not make an official
determination of jurisdictional aquatic resources; (2) the applicant has the option to request an AJD
before accepting the terms and conditions of the permit authorization, and that basing a permit
authorization on an AJD could possibly result in less compensatory mitigation being required or different
special conditions; (3) the applicant has the right to request an individual permit rather than accepting the
terms and conditions of the NWP or other general permit authorization; (4) the applicant can accept a
permit authorization and thereby agree to comply with all the terms and conditions of that permit,
including whatever mitigation requirements the Corps has determined to be necessary; (5) undertaking
any activity in reliance upon the subject permit authorization without requesting an AJD constitutes the
applicant's acceptance of the use of the PJD; (6) accepting a permit authorization (e.g., signing a
proffered individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the review area affected
in any way by that activity will be treated as jurisdictional, and waives any challenge to such jurisdiction
in any administrative or judicial compliance or enforcement action, or in any administrative appeal or in
any Federal court; and (7) whether the applicant elects to use either an AJD or a PJD, the JD will be
processed as soon as practicable. Further, an AJD, a proffered individual permit (and all terms and
conditions contained therein), or individual permit denial can be administratively appealed pursuant to 33
C.F.R. Part 331. If, during an administrative appeal, it becomes appropriate to make an official
determination whether geographic jurisdiction exists over aquatic resources in the review area, or to
provide an official delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD fmds that there "may be"
waters of the U.S. and/or that there "may be" navigable waters of the U.S. on the subject review area, and
identifies all aquatic features in the review area that could be affected by the proposed activity, based on
the following information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources below where
indicated for all checked items:
❑x Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: PJD Sketch Map — Figure 3
❑x Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ 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.
❑x U.S. Geological Survey map(s). Cite scale & quad name: 1:24,000 Crutchfield Crossroads, NC Quadrangle
❑ Natural Resources Conservation Service Soil Survey. Citation- Chatham County Soil Survey Soil Sheet 2
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
▪ Photographs: ❑Aerial (Name & Date):
or ❑x Other (Name & Date): Site Photos
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily been verified by the
Corps and should not be relied upon for later jurisdictional determinations.
h_.
August 19, 2021
Signature and date of Regulatory staff member
completing PJD
Signature and date of person
requesting PJD (REQUIRED,
unless obtaining the signature
is impracticable) 1
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester does not respond within
the established time frame, the district may presume concurrence and no additional follow up is necessary prior to
finalizing an action.

3501 Moon Lindley Road
Snow Camp. NC 27349
Parcel # 832 Moon Lindley Rd
PIN # 832
- 77767
66026 66026 E27
-- '—
s3224
Zon' g Approved Chatham County 871p / �1 �Y��_
C6/25/2C2C 11:18:35 ✓.M .• 870
J`3anenav&a, Nanning. Jecfcniciaan 4,869 },
0 1 ,4
653
Subject property
(in yellow)
653
r ,—t
Approx. areal
identified 9.si
suitable/soils for
septip.oy soil
sciarntist
r
vocation
of future single
family home site
833
1 601
832
/ f
• 869
Approx.location
for future
driveway
Intermittent
Stream per
Chatham GIS
50' riparian
buffer
89403
:,•
•„
834
Legend
Rivers / Streams
Streams /
Rivers
Intermittent
Streams
Lakes / Ponds
} Address Points
Parcels
J
Service Layer Credits: Chatham County,
Chatham County GIS
0
A
0.075
mi
0.15
CHATHAM COUNTY
NORTH CAROLINA
Date: 6/19/2020
Time: 9:10:30 AM

SOIL
Sampling Point: DP1
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
(inches)
Matrix Redox Features
Color (moist)
0-4 10YR 4/2
4-12 10YR 3/1
Color (moist)
Type' Loc2
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
Texture Remarks
5% redox
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
_ Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1)
Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
_ Stripped Matrix (S6)
Dark Surface (S7)
Polyvalue Below Surface (S8) (MLRA 147, 148)
_Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Mucky Mineral (F1) (MLRA 136)
_ Loamy Gleyed Matrix (F2)
_ Depleted Matrix (F3)
_Redox Dark Surface (F6)
Depleted Dark Surface (F7)
_ Redox Depressions (F8)
Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
Umbric Surface (F13) (MLRA 122, 136)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 147, 148)
Indicators for Problematic Hydric Soils3:
2 cm Muck (A10) (MLRA 147)
_ Coast Prairie Redox (A16)
(MLRA 147, 148)
_ Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
_ Red Parent Material (F21)
(outside MLRA 127, 147, 148)
_Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present?
Yes X No
Remarks:
ENG FORM 6116-4-SG, JUL 2018
Eastern Mountains and Piedmont — Version 2.0

SOIL
Sampling Point: DP2
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
(inches)
Matrix Redox Features
Color (moist)
0-8 10YR 4/4
8-12 10YR 5/4
Color (moist)
Type' Loc2
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
Texture Remarks
No hydro
No redox
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
_ Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1)
Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
_ Stripped Matrix (S6)
Dark Surface (S7)
Polyvalue Below Surface (S8) (MLRA 147, 148)
_Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Mucky Mineral (F1) (MLRA 136)
_ Loamy Gleyed Matrix (F2)
_ Depleted Matrix (F3)
_Redox Dark Surface (F6)
Depleted Dark Surface (F7)
_ Redox Depressions (F8)
Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
Umbric Surface (F13) (MLRA 122, 136)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 147, 148)
Indicators for Problematic Hydric Soils3:
2 cm Muck (A10) (MLRA 147)
_ Coast Prairie Redox (A16)
(MLRA 147, 148)
_ Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
_ Red Parent Material (F21)
(outside MLRA 127, 147, 148)
_Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present?
Yes No X
Remarks:
ENG FORM 6116-4-SG, JUL 2018
Eastern Mountains and Piedmont — Version 2.0

SITE PHOTOS
Photo 1: Stream A
Photo 2: Wetland WA-2

Photo 3: Wetland WA-1.
Photo 4: Area in the southern portion of the Site not evaluated due to thick vegetation.

Waters_Name
1
WA-1
WA-2
Stream A
NORTH CAROLINA
NORTH CAROLINA
NORTH CAROLINA

Cowardin_Code I HGM_Code I Meas_Type
PFO RIVERINE Area
PFO RIVERINE Area
PFO RIVERINE Linear
I
Amo
Units
0.44 ACRE
0.007 ACRE
1,045 FOOT
I

Waters_Type
DELINC
DELINC
DELINC
I
NWPR Determine_Code
Latitude
35.8339 78° N
35.833743°N
35.833792°N

Longitude
79.41 1521 °W
79.41 1265°W
79.411723°W

Local_Waterway

ters_Name
UT to Mud Lick Creek
Activity I Resource_Type
Stream A Discharge of fill material River/Stream

IPermanent_Loss II mpact_Duration I Amount Type I Amount Units l I nitially_Proposed_ I I nitially_Proposed_ I
YES Permanent

I nitially_Proposed_ I Proposed_ I Proposed_ I Proposed_ I Authorized I Authorized_ I Authorized_ I Debits

1
Notes

■•■•■
••• • NC DEPARTMENT OF
mu
NATURAL AND CULTURAL RESOURCES
• ■■■
Sean Clark
Sage Ecological Services
3707 Swift Drive
Raleigh, NC 27606-2543
RE: 3501 Moon Lindley Road; 2020.050
Dear Sean Clark:
Roy Cooper, Governor
Susi Hamilton, Secretary
Walter Clark, Director, Land and Water Stewardship
August 6, 2020
N CN H D E-12624
The North Carolina Natural Heritage Program (NCNHP) appreciates the opportunity to provide
information about natural heritage resources for the project referenced above.
Based on the project area mapped with your request, a query of the NCNHP database indicates that
there are no records for rare species, important natural communities, natural areas, and/or
conservation/managed areas within the proposed project boundary. Please note that although there
may be no documentation of natural heritage elements within the project boundary, it does not
imply or confirm their absence; the area may not have been surveyed. The results of this query
should not be substituted for field surveys where suitable habitat exists. In the event that rare
species are found within the project area, please contact the NCNHP so that we may update our
records.
The attached 'Potential Occurrences' table summarizes rare species and natural communities that
have been documented within a one -mile radius of the property boundary. The proximity of these
records suggests that these natural heritage elements may potentially be present in the project area
if suitable habitat exists. Tables of natural areas and conservation/managed areas within a one -mile
radius of the project area, if any, are also included in this report.
If a Federally -listed species is found within the project area or is indicated within a one -mile radius of
the project area, the NCNHP recommends contacting the US Fish and Wildlife Service (USFWS) for
guidance. Contact information for USFWS offices in North Carolina is found here:
httos://www.fws.gov/offices/Directory/ListOffices.cfm?statecode=37.
Please note that natural heritage element data are maintained for the purposes of conservation
planning, project review, and scientific research, and are not intended for use as the primary criteria
for regulatory decisions. Information provided by the NCNHP database may not be published
without prior written notification to the NCNHP, and the NCNHP must be credited as an information
source in these publications. Maps of NCNHP data may not be redistributed without permission.
The NC Natural Heritage Program may follow this letter with additional correspondence if a
Dedicated Nature Preserve, Registered Heritage Area, Clean Water Management Trust Fund
easement, or Federally -listed species are documented near the project area.
If you have questions regarding the information provided in this letter or need additional assistance,
please contact Rodney A. Butler at [e-mail] or 919-707-8603.
Sincerely,
NC Natural Heritage Program
DEPARTMENT OF NATURAL AND CULTURAL RESOURCES

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No Natural Areas are Documented Within a One -mile Radius of the Project Area
No Managed Areas are Documented Within a One -mile Radius of the Project Area
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NCNHDE-12624: 3501 Moon Lindley Road
Project Boundary
Buffered Project Boundary