20221175 Ver 1_BP7.R021_Draft_PJD_Package_08092022_20220831

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
August 9, 2022
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
ATTN: David Bailey
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
J. ERIC BOYETTE
SECRETARY
SUBJECT: Preliminary Jurisdictional Determination (PJD) Package for the following Natural
Resources Technical Memorandum: NCDOT Project No. BP7.R021: Proposed Removal
of Bridge No. 780233 on SR 1964 (Mebane Bridge Road) over the Dan River in Eden,
Rockingham County, North Carolina.
Mr. Bailey:
The North Carolina Department of Transportation (NCDOT) proposes to remove Bridge No. 780233 on
SR 1964 (Mebane Bridge Road) over the Dan River in Eden, Rockingham County, North Carolina
(Appendix A, Figure 1). Relocation of a utility line currently on the existing bridge is also proposed as
part of this project. Below and attached are a brief description of the project, figures depicting all
features, and appropriate forms.
Three Oaks Engineering, Inc. (Three Oaks) staff members Byron Levan (MS) and Trevor Hall
conducted the site investigation within the study area on January 28, 2022. Three potential jurisdictional
streams were identified within the study area (Table 1; Appendix A, Figures 2-4). No potential
jurisdictional open waters, non -stream surface waters (e.g., tributaries), or wetlands were identified
during this site investigation. This project is located in the Roanoke River Basin (United States
Geological Survey [USGS] Hydrologic Unit Code [HUC] 03010103).
North Carolina Division of Water Resources (NCDWR) Stream Identification forms were completed for
streams where jurisdictionality was in question. North Carolina Stream Assessment Method (NCSAM)
forms were not completed for any streams since none possessed characteristics conducive to them
receiving lower mitigation ratios and/or functional rating values. Since no potential wetlands were
identified, a United States Army Corps of Engineers (USACE) Wetland Determination form was
completed to provide data representative of the lowest -lying upland areas within the project study area.
A USACE ORM Data Entry form, USACE Jurisdictional Determination Request form, USACE PJD
form, and a USACE Waters Upload Spreadsheet (January 30, 2022 version) are also included with this
submittal (Appendix C), along with landscape photographs of the site (Appendix D).
LOCATION.
NC DEPARTMENT OF TRANSPORTATION
HIGHWAY DIVISION 7
1584 YANCEYVILLE STREET
GREENSBORO, NC 27415
Telephone: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
MAILING ADDRESS
PO BOX 14996
GREENSBORO, NC 27415-4996

Please see the following PJD Package:
Table 1. Potential jurisdictional streams in the study area
Stream
NCDWRBest
Usage
NCSAM
Name
Map ID
Index
Classification
Classification
Rating'
Length
Number
Dan River
Dan River
22-(39)
C
Perennial
*
254
Unnamed
Tributary
SA
22-(39)
C
Perennial
*
700
(UT) to Dan
River
UT to Dan
SB
22-(39)
C
Intermittent
*
41
River
Total
995
' — NCSAM forms were not completed for streams possessing qualities conducive to them receiving moderate or higher mitigation
ratios and/or functional rating values. These features are represented by an asterisk (*).
If you have any questions, require additional information, or would like to schedule a site visit, please
contact me by phone at [phone] or email at [e-mail]. Alternatively, you may also
contact James Mason at Three Oaks by phone at [phone] or email at
james.mason(2threeoaksen ing eering com. This is a request for concurrence with our assessment. We
appreciate your assistance on this project.
Sincerely,
Jerry Parker
North Carolina Department of Transportation
Division 7 Environmental Supervisor
Cc: Ryan Conchilla

Appendix A
Figures

- IrIq r
tO
Sources::Esri, HERE,-Garmin�
.11 )
USGS, Intermap, INCREIVIENTP,
04�I ff1h NRCan, Esri Japan, METI, ESri
}China (Hong Kong), Esri Korea,
Esri (Thailand), NGCC, (9)*'
Legend
Study Area
— Streets
4
IF
J
Al-rr
K
J� r
t kr�
A
ly
14
a
J
AP
.4
s d i5m
4�
07J,
4
x LE
opt, I
-47
AM*
IM.?l
IW' .1 q,
Prepared For:
OF NORTH
OF I
Proposed Replacement
of Bridge No. 233
on Mebane Bridge Road
over the Dan River
BP7.RO21
Project
Vicinity
Map
Rockingham County
North Carolina
Date:
August 2022
Scale: o 125 250 Ft
I I I
Job No.:
21-026
Drawn By:
By:
NDH
IChecked
ism
Figure

Legend
Study Area
Streets
Potential Nonwetland WOTUS (Stream)
Culvert
Intermittent
Perennial
L ire
I
w V—
;
a W
o'
m
a_
m
m
4-NJ a
a
w
Eden Loop_Rd
wrl
a
0
�Zq%ftal
$F
� OfsRo
M
C_
�# Copyri�013 National Geographi Society, i-cubed
*%1NEERI,y� y
Q
y '9 S�
N1833O*^>
Prepared For:
Proposed Replacement
of Bridge No. 233
on Mebane Bridge Road
over the Dan River
BP7.R021
Jurisdictional
Features
Map
over USGS Topographic
Rockingham County
North Carolina
Date:
August 2022
Scale: 0 125 250 Ft
I i I
Job No.:
21-026
Drawn By:
Checked By:
NDH
JSM
Figure
2

Prepared For:
Proposed Replacement of
Bridge No. 233
on Mebane Bridge Road
over the Dan River
BP7.R021
Jurisdictional
Features
Map
over Otrhoimagery
Rockingham County
North Carolina
Date:
August 2022
Scale: 0 125 250 Ft
I i I
Job No.:
21-026
Drawn By:
Checked By:
NDH
JSM
Figure

�C\pKERIyG.
. S r
Legend 1�
W
Study Area o
Streets
2ft Contours
Prepared For:
Potential Nonwetland WOTUS (Stream) of KORrN
Culvert
Intermittent o
9� eQ
Perennial SBF�T of SPA�SQO
Project Elevation SA
High : 665
Low : 491 Proposed Replacement of
Bridge No. 233
on Mebane Bridge Road
0
over the Dan River
m BP7.R021
SA
O
�5—_�, Jurisdictional pp
G��� ` Features
Dan River Map
over LiDAR
- — ~� , `- Dan River .
Rockingham County
North Carolina
t}
`� `�' ,� � '.� � � � f SIN ,.: . .'"' • : %.
1 �fj! ✓'' JJ
I ,1,
GTON Hy I
HARRIN WY
— - —
Date:
August 2022
Scale: 0
125 250 Ft

Appendix B
Stream and Upland Data Forms

NC DWQ Stream Identification Form Version 4.11
SA
Date: 01/28/2022
Project/Site: Mebane Bridge Road
Latitude: 36.472819
Evaluator:Byron Levan
County: Rockingham
Longitude:-79.74514
Total Points:
Other: Southeast Eden
Stream is at least intermittent if
34.5 Stream Determination:
B.Q. Quad Name:
>19 or perennial if >30
Perennial
A. Geomorphology (Subtotal =15 )
Abserl
Weak
Moderate
Strong
SCORE
1a. Continuous bed and bank
0
1
2
3
1
2. Sinuosity of channel along thalweg
0
1
2
3
2
3. In -Channel structure: ex. riffle -pool, step -pool, ripple-
ool se uence
0
1
2
3
1
4. Particle size of stream substrate
0
1
2
3
1
5. Active/relic flood lain
0
1
2
3
2
6. Depositional bars or benches
0
1
2
3
1
7. Recent alluvial deposits
0
1
2
3
2
8. Headcuts
0
1
2
3
1
9. Grade controls
0
0.5
1
1.5
0
10. Natural valley
0
0.5
1
1.5
1
11. Second or greater order channel
No = 0
Yes = 3
3
a artificial ditches are not rated; see discussions in manual.
B. Hydrology (Subtotal =11 )
Absent
Weak
Moderate
Strong
SCORE
12. Presence of Baseflow
0
1
2
3
3
13. Iron oxidizing bacteria
0
1
2
3
2
14. Leaflitter
1.5
1
0.5
0
1.5
15. Sediment on plants or debris
0
0.5
1
1.5
1
16. Organic debris lines or piles
0
0.5
1
1.5
0.5
17. Soil -based evidence of high water table?
No = 0
Yes = 3
3
C. Biology Subtotal = 8.5)
Absent
Weak
Moderate
Strong
SCORE
18. Fibrous roots in streambed
3
2
1
0
3
19. Rooted upland plants in streambed
3
2
1
0
3
20. Macrobenthos note diversity and abundance
0
1
2
3
1
21. Aquatic Mollusks
0
1
2
3
0
22. Fish
0
0.5
1
1.5
0
23. Crayfish
0
0.5
1
1.5
0.5
24. Amphibians
0
0.5
1
1.5
1
25. Algae
0
0.5
1
1.5
0
26. Wetland plants in streambed
FACW=0.75; OBL=1.5 Other=0
0
perennial stream may also be identified using other methods. See p.35 of manual.
Notes:
-variety of ephemeroptera and odonota larva
-Crayfish burrows and adult frogs seen on exposed banks
Bank Height (feet) 8
Bankfull Width (feet) 4
Water Depth inches 2-4
Channel Substrate ebble/Sand
Velocity: ast
Clarity: hlear

NC DWQ Stream Identification Form Version 4.11 1SIB
Date: 01/28/2022
Project/Site: Mebane Bridge Road
Latitude: 36.473643
Evaluator:Byron Levan
County: Rockingham
Longitude:-79.745087
Total Points:
Southeast Eden
Other:
Stream is at least intermittent if
� g Stream Determination:
B.Q. Quad Name:
>19 or perennial if >30
Intermittent
A. Geomorphology (Subtotal =9 )
Absent7
Weak
Moderate
Strong
SCORE
1a. Continuous bed and bank
0
1
2
3
1
2. Sinuosity of channel along thalweg
0
1
2
3
0
3. In -Channel structure: ex. riffle -pool, step -pool, ripple-
ool se uence
0
1
2
3
1
4. Particle size of stream substrate
0
1
2
3
1
5. Active/relic flood lain
0
1
2
3
1
6. Depositional bars or benches
0
1
2
3
1
7. Recent alluvial deposits
0
1
2
3
2
8. Headcuts
0
1
2
3
1
9. Grade controls
0
0.5
1
1.5
0
10. Natural valley
0
0.5
1
1.5
1
11. Second or greater order channel
No = 0
Yes = 3
0
a artificial ditches are not rated; see discussions in manual.
B. Hydrology (Subtotal =6.5)
Absent
Weak
Moderate
Strong
SCORE
12. Presence of Baseflow
0
1
2
3
1
13. Iron oxidizing bacteria
0
1
2
3
1
14. Leaflitter
1.5
1
0.5
0
0.5
15. Sediment on plants or debris
0
0.5
1
1.5
0.5
16. Organic debris lines or piles
0
0.5
1
1.5
0.5
17. Soil -based evidence of high water table?
No = 0
Yes = 3
3
C. Biology Subtotal = 3.5)
Absent
Weak
Moderate
Strong
SCORE
18. Fibrous roots in streambed
3
2
1
0
1
19. Rooted upland plants in streambed
3
2
1
0
1
20. Macrobenthos note diversity and abundance
0
1
2
3
0
21. Aquatic Mollusks
0
1
2
3
0
22. Fish
0
0.5
1
1.5
0
23. Crayfish
0
0.5
1
1.5
0.5
24. Amphibians
0
0.5
1
1.5
1
25. Algae
0
0.5
1
1.5
0
26. Wetland plants in streambed
FACW=0.75; OBL=1.5 Other=0
0
perennial stream may also be identified using other methods. See p.35 of manual.
Notes: Bank Height (feet) 2
-variety of ephemeroptera and odonota larva Bankfull Width (feet) 4
-Crayfish burrows and adult frogs seen on exposed banks Water Depth inches 0-4
-lower area confluence has water, but it seeps out of a bench. Channel Substrate ebble/Sand
Velocity: 5low
Cl

U.S. Army Corps of Engineers OMB Control #: 0710-0024, Exp:1113012024
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region Requirement Control Symbol EXEMPT.•
See ERDC/EL TR-12-9; the proponent agency is CECW-CO-R (Authority: AR 335-15, paragraph 5-2a)
Project/Site: NCDOT Project BP7.R021 City/County: Eden/Rockingham Sampling Date: 01/28/2022
Applicant/Owner: NCDOT State: NC Sampling Point: NEQuae_Uplane
Investigator(s): Byron Levana and Trevor Hall Section, Township, Range: Eden
Landform (hillside, terrace, etc.): Floodplain Local relief (concave, convex, none): Convex Slope (%): 3
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.472379 Long:-79.744993 Datum: NAD 83
Soil Map Unit Name: Dan River loam, 0-2% slopes, frequently flooded NWI classification: None
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
This upland plot is located within the floodplain of Stream SA and the Dan River.
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required: check all that apply)
—Surface Soil Cracks (136)
—Surface Water (Al)
—True Aquatic Plants (1314)
—Sparsely Vegetated Concave Surface (138)
_ High Water Table (A2)
—Hydrogen Sulfide Odor (Cl)
—Drainage Patterns (1310)
—Saturation (A3)
—Oxidized Rhizospheres on Living Roots (C3)
—Moss Trim Lines (1316)
—Water Marks (131)
—Presence of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
_Sediment Deposits (132)
_Recent Iron Reduction in Tilled Soils (C6)
_Crayfish Burrows (C8)
_ Drift Deposits (133)
_Thin Muck Surface (C7)
—Saturation Visible on Aerial Imagery (C9)
_Algal Mat or Crust (134)
_Other (Explain in Remarks)
_Stunted or Stressed Plants (D1)
—Iron Deposits (135)
X Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (137)
—Shallow Aquitard (D3)
—Water-Stained Leaves (139)
_ Microtopographic Relief (D4)
Aquatic Fauna (1313)
FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes
No X Depth (inches): 0
Water Table Present? Yes
No X Depth (inches): >12
Saturation Present? Yes
No X Depth (inches): >12
Wetland Hydrology Present? Yes No X
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: NE Quad _upland
Absolute
Dominant
Indicator
Tree Stratum (Plot size: 30' )
% Cover
Species?
Status
Dominance Test worksheet:
1.
Platanus occidentalis
30
Yes
FACW
Number of Dominant Species
2.
Fraxinus pennsylvanica
30
Yes
FACW
That Are OBL, FACW, or FAC: 8 (A)
3.
Acernegundo
30
Yes
FAC
Total Number of Dominant
4.
Species Across All Strata: 10 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 80.0% (A/B;
7.
Prevalence Index worksheet:
90
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
45
20%
of total cover:
18
OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 15'
)
FACW species x 2 =
1.
Asimina triloba
20
Yes
FAC
FAC species x 3 =
2.
Lindera benzoin
20
Yes
FAC
FACU species x 4 =
3.
Acernegundo
20
Yes
FAC
UPL species x 5 =
4.
Column Totals: (A) (B
5.
Prevalence Index = B/A =
6.
Hydrophytic Vegetation Indicators:
7.
_ 1 - Rapid Test for Hydrophytic Vegetation
8.
X 2 - Dominance Test is >50%
9.
3 - Prevalence Index is !2.01
60
=Total Cover
4 - Morphological Adaptations' (Provide supportin
50% of total cover:
30
20%
of total cover:
12
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5' )
-Problematic Hydrophytic Vegetation' (Explain)
1.
Allium vineale
30
Yes
FACU
Indicators of hydric soil and wetland hydrology must t
2.
Hexastylis arifolia
15
Yes
FAC
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3.
4.
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) c
5.
more in diameter at breast height (DBH), regardless o
6
height.
7.
Sapling/Shrub - Woody plants, excluding vines, less
8.
than 3 in. DBH and greater than or equal to 3.28 ft
9
m) tall.
10.
Herb - All herbaceous (non -woody) plants, regardless
11.
of size, and woody plants less than 3.28 ft tall.
45
=Total Cover
Woody Vine - All woody vines greater than 3.28 ft in
50% of total cover:
23
20%
of total cover:
9
height.
Woody Vine Stratum (Plot size: 30' )
1.
Lonicera japonica
30
Yes
FACU
2.
Smilax rotundifolia
20
Yes
FAC
3.
4.
5.
Hydrophytic
50
=Total Cover
Vegetation
50% of total cover:
25
20%
of total cover:
10
Present? Yes X No
Remarks: (Include photo numbers here or on a separate sheet.)

SOIL
Sampling Point: NE Quad _upland
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Types Loc2 Texture Remarks
0-12 10YR 5/6 100
Loamy/Clayey
Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
_ Histosol (Al)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_2 cm Muck (A10) (MLRA 147)
Histic Epipedon (A2)
_Thin Dark Surface (S9) (MLRA 147, 148)
_Coast Prairie Redox (A16)
_Black Histic (A3)
_Loamy Mucky Mineral (F1) (MLRA 136)
(MLRA 147, 148)
—Hydrogen Sulfide (A4)
—Loamy Gleyed Matrix (F2)
—Piedmont Floodplain Soils (F19)
—Stratified Layers (A5)
_ Depleted Matrix (F3)
(MLRA 136, 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
—Red Parent Material (F21)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
(outside MLRA 127, 147, 148)
_Thick Dark Surface (Al2)
_Redox Depressions (F8)
_Very Shallow Dark Surface (F22)
_Sandy Mucky Mineral (S1)
_Iron -Manganese Masses (F12) (LRR N,
_Other (Explain in Remarks)
—Sandy Gleyed Matrix (S4)
MLRA 136)
—Sandy Redox (S5)
_ Umbric Surface (F13) (MLRA 122, 136)
3Indicators of hydrophytic vegetation and
—Stripped Matrix (S6)
_ Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present,
Dark Surface (S7)
Red Parent Material (F21) (MLRA 127, 147, 148)
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No X
Remarks:
ENG FORM 6116-4, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

Appendix C
Preliminary ORM Data Sheet
JD Request Form
PJD Form
Waters Upload Sheet

Preliminary ORM Data Entry Fields for New Actions
SAW — 202 2 -
BEGIN DATE [Received Date]:
Prepare file folder ❑ ❑
I. Project Name [PCN Form A2a]: NCDOT Project No. BP7.R021
2. Work Type: Private ❑ Institutional ❑ Government FEW Commercial ❑
3. Project Description / Purpose [PCN Form 133d and 133e]:
Proposed Removal of Bridge No. 780233 on Mebane Bridge Road over the Dan River in Eden, NC
4. Property Owner / Applicant [PCN Form A3 or A4]: NCDOT
5. Agent / Consultant [PCN Form A5 — or ORM Consultant ID Number]: James Mason- Three Oaks Eng.
6. Related Action ID Number(s) [PCN Form 135b]:
7. Project Location - Coordinates, Street Address, and/or Location Description [PCN Form 131b]:
36.472249,-79.745289
8. Project Location - Tax Parcel ID [PCN Form 131a]: Multiple
9. Project Location —County [PCN Form A2b]: Rockingham
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Eden
11. Project Information — Nearest Waterbody [PCN Form 132a]: Dan River
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03010104
Authorization: Section 10 ❑ Section 404 ❑E Section 10 & 404 ❑
Regulatory Action Type:
❑Standard Permit
Nationwide Permit #
❑ Regional General Permit #
0 Jurisdictional Determination Request
R
Pre-Application Request
Unauthorized Activity
0 Compliance
❑ No Permit Required
ZT410-To 9%

urisdictional Determination Reauest
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.g my.mil/Missions/Re ul�atoiyPermitProgram/Contact/Coun!yLocator.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]
INSTRUCTIONS:
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]
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 Department 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: Multiple Parcels
City, State:
Eden, NC 27288
County: Rockingham
Parcel Index Number(s) (PIN): Multiple PIN No.'s
B. REQUESTOR INFORMATION
Name: Jerry Parker. Division 7 Env. Sur).
Mailing Address: PO BOX 14996
Telephone Number:
Electronic Mail Address
Select one:
Greensboro, NC 27415-4996
1-336-256-2063
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultanti
Interested Buyer or Under Contract to Purchase
Other, please explain. NCDOT Project
C. PROPERTY OWNER INFORMATION
Name: Multiple Property Owners
Mailing Address: Multiple Addresses
Eden, NC 27288
Telephone Number: Multiple
Electronic Mail Address: Multiple
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 CERTIFICATION',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.
Print Name
Capacity: ❑ Owner ❑ Authorized Agents
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
0 I intend to construct/develop a projector 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 projector 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.
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.
❑ Other:
3 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
a 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 form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
ZI 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
Map of Property or Project Area. This Map must clearly depict the boundaries of the
I I review area.
✓❑ Size of Property or Review Area 12.4 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
Project Coordinates (Decimal Degrees): Latitude:
36.472249
Longitude:-79.745289
zA legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 1 Ix 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.
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/Regulatoiy-Permit-
Pro gram/Juri sdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
F4Completed 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
W1 Vicinity Map
zAerial Photograph
z USGS Topographic Map
Soil Survey Map
zOther Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
zLandscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
❑✓ NC Division of Water Resources Stream Identification Forms
�J Other Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/regulatory/readocs/JD/RGL 08-02 App A Prelim JD_ Form_fillable.pdf
s Please see http://www.saw.usace.4M.mil/Missions/Regulatory-Permit-Program/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 federal jurisdiction 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

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD:
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: .ferry Parker, PO Box 14996, Greensboro, NC 27415-4996
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Rockingham City Eden
Center coordinates of site (lat/long in degree decimal format):
Lat.: 36.472249 Long.:-79.745289
Universal Transverse Mercator: 17
Name of nearest waterbody: Dan River
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 resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (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)
See
Attached
List

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 finds
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:
■❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map: Vicinity Map, Topo Map, Aerial Map, LiDAR Map
0 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.
■❑ U.S. Geological Survey map(s). Cite scale & quad name:
1-24,000 1977 Southeast Eden, NC
❑ Natural Resources Conservation Service Soil Survey. Citation: 1992 Rockingham County soil survey
❑ 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): NCOneMap Orthoimagery
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
' Districts may establish timeframes for requestor to return signed PJD forms. If the requestor 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.

Waters_Name
Dan River
State Cowardin_Code
NORTH CAROLINA R3UB
HGM_Code
RIVERINE
Meas_Type
Linear
Amount
254
Units
FOOT
Waters_Type Latitude
DELINEATE 36.472132
Longitude
-79.745337
Local _Waterway
Dan River
SA
NORTH CAROLINA RSUB
RIVERINE
Linear
700
FOOT
DELINEATE 36.472819
-79.74514
Dan River
SB
NORTH CAROLINA R4SB
RIVERINE
Linear
41
FOOT
DELINEATE 36.473643
-79.745087
Dan River

Appendix D
Site Photographs

Photo 1: Confluence of Stream SA and the Dan River.
Photo 2: Confluence of Streams SA and SB at a roadside culvert outlet on the east side of Mebane Bridge Road, north of the
Dan River.

Photo 3: Intermittent stream SB, above the culvert outlet/confluence area shown in Photo 2.