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Home My WebLink About20180795 Ver 1_Mitigation 401 Application_20191125ID#* 20180795 Version* 1 Select Reviewer:* Mac Haupt Initial Review Completed Date 11/26/2019 Mitigation Project Submittal - 11/25/2019 Is this a Prospectus, Technical Proposal or a New Site?* r Yes r No Type of Mitigation Project:* V Stream r1 Wetlands r- Buffer r` Nutrient Offset (Select all that apply) Project Contact Information Contact Name:* Lin Xu Project Information ................................................................................... ID#:* 20180795 Existing IDY Project Type: Project Name: County: Email Address:* lin.xu@ncdenr.gov Version: *1 Existing Version r DMS r Mitigation Bank Slingshot Stream & Wetland Mitigation Site Mitigation Project Rockingham Document Information Mitigation Document Type:* Mitigation Plans File Upload: Slingshot _100058_FinalMP 2019-11-22.pdf 87.21MB Slingshot_100058_Response to IRT 35.32KB comments_2019-11-22. pdf Slingshot_100058_USACE eApproval_2019.pdf 226.73KB Slingshot _Site_Construction_Plans_Sealed_20191... 8.37MB SlingshotPCN.pdf 2MB SlingshotSite401 COffice.pdf 48.41 KB SlingshotSite401 FeeMemo.pdf 44.55KB Rease upload only one RDFcf the conplete file that needs to be subnitted... Signature Print Name:* Lin Xu Signature:* DEPARTMENT OF THE ARMY WILMINGTON DISTRICT, CORPS OF ENGINEERS 69 DARLINGTON AVENUE WILMINGTON, NORTH CAROLINA 28403-1343 November 12, 2019 Regulatory Division Re: NCIRT Review and USACE Approval of the NCDMS Slingshot Creek Mitigation Site / Rockingham County / SAW-2018-01170/ NCDMS Project 9 100058 Mr. Tim Baumgartner North Carolina Division of Mitigation Services 1652 Mail Service Center Raleigh, NC 27699-1652 Dear Mr. Baumgartner: The purpose of this letter is to provide the North Carolina Division of Mitigation Services (NCDMS) with all comments generated by the North Carolina Interagency Review Team (NCIRT) during the 30-day comment period for the Slingshot Creek Stream and Wetland Draft Mitigation Plan, which closed on September 25, 2019. These comments are attached for your review. Based on our review of these comments, we have determined that no major concerns have been identified with the Draft Mitigation Plan, which is considered approved with this correspondence. However, several minor issues were identified, as described in the attached comment memo, which must be addressed in the Final Mitigation Plan. The Final Mitigation Plan is to be submitted with the Preconstruction Notification (PCN) Application for Nationwide permit approval of the project along with a copy of this letter. Issues identified above must be addressed in the Final Mitigation Plan. All changes made to the Final Mitigation Plan should be summarized in an errata sheet included at the beginning of the document. If it is determined that the project does not require a Department of the Army permit, you must still provide a copy of the Final Mitigation Plan, along with a copy of this letter, to the appropriate USACE field office at least 30 days in advance of beginning construction of the project. Please note that this approval does not preclude the inclusion of permit conditions in the permit authorization for the project, particularly if issues mentioned above are not satisfactorily addressed. Additionally, this letter provides initial approval for the Mitigation Plan, but this does not guarantee that the project will generate the requested amount of mitigation credit. As you are aware, unforeseen issues may arise during construction or monitoring of the project that may require maintenance or reconstruction that may lead to reduced credit. Thank you for your prompt attention to this matter, and if you have any questions regarding this letter, the mitigation plan review process, or the requirements of the Mitigation Rule, please call me at 919-554-4884, ext 60. Sincerely, BROWN ING.KIMBERLY Digitally signed by DANIELLE.152768351 BROWN ING.KIMBERLY.DANIELLE. 1527683510 0 Date: 2019.11.12 15:37:30-05'00' Kim Browning Mitigation Project Manager for Tyler Crumbley Enclosures Electronic Copies Furnished: NCIRT Distribution List Jeremiah Dow— NCDMS Ray Holz, Worth CreechRS ROY COOPER Governor NCHAEL S. REGAN Secretary TIM BAUMGARTNER Director NORTH CAROLINA Environmental Quality November 25, 2019 Mac Haupt, Acting 401 & Buffer Permitting Unit Supervisor Division of Water Resources 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699 - 1617 Re: Permit Application- Slingshot Stream & Wetland Mitigation Site Mitigation Project, Rockingham County (DMS Full Delivery Project) Dear Mr. Haupt: Attached for your review is 404/401 permit application package for the subject project. A memo for the permit application fee is also included in the package. Per agreement between DMS and DWR, the hard copy of the final mitigation plan is not included in the submittal. However, the electronic copy of the final mitigation plan along with all other electronic files have been uploaded to NC DWR's file system. Please feel free to contact me with any questions regarding this plan (919-707-8319). Thank you very much for your assistance. Sincerely Lin Xu Attachment: 404/401 Permit Application Package Permit Application Fee Memo E Q; North Carolina Department of Environmental Quality I Division of Mitigation Services 217 W. Jones Street 11652 Mail Service Center I Raleigh, North Carolina 27699-1652 919.707.8976 ROY COOPER Governor MICHAEL S. REGAN Secretary TIM BAUMGARTNER Director MEMORANDUM: NORTH CAROLINA Environmental Quality TO: Debby Davis FROM: Lin Xu �X SUBJECT: Payment of Permit Fee 401 Permit Application DATE: November 25, 2019 The Division of Mitigation Services (DMS) is implementing a mitigation project for Slingshot Stream & Wetland Mitigation Site Mitigation Project in Rockingham County (DMS IMS # 100058). The activities associated with this restoration project involve stream restoration related temporary stream and wetland impact. To conduct these activities, the DMS must submit a Pre -construction Notification (PCN) Form to the Division of Water Resources (DWR) for review and approval. The DWR assesses a fee of $570.00 for this review. Please transfer $570.00 from DMS Fund # 2984, Account # 535120 to DWR as payment for this review. If you have any questions concerning this matter I can be reached at 919-707-8319. Thanks for your assistance. cc: Mac Haupt, DWR North Carolina Department of Environmental Quality I Division of Mitigation Services 217 W. Jones Street 1 1652 Mail Service Center I Raleigh, North Carolina 27699-1652 919.707.8976 �p wAxF9 o� p� Office Use Only: � Corps action ID no. DWQ project no. L i Form Version 1.4 January 2009 Pre -Construction Notification (PCN) Form A. Applicant Information 1. Processing 1 a. Type(s) of approval sought from the Corps: X❑ Section 404 Permit ❑ Section 10 Permit 1 b. Specify Nationwide Permit (NWP) number: 27 or General Permit (GP) number: 1 c. Has the NWP or GP number been verified by the Corps? ® Yes ❑ No id Tvnafsl of nnnrnvnl cni inht from tha r)WC1 trhark all that nnnhil- ❑X 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit ❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization le. Is this notification solely for the record because written approval is not required? For the record only for DWQ 401 Certification: ❑ Yes ❑x No For the record only for Corps Permit: ❑ Yes ❑X No 1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu fee program. ❑ Yes ❑X No 1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h below. ❑ Yes 0 No 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes 0 No 2. Project Information 2a. Name of project: Slingshot Stream & Wetland Mitigation Site 2b. County: Rockingham 2c. Nearest municipality / town: Reidsville 2d. Subdivision name: -- 2e. NCDOT only, T.I.P. or state project no: DMS Project ID No. 100058 3. Owner Information 3a. Name(s) on Recorded Deed: Robert L. Wheless 3b. Deed Book and Page No. 1269, 277 3c. Responsible Party (for LLC if applicable): 3d. Street address: 1400 Front Street 3e. City, state, zip: Reidsville, NC 27320 3f. Telephone no.: 336-634-3862 3g. Fax no.: -- 3h. Email address: -- Page 1 of 10 PCN Form — Version 1.4 January 2009 4. Applicant Information (if different from owner) 4a. Applicant is: ❑ Agent ❑X Other, specify: Permittee 4b. Name: Lin Xu 4c. Business name (if applicable): NC Division of Mitigation Services 4d. Street address: 217 West Jones St. 4e. City, state, zip: Raleigh, NC 27603 4f. Telephone no.: 919-707-8319 4g. Fax no.: 4h. Email address: lin.xu@ncdenr.gov S. Agent/Consultant Information (if applicable) 5a. Name: Worth Creech 5b. Business name (if applicable): Restoration Systems, LLC 5c. Street address: 1101 Haynes Street, Suite 211 5d. City, state, zip: Raleigh, NC 27604 5e. Telephone no.: 919-755-9490 5f. Fax no.: 919-755-9492 5g. Email address: Worth@restorationsystems.com Page 2 of 10 B. Project Information and Prior Project History 1. Property Identification 1a. Properly identification no. (tax PIN or parcel ID): 1170686 1 b. Site coordinates (in decimal degrees): Latitude: 36.33348 Longitude:-79.715103 1 c. Property size: 12 acres 2. Surface Waters 2a. Name of nearest body of water to proposed project: Lake Hunt 2b. Water Quality Classification of nearest receiving water: WS-III, B, NSW 2c. River basin: Cape Fear 3. Project Description 3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application: The Site drainage area is dominated by pasture, agricultural land, and sparse residential property. Impervious surfaces account for less than 5 percent of the upstream watershed land surface. 3b. List the total estimated acreage of all existing wetlands on the property: 0.689 1 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 4,116 3d. Explain the purpose of the proposed project: Stream restoration, enhancement (Level 1 and Level 2), and preservation; in addition to riparian wetland restoration and enhancement. 3e. Describe the overall project in detail, including the type of equipment to be used: A detailed description of proposed activities is provided in the attached Mitigation Plan. The project will be completed with standard earth -moving equip 0 4. Jurisdictional Determinations 4a. Have jurisdictional wetland or stream determinations by the 1 X❑ Yes ❑ No ❑ Unknown Corps or State been requested or obtained for this property / project(including all prior hases in thepast? Comments: 4b. If the Corps made the jurisdictional determination, what type Preliminary ❑ Final of determination was made? 4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Name (if known): W. Grant Lewis Other: Axiom Environmental, Inc. 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. Site visit on August 22, 2018; the signed Notification of Jurisdictional Determination dated May 7, 2019 is attached.. 5. Project History 5a. Have permits or certifications been requested or obtained for ❑Yes ❑X No ❑ Unknown this project (including all prior phases) in the past? 5b. If yes, explain in detail according to "help file" instructions. 6. Future Project Plans 6a. Is this a phased project? j ❑ Yes ❑X No 6b. If yes, explain. Page 3 of 10 PCN Form — Version 1.4 January 2009 C. Proposed Impacts Inventory 1. Impacts Summary 1 a. Which sections were completed below for your project (check all that apply): X❑ Wetlands ❑X Streams —tributaries ❑X Buffers ❑ Open Waters ❑ Pond Construction 2. Wetland Impacts If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted. 2a. 2b. 2c. 2d. 2e. 2f. Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of number Corps (404,10) or impact Permanent (P) or DWQ (401, other) (acres) T —Temporary LB SEE ATTACHED TABLE PA SH SG SD 2g. Total Wetland Impacts: 2h. Comments: Permanent impacts to small wetland areas are anticipated by construction of proposed stream channels. Temporary impacts to wetlands are limited to enhancement activities including planting with native forest species. Jurisdictional wetland areas will be avoided to the maximum extent practicable; however, some encroachment will be necessary during project construction. Construction -related impacts will be temporary and all areas will be restored to pre -project elevations and planted appropriately. 3. Stream Impacts If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted. 3a. 3b. 3c. 3d. 3e. 3f. 3g. Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact number intermittent (INT)? jurisdiction stream length Permanent (P) or width (linear Temporary (T) (feet) feet) S1 Choose one SEE ATTACHED TABL - - S2 Choose one - S3 S4 S5 S6 3h. Total stream and tributary impacts 3i. Comments: Project activities include restoration of 2501 If, enhancement (Level 1) of 391 If, enhancement (Level II) of 254 If, and preservation of 39 If of stream channels. No impacts are anticipated in conjunction with Enhancement (level II) and Preservation activities. Please see the attached Mitigation Plan. Page 4 of 10 PCN Form —Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then individually list all open water impacts below. 4a. 4b. Open water Name of waterbody impact number (if applicable) Permanent (P) or Temporary TI 4c. Type of impact 4d. 4e. Waterbody Area of impact (acres) type 01 - Choose one Choose Choose 02 - Choose one 03 - 'Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete the chart below. 5a. 5b. 5c. 5d. 5e. Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland purpose of pond (acres) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 5f. Total: 5g. Comments: NA 5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no: 5i. Expected pond surface area (acres): 5j. Size of pond watershed (acres): 5k. Method of construction: 6. Buffer Impacts (for DWQ) If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar -Pamlico ❑ Catawba []Randleman ❑X Other: Jordan Lake 6b. 6c. Buffer Impact Reason for impact number— Permanent (P) or Temporary (T) 6d. 6e. Stream name Buffer mitigation required? 6f. Zone 1 impact (square feet) 6g. Zone 2 impact (square feet) B1 - See attached table Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No 135 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 0 0 6i. Comments: All impacts to riparian buffers involve planting with native vegetation and removal of invasive species. No impervious surface is created and all buffers are being converted from active pasture land to a wooded riparian buffer consisting of native vegetation. Page 5 of 10 D. Impact Justification and Mitigation 1. Avoidance and Minimization 1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. This is a stream and wetland mitigation project. As a result, avoidance and minimization were not part of the original design planning. The proposed project is anticipated to increase the function and length of jurisdictional stream. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. The only activities that will take place within the stream are filling and stabilization of banks, placement of channel bed material, and the installation of cross vanes and drop structures. No machinery will be driven within existing stream channels. If water is present, channels will be temporarily dewatered and all work will be performed in the dry. Impacts to jurisdictional areas are designed to benefit hydrology and vegetative communities. 2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State 2a. Does the project require Compensatory Mitigation for ❑ Yes ❑X No impacts to Waters of the U.S. or Waters of the State? 2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps ❑ Mitigation bank 2c. If yes, which mitigation option will be used for this El Payment to in -lieu fee program project? ❑ Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: Type: Choose one Quantity: 3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity: Type: Choose one Quantity: 3c. Comments: 4. Complete if Making a Payment to In -lieu Fee Program 4a. Approval letter from in -lieu fee program is attached. ❑ Yes 4b. Stream mitigation requested: linear feet 4c. If using stream mitigation, stream temperature: Choose one 4d. Buffer mitigation requested (DWQ only): square feet 4e. Riparian wetland mitigation requested: acres 4f. Non -riparian wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested: acres 4h. Comments: 5. Complete if Using a Permittee Responsible Mitigation Plan 5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. Page 6 of 10 PCN Form — Version 1.4 January 2009 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ 6a. Will the project result in an impact within a protected riparian buffer that requires Yes X No buffer mitigation? 6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the amount of mitigation required. 6c. 6d. 6e. Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (square feet) Zone 1 1 1 3 (2 for Catawba) Zone 2 1 1 1 1.5 I 6f. Total buffer mitigation required: � 0 6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank, permittee responsible riparian buffer restoration. payment into an approved in -lieu fee fund). NA. 6h. Comments: Page 7 of 10 E. Stormwater Management and Diffuse Flow Plan (required by DWQ) 1. Diffuse Flow Plan 1 a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules? 1 b. If yes, then is a diffuse flow plan included? If no, explain why. NA; however, numerous marsh treatment areas are included in the Site design. 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of this project? 2b. Does this project require a Stormwater Management Plan? 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: ❑ Yes ❑X No ❑ Yes ❑ No 0% ❑ Yes ❑X No No impervious surfaces will be generated by the proposed project. On -site stormwater will be treated by a marsh treatment areas or flow through vegetated riparian buffers prior to flowing into surface waters. 2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan: IMA 2e. Who will be responsible for the review of the Stormwater Management Plan? 3. Certified Local Government Stormwater Review 3a. In which localgovernment's jurisdiction is thisproject? Local -Winston Salem ❑ Phase II 3b. Which of the following locally -implemented stormwater management programs 0 NSW apply (check all that apply): I ElUSMP ❑X Water Supply Watershed ❑ Other: 3c. Has the approved Stormwater Management Plan with proof of approval been attached? 4. DWQ Stormwater Program Review 4a. Which of the following state -implemented stormwater management programs apply (check all that apply): []Yes ❑X No []Coastal counties ❑HQW ❑ORW ❑X Session Law 2006-246 []Other: 4b. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑X No attached? 5. DWQ 401 Unit Stormwater Review 5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑ Yes ❑ No 5b. Have all of the 401 Unit submittal requirements been met? I ❑ Yes ❑ No Page 8 of 10 PCN Form —Version 1.4 January 2009 F. Supplementary Information i 1. Environmental Documentation (DWQ Requirement) la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? 0 Yes ❑ No 1 b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State OYes ❑ No (North Carolina) Environmental Policy Act (NEPA/SEPA)? 1 c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter.) Please see the Approved Categorical Exclusion Form (Appendix E of the Detailed Yes ❑ No Comments: Mitigation Plan) 2. Violations (DWQ Requirement) 2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300). DWQ Surface Water or Wetland Standards, El Yes 0 No or Riparian Buffer Rules (15A NCAC 2B .0200)? 2b. Is this an after -the -fact permit application? ❑Yes 0 No 2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): 3. Cumulative Impacts (DWQ Requirement) 3a. Will this project (based on past and reasonably anticipated future impacts) result in ❑Yes 0 No additional development, which could impact nearby downstream water quality? 3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWQ policy. If you answered "no," provide a short narrative description. 4. Sewage Disposal (DWQ Requirement) 4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from the proposed project, or available capacity of the subject facility. NA - No sewage will be generated by the proposed project. Page 9 of 10 PCN Form — Version 1.4 January 2009 5. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or habitat? 5b. Have you checked with the USFWS concerning Endangered Species Act impacts? 5c. If yes, indicate the USFWS Field Office you have contacted. 1 5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? USFWS Raleigh Field Office Website, informal Section 7 review 0 Yes ❑ No 0 Yes ❑ No Raleigh 6. Essential Fish Habitat (Corps Requirement) 6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes 6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat? NOAA Fisheries Essential Fish Habitat Mapper v2.0 (online) 7. Historic or Prehistoric Cultural Resources (Corps Requirement) 7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)? ❑ Yes 0 No 0 No 7b. What data sources did you use to determine whether your site would impact historic or archeological resources? .Consultation with SHPO 8. Flood Zone Designation (Corps Requirement) 8a. Will this project occur in a FEMA-designated 100-year floodplain? 8b. If yes, explain how project meets FEMA requirements: 8c. What source(s) did you use to make the floodplain determination? FEMA Flood Insurance Rate Map 3710798400J, Panels 7984 and 7994, effective September 3, 2007 Applicant/Agent's Printed Name Worth Creech Restoration Systems, LLC Co-Applicant/Agent's Printed Name ❑ Yes ® No Applicant/Agent's Signature (Agent's signature is valid only if an authorization letter from the applicant is provided.) Co-Applicant/Agent's Signature (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 10 of 10 Date 11/22/19 Date Proposed Impacts Inventory - Slingshot Mitigation Site WETLAND IMPACTS Wetland impact number Permanent (P) or Temporary (T) Type of impact Type of wetland Forested I Type of jurisdiction Corps (404,10) or Area of impact DWQ (401, other) (acres) JA (P) Stream Restoration Headwater Wetland Yes Corps 0.0002 JB (T) Planting Headwater Wetland Yes Corps 0.010 JB (P) Stream Restoration Headwater Wetland Yes Corps 0.050 JC (T) Planting Headwater Wetland No Corps 0.002 JC (P) Stream Restoration Headwater Wetland No Corps 0.0005 GE (T) Planting Headwater Wetland No Corps 0.480 GE (P) Stream Restoration Headwater Wetland No Corps 0.030 SC (T) Planting Headwater Wetland No Corps 0.001 SC (P) Stream Restoration Headwater Wetland No Corps 0.00005 GA (T) Planting Headwater Wetland No Corps 0.050 GA (P) Planting Headwater Wetland No Corps 0.040 Total Wetland impacts 0.66 STREAM IMPACTS Stream Impact Number Average Stream Permanent (P) or Type of Impact" Stream Name PER or INT Type of Jurisdiction Stream Width Impact Temporary (T) (feet) Length (feet) Slingshot Creek" (P) Relocation Slingshot Creek PER Co r s 743 Slingshot Creek" (T) Stabilization Slingshot Creek I PER Corps 2225 UT1(P) Relocation UT1 PER Corps 275 UT1(T) Stabilization UT1 PER Corps 448 UT2 (P) Relocation UT2 PER Corps 130 Total Stream & Tributary Impacts 3621 : No impacts are anticipated in conjunction with Enhancement (level II) or Preservation activities. "The stream was originally called Troublesome Creek on the PJD package; the name was changed to Slingshot Creek during detailed planning at the request of NCDMS. OPEN WATER IMPACTS Open Waterlmpact I Number Permanent (P) or Name of Waterbody Type of Impact Wa y Area of Impact (acres) Temporary (T) T Type YPe NONE Total Open Water Impacts 0 BUFFER IMPACTS Buffer Impact Number Buffer Permanent (P) or Reason for Impact Stream Name Mitigation Zone 1 Impact (ft sq) Zone 2lmpact Temporary (T) Required Ift sq) P Stream Restoration Slingshot Creek & Uts No 205,052 114,752 Total Buffer Impactsl 205,052 114,752 SAW-2018-01170 U.S. ARMY CORPS OF ENGINEERS WILMINGTON DISTRICT Action Id. SAW-2018-01170 County: Rockingham U.S.G.S. Quad: NC -Reidsville NOTIFICATION OF JURISDICTIONAL DETERMINATION Property Owner: NCDEO DMS Attn: Tim Baumgartner Address: 1619 Mail Service Center Raleigh, NC 27699-1619 Size (acres) —12 Nearest Town Reidsville Nearest Waterway UT to Troublesome Creek / Lake Hunt River Basin Cape Fear USGS 1JUC 03030002 Coordinates 36.333480 N,-79.715103 W Location description: The project area is located approximately 0.1 mile north of the northern terminus of Harbor Road, near Reidsville. Rockingham County, North Carolina. The Project Area is shown as the "Slingshot Creek Stream Restoration Site Easement" on the attached Figure 3, titled "Slingshot Creek Stream and Wetland Mitigation Site Potential Waters of the US." Indicate Which of the Following Apply,: A. Preliminary Determination ® There appear to be waters including wetlands, on the above described project area, that may be subject to Section 404 of the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). The waters including wetlands, have been delineated, and the delineation has been verified by the Corps to be sufficiently accurate and reliable. The approximate boundaries of these waters are shown on the enclosed delineation map dated Aueust 2018. Therefore this preliminary jurisdiction determination may be used in the permit evaluation process, including determining compensatory mitigation. For purposes of computation of impacts, compensatory mitigation requirements, and other resource protection measures, a permit decision made on the basis of a preliminary JD will treat all waters and wetlands that would be affected in any way by the permitted activity on the site as if they are jurisdictional waters of the U.S. This preliminary determination is not an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part 331). However, you may request an approved JD, which is an appealable action, by contacting the Corps district for further instruction. ❑ There appear to be waters including wetlands, on the above described project area/property, that may be subject to Section 404 of the Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). However, since the waters including wetlands, have not been properly delineated, this preliminary jurisdiction determination may not be used in the permit evaluation process. Without a verified wetland delineation, this preliminary determination is merely an effective presumption of CWA/RHA jurisdiction over all of the waters including wetlands, at the project area, which is not sufficiently accurate and reliable to support an enforceable permit decision. We recommend that you have the waters including wetlands, on your project area/property delineated. As the Corps may not be able to accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can be vcrificd by the Corps. B. Approved Determination ❑ There are Navigable Waters of the United States within the above described project area/property subject to the permit requirements of Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in law or our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification. ❑ There are waters including wetlands, on the above described project area/property subject to the permit requirements of Section 404 of the Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification. ❑ We recommend you have the waters including wetlands, on your project area/property delineated. As the Corps may not be able to accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by the Corps. ❑ The waters including wetlands, on your project area/property have been delineated and the delineation has been verified by the Corps. The approximate boundaries of these waters are shown on the enclosed delineation map dated MAP DATE. If you wish to have the delineation surveyed, the Corps can review and verify the survey upon completion. Once verified, this survey will SAW-2018-01170 provide an accurate depiction of all areas subject to CWA and/or RHA jurisdiction on your property which, provided there is no change in the law or our published regulations, may be relied upon for a period not to exceed five years. ❑ The waters including wetlands, have been delineated and surveyed and are accurately depicted on the plat signed by the Corps Regulatory Official identified below on SURVEY SIGNED DATE. Unless there is a change in the law or our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification. ❑ There are no waters of the U.S., to include wetlands, present on the above described project area/property which are subject to the permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification. ❑ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (CAMA). You should contact the Division of Coastal Management in Morehead City, NC, at (252) 808-2808 to determine their requirements. Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit may constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material, construction or placement of structures, or work within navigable waters of the United States without a Department of the Army permit may constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If you have any questions regarding this determination and/or the Corps regulatory program, please contact David Bailey at t919) 554-4884 X 30 or David.E.Baile 2�a`usace.arm .mil. C. Basis For Determination: See the Preliminary Jurisdictional Determination form dated 5/7/2019. D. Remarks: None. E. Attention USDA Program Participants This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site identified in this request. The delineation/determination 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 request a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work. F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B. above) This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this determination you must submit a completed RFA form to the following address: US Army Corps of Engineers South Atlantic Division Attn: Jason Steele, Review Officer 60 Forsyth Street SW, Room 1OM15 Atlanta, Georgia 30303-8801 In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you decide to submit an RFA form, it must be received at the above address by Not applicable. **It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.** Digitally signed by BAILEY.DAVID.E.1379283736 Corps Regulatory Official: Date: 2019.05.07 11:48:14 -04'00' Date of JD: 5/7/2019 Expiration Date of JD: Not applicable The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so, please complete our Customer Satisfaction Survey, located online at littp,://coEpsmapu.usace.ai-m%.mil/ciii a ex/V =136:4:0. Copy furnished: Grant Lewis, Axiom Environmental, Inc., 218 Snow Avenue, Raleigh, NC 27603 Sue Homewood, NCDEQ-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston-Salem, NC 27105 ti Y y ra o LL m 0 02 Z z LLI w r m 'ern- U N 0 0 Lu LL21 Qa ix 0 f%J2 „ap9E (J m Jm 0<zz9 m =-- Y 7 LU I aWomQ U xy �� g��OO E °mEu'6s ui Q M cc a F6,m E n m Z L.L CL fy 3 �mry cnSci O D m a` Z �•7 s — � � o LL SAW-2018-01 l 70 Applicant: NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND REQUEST FOR APPEAL NCDE0 DMS Attn: Tim Baumgartner File Number: SAW-2018-01170 Date: 5/7/2019 Attached is: ❑ INITIAL PROFFERED PERMIT. Standard Permit or Letter of permissions See Section below A ❑ PROFFERED PERMIT (Standard Permit or Letter ofpermission) B ❑ PERMIT DENIAL C ❑ APPROVED JURISDICTIONAL DETERMINATION D El PRELIMINARY JURISDICTIONAL DETERMINATION E SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision. Additional information may be found at or - Afww.usace.ann`.mii'Missions,CivilWorks,Reauiat, . ProiramandPermits.as x or the Corps regulations at 33 CFR Part 331. A: INITIAL PROFFERED PERMIT: You may accept or object to the permit. • ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit. OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request that the permit be modified accordingly. You must complete Section 11 of this form and return the form to the district engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in Section B below. B: PROFFERED PERMIT: You may accept or appeal the permit • ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit. • APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein, you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days of the date of this notice. C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days of the date of this notice. D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new information. • ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD. • APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form must be received by the division engineer within 60 days of the date of this notice. E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed), by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the Corps to reevaluate the JD. SAW-2018-01170 SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or objections are addressed in the administrative record.) ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record. However, you may provide additional information to clarify the location of information that is already in the administrative record. POINT OF CONTACT FOR QUESTIONS OR INFORMATION: If you have questions regarding this decision and/or the If you only have questions regarding the appeal process you may appeal process you may contact: also contact: District Engineer, Wilmington Regulatory Division Mr. Jason Steele, Administrative Appeal Review Officer attn: David E. Bailey CESAD-PDO Raleigh Regulatory Field Office U.S. Army Corps of Engineers, South Atlantic Division 3331 Heritage Trade Drive, Suite 105 60 Forsyth Street, Room 1OM15 Wake Forest, North Carolina 27587 Atlanta, Georgia 30303-8801 Phone: 404)562-5137 RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day notice of any site investigation, and will have the opportunit to participate in all site investigations. Date: Telephone number: Signature of appellant or agent. For appeals on Initial Proffered Permits send this form to: District Engineer, Wilmington Regulatory Division, David Bailey, 69 Darlington Avenue, Wilmington, North Carolina 28403 For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to: Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Administrative Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801 Phone: (404) 562-5137 Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM BACKGROUND INFORMATION A. REPORT COMPLETION DATE FOR PJD: 5/7/2019 B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Grant Lewis -Axiom Environmental, Inc, 218 snow Avenue, Raleigh, NC 27603 C. DISTRICT OFFICE, FILE NAME, AND NUMBER: CESAW-RG-R, SAW-2018-01170 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: Reidsville Center coordinates of site (lat/long in degree decimal format): Lat.: 36.333480 Long.:-79.715103 Universal Transverse Mercator: Name of nearest waterbody: UT to Troublesome Creek / Lake Hunt E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY): 0 Office (Desk) Determination. Date: 5/7/2019 0 Field Determination. Date(s): 1/6/2015 TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY JURISDICTION. Site Latitude Longitude Estimated amount Type of aquatic Geographic authority number (decimal (decimal of aquatic resource 1 resource (i.e., wetland to which the aquatic degrees) degrees) in review area vs. non -wetland resource "may be" (acreage and linear waters) subject (i.e., Section feet, if applicable) 404 or Section 10/404) See attached Site Number/ Feature Name Latitude Longitude Cowardin Class Estimated amount of aquatic resource in review area Class of aquatic resources Main Channe (UT to Troublesom Creek) 36.335113 -79.711581 R3UB1/2 2808.4 feet Non -section 10 - Non -wetland UT 1 to Troublesome Creek 36.33468 -79.710414 R3UB1/2 968.2 feet Non -section 10 - Non -wetland UT 2 to Troublesome Creek 36.333898 -79.712397 R3UB1/2 130.4 feet Non -section 10 - Non -wetland UT 3 to Troublesome Creek 36.3371 -79.7102 R2UB1/2 172.0 feet Non -section 10 - Non -wetland UT IA to Troublesome Creek 36.3374 -79.7095 R3UB1/2 37.1 feet Non -section 10 - Non -wetland GA 36.334091 -79.713219 PSS1 0.088 acres Non -section 10 - Wetland GE 36.334714 -79.711486 PSS1 0.513 acres Non -section 10 - Wetland SC 36.33531 -79.711542 PSS1 0.001 acres Non -section 10- Wetland JC 36.335981 -79.710591 PSS1 0.007 acres Non -section 10 - Wetland JB 36.33692 -79.709894 PSS1 0.059 acres Non -section 10 - Wetland JA 36.337071 -79.709727 PSS1 0.021 acres Non -section 10 - Wetland 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: Aerial, soils, and topo maps (Axiom) 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 Reisdville Quad [07 Natural Resources Conservation Service Soil Survey. Citation: Rockingham Co. 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) X Photographs: FW1 Aerial (Name & Date): 2014 NC OneMap or ❑ Other (Name & Date): ❑ Previous determination(s). File no. and date of response letter: ❑■ Other information (please specify): LiDAR (NC Floodmaps) IMPORTANT NOTE: The information recorded on this form has not necessarily been verified by the Corns 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. This preliminary JD finds that there "maybe" waters of the United States on the subject project site, and identifies all aquatic features on the site that could be affected by the proposed activity, based on the following information: IMPORTANT NOTE: The information recorded on this form has not necessarily been verified by the Corps and should not be relied upon for later iurisdicfional determinations. Digitally signed by BA I LEY. Date:201 .05.0 1 1:43: 3736 Date: 2019.05.0711:43:36 -04'00' Signature and date of Regulatory Project Manager (REQUIRED) 4 a,e+s, anyw.cnmi",.. W. Grant Lewis`%�°";,�,.U9 oem: zo+sm ox o":u"s osnv Signature and date of person requesting preliminary JD (REQUIRED, unless obtaining the signature is impracticable) Jurisdictional Determination Request A. PARCEL INFORMATION Street Address: 1400 Front Street City, State: Reidsville, NC County: Rockingham Parcel Index Number(s) (PIN): 170686 B. REQUESTOR INFORMATION Name: Grant Lewis - Axiom Environmental, Ind Mailing Address: 218 Snow Avenue Raleigh, NC 27603 Telephone Number: (919) 215-1693 Electronic Mail Address: glewis@axiomenvironmental.org Select one: I am the current property owner. ❑✓ I am an Authorized Agent or Environmental Consultantl Interested Buyer or Under Contract to Purchase ❑ Other, please explain. C. PROPERTY OWNER INFORMATION' Name: Robert L. Wheless Mailing Address: 1400 Front Street Reidsville, NC 27320 Telephone Number: (336) 634-3862 Electronic Mail Address: ' 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. W. Grant Lewis Print Name Capacity: ❑ Owner 91 Authorized Agents Date * Please see attached Agent Authorization form 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. ❑ 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. ✓❑ 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 projector 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: s For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E. ° If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a continuation sheet. s 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) ❑✓ 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 Map of Property or Project Area. This Map must clearly depict the boundaries of the review area. ✓❑ Size of Property or Review Area -12 _ 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: 36.333480 Longitude: -79.715103 ❑✓ A legible delineation map depicting the aquatic resources and the property/review area. Delineation maps must be no larger than 11x17 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) b 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- Program/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 Forms ✓❑ 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) ✓❑ NCWAM and/or NCWAM Assessment Forms and Rating Sheets ❑✓ NC Division of Water Resources Stream Identification Forms Other Assessment Forms ' www.saw.usace.arm .mil/Portals/59/dots/reeulator►•/re does/JD/RGL 08-02 App A Prelim JD Form fillable. df s Please see httii://www.saw.usace.arm.mil/Missions/Re ulatorv-Permit-Pro ram/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 federaljurisdiction 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 isvoluntary; 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