20191209 Ver 2_Pre-JD Request_20191122

urisdictional Determination Reauest
U5 Army Corps
of Engineers
Wilminglon 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:
htlp: //www.saw.usace. gM.mil/Missions/Re pul atoryPermitPro i4ram/Contact/CountyLoc ator. aMx,
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

►3
Jurisdictional Determination Request
PARCEL INFORMATION
Street Address: West of US Highw
City, state: Williamston
17
County: Beaufort and Martin Counties
Parcel Index Number(s) (PIN): Multiple Tracts
B. REQUESTOR INFORMATION
Name: Joey Lawler of S&ME, Inc.
Mailing Address: 9751 Southern Pine Blvd
Telephone Number:
Charlotte, NC 28273
704-523-4726
Electronic Mail Address: [e-mail]
Select one:
❑ I am the current property owner.
�✓ I am an Authorized Agent or Environmental Consultant'
❑ Interested Buyer or Under Contract to Purchase
❑ Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: PNG (easement only)
Mailing Address: 4720 Piedmont Row Drive
Charlotte, NC 28210
Telephone Number: 704-731-4246
Electronic Mail Address: [e-mail]
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.
See attached agent authorization
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.
QI 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 DETERNIINATION (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 — 90 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:
35.7310390
Longitude:-77.0778100
aA legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I Ix17 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.armv.mil/Missions/Regulatory-Permit-
Pro gram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDs• please complete an Approved Jurisdictional Determination Form'
Vicinity Map
Aerial Photograph
0 USGS Topographic Map
Soil Survey Map
RIOther Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
F] NCSAM and/or NCWAM Assessment Forms and Rating Sheets
❑ NC Division of Water Resources Stream Identification Forms
FJ Other Assessment Forms
' www.saw.usace.4rmy.mil/Portals/59/docs/regulatory/regdocs/JD/RGL 08-02_App A Prelim JD_ Form_fillable.pdf
' 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: Joey LawlerofS&ME, Inc.
9751 Southern Pine Blvd., Charlotte, NC 28273
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: Beaufort and Martin City: Williamston
Center coordinates of site (lat/long in degree decimal format):
Lat.: 35.7310390 Long.:-77.0778100
Universal Transverse Mercator: NAD83
Name of nearest waterbody: Gum Swamp, Jacks Swamp, Ready Branch and multiple unnamed tributaries
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALTHAT APPLY): Office (Desk)
❑ Determination. Date:
❑ Field Determination. Date(s):
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
resource (i.e.,
to which the aquatic
degrees)
degrees)
in review area
wetland vs. non-
resource "may be"
(acreage and linear
wetland waters)
subject (i.e., Section
feet, if applicable)
404 or Section 10/404)
SEE TABLES INCLUDED WITH PCN

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 preliminary JD (check all that apply - checked items should
be included in case file and, where checked and requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant:
® Data sheets prepared/submitted by or on behalf of the applicant/consultant.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
® U.S. Geological Survey Hydrologic Atlas:
® USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: Leggetts Crossroads, Old Ford and
Williamston NC USGS
® USDA Natural Resources Conservation Service Soil Survey. Citation: USDA-SCS Published Soil
Surveys of Beaufort and Martin Counties.
® National wetlands inventory map(s). Cite name:2017 USFWS NWI geodatabase.
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date):2016 NC One Map aerial orthoimagery.
or ® Other (Name & Date):Site photos taken July 2019.
❑ 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 Signature and date of
Regulatory Project Manager person requesting preliminary JD
(REQUIRED) (REQUIRED, unless obtaining the signature is
impracticable)'
i 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.

AGENT AUTHORIZATION FORM
Date:
rroiect intormation
S&ME Project Name: PNG Line 204 Relocation
Type of Project: Natural Gas Transmission Line Relocation
Location: Beaufort and Martin Counties, NC
rroperty uwnerlKep information
Owner Name: Piedmont Natural Gas
Mailing Address: 4720 Piedmont Row Drive
City, State, Zip Code: Charlotte, NC 28054
Telephone No. 704.731.4705
Contact: Kelsey Pace ([e-mail])
Agent iintormation
Business Name:
Street Address:
City, State, Zip:
Telephone No.
Contact:
S&ME, Inc.
9751 Southern Pine Blvd
Charlotte, NC 28273
704.523.4726
Joey Lawler, PWS / Walter Cole, LSS
Authorization: I, Kelsey Pace , hereby authorize S&ME, Inc. to
submit information to and coordinate with the US Army Corps of Engineers
(USACE) and/or the NC Division of Environmental Quality (NCDEQ) and other
relevant Federal/State/Local agencies pursuant to obtaining necessary
environmental permits for the project referenced above. If applicable, this also
authorizes the USACE/NCDEQ to access the proposed easement for the
purposes of conducting site assessment/confirming the accuracy of delineated
boundaries.
KelseyPace Digitally signed by Kelsey Pace
Signature:Date: 2019.08.0711:18:51-04'00r
S&ME, INC. / 9751 Southern Pine Blvd /p 704.523.4726 f 704.525.3953 / www.smeinc.com