20191518 Ver 1_USACE Permit_20200205

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2019-01855 County: Guilford U.S.G.S. Quad: NC -Greensboro
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Keystone Group, Inc.
Attn: Scott Wallace
Address: 3708 Alliance Drive
Greensboro, NC 27407
Size (acres) —30 Nearest Town Greensboro
Nearest Waterway Ryan Creek River Basin Cape Fear
USGS HUC 03030002 Coordinates 36.000441,-79.816358
Location description: The proiect area is located at the northern terminus of Carol Avenue, and on the west side of the northern
terminus of Sumner Church Road, in Greensboro, Guilford County, North Carolina.
Description of projects area and activity: This verification authorizes the permanent discharge of fill material into 128 linear feet
of stream channel (112 linear feet of which is a loss of stream channel, 16 linear feet is associated with a rip rap dissapator
pad) and 0.048 acre of wetlands, and the temporary discharge of fill material into 10 linear feet of stream channel, necessary
for the installation of one road crossing for the Avondale residential development.
Applicable Law(s): ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: NWP 29. Residential Developments
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the enclosed
Conditions, your application signed and dated 10/14/2019, and updated information submitted via email on 12/17/2019 and
1/15/2020, and the enclosed plans Sheets Cl, C2, 1, 2, and 3. Any violation of the attached conditions or deviation from your
submitted plans may subject the permittee to a stop work order, a restoration order, a Class I administrative penalty, and/or
appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified, suspended
or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or modified, this
verification will remain valid until the expiration date identified below, provided it complies with all requirements of the modified
nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the activity would
no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are under construction)
or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the activity is completed
within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless discretionary authority has
been exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (LAMA), prior
to beginning work you must contact the N.C. Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory program,
please contact David E. Bailey at [phone] X 30or David.E.Bailey2(a,usace.army.mil.
6 Date: 2020.02.05 16:19:24
Corps Regulatory Official:-05-00' Date: 02/05/2020
Expiration Date of Verification: 03/18/2022

SAW-2019-01855
SPECIAL CONDITIONS
1. Please note that this project is considered cumulative with all current and future phases of the
Avondale development with respect to compensatory mitigation and Nationwide Permit
thresholds. As such, impacts permitted for this project (SAW-2019-01855) are considered
cumulative with impacts proposed for future phases. Current cumulative impacts to waters of the
US for Avondale single and complete project include permanent impacts to 128 linear feet of
stream channel (112 linear feet [0.008 acre] of which is a loss of stream channel) and 0.048 acre of
wetlands, or a total of 0.056 acre of waters of the US.
Date:2020.02.05
Corps Regulatory Official: 1 6:1 9:11-05'00' Date: 02/05/2020
Expiration Date of Verification: 03/18/2022
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 the Customer Satisfaction Survey located at http://corpsmapu.usace.army.mil/cm apex/Pp=136:4:0.
Copy furnished:
Chuck Truby, CPT Engineering and Surveying, Inc., 4400 Tyning Street, High Point NC 27165
Sue Homewood, NCDEQ-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston-Salem, NC 27105

REVISIONS
EASTERN T.O.B. OF STREAM
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SCOD BUFFER CALCULATIONS:
AREA REQUIRED:
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3,102' X 50- 155, 100 SF
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AREA PROPOSED:
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75' X 986± = 71,828 SF
TOTAL = 156,627 SF
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AT THE TIME OF BUILDING PERMIT SUBMITTAL.
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DATE: 12/16/111
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UPSTREAM TEMPORARY SANDBAG COFFERDAM
FOR WORK AREA DEWATERING. 5 LF IMPACT
(STREAM LENGTH)
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REVISIONS
SCALE: 1"=30'
DATE: 12/16/1-1
PROJECT: 1405-16
DRAWN BY:
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GENERAL SEQUENCE:
1. CONSTRUCT TEMPORARY CONSTRUCTIONmm
ENTRANCE/STREAM CROSSING.
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2. STOCKPILE GRAVEL (IF PRESENT) FOR USE ASQ
a^
STREAM BOTTOM RESTORATION MATERIAL.
3. CONSTRUCT TEMPORARY COFFER DAMS.
FLOW
_]3
4. PROVIDE ADEQUATE PUMP(S) TO DEWATER WORK
36" RGP
AREA. DO NOT REDUCE OR HALT STREAM BASE FLOW.
— DISCHARGE PUMP EFFLUENT INTO SILT BAG. DISCHARGE
SILT BAG BEHIND SILT FENCE AT SILT FENCE OUTLET.
5. INSTALL THE 36" I.D. CULVERT PIPE &
_/— —
— — — — — —
—
FLARED -END -SECTIONS.
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6. PROVIDE CONSOLIDATED AGGREGATE BACKFILL PER
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CITY OF GREENSBORO STANDARDS. A LICENSED NC
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GEOTECHNICAL ENGINEER AND THE CITY OF
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GREENSBORO INSPECTIONS DEPARTMENT SHALL
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APPROVE BACKFILL PRIOR TO PLACING ROADWAY BASE
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EX. STREAM BED
RIP -RAP APRON IMBED
COURSE.
7. PROVIDE ANY REQUIRED SOIL BACKFILL IN SHORT,
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INTO EX. STREAM
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WELL COMPACTED LIFTS. TEST FOR PROPER
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COMPACTION, CONSULT GEOTECHNICAL ENGINEER.
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8. SEED UPLAND AREAS AS SOON AS GRADING ALLOWS.
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SEE EROSION CONTROL PLAN FOR SEEDING SCHEDULEvk
REQUIREMENTS.
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1 inch = 20 ft. (H)
DRAM BY, TL
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1 inch = 2 ft. (V)
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INSTALL THE PERMANENT GULVERT GRO55INC75:
The culverts are to be
window of storm events
and be low the fill area,
pipe. Gore will be taker
stream banks and bed 1
areas subject to flowinc
Upon completion of crop
properly. Remove any it
installed in the dry within a 2 to 3 day
Sediment fencing shall be installed above
wrapping the fencing around the ends of the
i to keep clearing and excavation of the
.o o minimum. 5toblilize all distrubed
3 water with rip rap below the stream bed.
,sing, fill, compact, and sterilize the slopes
I stream sediment control measures.
IF NOT ABLE TO IN5TALL GROSSING IN THE DRY:
Then they must be installed with the use of Goffer/Sand bag Dams.
The dams will be installed above and below the culvert installations.
Pumps will be used to install culvert in the dry and divert
stream through and away from the crossing installation. 5ilt fencing
Hill be used parallel to the crossing to prevent down stream
impacts. The installation of culvert will not proceed until the flow has
been diverted. Upon completion of the culvert, divert flow to the
permanent culvert, install sediment fencing above the inlets and
outlet, install outlet protection, fill, compact and stabilize any part of
the stream that is unstable appropriately. The temporary coffer
dams shall remain intact and functioning until the all the stream
work/stobilizotions has been completed. After the stream is
stobi I ized and flow has been diverted
then fill can be brought up and other utilities and headwalls installed.
Gheck and reinstall any silt fencing than needs to be repaired on o
regular basis during construction. Mat the slopes above the top of
bank with erosion control matting as soon as permanent grade has
been established if grass can not be estoblised.
The culvert construction, in order to divert the flow from temporary
coffer dams to the permanent pipes should be completed within two
weeks. Any material that needs to be stockpiled near the stream
banks will be protect by silt fencing and shall remain no more than I
week.
If stockpile is required for longer lengths of time it shall be moved
above the temporary sediment basins that are planned for the site
and that will be installed before the culvert installation. Sand bag
dams will be removed within 2 days after the culvert has been
stobi I ized.
(N.CA&O ///,
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SEAL
n 14984
151
9 FNGINEE�.'�,
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9GALEAS SHOWN
DATES 12/I6/19
PROJECT- 1405-16
DRAYN BYe
*er:T 3

Action ID Number: SAW-2019-01855 County: Guilford
Permittee: Keystone Group, Inc. (Attn: Scott Wallace)
Project Name: Avondale / Keystone Group / Carol Avenue / Greensboro / Guilford County / residential
Date Verification Issued: 02/05/2020
Project Manager: David E. Bailey
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: David E. Bailey
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee
Date

Determination of Jurisdiction:
A. ® There are 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). 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. Please note, if work is authorized by either a general or nationwide permit, and
you wish to request an appeal of an approved JD, the appeal must be received by the Corps and the appeal process
concluded prior to the commencement of any work in waters of the United States and prior to any work that could alter
the hydrology of waters of the United States.
B. ❑ There are Navigable Waters of the United States within the above described project area 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 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.
C. ❑ There are waters, including wetlands within the above described project area that are 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.
D. ❑ The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued DATE. Action ID: FILE NUMBER.
Basis For Determination: See the Preliminary Jurisdictional Determination form dated 02/05/2020.
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 jurisdiction determinations as indicated in B and C
above).
This correspondence constitutes an approved jurisdiction 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: Phillip Shannin, Review Officer
60 Forsyth Street SW, Room 10M15
Atlanta, Georgia 30303-8801
Phone: [phone]
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.**
Corps Regulatory Official: Date: 2020.02.05 16:18:17-05'00'
David E. Bailey
Date of JD: 02/05/2020 Expiration Date of JD: Not applicable

SAW-2019-01855
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Keystone Group,, Inc. (Attn: Scott Wallace) File Number: SAW-2019-01855 Date: 02/05/2020
Attached
is:
See Section below
PROFFERED PERMIT Standard Permit or Letter of ermission
A
RED PERMIT Standard Permit or Letter of ermission
B
DENIAL
LAPPROVED
C
JURISDICTIONAL DETERMINATION
D
INARY 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 http://www.usace.q=.mil/Missions/CivilWorks/Re ugulatoryProgramandPermits.aspx
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 II 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-2019-01855
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. Phillip Shannin, Administrative Appeal Review Officer
Attn: David E. Bailey
CESAD-PDO
Raleigh Regulatory Office
U.S. Army Corps of Engineers, South Atlantic Division
U.S Army Corps of Engineers
60 Forsyth Street, Room 10M15
3331 Heritage Trade Drive, Suite 105
Atlanta, Georgia 30303-8801
Wake Forest, North Carolina 27587
Phone: [phone]
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 opportuni to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: David E. 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. Phillip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 2/5/2020
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Michael Brame, Pilot Environmental, Inc.
Post Office Box 128, Kernersville, North Carolina 27285
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, Carol Avenue, SAW-2019-01855
SAW-2019-01855 (Keystone Group / Carol Avenue / Greensboro / Guilford County / residential)
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The site is located north of Carol Avenue in
Greensboro, Guilford County, NC. The site contains wooded land. The site is proposed for residential development.
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: North Carolina County/parish/borough: Guilford City: Greensboro
Center coordinates of site (lat/long in degree decimal format): Lat.: 36.000155' Long.:-79.813631'
Universal Transverse Mercator: WGS 84
Name of nearest waterbody: Ryan Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑x Field Determination. Date(s): 10/23/2019
TABLE OF AQUATIC RESOURCES INREVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
Latitude (decimal
Longitude
Estimated amount of
Type of aquatic
Geographic authority to
Number
degrees)
(decimal degrees)
aquatic resources in
resources (i.e.,
which the aquatic resource
review area (acreage
wetland vs. non-
"may be" subject (i.e.,
and linear feet, if
wetland waters)
Section 404 or Section
applicable
10/404
SA
35.9995830
-79.8100060
345 linear feet
Non -wetland
404
water (intermittent
stream)
SB
36.0002330
-79.8104130
790 linear feet
Non -wetland
404
water (perennial
stream)
SD
36.0005730
-79.8163320
390 linear feet
Non -wetland
404
water (perennial
stream)
SE
36.0007930
-79.8180870
245 linear feet
Non -wetland
404
water (perennial
stream)
WA 1-11/
35.9999330
-79.8094000
2.77 acres
Wetland - PFO
404
WAA 1-5
WD 1-8
36.0004730
-79.8162580
0.11 acres
Wetland - PFO
404
WD 9-14
36.0007730
-79.8167770
0.067 acres
Wetland - PFO
404
WE 1-7
36.0008630
-79.8179380
0.37 acres
Wetland - PFO
404

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 (PEI)
® Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑x 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: Drawing 1/1"=2000'/Greensboro (1997)
and Pleasant Garden (1970)
®Natural Resources Conservation Service Soil Survey. Citation: Drawing 2 (Web Soil Map) & Drawing 2A
(Published Soil Map)
®National wetlands inventory map(s). Cite name: Drawing 3/NWI Map
❑State/local wetland inventory map(s):
®FEMA/FIRM maps: Drawing 4/FEMA FIRM
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
®Photographs: ®Aerial (Name & Date): Drawing 5/Wetland Map
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 Corps and should not be relied upon for later jurisdictional
determinations.
Date: 2020.02.05
15:25:24-05'00'
Signature and date of Regulatory
staff member completing PJD
-7 f September 26, 2019
Signature and date of person
requesting PJD (REQUIRED,
unless obtaining the signature
is impracticable)1
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester does not respond within the
established time frame, the district may presume concurrence and no additional follow up is necessary prior to finalizing
an action.