20200598 Ver 1_05a_PJD_Request_20200505

Jurisdictional Determination Request
Version: May 2017
Page 1

This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.army.mil/Missions/RegulatoryPermitProgram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE& CHARLOTTE REGULATORY
FIELDOFFICES
US ArmyCorps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina28801-5006
GeneralNumber: [phone]
Fax Number: [phone]
RALEIGHREGULATORYFIELDOFFICE
US ArmyCorps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina27587
GeneralNumber: [phone]
Fax Number: [phone]
WASHINGTONREGULATORYFIELDOFFICE
US ArmyCorps of Engineers
2407 West Fifth Street
Washington, North Carolina27889
GeneralNumber: [phone]
Fax Number: [phone]
WILMINGTONREGULATORYFIELDOFFICE
US ArmyCorps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
GeneralNumber:910-251-4633
Fax Number: [phone]
INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D – PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina 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.
Jurisdictional Determination Request
Version: May 2017
Page 2
A. PARCEL INFORMATION
Street Address: _______________________________________________
City, State: _______________________________________________
County:
Parcel Index Number(s) (PIN):
B. REQUESTORINFORMATION
Name:
Mailing Address:
_________________________________________
Telephone Number: _________________________________________
Electronic Mail Address: ________________________________________
Select one:
I am the current property owner.
I am an Authorized Agent or Environmental Consultant
1
Interested Buyer or Under Contract to Purchase
Other, please explain. ________________________________________
__________________________________________________________
C. PROPERTY OWNER INFORMATION
2
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address:
_______________________________________________________________________________________________________________________
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).
West Ten Road
Mebane, NC
Orange
9834743184; 9834846079
Chris Tinklenberg
200 South Tryon St
Suite 200
704-333-5131
[e-mail]
See Attached.
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Jurisdictional Determination Request
Version: May 2017
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D. PROPERTY ACCESS CERTIFICATION
3,4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on-
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: Owner Authorized Agent5
Date
Signature
E. REASON FOR JD REQUEST:(Check as many as applicable)
I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources underCorpsauthority.
Iintendto construct/develop a project or perform activities on this parcelwhich may
require authorization from the Corps, andthe JDwould beusedto avoid and minimize
impacts tojurisdictional aquatic resources and as aninitialstep in a future permitting
process.
I intendto construct/develop a project or perform activities on this parcelwhich 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.
Iintendto 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.
4 If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Chris Tinklenberg, PWS
3/10/2020
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Jurisdictional Determination Request
Version: May 2017
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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 acres.
The property boundary (or review area boundary) is clearly physically marked on the site.
45.6
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Jurisdictional Determination Request
Version: May 2017
Page 5

H. REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude: ______________________
Longitude: ______________________
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
ƒNorth Arrow
ƒGraphical Scale
ƒBoundary of Review Area
ƒDate
ƒLocation of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
ƒJurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
ƒJurisdictional 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.
ƒIsolated 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:
ƒWetland and non-wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non-wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
____________________________________________________________________________
6 Please refer to the guidance document titled “Survey Standards for Jurisdictional Determinations” to ensure that the
supplied map meets the necessary mapping standards.http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Jurisdiction/
36.069258 N
-79.208247 W
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Jurisdictional Determination Request
Version: May 2017
Page 6

Completed appropriate Jurisdictional Determination form
x PJDs,please complete a Preliminary Jurisdictional Determination Form7 and include the
Aquatic Resource Table
x AJDs, please complete an Approved Jurisdictional Determination Form
8
Vicinity Map
Aerial Photograph
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
Other Assessment Forms
_____________________________________________________________________________
7 www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/JD/RGL_08-02_App_A_Prelim_JD_Form_fillable.pdf
8 Please see http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose:The information thatyouprovide will beusedinevaluating your requestto determine
whether thereareany aquatic resources within the project areasubjecttofederaljurisdictionunder the regulatory
authorities referencedabove.
RoutineUses:Thisinformation maybeshared with the Departmentof Justice andotherfederal, state,and local
government agencies, and the public,andmaybe made available aspartof a public notice as required byfederal
law. Your nameandproperty location wherefederal jurisdiction is to bedetermined will beincluded in the
approved jurisdictional determination (AJD),which will bemade available tothe public on the District's website
andontheHeadquartersUSAGEwebsite.
Disclosure:Submission ofrequested information is voluntary; however, ifinformation is notprovided, the
requestforanAJDcannot beevaluatednorcananAJD be issued.
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Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A.REPORT COMPLETION DATE FOR PJD:
B.NAME AND ADDRESS OF PERSON REQUESTING PJD:
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: County/parish/borough: City:
Center coordinates of site (lat/long in degree decimal format):
Lat.:Long.:
Universal Transverse Mercator:
Name of nearest waterbody:
E.REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
Office (Desk) Determination. Date:
Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH “MAY BE”SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non-wetland
waters)
Geographic authority
to which the aquatic
resource “may be”
subject (i.e., Section
404 or Section 10/404)
See attached table
Chris Tinklenberg, 200 South Tryon St. Suite 200 Charlotte, NC 28202
NC Orange Mebane
36.069258 N -79.208247 W
17N
UT to Sevenmile Creek
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: ________________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
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: _______BBBBBBBBBBBB.
Data sheets prepared by the Corps: ________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
Corps navigable waters’ study: ____________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
U.S. Geological Survey Hydrologic Atlas: ________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
USGS NHD data.
USGS 8 and 12 digit HUC maps.
U.S. Geological Survey map(s). Cite scale & quad name: _________BBBBBBBBBBBBBBBBBBBBBB.
Natural Resources Conservation Service Soil Survey. Citation: __________BBBBBBBBBBBBBBBBB.
National wetlands inventory map(s). Cite name: ________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
State/local wetland inventory map(s): ____________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
FEMA/FIRM maps: ________________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
100-year Floodplain Elevation is: ____BBBBBBBBBBBB.(National Geodetic Vertical Datum of 1929)
Photographs: Aerial (Name & Date): ______BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
or Other (Name & Date): ______BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
Previous determination(s). File no. and date of response letter: __________BBBBBBBBBBBBBBBB.
Other information (please specify): ______________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB.
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 staff member person requesting PJD
completing PJD (REQUIRED, unless obtaining
the signature is impracticable)
1
1 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.
1:12,000; Efland
Orange County SSURGO Soils
NWI digital data
North Carolina 2017, 2/5/2017
Site photographs, 10/1/2019 and 10/17/2019
Site Number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount of
aquatic resource in
review area
Type of aquatic
resource
Geographic authority to
which the aquatic resource
"may be" subject
S1- UT of Sevenmile
Creek 36.068329 -79.212744 1,338 lf
Non-wetland
waters Section 404
S2- UT of Sevenmile
Creek 36.068432 -79.206313 56 lf
Non-wetland
waters Section 404
S3- UT of Sevenmile
Creek 36.068733 -79.205991 98 lf
Non-wetland
waters Section 404
W1 36.068206 -79.211809 0.02 ac Wetland waters Section 404
W2 36.068372 -79.206522 0.04 ac Wetland waters Section 404
W3 36.068886 -79.208748 0.18 ac Wetland waters Section 404
W4 36.068299 -79.20906 0.03 ac Wetland waters Section 404