20201578 Ver 1_JD (Signed)_20210129

Appendix 1 - REQUEST FOR CORPS JURISDICTIONAL DETERMINATION (JD)
To: District Name Here
•I am requesting a JD on property located at: _________________________________
(Street Address)
City/Township/Parish: ________________ County: _______________ State: ______
Acreage of Parcel/Review Area for JD: ___________
Section: ______ Township: _______ Range: _______
Latitude (decimal degrees):___________ Longitude (decimal degrees): ___________
(For linear projects, please include the center point of the proposed alignment.)
•Please attach a survey/plat map and vicinity map identifying location and review area for the JD.
•___ I currently own this property. ___ I plan to purchase this property.
___ I am an agent/consultant acting on behalf of the requestor.
___ Other (please explain): ____________________________________________________________.
•Reason for 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 project or 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 project or 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 to 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: ___________________________________________________________
•Type of determination being requested:
___ I am requesting an approved JD.
___ I am requesting a preliminary JD.
___ I am requesting a “no permit required” letter as I believe my proposed activity is not regulated.
___ I am unclear as to which JD I would like to request and require additional information to inform my decision.
By signing below, you are indicating that you have the authority, or are acting as the duly authorized agent of a
person or entity with such authority, to and do hereby grant Corps personnel right of entry to legally access the
site if needed to perform the JD. Your signature shall be an affirmation that you possess the requisite property
rights to request a JD on the subject property.
*Signature: ____________________________________Date: _________________
•Typed or printed name: __________________________________________
Company name: __________________________________________
Address: __________________________________________
__________________________________________
Daytime phone no.: __________________________________________
Email address: __________________________________________
*Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act,
Section 103, 33 USC 1413; Regulatory Program of the U.S. Army Corps of Engineers; Final Rule for 33 CFR Parts 320-332.
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 USACE 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.
Bridge 180 - SR 1369 (Tellico Road)
Franklin Macon NC
1.50
35.275155 -83.534473
NCDOT - Division 14 ROW
Patrick J. Breedlove Digitally signed by Patrick J. Breedlove
Date: 2018.02.06 10:44:25 -05'00'1.27.2020
Patrick J. Breedlove
NCDOT - Division 14 - Environmental Specialist II
253 Webster Road
Sylva, N.C. 28779
(828) 631 - 1145
[e-mail]
4
4
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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)
n
S1 35.27435 -83.53323 120 linear feet Non-Wetland 404
S2 35.27442 -83.53233 213 linear feet Non-Wetland 404
1.27.2021
Patrick Breedlove 253 Webster Road, Sylva NC 28779
NCDOT Division 14 (17BP.14.R.208)
North Carolina Macon County Franklin
35.275155 -83.534473
269477, 3906503; Zone 17
Sugar Cove Creek
1.21.2021
9.23.2020
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: ___________________________________________________.
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: _______________________________.
Natural Resources Conservation Service Soil Survey. Citation: ___________________________.
National wetlands inventory map(s). Cite name: ______________________________________.
State/local wetland inventory map(s): _______________________________________________.
FEMA/FIRM maps: ____________________________________________________________.
100-year Floodplain Elevation is: ________________.(National Geodetic Vertical Datum of 1929)
Photographs: Aerial (Name & Date): ___________________________________________.
or Other (Name & Date): ____________________________________________.
Previous determination(s). File no. and date of response letter: __________________________.
Other information (please specify): _________________________________________________.
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of 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.
NCDOT project Plans, GIS Map, Topo Map
Web Soil Survey
Site Photos (8.20.2020)
Patrick J. Breedlove Digitally signed by Patrick J. Breedlove
Date: 2018.02.06 11:05:24 -05'00'
1/29/2021