Final PJD PDF Guilford 183.pdf

Preliminary ORM Data Entry Fields for New Actions
ACTION ID#: SAW- Begin Date(Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM 0
1. Project Name [PCN Form A2a]: 17BP.7.R.134 Bridge No. 183
2. Work Type: (Private nInstitutional ❑✓ Government n Commercial
3. Project Description/Purpose [PCN Form B3d and B3e]:
REPLACE BRIDGE NO. 183 OVER AN UT TO HAW RIVER
SR 2710(RUNNING CREEK ROAD)
GUILFORD COUNTY
4. Property Owner/Applicant [PCN Form A3 or A4]: Mike Mills, NCDOT Div 7 Engineer [e-mail]
5. Agent/Consultant[PNC Form A5—or ORM Consultant ID Number]:
Axiom Environmental
6. Related Action ID Number(s) [PCN Form B5b]: N/A
7. Project Location—Coordinates, Street Address, and/or Location Description[PCN Form Bib]:
36.233434, -79.561191 SR 2710 (Running Creek Road)
8. Project Location—Tax Parcel ID [PCN Form Bla]: Multiple, NCDOT project
9. Project Location—County[PCN Form A2b]: Guilford
10. Project Location—Nearest Municipality or Town[PCN Form A2c]: Greensboro
11. Project Information—Nearest Waterbody[PCN Form B2a]: Haw River
12.Watershed/8-Digit Hydrologic Unit Code [PCN Form B2c]:03030002
Authorization: Section 10 n Section 404 ❑✓ Section 10 and 404 n
Regulatory Action Type:
I. Standard Permit Pre-Application Request
U Nationwide Permit# Unauthorized Activity
• Regional General Permit# _Compliance
0 Jurisdictional Determination Request _No Permit Required
Revised 20150602

Jurisdictional Determination Request
US Army Corps
of Engtneors
Wilmington 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:
htty://www.saw.usace.armv.mil/Missions/RegulatoryPermitProgram/Contact/CountvLocator.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 WASHINGTON REGULATORY FIELD OFFICE
FIELD OFFICES US Army Corps of Engineers
US Army Corps of Engineers 2407 West Fifth Street
151 Patton Avenue,Room 208 Washington,North Carolina 27889
Asheville,North Carolina 28801-5006 General Number:[phone]
General Number:[phone] Fax Number:[phone]
Fax Number:[phone]
WILMINGTON REGULATORY FIELD OFFICE
RALEIGH REGULATORY FIELD OFFICE US Army Corps of Engineers
US Army Corps of Engineers 69 Darlington Avenue
3331 Heritage Trade Drive,Suite 105 Wilmington,North Carolina 28403
Wake Forest,North Carolina 27587 General Number:910-251-4633
General Number:[phone] Fax Number:[phone]
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.
Version:May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: SR 2710 (Running Creek Rd.) Bridge No.183
City, State: Greensboro, NC
County: Guilford County
Parcel Index Number(s)(PIN): N/A
B. REQUESTOR INFORMATION
Name: Jerry Parker, Division Environmental So
Mailing Address: 1584 Yanceyville St, PO Box 14996
Greensboro, 27415-4996
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
Select one:
❑ I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultant)
n Interested Buyer or Under Contract to Purchase
Q Other,please explain. This JD request is for an NCDOT
bridge replacement project; landowners have been contE
C. PROPERTY OWNER INFORMATION2
Name: Mike Mills, NCDOT Div 7 Engineer
Mailing Address: 1584 Yanceyville St, PO Box 14996
Greensboro, NC 27415-4996
Telephone Number: 336-487-0000
Electronic Mail Address: [e-mail]
I 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 CERTIFICATION3'4
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 Agents
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 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.
ElA 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).
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 4.98 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
0 Project Coordinates (Decimal Degrees): Latitude: 36.233434
Longitude: -79.561191
ElA legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than l 1 x 17 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.army.mil/Missions/Regulatorv-Permit-
Prog.rarn Jurisr.iictiun+
Version:May 2017 Page 5

Jurisdictional Determination Request
aCompleted appropriate Jurisdictional Determination form
• PJDst 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
n 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)
' I NCSAM and/or NCWAM Assessment Forms and Rating Sheets
❑✓ NC Division of Water Resources Stream Identification Forms
▪ Other Assessment Forms
7 www.saw.usace.armv.mil/Portals/59/docs/regutatorvlregdocs/JD/RGL 08-02 App A Prelim JD Form fillable.pdf
8 Please see http://www.saw.usace.army.mil/Missions/Regulatorv-Permit-Pro gram/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 anAJD cannot be evaluated nor can an AJD be issued.
Version:May 2017 Page 6

ATTACHMENT
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
North Carolina Department of Transportation, Division of Highways
1598 Mail Service Center, Raleigh NC, 27699-1598
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
Replace 17BP.7.R.134 Bridge No. 183 over UT to Haw River on SR 2710
(Running Creek Road)
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES
AT DIFFERENT SITES)
State: North Carolina County/parish/borough: Guilford County City:
Greensboro
Center coordinates of site (lat/long in degree decimal format):
Lat. 36.233434°, Long. -79.561191°
Name of nearest waterbody: Haw River
Identify (estimate) amount of waters in the review area:
Non-wetland waters: 250 linear feet: 2-25 width (ft)
Cowardin Class: R2UB1/2
Stream Flow: Perennial
Wetlands: N/A
Cowardin Class: N/A
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal: 0
Non-Tidal: 0
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
Office (Desk) Determination. Date:
Field Determination. Date(s):
1

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
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
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
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)
that 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) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (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 preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes 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 approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, 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,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.
This preliminary JD finds that there "may be"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:
2

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):
X Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant:
X 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.
X U.S. Geological Survey map(s). Cite scale & quad name: Ossipee, NC
(1970) 7.5-minute topographic quadrangle.
X USDA Natural Resources Conservation Service Soil Survey. Citation:
Web Soil Survey (online at http://websoilsurvey.nrcs.usda.gov), and Soil
Survey of Guilford County (1977)
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: IX Aerial (Name & Date): NC OneMap 2014 Orthoimagery.
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 Project Manager person requesting preliminary JD
(REQUIRED) (REQUIRED, unless obtaining
the signature is impracticable)
3

Estimated amount
Cowardin of aquatic Class of
Class resource in review aquatic
Site number Latitude Longitude area resource
1. UT to Haw 288feet length, non-section 10
River 36.233266 -79.561107 R2UB1/2 20-30 feet avg —non-wetland
width
2. Stream SA 36.232992 -79.561046 R2UB2 22 feet length, non-section 10
2-6 feet avg width —non-wetland
4

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UT to Haw River NORTH CAROLINA R2UE RIVERINE Linear 266 FOOT RPW 36.23326600 -79.56110700
Stream SA NORTH CAROLINA R2UB RIVERINE Linear 22 ACRE RPW 36.23299200 -79.56104600