19950796 Ver 3_Approved JD Request_REVISED_20210209

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 4: SAW- Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Stonebridge Development
2. Work Type: ❑Private ❑Institutional ❑Government ❑ Commercial
3. Project Description / Purpose [PCN Form 133d and 133e]:
Residential Development
4. Property Owner / Applicant [PCN Form A3 or A41: DHG SP, LLC - Eric Wood
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Lowrys Environmental & Ecological Services, LLC - S. Paul Petitgout
6. Related Action ID Number(s) [PCN Form 135b]: SAW-2009-02274
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
34.941556 N-80.631866 W; Doster Road, Mineral Springs,NC
8. Project Location —Tax Parcel ID [PCN Form Bla]: 09417001 F
9. Project Location — County [PCN Form A2b]: Union
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Mineral Springs
11. Project Information — Nearest Waterbody [PCN Form 132a]: Little Twelvemile Creek/Richardson Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03050103 Catawba/03040105 Yadkin-PD
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
❑ Standard Permit
Nationwide Permit 4
Regional General Permit 9
✓ Jurisdictional Determination Request
Section 10 and 404 ❑
❑Pre -Application Request
❑ Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

urisdictional Determination Rea uest
otEnginesraros
Wilmington DistAct
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 snail, 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:
hU://www.saw.usace-anny.mil/Missions/ReaWgIgMPcrmitProp-raWCon ounLocator.as x
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]
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
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: (9I9) 5544884 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: Doster Road
City, State:
County:
Mineral Springs, North Carolina
Union
Parcel Index Number(s) (PIN)
09417001 F
B. REQUESTOR INFORMATION
Name: S. Paul Petitgout
Mailing Address: 1823 Quinn Road
Telephone Number:
Electronic Mail Address
Select one:
Chester, SC 29706
803-992-0910
[e-mail]
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 INFORNUtTIOV
Name: DHG SB, LLC c/o K&L Gates, LLP
Mailing Address:
Telephone Number:
Electronic Mail Address
134 Box 3965
Mooresville, NC 28117
980-500-1240
[e-mail]
I Must provide completed Agent Authorization FornAetter.
2 Documentation of oxrmerslup also needs to be provided A ith request (copy of Deed,_ County GISIParceUTax Record).
Version: May 2017 Page 2

jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION1A
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.
Eric M. Wood, Vice President of DHG SB, LLC
Print Name
Capacity: ❑✓ Owner ❑ Authorized. Agents
June 12, 2020
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
PI intend to construct/develop a project or perform activities on this parcel which would be
igned 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 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 constmet/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.
HA 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 NCDOTIUSACE 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.
s Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
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 auuroved 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 ID I would like to request andrequire 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.
0 Size of Property or Review Area ±139 acres.
R1The 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:
34.941556
Longitude:-80.631866
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 surrey plats will occur after the submitted delineation map has been
reviewed and approved).'
North Arrow
• Graphical Scale
Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Farm or tributary
assessment reach.
For Avproved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 444
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-« etland features should not be identified as Jurisdictional, 444,
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)
Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. hU://www.saw.usace.arrmy.mii/Mssions/Regulatory-Permit-
1'ru onL+tkLCLNdi,11{1SL
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 AMroved Jurisdictional Determination Forme
❑ 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 snaps, FEMA floodpNin maps)
Landscape Photos (if taken)
NCWAM and/or NCWAM Assessment Forms and Rating Sheets
W1NC Division of Water Resources Stream Identification Forms
Other Assessment Forms
7 www.saw.usace.ymy.miWortals/59/dDcs/reMLatML/regdoes/JD/RGL 08-02 An A Prelim JD Form fillable.pdf
e Please see htto://www.saw.usace.g=.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide wd l be used in evaluating your request to determine
whether there are any aquatic resources within the proiect area subject to federal jurisdiction under the regulator'
authorities referenced above.
Routine Uses: This information may be shared with the Department of]ustice and other federal, state, and local
government agencies, and the public, and may be made available as part ofa 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
andon 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

Parcel Report
Parcel Number
09417001F
Owner
DHG SB LLC % K&L GATES LLP
Mailing Address
PO BOX 3965
MOORESVILLE
NC, 28117
Account Information
Land Value $916,500.00
Building Value $0.00
Total Value $916,500.00
Acreage 187.9200
Sales Information
Sale Date Sale Amount
08/23/2013 $6,100, 000.00
07/02/2012 $1, 650, 000.00
04/06/2011 $8, 280, 000.00
Subdivision
Description SECREST
Situs Address DOSTER RD
Property Class RESIDENTIAL - SINGLE FAMILY
Book & Page Grantor
6086 467 B & C LAND HOLDINGS LLC
5768 806 BANK OF AMERICA N A
JARNAR-
5516 743 SECREST/HOUSTON
DEVELOPMENT
Location Information
Municipal
Union County
12 Mile Service Area
Yes
Administration
County Zoning Code
RA-40
School
School Assignment Information
Zoning Administration
Union County
Census Tract Number
210.05
ETJ
FEMA Panel
5402
Fire District
Springs
FEMA Zone
Soils MhA,TbB2,GsB,CmB
Building Information
Total Living Area Type of Building
Year Build Improvement Type
District Voting Assignments (Jurisdictions)
Polling Place Mt. Carmel United School District 3 Congressional 9
Methodist Church District
Precinct District #7 State House 55 Senate 35
District
gis-web.co.union.nc.us/gomaps/Reports/UserDefined/parcelReport.cfm?objectids=14502713&bbox=-8978459.637710828,4154761.2478650333,-897... 1 /1

AGENT AUTHORIZATION FORM
PROJECT NANM: Stonebridge
PARCEL ID: 09417001E
PROJECT STREET ADDRESS: Doster Road, Mineral Springs, NC
PROPERTY OWNER'S): DHG SB, LLC c/o K&L Gates, LLC
The undersigned, registered property owner(s) of the above noted property, do hereby authorize
S. Paul Petitaout, of Lowrvs Environmental & Ecological Services. LLC,
(Contractor (Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
Jurisdictional Determination, Permit or Certification and any and all standard and special conditions attached
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of Engineers
(Corps) and/or NC Division of Water Resources (NCDWR) to enter upon the property herein described
(accompanied by the authorized agent) for the purpose of conducting on -site investigations, if necessary; and
issuing a jurisdictional determination and/or permit pursuant to Section 404/401 of the Clean Water Act
and/or Section 10 of the Rivers and Harbors Act of 1899. I, the undersigned, am a duly authorized owner of
record of the property identified herein.
PROPERTY OWNER'S ADDRESS: PO Boa 3965
Mooresville, NC 28117
I hereby certify the above information submitted in this jurisdictional determination/application is true and
accurate to the best of our knowledge.
AUTHORIZED SIGNATURE:
PRINT NAME; Eric M. Wood, Vice President DHG SB, LLC
DATE: June 12, 2020

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Source: USGS Waxhaw and Monroe Quads (2019)
Disclaimer: The information depicted on this figure is for
informational purposes only and was not prepared for, and
is not suitable for legal or engineering purposes.
Stonebridge Development
Lowrys Environmental 8�
Mineral Springs, Union County, North Carolina
USGS 1:24,000 Topographic Map
Ecological Services, LLC
1823 Quinn Road
Chester, South Carolina 29706
Drawn By: SPP
Date: 6-9-20
Rev.
Project Mgr. SPP
Scale: 1:24,000
Sheet: 1
803-992-0910

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V
Disclaimer: The information depicted on this figure is for
informational purposes only and was not prepared for, and
is not suitable for legal or engineering purposes.
l
111111
Stonebridge Development
Lowrys Environmental 8�
Mineral Springs, Union County, North Carolina
USGS 1:24,000 Topographic Map
Ecological Services, LLC
1823 Quinn Road
Chester, South Carolina 29706
Drawn By: SPP
Date: 6-9-20
Rev.
Project Mgr. SPP
Scale: 1:24,000
Sheet: 2
803-992-0910

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'
ed
70
f' I 1

Stonebridge Development
Mineral Springs, Union County, North Carolina
USDA NRCS Soil Survev Map
Drawn By: SPP Date: 6-9-20 Rev.
Project Mgr. SPP Scale: 1:12,000 Sheet: 4
Lowrys Environmental 8,
Ecological Services, LLC
1823 Quinn Road
Chester, South Carolina 29706
803-992-0910

I.S
lW µ IRIR F
U.S. Fish 1 Wildlife Service
National Wetlands Inventor
O
Wetlands
rip
Wetlands Freshwater Emergent Wetland Lake
❑ Estuarine and Marine Deepwater Freshwater Forested/Shrub Wetland Other
Estuarine and Marine Wetland Freshwater Pond ❑ Riverine
Stonebridge Development
New Development Area
Scale: As Shown
Source: USFWS NWI Mapper(2020)
Disclaimer: The information depicted on this figure is for
informational purposes only and was not prepared for, and
is not suitable for legal or engineering purposes.
Stonebridge Development Lowrys Environmental 8�
Mineral Springs, Union County, North Carolina
USFWS National Wetlands Inventory Map Ecological Services, LLC
Drawn By: SPP Date: 6-9-20 Rev. 1823 Quinn Road
Chester, South Carolina 29706
Project Mgr. SPP Scale: As Shown Sheet: 5 803-992-0910

Flagging Sequences For Stonebridge Parcels 3, 7, & 9
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1823 Quinn Road W=Wetland; U=Upland; S=Stream
Chester, SC 29706 ° 0.1 0.2 0.4 km
- Stream Soy yes: Earl HERE, Gam Ir, USGS, Ir4 mom, INCREIAENr P.
NRCar, BrlJapar, PAETI, BrlCYlra (Horg 10rg, Esn Ybrea,
Earl Jkatno, NGCC, 0 OpekGtreetl.Mp corlrMlDrs, akd lie
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Note: Wetlands are not drawn to scale. This map is just a representation of the jurisdictional areas and also the general locations of data points. Sheet 6

NOTES
1. THE PURPOSE OF THIS SITE SURVEY IS TO SHOW THE LOCATION OF THE
WETLANDS ON THE SUBJECT PARCEL. THE SUBJECT PARCEL (A PORTION OF `
009417001 F) IS SHOWN HEREON HATCHED IN THE LIGHTEST GRAY. THE OTHER
IRREGULAR GRAY HATCHED AREAS ARE GOLF COURSE FEATURES SHOWN FOR 5A
ILLUSTRATION PURPOSES.
2. THE WETLAND LOCATIONS WERE DETERMINED AND FLAGGED BY LOWRY'S
ENVIRONMENTAL AND ECOLOGICAL SERVICES. THE FLAGS WERE LOCATED
BY PROVIDENCE LAND GROUP AND SHOWN HEREON. �0R) v \�
3. BEARINGS FOR THIS PLAT ARE REFERENCED TO NC GRID 83(2011)
4. THIS PROPERTY IS SUBJECT TO ALL EASEMENTS, RIGHTS -OF -WAY, �0�� 1
AND RESTRICTIONS OF RECORD. THIS SURVEY WAS COMPLETED 6�
WITHOUT A FULL TITLE SEARCH. PROPERTY IS SUBJECT TO
DECLARATION OF COVENANTS, CONDITIONS AND
RESTRICTIONS, RECORDED, OR UNRECORDED.
5. ADJOINING OWNER INFORMATION TAKEN FROM <Oi \�
UNION COUNTY TAX OFFICE AND ARE
CONSIDERED NOW OR FORMERLY. n
6. UNDERGROUND UTILITIES NOT LOCATED <2_1
AT THE TIME OF SURVEY.
7. A FULL BOUNDARY AND -
TOPOGRAPHIC SURVEY WAS \ J_
\
\
WETLAND WD
\
AND STREAM SC
SEE SHEET 2
\
1 \�
CEDAR HILL FARM INC \\`
PARCEL 09414029 \
D.B.7115-284 \
PERFORMED IN CONJUCTION `\ �d/ �. _.
WITH THIS WETLANDS MAP. \ Oi� WINGATE HOLDINGS LLC
SEE THE BOUNDARY AND PARCEL 09417001B
TOPO FOR FURTHER i�� / D.B. 7080-906
INFORMATION. �' - - (GOLF COURSE) \\ \
1 I 7.
* STONEBRIDGE SUBDIVISION
PARCEL 5 MAPS 1& 2
P.C. 0-485 & 0-620
See P C. J-774
l y� 1v' Bent Green
\\ LINDA FLY POWELL &
\ CATHERINE FANDREWS CO \
EXECUTRIX j
III PARCEL 09414031A !
\ D.B.7246-053
---------------------
STREAM SB
SEE SHEET 6
WILLIAM R, JR &
SHARON D MEDLIN
PARCEL 09414030C
D.B. 317-484
EXCLUDED
WETLAND WC
SEE SHEET 5
EXCLUDED
WETLANDS WA
AND WB
SEE SHEET 3
STREAM SA
SEE SHEET 4
1
ROBERT W & MARY F CRAIG
PARCEL 09384018E
D.B.441-519
DHG SB LLC
PORTION OF
PARCEL 09417001F
D.B.6086-467
1 3.660 ACRES
1
1
-� \ F 1
\` 0. 4 C `\ DHG SB LLC \. ` �' _ ' ` ♦ WINGATE HOLDINGS LLC
`.. PORTION OF �\\ ; � �� PARCEL 09417001B
RED LEVEL BAPTIST CHURCH -
PARCEL 09384019
D.B. 43-704
WINGATE HOLDINGS LLC
PARCEL 09417001B
D.B.7080-906
(GOLF COURSE) \.
11
d*
111 �
lil \
1 m_
00
1 0
1 1 �
1 (D
--�- z
\
1 it
1
I RICKY CHARLES &
SUZANNE STRAWN
1 PARCEL 09387002
1 1 D.B.6646-388
AREA NOT i
INCLUDED IN JD I I
REQUEST
SAW-2009-002274 i 1
(AUGUST 2020) I A g
0
0 � Teo 1
-A A= --------
<0
A m -----
0 Z I
� I
a 0 I
I
I
I
b
----------- - r ` PARCEL 09417001F \� I do D.B. 7080-906
--r------ D.B. 6086-467 ��\ �♦ 91 (GOLF COURSE)
3.660 ACRES ��>\ �♦ - �T��\ 1 T- ` I I
-STONEBRIDGE SUBDIVISION '-
% PARCEL 6
P.C. J-774 A �\ a
\-F-- - ``\\\'
/ /- r \ f-� +__� -�- � - > \ =i_ _,-\ STONEBRIDGE SUBDIVISION
1 / / / \ i� 1 \ \ PHASE 8T---
/ P.C. J-523
/-----------Liiiiiy / / \ ' \ . O Y
_ _ 1 SHEET 1 OF 7
'----� ' WINGATE HOLDINGS LLC --� -
a \
PARCEL 09417001B
i D.B.7080-906 P-
. (GOLF COURSE) -
CERTIFICATION foster Road (S-R- 1149) 1 I Le end
I, MATTHEW J. STIKELEATHER, CERTIFY THAT THIS SURVEY DITCH -TO -DITCH R/W PER NC DOT I I g
WAS COMPLETED UNDER MY SUPERVISION FROM AN \`\ i I i I (MAJOR THOROUGHFARE) j WA - WETLANDS DESIGNATION
ACTUAL SURVEY MADE UNDER MY SUPERVISION \\\\``N CARD ,� I SA -STREAM DESIGNATION
(DESCRIPTION FROM M.B. 17-517); THAT THE BOUNDARIES C / SF SQUARE FEET
NOT SURVEYED ARE CLEARLY INDICATED; THAT THE RATIO
OF PRECISION EXCEEEDS 1:10,000; AND THAT THIS SURVEY
MEETS OR EXCEEDS NORTH CAROLINA STANDARDS OF
PRACTICE FOR PROFESSIONAL LAND SURVEYING AS SET
FORTH IN TITLE 21-56.1606 OF THE NORTH CAROLINA
ADMINISTRATIVE CODE.
MA'
tea'
0
Qo
x
�o
ray' SITE
O�d\C1a� a
Stonebridge
poste Goff Course
�Ra.
VICINITY MAP
NOT TO SCALE
THEIR, NC PLS L-4243
O•• SS ••
�..•�0 tOiy • 9
SEAL s cr
L-4243�0 ; Lu
SUR
500' 0' 250' 500'
1 " = 500'
AC - ACRE
R/W - RIGHT OF WAY
O PROPERTY CORNER -AS DESCRIBED
IPS (#4 REBAR SET)
O CALCULATED POINT (CP)
SUBJECT PROPERTY LINE
— — — — ADJACENT OWNER LINE
(UNSURVEYED UNLESS DIMENSIONED)
RIGHT-OF-WAY
WETLANDS
STREAM
SCALE
TOWNSHIP
COUNTY
STATE
DATE
1" = 500'
MONROE
UNION
N.C.
1 R15 21

.0
0
.0
.0
DHG SB LLC
PORTION OF
PARCEL 09417001 F
D.B.6086-467
Bolt Fd.
N A39693.29
E:1509064.62
NAD 83/2011
TIE FROM SC1 TO IPS ON R/W
STREAM "SC"
STREAM EXTENDS FROM POINT "SC 1"
TO POINT "SC2 WD1 WD25"
L1 REPRESENTS THE BEARING AND
DISTANCE FROM SC1 TO SC2
NAD 83/2011 �<01 "j - TOTAL LENGTH = 49.-a
u
Q `
CEDAR HILL FARM INC o
PARCEL 09414029 Cl)
"./ QWD 7 D.B.7115-284 00
n \W D 24
/0� / / / ' `
z
I ` ``Cry
eo
/ Qs" • •• • \\�13� NWD 8 \WD 23
'`IS ©WD 6
I
NGS "UNN 12
E:1508390.44
NAD 83/2011
..• j Tie IPS to Bolt Fd. in CL l�
. •'/62'5 IGFZ30.93'/ IPS on R/W
NGS UNN 13 A-,
NA39261.26
E:1504408.23 / J
01
I
�r
\W D 22 ss� 7O n Sol
APPROXIMATE LOCATION OF 2�\7 To
POSSIBLE 30' WATER LINE ♦WAD 10 `< WETLAND "WD" F Re
EASEMENT PER DEED BOOK o, L16 ` t3' TOTAL AREA: 24,960 SF (0.57 AC) 78 bIlk
3806 PAGE 542. IT IS 6'j a
UNCLEAR IF THERE IS ANY < �3
WATER LINE IN THIS AREA. `r\WD 11 `
I
WD 19
` TYp7cgC J
&4D 12
IWD 18
iiiiiiii 413�WD 13
`•� �\A Cq O
SEAL �WD 14 `
vA L-4243 Of: LU
_ ``
�A
4WD 16
SEE SHEET 1 FOR FULL CERTIFICATION
I
Line Table
Line #
Length
Direction
L1
49.26
•••••••-•••••
L2
70.69
• ••••••-••••
L3
67.04
• ••••••-••••
L4
65.62
• ••••••-••••
L5
79.64
• ••••••-••••
L6
38.56
•••••••-••••
L7
35.92
• ••••••-••••
L8
42.71
• ••••••-••••
L9
90.16
• ••••••-••••
L10
19.76
• ••••••-••••
L11
42.72
•••••••-•••••
L12
48.38
•••••••-•••••
Line Table
Line #
Length
Direction
• .L�l 8 ...
64.12
....... _.... .
•L44.
•75.74•
....... -....
•1_95• •
•39.97•
....... -.... .
•1_46•
•27.06•
....... -....
•1_97•
•79.77•
• • • ••• • -• • ••
•LI&
•65.56•
.......-.....
•L99. •
•94A9•
....... -.... .
•LPO•
•69.92•
....... -....
• L21. .
.79.29.
....... _.... .
••L22•••83.84
.......-....
• .L26...
66.08
....... _.... .
• •L24 • •
• 68.56
....... -.... .
SEE SHEET 7 FOR FULL LIST OF
COORDINATES FOR ALL POINTS
Legend
WA - WETLANDS DESIGNATION
SA -STREAM DESIGNATION
SF -SQUARE FEET
AC - ACRE
R/W - RIGHT OF WAY
O PROPERTY CORNER -AS DESCRIBED
IPS (#4 REBAR SET)
O CALCULATED POINT (CP)
SUBJECT PROPERTY LINE
- - - - ADJACENT OWNER LINE
(UNSURVEYED UNLESS DIMENSIONED)
RIGHT-OF-WAY
WETLANDS
STREAM
SHEET 2 OF 7
SCALE
TOWNSHIP
COUNTY
STATE
DATE
MONROE
UNION
N.C.
REV
1-115 21

i
1 Rebar Fd. 1
5' UTILITY (Bent) T UTILITY
EASEMENT (PER c0 I \ EASEMENT (PER
PC J-775) N \ J-775)
rn
F-�co I \ \
�I \
Oo
N I
0
Z (I� Rebar Fd. \
0.
\
Rebar Fd.
` (Bent)
CC)
a
` ` .\ �i
0 �Fa
Leg a n d 60' 0' 30' 60' SEE SHEET 7 FOR FULL LIST OF
WA -WETLANDS DESIGNATION COORDINATES FOR ALL POINTS
SA -STREAM DESIGNATION 7 L49
AC -ACRE
SF -SQUARE FEET 1" = 60' 00(r "' IWA 15
PC R/W - RIGHT OF WAY �31
O PROPERTY CORNER -AS DESCRIBED Wq _j
IPS (#4 REBAR SET) 73 v
O CALCULATED POINT (CP) WA 16
SUBJECT PROPERTY LINE v
- - - - ADJACENT OWNER LINE
(UNSURVEYED UNLESS DIMENSIONED) ,2Y
RIGHT-OF-WAY �Yy �,fWA 17
WETLANDS 7�� 1
STREAM D�,� b LO
�q 7 V� �WA 18
pROX \,OCP�\ONE W 8�'I�,93
C J TT51 lPP v <KA �
WA 7
fWq 20
J 1� LO
WA 600
� J
` •'.� �i \.\ EXCLUDED \G
Pa��S • • • •''0016
000
FzFpl _
6� ` ••\ WETLAND WA �WA 22 p Fz
TOTAL AREA: 13,785 SF
(0.32 AC) �WA `''� ��00�,
APPROX. LOCATION20'co
SIDE (PER PC �!0 X �d. \ J' 2`L6 •• ..•'
7 775) m e°a� \ ' 10 ,. • r �/�
EXCLUDED �� \
WETLAND "WB" \
TOTAL AREA: 8,071 SF \
(0.19 AC) �uN
CID
ov
L7 1
Rebar Fd. I
(Bent) 1
I
1
1
I
1
WA 4(t(fCP in Wetland
001
MIJ
I
WA 3C�
` '
` O
` t
WA 2�
� 1
co
IPS at 200.00' from C
CAR 0��,
OQ, •.........
_ ..•OFES S /O�
=K'� SEAL
= a L-4243 Of: LU
S-f
Line Table
Line #
Length
Direction
L25
93.11
•••••••-•••••
L26
83.01
•••••••-••••
L27
69.65
•••••••-••••
L28
53.93
•••••••-••••
L29
33.90
•••••••-••••
L30
28.82
• ••••••-••••
L31
52.58
• ••••••-••••
L32
55.03
• ••••••-••••
L33
42.02
• ••••••-••••
L34
50.25
• ••••••-••••
L35
66.55
• • • ••• • -• • ••
L36
24.13
• ••••••-••••
L37
71.82
• ••••••-••••
L38
60.70
• • • ••• • -• • ••
L39
54.65
• • • ••• • -• • ••
L40
55.95
• • • ••• • -• • ••
L41
37.71
• ••••••-••••
SEE SHEET 1 FOR FULL CERTIFICATION
Line Table
Line #
Length
Direction
..L• 22...
25.51
....... _.... .
•L•48•••19.17
.......-....
•L•44• •
• 65.86
....... -....
•L•45• •
• 63.38
....... -....
•L46. •
•19.37•
....... -.... .
•1_47•
•34.29•
• • • ••• • -• • ••
•1_48.
•28.32•
• • • ••• • -• • ••
•1_49.
•32.56•
....... -....
•1_61•
.32.79.
....... _....
•L52.
•24.29•
....... -....
•1_53•
•44.78•
....... -....
•1_54• .
•38.76.
....... _.... .
•1_55 .
•36.74.
....... _....
•L•56• •
• 63.57
....... -....
..Lbq...
65.65
....... _.... .
CURVE TABLE
CURVE
LENGTH
RADIUS
CHORD
CH. LENGTH
C1
99.45'
376.92'
••••••»•••
••99.16'•-
C2
13.89'
250.00'
• • • •• • » • •• •
• • • 13.89'
C3
66.11'
461.22'
• • • •• • » • •• •
• • • 66.05'
C4
21.70'
525.00'
• • • •• • » • ••
24.7-0'-
05
j 217.83'
j 525.00'
• • • •• • » • ••
216271
SHEET 3 OF 7
SITE SURVEY FOR:
WETLANDS
AT STONEBRI1DGE
A 1 I
I
SCALE
TOWNSHIP
COUNTY
STATE
DATE
MONROE
UNION
N.C.
1 R15 21
N
Portion of Tax Parcel 09417001 F
o
Reference Deed Book 6086 Page 467
•�
DEED RECORDED
•
6086-467
PROVIDENCE LAND GROUP, PLLC
�m
I
MAP RECORDED
3716 PROVIDENCE ROAD SOUTH
NONE
WAXHAW NC 28173
Q I
SURVEYED
704.400.0117
'
CJS
NC FIRM # P-0910
PrLvidence
DRA"m
SC COA # 4356
�
JCK

53� 60' 0' 30' 60'
Sy , e ��g9 �Z�F0
Fc/N �S8 2 '0���� 60'
1oSP
S'I()o R6 9�00�0 �S9
60
NkSF
/67
♦ ASP 5
♦ <62
FV'
COR P, � SP
PV,ps, CP
STREAM "SA"
TOTAL LENGTH: 627.7 FT
Legend
WA - WETLANDS DESIGNATION
SA -STREAM DESIGNATION
SF-SQUAREFEET
AC -ACRE
R/W - RIGHT OF WAY
O PROPERTY CORNER -AS DESCRIBED
IPS (#4 REBAR SET)
O CALCULATED POINT (CP)
SUBJECT PROPERTY LINE
— — — — ADJACENT OWNER LINE
(UNSURVEYED UNLESS DIMENSIONED)
RIGHT-OF-WAY
WETLANDS
STREAM
1 1a\N C??
\\\\\\%IIIIII"/
CARO
SEE SHEET 7 FOR FULL LIST OF ` .....
�..
Z/
COORDINATES FOR ALL POINTS =O•; pF_SS/O�%��
SEAL C
= vA L-4243 0 ; LU
11110���`
SEE SHEET 1 FOR FULL CERTIFICATION
41%P $
466'
36" CORRUGATED -
PLASTIC PIPE (CPP)
P9
CT 66
p/ C�
ffi Fd.
/ 128.91'
Reb N72°37'43"W
SOIL ROADS OR TRAILS ARE SHOWN HEREON BECAUSE
SOME OF THEM APPEAR TO BE USED BY THE GOLF
COURSE PERSONNEL FOR ACCESS
/
/
/
STREAM "SAX
TOTAL LENGTH: 137.
/j m
II a m
I� ? N
1 v> 99
�1p000 , to /R3 ebarFa Se8 3 a
O �Oo 9 S a�
�"�7 `�O�Repa� �eom
C'
STREAM "SBB"
TOTAL LENGTH: 121.6 FT
'pebg om CP
g9 TIE FROM
r2v' /SBB 4 TO REBAIR
F` GG Reba R
>s'r9p.'
O �
^1b C��
CP
FA
Line Table
Line #
Length
Direction
L58
21.06
•••••••-••••
L59
55.53
•••••••-••••
L60
30.11
•••••••-••••
L61
61.89
•••••••-•••••
L62
82.07
•••••••-•••••
L63
62.53
•••••••-•••••
L64
78.90
•••••••-•••••
L65
69.49
•••••••-•••••
L66
66.56
•••••••-•••••
L67
21.10
•••••••-••••
L68
38.26
•••••••-•••••
L69
40.21
•••••••-••••
L107
28.01
•••••••-•••••
L108
64.56
•••••••-•••••
L109
44.90
•••••••-•••••
L110
33.83
•••••••-••••
L111
28.36
•••••••-••••
L112
59.38
•••••••-••••
L113
52.21
•••••••-••••
L114
47.62
• ••••••-••••
L115
108.45
•••••••-••••
SHEET 4 OF 7
SCALE
TOWNSHIP
COUNTY
STATE
DATE
MONROE
UNION
N.C.
1 R15 21

\
\
\ \ NO
60' 0' 30' 60'
1"=60'
SEE SHEET 7 FOR FULL LIST OF
COORDINATES FOR ALL POINTS
EXCLUDED WETLAND "WC"
TOTAL AREA: 30,002 SF
(0.69 AC)
W0 16� \ ♦ G \'6
\ \
N
�G co \\\ \\ q6
TO
co
\\ \\
�-(\A• CAR04�ti
_�•OFESS/O% ••
SEAL
v L-4243 0 ? LU
S-f
Rebar Fd.
-I>
\ \ � ft%9y: � �L88 ,`L
G�L89�
I
41
SEE SHEET 1 FOR FULL CERTIFICATION
L e g e n d
WA - WETLANDS DESIGNATION
SA -STREAM DESIGNATION
SF-SQUAREFEET
AC -ACRE
R/W - RIGHT OF WAY
O PROPERTY CORNER -AS DESCRIBED
IPS (#4 REBAR SET)
O CALCULATED POINT (CP)
SUBJECT PROPERTY LINE
— — — — ADJACENT OWNER LINE
(UNSURVEYED UNLESS DIMENSIONED)
RIGHT-OF-WAY
WETLANDS
STREAM
I
I
I
I
I
I I
1
I
I1
I
I
I
I
I I
Line Table
Line #
Length
Direction
L70
51.89
•••••••-•••••
L71
56.31
•••••••-•••••
L72
48.71
• ••••••»••••
L73
39.85
•••••••-•••••
L74
42.50
•••••••-•••••
L75
33.33
• • • ••• • »• • ••
L76
51.79
•••••••-•••••
L77
50.37
•••••••-•••••
L78
66.65
• • • ••• • »• • ••
L79
42.86
•••••••-•••••
L80
44.38
•••••••-••••
L81
33.51
•••••••-•••••
L82
21.49
•••••••-•••••
L83
15.39
•••••••-••••
L84
46.25
• • • ••• • »• • ••
L85
78.43
• • • ••• • »• • ••
L86
70.30
• ••••••»••••
L87
84.63
• • • ••• • »• • ••
L88
126.17
• ••••••»••••
L89
71.40
•••••••-••••
I
SHEET 5 OF 7
SCALE
TOWNSHIP
COUNTY
STATE
DATE
R15
MONROE
UNION
N.C.
1 21

0
co
00
0
Of
(D
U
z
L e g e n d
WA - WETLANDS DESIGNATION
SA -STREAM DESIGNATION
i0l
01
3
.0
.0
�SB 1
0
_rn
W llJ
z ®SB 2
r `<1 /
4. �� I
�QQ I\
'<9
SF-SQUAREFEET
AC -ACRE
R/W - RIGHT OF WAY
O PROPERTY CORNER -AS DESCRIBED
IPS (#4 REBAR SET)
O CALCULATED POINT (CP)
SUBJECT PROPERTY LINE
— — — — ADJACENT OWNER LINE
(UNSURVEYED UNLESS DIMENSIONED)
RIGHT-OF-WAY
WETLANDS
— — — STREAM
I /
II
II
II
II
II
II
I I
/ I
/ STREAM "SB"
SEE SHEET 7 FOR FULL LIST OF
COORDINATES FOR ALL POINTS
Rebar F
I TOTAL LENGTH: 519.6 FT
I NOTE THAT THE TOTAL
I
LENGTH SHOWN ENDS AT
\ THE PROPERTY LINE
\ POINT SB 17A
1b `g7�
I
I m
I
I
I
1
1
Rebar Fd.
TIE TO REBAR FD.
Line Table
Line #
Length
Direction
L90
36.28
•••••••-••••
L91
66.79
•••••••-•••••
L92
36.83
•••••••-•••••
L93
29.59
•••••••-•••••
L94
53.76
•••••••-•••••
L95
29.28
•••••••-•••••
L96
24.98
• ••••••-••••
L97
19.19
• ••••••-••••
L98
35.86
•••••••-•••••
L99
18.51
• ••••••-••••
L100
31.84
•••••••-•••••
L101
23.18
• ••••••-••••
L102
28.08
•••••••-•••••
L103
24.32
• ••••••-••••
L104
42.52
• ••••••-••••
L105
18.56
• ••••••-••••
L106
j 20.77
•••••••-•••••
SEAL
v : L-4243 0 ; LU
SEE SHEET 1 FOR FULL CERTIFICATION
SHEET 6 OF 7
SCALE
TOWNSHIP
COUNTY
STATE
DATE
R15
MONROE
UNION
N.C.
1 21

CO(DFRF-)INATE TABLE FOR WETLANDS FLAG POINTS
Point Table
Raw Description
Northing
Easting
SA 1 BEGIN
437928.8
1510912.7
SA 2
437912.3
1510925.7
SA 3
437863.4
1510952.0
SA 4
437836.7
1510965.9
SA 5
437783.9
1510998.2
SA 6 / 181N CPP
437715.3
1511043.3
SA 7 / 181N CPP
437665.5
1511081.1
SA 8
437603.4
1511129.7
SA 9
437548.8
1511172.7
SA 10
437504.8
1511222.7
SA 11
437491.1
1511238.8
SA 12 / 361N CPP
437466.2
1511267.8
SA 13 / 361N CPP
437452.0
1511305.4
SAA 1
437448.7
1511333.2
SAA 2 / SBB 1
437448.6
1511397.8
SAA 3
437447.8
1511442.7
SB 1
439104.7
1511674.0
SB 2
439068.7
1511669.7
SB 3
439006.2
1511693.4
SB 5
438976.2
1511714.7
SB 6
438959.4
1511739.1
SB 7
438933.7
1511786.3
SB 8
438920.9
1511812.6
Point Table
Raw Description
Northing
Easting
SB 9
438923.8
1511837.5
SB 10
438928.6
1511856.0
SB 11
438909.9
1511886.6
SB 12
438919.1
1511902.7
SB 13
438900.1
1511928.2
SB 14
438914.6
1511946.3
SB 15
438913.7
1511974.3
SB 16
438929.5
1511992.9
SB 17
438940.8
1512033.9
SB 17A
438952.4
1512048.4
SB 18
438958.9
1512056.6
SB 19
438959.0
1512076.4
SBB 2
437426.4
1511372.2
SBB 3
437403.4
1511355.6
SBB 4
437364.7
1511310.5
SC 1
439673.3
1509090.5
SC2 WD 1 WD 25
439624.4
1509096.6
WA 1
437098.3
1510581.5
WA 2
437117.5
1510566.9
WA 3
437185.1
1510542.6
WA 4
437245.7
1510539.6
WA 5
437300.2
1510543.1
WA 6
437356.0
1510547.8
NOTES
1. SEE SHEETS 2-6 FOR DETAILS OF EACH WETLANDS AREA.
2. COORDINATES SHOWN ARE BASED ON THE NAD 83(2011) DATUM.
Point Table
Raw Description
Northing
Easting
WA 7
437392.5
1510557.2
WA 8
437414.3
1510570.4
WA 9
437404.4
1510586.8
WA 10
437421.2
1510618.4
WA 11
437443.5
1510643.3
WA 12
437461.0
1510651.4
WA 13
437490.6
1510668.8
WA 14
437518.9
1510668.1
WA 15
437515.9
1510700.5
WA 16
437481.5
1510677.1
WA 17
437454.0
1510659.2
WA 18
437429.8
1510657.6
WA 19
437404.8
1510624.1
WA 20
437385.5
1510596.4
WA 21
437347.6
1510604.9
WA 22
437317.8
1510620.3
WA 23
437287.7
1510639.4
WB 1 WB12
437177.1
1510345.7
WB 2
437164.2
1510314.3
WB 3
437190.4
1510302.3
WB 4
437234.8
1510274.1
WB 5
437283.4
1510248.4
WB 6
437321.2
1510230.1
Point Table
Raw Description
Northing
Easting
WB 7
437367.8
1510211.4
WB 8
437430.9
1510190.0
WB 9
437356.0
1510245.4
WB 10
437282.0
1510282.9
WB 11
437227.4
1510326.2
WC 1
438511.1
1512369.7
WC 2
438511.1
1512317.8
WC 4
438516.6
1512261.8
WC 5
438510.9
1512213.4
WC 6
438524.7
1512176.0
WC 7
438540.8
1512136.7
WC 8
438536.9
1512103.6
WC 9
438544.5
1512052.4
WC 10
438574.1
1512011.6
WC 12
438544.3
1511952.0
WC 13
438573.7
1511920.8
WC 14
438616.1
1511907.9
WC 15
438647.9
1511897.1
WC 16
438666.8
1511886.9
WC 17
438677.1
1511898.3
WC 18
438657.9
1511940.3
WC 19
438638.0
1512016.2
WC 20
438606.0
1512078.8
•.
�• Q�oF�-SS/O��•.�
_K: SEAL �ry,_
v.A : - L-4243 cc: LU
S
SEE SHEET 1 FOR FULL CERTIFICATION
Point Table
Raw Description
Northing
Easting
WC 21
438578.9
1512159.0
WC 22
438563.7
1512284.2
WC 23
438566.5
1512355.5
WD 2
439587.6
1509085.2
WD 3
439621.0
1509071.6
WD 4
439612.4
1509038.9
WD 5
439533.5
1509047.1
WD 6
439472.9
1509059.5
WD 7
439565.0
1509078.9
WD 8
439502.3
1509098.1
WD 9
439424.7
1509116.5
WD 10
439427.6
1509143.4
WD 11
439396.2
1509168.1
WD 12
439325.7
1509195.7
WD 13
439304.3
1509245.4
WD 14
439260.7
1509266.4
WD 15
439227.9
1509293.8
WD 16
439228.4
1509313.5
WD 18
439314.9
1509288.1
WD 19
439357.4
1509283.5
WD 20
439383.4
1509258.7
WD 21
439372.5
1509221.8
WD 22
439446.8
1509193.1
SHEET 7 OF 7
SCALE
TOWNSHIP
COUNTY
STATE
DATE
R15
N/A
MONROE
UNION
N.C.
1 21

U.S. Army Corps of Engineers OMB Control #: 0710-xxxx, Exp: Pending
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region Requirement Control Symbol EXEMPT:
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R (Authority: AR 335-15, paragraph 5-2a)
Project/Site: Stonebridge City/County: Mineral Springs/Union Sampling Date: 2/2020
Applicant/Owner: DHG SB, LLC State: NC Sampling Point: wwweMc Up
Investigator(s): Petitgout Section, Township, Range:
Landform (hillside, terrace, etc.): flat Local relief (concave, convex, none): flat Slope (%): 0.05
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 34.941556 Long:-80.631866 Datum:
Soil Map Unit Name: Cid Channery Silt Loam NWI classification:
Are climatic / hydrologic conditions on the site typical for this time of year? Yes No X (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes No X
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS —Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes No X Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
Very wet season
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required: check all that apply)
_Surface Soil Cracks (136)
_Surface Water (Al) _True
Aquatic Plants (1314)
_Sparsely Vegetated Concave Surface (138)
—High Water Table (A2) —Hydrogen
Sulfide Odor (Cl)
_ Drainage Patterns (B10)
_Saturation (A3) _Oxidized
Rhizospheres on Living Roots (C3)
_Moss Trim Lines (1316)
_Water Marks (131) _Presence
of Reduced Iron (C4)
_Dry -Season Water Table (C2)
_Sediment Deposits (132) _Recent
Iron Reduction in Tilled Soils (C6)
_Crayfish Burrows (C8)
_Drift Deposits (133) _Thin
Muck Surface (C7)
_Saturation Visible on Aerial Imagery (C9)
_Algal Mat or Crust (134) _Other
(Explain in Remarks)
_Stunted or Stressed Plants (D1)
_Iron Deposits (135)
_Geomorphic Position (D2)
—Inundation Visible on Aerial Imagery (137)
_Shallow Aquitard (D3)
—Water-Stained Leaves (139)
Microtopographic Relief (D4)
Aquatic Fauna (1313)
FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No
X Depth (inches):
Water Table Present? Yes No
X Depth (inches):
Saturation Present? Yes No
X Depth (inches):
Wetland Hydrology Present? Yes No X
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: WA/WB/WC Up
Absolute Dominant
Indicator
Tree Stratum (Plot size: 30 )
% Cover Species?
Status
Dominance Test worksheet:
1
Number of Dominant Species
2.
That Are OBL, FACW, or FAC: 0 (A)
3.
Total Number of Dominant
4.
Species Across All Strata: 1 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 0.0% (A/B)
7.
Prevalence Index worksheet:
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
20% of total cover:
OBL species 0 x 1 = 0
Sapling/Shrub Stratum (Plot size: 15
)
FACW species 0 x 2 = 0
1.
FAC species 0 x 3 = 0
2.
FACU species 100 x 4 = 400
3.
UPL species 0 x 5 = 0
4.
Column Totals: 100 (A) 400 (B)
5.
Prevalence Index = B/A = 4.00
6.
Hydrophytic Vegetation Indicators:
7.
_ 1 - Rapid Test for Hydrophytic Vegetation
8.
2 - Dominance Test is >50%
9.
3 - Prevalence Index is :53.0'
=Total Cover
4 - Morphological Adaptations' (Provide supporting
50% of total cover:
20% of total cover:
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5 )
-Problematic Hydrophytic Vegetation' (Explain)
1. Cynodon dactylon
100 Yes
FACU
'Indicators of hydric soil and wetland hydrology must be
2.
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3.
4.
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
5.
more in diameter at breast height (DBH), regardless of
6
height.
7.
Sapling/Shrub - Woody plants, excluding vines, less
8.
than 3 in. DBH and greater than or equal to 3.28 ft
9
(1 m) tall.
10.
Herb - All herbaceous (non -woody) plants, regardless
11.
of size, and woody plants less than 3.28 ft tall.
100 =Total Cover
Woody Vine - All woody vines greater than 3.28 ft in
50% of total cover:
50 20% of total cover:
20
height.
Woody Vine Stratum (Plot size: 30 )
1.
2.
3.
4.
5
Hydrophytic
=Total Cover
Vegetation
50% of total cover:
20% of total cover:
Present? Yes No X
Remarks: (Include photo numbers here or on a separate sheet.)
Upland plot beside golf course in rough area.
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont - Version 2.0

SOIL Sampling Point: wnnivefWC Up
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
Matrix
Redox Features
(inches)
Color (moist)
%
Color (moist) % Type' Locz
Texture Remarks
0-3
2.5YR 3/2
100
Loamy/Clayey
3-12
2.5YR 4/3
60
10YR 4/6 40 PL/M
Loamy/Clayey
12-20
2.5YR 5/3
70
10YR 4/6 30 PL/M
Loamy/Clayey
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
Hydric Soil Indicators:
_ Histosol (Al)
_ Histic Epipedon (A2)
—Black Histic (A3)
—Hydrogen Sulfide (A4)
_Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
_Depleted Below Dark Surface (A11)
_Thick Dark Surface (Al 2)
_Sandy Mucky Mineral (S1)
_Sandy Gleyed Matrix (S4)
_Sandy Redox (S5)
—Stripped Matrix (S6)
Dark Surface (S7)
Restrictive Layer (if observed):
Type:
Depth (inches):
Remarks:
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_Thin Dark Surface (S9) (MLRA 147, 148)
_Loamy Mucky Mineral (F1) (MLRA 136)
—Loamy Gleyed Matrix (F2)
—Depleted Matrix (F3)
_ Redox Dark Surface (F6)
—Depleted Dark Surface (F7)
_ Redox Depressions (F8)
_ Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
_ Umbric Surface (F13) (MLRA 122, 136)
—Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 1479 148)
2Location: PL=Pore Lining, M=Matrix
Indicators for Problematic Hydric Soils3:
2 cm Muck (A10) (MLRA 147)
_Coast Prairie Redox (A16)
(MLRA 147, 148)
—Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
—Red Parent Material (F21)
(outside MLRA 127, 1479 148)
_Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
31ndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes No X
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

U.S. Army Corps of Engineers OMB Control #: 0710-xxxx, Exp: Pending
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region Requirement Control Symbol EXEMPT:
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R (Authority: AR 335-15, paragraph 5-2a)
Project/Site: Stonebridge City/County: Mineral Springs/Union Sampling Date: 2/2020
Applicant/Owner: DHG SB, LLC State: NC Sampling Point: wwVVBANCwec
Investigator(s): Petitgout Section, Township, Range:
Landform (hillside, terrace, etc.): flat Local relief (concave, convex, none): flat Slope (%): 0.05
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 34.941556 Long:-80.631866 Datum:
Soil Map Unit Name: Cid Channery Silt Loam NWI classification:
Are climatic / hydrologic conditions on the site typical for this time of year? Yes No X (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes No X
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS —Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes X No within a Wetland? Yes X No
Wetland Hydrology Present? Yes X No
Remarks:
Very wet year
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required: check all that apply)
_Surface Soil Cracks (136)
_Surface Water (Al) _True
Aquatic Plants (1314)
? Sparsely Vegetated Concave Surface (138)
X High Water Table (A2) —Hydrogen
Sulfide Odor (Cl)
_ Drainage Patterns (B10)
X Saturation (A3) _Oxidized
Rhizospheres on Living Roots (C3)
_Moss Trim Lines (1316)
_Water Marks (131) _Presence
of Reduced Iron (C4)
_Dry -Season Water Table (C2)
_Sediment Deposits (132) _Recent
Iron Reduction in Tilled Soils (C6)
X Crayfish Burrows (C8)
_Drift Deposits (133) _Thin
Muck Surface (C7)
_Saturation Visible on Aerial Imagery (C9)
_Algal Mat or Crust (134) _Other
(Explain in Remarks)
_Stunted or Stressed Plants (D1)
_Iron Deposits (135)
_Geomorphic Position (D2)
—Inundation Visible on Aerial Imagery (137)
_Shallow Aquitard (D3)
—Water-Stained Leaves (139)
_Microtopographic Relief (D4)
Aquatic Fauna (1313)
X FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No
X Depth (inches):
Water Table Present? Yes X No
Depth (inches): 4
Saturation Present? Yes X No
Depth (inches): 0
Wetland Hydrology Present? Yes X No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Flat topography. Area meets the hydrology criteria
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: WANVBNVC Wet
Absolute
Dominant
Indicator
Tree Stratum (Plot size: 30 )
% Cover
Species?
Status
Dominance Test worksheet:
1.
Liquidambarstyraciflua
20
Yes
FAC
Number of Dominant Species
2.
Acer rubrum
10
Yes
FAC
That Are OBL, FACW, or FAC: 4 (A)
3.
Fraxinus pennsylvanica
2
No
FACW
Total Number of Dominant
4.
Species Across All Strata: 4 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 100.0% (A/B)
7.
Prevalence Index worksheet:
32
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
16 20% of total cover:
7
OBL species 0 x 1 = 0
Saplinq/Shrub Stratum (Plot size: 15
)
FACW species 2 x 2 = 4
1.
Liquidambarstyraciflua
10
Yes
FAC
FAC species 49 x 3 = 147
2.
Acer rubrum
5
Yes
FAC
FACU species 0 x 4 = 0
3.
UPL species 0 x 5 = 0
4.
Column Totals: 51 (A) 151 (B)
5.
Prevalence Index = B/A = 2.96
6.
Hydrophytic Vegetation Indicators:
7.
_ 1 - Rapid Test for Hydrophytic Vegetation
8.
X 2 - Dominance Test is >50%
9.
X 3 - Prevalence Index is <-3.0'
15
=Total Cover
4 - Morphological Adaptations' (Provide supporting
50% of total cover:
8 20% of total cover:
3
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5 )
-Problematic Hydrophytic Vegetation' (Explain)
1.
Microstegium vimineum
2
No
FAC
'Indicators of hydric soil and wetland hydrology must be
2.
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3.
4.
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
5.
more in diameter at breast height (DBH), regardless of
6
height.
7.
Sapling/Shrub - Woody plants, excluding vines, less
8.
than 3 in. DBH and greater than or equal to 3.28 ft
9
(1 m) tall.
10.
Herb - All herbaceous (non -woody) plants, regardless
11.
of size, and woody plants less than 3.28 ft tall.
2
=Total Cover
Woody Vine - All woody vines greater than 3.28 ft in
50% of total cover:
1 20% of total cover:
1
height.
Woody Vine Stratum (Plot size: 30 )
1.
Toxicodendron radicans
2
No
FAC
2.
3.
4.
5
Hydrophytic
2
=Total Cover
Vegetation
50% of total cover:
1 20% of total cover:
1
Present? Yes X No
Remarks: (Include photo numbers here or on a separate sheet.)
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont - Version 2.0

SOIL Sampling Point: wFvwBANcwet
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
Matrix
Redox Features
(inches)
Color (moist)
%
Color (moist) % Type' Locz
Texture Remarks
0-3
2.5YR 3/2
100
Loamy/Clayey
3-11
2.5YR 4/2
60
10YR 4/6 40 C PL/M
Loamy/Clayey Prominent redox concentrations
11-20
2.5YR 5/2
70
10YR 4/6 30 C PL/M
Loamy/Clayey Prominent redox concentrations
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
Hydric Soil Indicators:
_ Histosol (Al)
_ Histic Epipedon (A2)
—Black Histic (A3)
—Hydrogen Sulfide (A4)
_Stratified Layers (A5)
_2 cm Muck (A10) (LRR N)
X Depleted Below Dark Surface (A11)
_Thick Dark Surface (Al2)
_Sandy Mucky Mineral (S1)
_Sandy Gleyed Matrix (S4)
_Sandy Redox (S5)
—Stripped Matrix (S6)
Dark Surface (S7)
Restrictive Layer (if observed):
Type:
Depth (inches):
Remarks:
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_Thin Dark Surface (S9) (MLRA 147, 148)
_Loamy Mucky Mineral (F1) (MLRA 136)
—Loamy Gleyed Matrix (F2)
X Depleted Matrix (F3)
_ Redox Dark Surface (F6)
—Depleted Dark Surface (F7)
? Redox Depressions (F8)
_ Iron -Manganese Masses (F12) (LRR N,
MLRA 136)
_ Umbric Surface (F13) (MLRA 122, 136)
—Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 1479 148)
2Location: PL=Pore Lining, M=Matrix
Indicators for Problematic Hydric Soils3:
2 cm Muck (A10) (MLRA 147)
_Coast Prairie Redox (A16)
(MLRA 147, 148)
? Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
—Red Parent Material (F21)
(outside MLRA 127, 1479 148)
_Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
31ndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes X No
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

NC DW'Q stream Identification Form Version 4.11
Date: Z ZDZO Project/Site: 57'bmte--i(�e(obe� Latitude:�4f
Evacuator: ����.-� county: u Longitude:
[Total Points: Stream Det r�itl�tj_on (circle one) Other ►'HOIrV aE �XaPvD
Stream is at least intermittent 2 ` Ephemeral" Intermitt n Perennial e. Quad Name:
rf > 19 or Perennial if >_ 30" p g�
1 P-%,
A. Geomor
artiiiciai aitcnes are not rated: see discussions in manual
B.
Hydrology (Subtotal
12
Presence of Baseflow
0
1
2
3
13.
Iron oxidizing bacteria
0)
2
3
14
Leaf litter
.5
1
0.5
0
15.
Sediment on plants or debris
0
'0.5
1
1.5
16.
Organic debris lines or piles
0
0.5
1
1.5
17
Soil -based evidence of high water table?
No
= 0
Yes = 3
C.
Biology (Subtotal J )
18
Fibrous roots in streambed
3
2
1
0
19.
Rooted upland plants in streambed
3
2
1
0
20
MaCrobenthos (note diversity and abundance)
ro)
1
2
3
21
Aquatic Mollusks
0
1
2
3
22.
Fish
0.5
1
1.5
23.
Crayfish
0
rv6.5
1
1.5
24.
Amphibians
0.5
1
1.5
25.
Algae
0.5
1
1.5
26.
Wetland plants in streambed
FACW = 0.75: OBL =
1.5 Other = 0
"perennial streams may also be identified using other methods. See p.
35 of manual.
Notes
Sketch: 'Sc.

NC DWQ Stream Identification Form Version 4.11
Date: Z Project/Site:
Evaluator: ���T����
Total Points:
Stream is at least intermittent �Q
If >_ 19 or perennial if >_ 30` O
A. Geomor
M
artificial ditches are not rated: see discussions in manual
B. Hydrology (Subtotal=
r� )
12. Presence of Basefiow
13. Iron oxidizing bacteria
14. Leaf litter
15. Sediment on plants or debris
16. Organic debris lines or piles
17 Soil -based evidence of high water table
C. Biology (Subtotal
18. Fibrous roots in streambed
10. Rooted upland plants in streambed
20. Macrobenthos (note diversity and abundance)
21. Aquatic Mollusks
22. Fish
23. crayfish
24 Amphibians
25_ Algae
26. Wetland plants in streambed
County:
G
Stream Determination circle one)
Ephemeral(lntermittent Perennial
0
W_ -w
1.5
0
No=0
C
0
0
O
1
1
19W
904 0.5
0 0.5
g- 0.5
FACW = 0.75;
perennial streams may also be identified using other methods. see p. 35 of manual.
Notes:
Sketch: � S�
Latitude: 3c� qq���
Longitude:
Other f1'1 ONfOd OLWPip
e.g. Quad Name:
OBL = 1.
0.5
1
1
2
2
1
5 =
Other = ja
3
3
0
1.5
1.5
�i
V
1.5
1.5
1.5
1.5

M
G. Biology......,,(Subtotal
I�� i bro us roots n stre a m b
3
`�
��
19. Rooted upland plants in strew d
3
0
0 acro Mhos (note dvrsty and abundance)
s
2
3
21 . Aquatic Mollusks
O
3
2x Fish
G,
1
1
23. Crayfish
��
�
1.5
24. . Amphibians
0.5
1
1.5
25, Algae a
0.5
1
1.5
26. Wetland plants n st am b
. .
.................. ....... ...... ........................
FAC 0.75 O B L Rrrrrr
........... ....... ............
1. th r
*pe enn l streams may also be Identified uslwng other methods.
See Pa 35 of manual,
Notes:
R
Sketch:
................... ....... . . .... . . . ........

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION L• BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Union City: Mineral S rings
Center coordinates of site (lat/long in degree decimal format): Lat. 34.941556' i, Long.-80.631886' �.
Universal Transverse Mercator:
Name of nearest waterbody: Richardson Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Rocky River
Name of watershed or Hydrologic Unit Code (HUC): 03040105 Yadkin -Pee Dee
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
❑ Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
Office (Desk) Determination. Date:
Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Pick List "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
❑ Waters subject to the ebb and flow of the tide.
❑ Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There 0 "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): r
❑ TNWs, including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
❑ Non-RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
® Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non -wetland waters: 886 linear feet: 2-3 width (ft) and/or acres.
Wetlands: 0.32 acres.
c. Limits (boundaries) of jurisdiction based on: 1987 Delineation Manual
Elevation of established OHWM (if known):
2. Non -regulated waters/wetlands (check if applicable):'
❑ Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
1 Boxes checked below shall be supported by completing the appropriate sections in Section III below.
2 For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
s Supporting documentation is presented in Section II1.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section I LAA and Section IILD.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections I LAA and 2
and Section III.D.1.; otherwise, see Section I LB below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent'
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non -navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section IILD.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section IILDA.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section I LB.1 for
the tributary, Section I LB.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section IILC below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 1,417 square miles
Drainage area: 234 square miles
Average annual rainfall: 45 inches
Average annual snowfall: 2 inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
® Tributary flows through I tributaries before entering TNW.
Project waters are 25-30 river miles from TNW.
Project waters are 1 (or less) river miles from RPW.
Project waters are 15-20 aerial (straight) miles from TNW.
Project waters are 1 (or less) aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW': UT to Richardson Creek, Richardson Creek, Rocky River, Yadkin -Pee Dee River.
'Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
' Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Tributary stream order, if known:
(b) General Tributary Characteristics (check all that apply):
Tributary is: ® Natural
❑ Artificial (man-made). Explain:
❑ Manipulated (man -altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: 2-3 feet
Average depth: 0.5 feet
Average side slopes: "
Primary tributary substrate composition (check all that apply):
❑ Silts ® Sands ❑ Concrete
❑ Cobbles ® Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain: relatively stable.
Presence of run/riffle/pool complexes. Explain: features are present.
Tributary geometry: Relatively straight
Tributary gradient (approximate average slope): 0.1 %
(c) Flow:
Tributary provides for. Intermittent but not seasonal now
Estimate average number of flow events in review area/year: 6-10
Describe flow regime: Intermittent.
Other information on duration and volume:
Surface flow is: Discrete and confined. Characteristics:
Subsurface flow: Unknown. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
® Bed and banks
® OHWM6 (check all indicators that apply):
❑ clear, natural line impressed on the bank
®
the presence of litter and debris
❑ changes in the character of soil
❑
destruction of terrestrial vegetation
❑ shelving
®
the presence of wrack line
❑ vegetation matted down, bent, or absent
®
sediment sorting
❑ leaf litter disturbed or washed away
❑
scour
❑ sediment deposition
❑
multiple observed or predicted flow events
❑ water staining
❑
abrupt change in plant community
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
High Tide Line indicated by: &J Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain: water colot is clear, some sediment sorting occurs.
Identify specific pollutants, if known:
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OH'W M has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
')bid.

(iv) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average width): vegetated with low growing saplings and shrubs with few trees;
wide - ±50 ft.
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size:0.32 acres
Wetland type. Explain:PFO, topographically flat area.
Wetland quality. Explain: Fair to poor because of adjaceney to golf course.
Project wetlands cross or serve as state boundaries. Explain:
tributary.
(b) General Flow Relationship with Non-TNW:
Flow is: Intermittent flow. Explain: Wetland surface water releases at higher rain events. Wetlands flow into the
Surface flow is: Discrete and confined
Characteristics: Intermittent.
Subsurface flow: Unknown. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW:
❑ Directly abutting
® Not directly abutting
® Discrete wetland hydrologic connection. Explain: small swale connects wetland to Stream SB.
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are 25-30 river miles from TNW.
Project waters are 20-25 aerial (straight) miles from TNW.
Flow is from: Wetland to navigable waters.
Estimate approximate location of wetland as within the 2-year or less floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain: Water color is clear, water quality fair to poor.
Identify specific pollutants, if known: Golf Course chemicals/fertilizers.
(iii) Biological Characteristics. Wetland supports (check all that apply):
® Riparian buffer. Characteristics (type, average width):
® Vegetation type/percent cover. Explain:Forested/ 100% cover.
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if an�
All wetland(s) being considered in the cumulative analysis:
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain fmdings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D: Significant nexus exists due to small swale connecting the wetland to the tributary. This will allow for the transfer of
pollutants and/or nutirents downstream .
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
TNWs: linear feet width (ft), Or, acres.
Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
❑ Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial:
® Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section IILB. Provide rationale indicating that tributary flows
seasonally: Tributary has been viewed during times of low or no flow.

Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 886 linear feet 2-3 width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Non-RPWs'that flow directly or indirectly into TNWs.
❑ Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section IILC.
Provide estimates for jurisdictional waters within the review area (check all that apply):
Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
❑ Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section IILD.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.13 and rationale in Section IILD.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
® Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section IILC.
Provide acreage estimates for jurisdictional wetlands in the review area: 0.3 acres.
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
❑ Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section IILC.
Provide estimates for jurisdictional wetlands in the review area: acres.
Impoundments of jurisdictional waters?
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
❑ Demonstrate that impoundment was created from `waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):'"
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
❑ Other factors. Explain:
'See Footnote # 3.
9 To complete the analysis refer to the key in Section III.13.6 of the Instructional Guidebook.
"Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
F. NON -JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
'Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
Other. (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet width (ft).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet, width (ft).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall 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:1:24,000 Waxhaw (2019) Monroe (2019) Quads.
® USDA Natural Resources Conservation Service Soil Survey. Citation:Web Soil Survey (2020).
® National wetlands inventory map(s). Cite nameNWI Wetland Mapper (2020).
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date): .
or ❑ Other (Name & Date): Site photographs.
❑ Previous determination(s). File no. and date of response letter -
El Applicable/supporting case law:
❑ Applicable/supporting scientific literature:
❑ Other information (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD: This form represents Stream SA, Stream SAA and Stream SBB and Wetland WA.

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Union City: Mineral S rings
Center coordinates of site (lat/long in degree decimal format): Lat. 34.941556' i, Long.-80.631866' �.
Universal Transverse Mercator:
Name of nearest waterbody: Richardson Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Rocky River
Name of watershed or Hydrologic Unit Code (HUC): 03040105 Yadkin -Pee Dee
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
❑ Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Pick List "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
❑ Waters subject to the ebb and flow of the tide.
❑ Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Pick List "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply) : '
❑ TNWs, including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
❑ Non-RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non -wetland waters: 519 linear feet: 1-2 width (ft) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: 1987 Delineation Manual
Elevation of established OHWM (if known):
2. Non -regulated waters/wetlands (check if applicable):3
❑ Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
1 Boxes checked below shall be supported by completing the appropriate sections in Section III below.
2 For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
s Supporting documentation is presented in Section III.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non -navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 1417 square miles
Drainage area: 234 square miles
Average annual rainfall: 45 inches
Average annual snowfall: 2 inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
® Tributary flows through 4 tributaries before entering TNW.
Project waters are 25-30 river miles from TNW.
Project waters are 1 (or less) river miles from RPW.
Project waters are 15-20 aerial (straight) miles from TNW.
Project waters are 1 (or less) aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW5: UT to Richardson Creek, Richarson Creek, Rocky River, Yadkin -Pee Dee River.
4 Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
5 Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Tributary stream order, if known:
(b) General Tributary Characteristics (check all that apply):
Tributary is: ® Natural
❑ Artificial (man-made). Explain:
❑ Manipulated (man -altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: 2-3 feet
Average depth: 0.5 feet
Average side slopes: E.
Primary tributary substrate composition (check all that apply):
❑ Silts ® Sands ❑ Concrete
❑ Cobbles ® Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain: relatively stable.
Presence of run/riffle/pool complexes. Explain: features are present.
Tributary geometry: Relatively straight
Tributary gradient (approximate average slope): 0.1 %
(c) Flow:
Tributary provides for: Intermittent but not seasonal flow
Estimate average number of flow events in review area/year: 6-10
Describe flow regime: Intermittent.
Other information on duration and volume:
Surface flow is: Discrete and confined. Characteristics: bed and bank channel.
Subsurface flow: Unknown. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
® Bed and banks
® OHWM6 (check all indicators that apply):
❑ clear, natural line impressed on the bank
®
the presence of litter and debris
❑ changes in the character of soil
❑
destruction of terrestrial vegetation
❑ shelving
❑
the presence of wrack line
❑ vegetation matted down, bent, or absent
®
sediment sorting
® leaf litter disturbed or washed away
❑
scour
® sediment deposition
❑
multiple observed or predicted flow events
❑ water staining
❑
abrupt change in plant community
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
High Tide Line indicated by: &J Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain: water color is clear, water quaky is fair.
Identify specific pollutants, if known:
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OIIWM has been removed by development or agricultural practices). Where there is a break in the OIIWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average width): forested, wide corridor.
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain: .
Wetland quality. Explain:.
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Pick List. Explain: Wetland surface water releases at higher rain events. Wetlands flow into the culvert and
then into the tributary.
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the Pick List floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. ExplainTorested/ 100% cover.
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section IILD:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet width (ft), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
RPWs that flow directly or indirectly into TNWs.
❑ Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial:
® Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally: Stream channel has been reviewed during times of low to no flow.

Provide estimates for jurisdictional waters in the review area (check all that apply):
Tributary waters: 519 linear feet 1-2 width (ft).
Other non -wetland waters: acres.
Identify type(s) of waters:
Non-RPWs1 that flow directly or indirectly into TNWs.
JW Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section IILC.
Provide estimates for jurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
❑ Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
$ Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.13 and rationale in Section IILD.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section IILC.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
❑ Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section IILC.
Provide estimates for jurisdictional wetlands in the review area: acres.
Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
❑ Demonstrate that impoundment was created from "waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
❑ Other factors. Explain:
'See Footnote # 3.
9 To complete the analysis refer to the key in Section IILD.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA ActJurisdiedon FollowingRapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
F. NON -JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
❑ If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
'Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
Other. (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet width (11).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet, width (11).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall 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:1;24,000 Waxhaw (2019) and Monroe (2019) Quads.
® USDA Natural Resources Conservation Service Soil Survey. Citation:Web Soils Survey (2020).
® National wetlands inventory map(s). Cite name:USFWS NWI Wetlands Mapper (2020).
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date): .
or ❑ Other (Name & Date): Site photographs.
❑ Previous determination(s). File no. and date of response letter -
El Applicable/supporting case law:
❑ Applicable/supporting scientific literature:
❑ Other information (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD: This form represents Stream SB.

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Union City: Mineral S rings
Center coordinates of site (lat/long in degree decimal format): Lat. 34.941556' i, Long.-80.631866' �.
Universal Transverse Mercator:
Name of nearest waterbody: Little Twelvemile Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Catawba River
Name of watershed or Hydrologic Unit Code (HUC): 03050103
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
❑ Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Pick List "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
❑ Waters subject to the ebb and flow of the tide.
❑ Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply): 1
❑ TNWs, including territorial seas
❑ Wetlands adjacent to TNWs
❑ Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
® Non-RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
® Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non -wetland waters: 46 linear feet: 1 width (ft) and/or acres.
Wetlands: 0.57 acres.
c. Limits (boundaries) of jurisdiction based on: 1987 Delineation Manual
Elevation of established OHWM (if known):
2. Non -regulated waters/wetlands (check if applicable):3
❑ Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
1 Boxes checked below shall be supported by completing the appropriate sections in Section III below.
z For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
s Supporting documentation is presented in Section III.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non -navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody4 is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 108 square miles
Drainage area: 54 square miles
Average annual rainfall: 45 inches
Average annual snowfall: 2 inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
® Tributary flows through 3 tributaries before entering TNW.
Project waters are 15-20 river miles from TNW.
Project waters are 1 (or less) river miles from RPW.
Project waters are 10-15 aerial (straight) miles from TNW.
Project waters are 1 (or less) aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNWS: UT to Little Twelvemile Creek, Little Twelvemile Creek, Twelvemile Creek, Catawba
River.
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
5 Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Tributary stream order, if known:
(b) General Tributary Characteristics (check all that apply):
Tributary is: ® Natural
❑ Artificial (man-made). Explain:
❑ Manipulated (man -altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: 1 feet
Average depth: 0.25 feet
Average side slopes: M.
Primary tributary substrate composition (check all that apply):
® Silts ® Sands ❑ Concrete
❑ Cobbles ® Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain: relatively stable.
Presence of run/riffle/pool complexes. Explain: Features present.
Tributary geometry: Relatively straight
Tributary gradient (approximate average slope): 0.1 %
(c) Flow:
Tributary provides for: Intermittent but not seasonal flow
Estimate average number of flow events in review area/year: 2-5
Describe flow regime:
Other information on duration and volume:
Surface flow is: Confined. Characteristics: bed and bank.
Subsurface flow: Unknow4. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
® Bed and banks
® OHWM' (check all indicators that apply):
❑ clear, natural line impressed on the bank
❑
the presence of litter and debris
❑ changes in the character of soil
❑
destruction of terrestrial vegetation
❑ shelving
®
the presence of wrack line
❑ vegetation matted down, bent, or absent
®
sediment sorting
® leaf litter disturbed or washed away
❑
scour
❑ sediment deposition
❑
multiple observed or predicted flow events
❑ water staining
❑
abrupt change in plant community
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
d High Tide Line indicated by: ❑ Mean High Water Mark indicated by:
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings/characteristics
❑ tidal gauges
❑ other (list):
(III) Chemical Characteristics:
❑ survey to available datum;
❑ physical markings;
❑ vegetation lines/changes in vegetation types.
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain: water color is clear Quality is fair.
Identify specific pollutants, if known:
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OIIWM has been removed by development or agricultural practices). Where there is a break in the OIIWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
')bid.

(iv) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average width): forested, wide.
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size:0.57 acres
Wetland type. Explain:PFO forested.
Wetland quality. Explain: Fair.
Project wetlands cross or serve as state boundaries. Explain:
tributary.
(b) General Flow Relationship with Non-TNW:
Flow is: Intermittent flow. Explain: Wetland surface water releases at higher rain events. Wetlands flow into the
Surface flow is: Confined
Characteristics:
Subsurface flow: Unknown. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW:
® Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are 15-20 river miles from TNW.
Project waters are 10-15 aerial (straight) miles from TNW.
Flow is from: Wetland to/from navigable waters.
Estimate approximate location of wetland as within the � floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain: water has iron oxidizing bacteria present, quality -fair.
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
® Riparian buffer. Characteristics (type, average width): forested, wide buffer.
® Vegetation type/percent cover. ExplainTorested/ 100% cover.
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D: Wetland above provides surface water to make this an intermittent stream able to carry
pollutants and nutrients downstream.
Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain fmdings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section IILD:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet width (ft), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
❑ Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial:
❑ Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section IILB. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
'Tributary waters: linear feet width (ft).
Other non -wetland waters: acres.
Identify type(s) of waters:
Non-RPWs8 that flow directly or indirectly into TNWs.
® Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section IILC.
Provide estimates for jurisdictional waters within the review area (check all that apply):
Tributary waters: 46 linear feet lwidth (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
❑ Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section IILD.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.13 and rationale in Section IILD.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section IILC.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
® Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section IILC.
Provide estimates for jurisdictional wetlands in the review area: 0.57acres.
Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
❑ Demonstrate that impoundment was created from `waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
❑ Other factors. Explain:
'See Footnote # 3.
9 To complete the analysis refer to the key in Section III.13.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction FollowingRapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
NON -JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
❑ If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
'Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
Other. (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet width (ft).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet, width (ft).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall 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:1:24,000 Waxhaw (2019) Monroe (2019) Quads.
® USDA Natural Resources Conservation Service Soil Survey. Citation:Web Soil Survey (2020).
® National wetlands inventory map(s). Cite name:USFWS NWI Wetland Mapper (2020).
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date): .
or ❑ Other (Name & Date): Site photographs.
❑ Previous determination(s). File no. and date of response letter -
El Applicable/supporting case law:
❑ Applicable/supporting scientific literature:
❑ Other information (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD: This form represents Stream SC and Wetland WD.

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Union City: Mineral S rings
Center coordinates of site (lat/long in degree decimal format): Lat. 34.941556' i, Long.-80.631866' �.
Universal Transverse Mercator:
Name of nearest waterbody: Richardson Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Rocky Creek
Name of watershed or Hydrologic Unit Code (HUC): 03040105
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
❑ Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
❑ Waters subject to the ebb and flow of the tide.
❑ Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Pick List "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply) : '
❑ TNWs, including territorial seas
❑ Wetlands adjacent to TNWs
❑ Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
❑ Non-RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non -wetland waters: linear feet: width (ft) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: Pick List
Elevation of established OHWM (if known):
2. Non -regulated waters/wetlands (check if applicable):3
® Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain: Wetland is isolated.
1 Boxes checked below shall be supported by completing the appropriate sections in Section III below.
z For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
s Supporting documentation is presented in Section III.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non -navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody' is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: Pick List
Drainage area: Pick List
Average annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
❑ Tributary flows through Pick List tributaries before entering TNW.
Project waters are Pick List river miles from TNW.
Project waters are Pick List river miles from RPW.
Project waters are Pick List aerial (straight) miles from TNW.
Project waters are Pick List aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW': .
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
s Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Tributary stream order, if known:
(b) General Tributary Characteristics (check all that apply):
Tributary is: ❑ Natural
❑ Artificial (man-made). Explain:
❑ Manipulated (man -altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: feet
Average depth: feet
Average side slopes: Pick List.
Primary tributary substrate composition (check all that apply):
❑ Silts ❑ Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain:
Presence of run/riffle/pool complexes. Explain:
Tributary geometry: Pick List
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for: Pick List
Estimate average number of flow events in review area/year: Pick List
Describe flow regime:
Other information on duration and volume:
Surface flow is: Pick List. Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
❑ Bed and banks
❑ OHWM' (check all indicators that apply):
❑ clear, natural line impressed on the bank
❑
the presence of litter and debris
❑ changes in the character of soil
❑
destruction of terrestrial vegetation
❑ shelving
❑
the presence of wrack line
❑ vegetation matted down, bent, or absent
❑
sediment sorting
❑ leaf litter disturbed or washed away
❑
scour
❑ sediment deposition
❑
multiple observed or predicted flow events
❑ water staining
❑
abrupt change in plant community
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
High Tide Line indicated by: &J Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OIIWM has been removed by development or agricultural practices). Where there is a break in the OIIWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break-
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
❑ Riparian corridor. Characteristics (type, average width):
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain: .
Wetland quality. Explain:.
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Pick List. Explain: Wetland surface water releases at higher rain events. Wetlands flow into the culvert and
then into the tributary.
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the Pick List floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. ExplainTorested/ 100% cover.
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section IILD:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet width (ft), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
RPWs that flow directly or indirectly into TNWs.
❑ Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial:
❑ Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
11 Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Non-RPWs1 that flow directly or indirectly into TNWs.
JW Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section IILC.
Provide estimates for jurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
❑ Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
$ Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.13 and rationale in Section IILD.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section IILC.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
❑ Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section IILC.
Provide estimates for jurisdictional wetlands in the review area: acres.
Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
❑ Demonstrate that impoundment was created from "waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
❑ Other factors. Explain:
'See Footnote # 3.
9 To complete the analysis refer to the key in Section IILD.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA ActJurisdiedon FollowingRapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
F. NON -JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
® If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
'Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
Other. (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet width (11).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet, width (11).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
® Wetlands:0.19acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall 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:
❑ USDA 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 Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date): .
or ❑ Other (Name & Date): Site photographs.
❑ Previous determination(s). File no. and date of response letter -
El Applicable/supporting case law:
❑ Applicable/supporting scientific literature:
❑ Other information (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD: This for represents potential isolated wetland 'AT.

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Union City: Mineral S rings
Center coordinates of site (lat/long in degree decimal format): Lat. 34.941556' i, Long.-80.631866' �.
Universal Transverse Mercator:
Name of nearest waterbody: Richardson Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Rocky Creek
Name of watershed or Hydrologic Unit Code (HUC): 03040105
® Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
❑ Check if other sites (e.g., offsite mitigation sites, disposal sites, etc...) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
❑ Waters subject to the ebb and flow of the tide.
❑ Waters are presently used, or have been used in the past, or maybe susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Pick List "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply) : '
❑ TNWs, including territorial seas
❑ Wetlands adjacent to TNWs
❑ Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
❑ Non-RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non -wetland waters: linear feet: width (ft) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: Pick List
Elevation of established OHWM (if known):
2. Non -regulated waters/wetlands (check if applicable):3
® Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain: Wetland is isolated.
1 Boxes checked below shall be supported by completing the appropriate sections in Section III below.
z For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least "seasonally"
(e.g., typically 3 months).
s Supporting documentation is presented in Section III.F.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non -navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year-round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year-round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody' is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section III.B.2 for any onsite wetlands, and Section III.B.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: Pick List
Drainage area: Pick List
Average annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
❑ Tributary flows through Pick List tributaries before entering TNW.
Project waters are Pick List river miles from TNW.
Project waters are Pick List river miles from RPW.
Project waters are Pick List aerial (straight) miles from TNW.
Project waters are Pick List aerial (straight) miles from RPW.
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW': .
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
s Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Tributary stream order, if known:
(b) General Tributary Characteristics (check all that apply):
Tributary is: ❑ Natural
❑ Artificial (man-made). Explain:
❑ Manipulated (man -altered). Explain:
Tributary properties with respect to top of bank (estimate):
Average width: feet
Average depth: feet
Average side slopes: Pick List.
Primary tributary substrate composition (check all that apply):
❑ Silts ❑ Sands ❑ Concrete
❑ Cobbles ❑ Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type/% cover:
❑ Other. Explain:
Tributary condition/stability [e.g., highly eroding, sloughing banks]. Explain:
Presence of run/riffle/pool complexes. Explain:
Tributary geometry: Pick List
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for: Pick List
Estimate average number of flow events in review area/year: Pick List
Describe flow regime:
Other information on duration and volume:
Surface flow is: Pick List. Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
❑ Bed and banks
❑ OHWM' (check all indicators that apply):
❑ clear, natural line impressed on the bank
❑
the presence of litter and debris
❑ changes in the character of soil
❑
destruction of terrestrial vegetation
❑ shelving
❑
the presence of wrack line
❑ vegetation matted down, bent, or absent
❑
sediment sorting
❑ leaf litter disturbed or washed away
❑
scour
❑ sediment deposition
❑
multiple observed or predicted flow events
❑ water staining
❑
abrupt change in plant community
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
High Tide Line indicated by: &J Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits (foreshore) ❑ physical markings;
❑ physical markings/characteristics ❑ vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain:
Identify specific pollutants, if known:
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OIIWM has been removed by development or agricultural practices). Where there is a break in the OIIWM that is unrelated to the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break-
'Ibid.

(iv) Biological Characteristics. Channel supports (check all that apply):
❑ Riparian corridor. Characteristics (type, average width):
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain: .
Wetland quality. Explain:.
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non-TNW:
Flow is: Pick List. Explain: Wetland surface water releases at higher rain events. Wetlands flow into the culvert and
then into the tributary.
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non-TNW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial (straight) miles from TNW.
Flow is from: Pick List.
Estimate approximate location of wetland as within the Pick List floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain:
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. ExplainTorested/ 100% cover.
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other environmentally -sensitive species. Explain findings:
❑ Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (Y/N) Size (in acres)
Summarize overall biological, chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands, where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section IILD:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet width (ft), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
RPWs that flow directly or indirectly into TNWs.
❑ Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial:
❑ Tributaries of TNW where tributaries have continuous flow "seasonally" (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
11 Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Non-RPWs1 that flow directly or indirectly into TNWs.
JW Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section IILC.
Provide estimates for jurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
❑ Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW:
$ Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.13 and rationale in Section IILD.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section IILC.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
❑ Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section IILC.
Provide estimates for jurisdictional wetlands in the review area: acres.
Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
❑ Demonstrate that impoundment was created from "waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1-6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
❑ Other factors. Explain:
'See Footnote # 3.
9 To complete the analysis refer to the key in Section IILD.6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA ActJurisdicdon Following Rapanos.

Identify water body and summarize rationale supporting determination:
Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
F. NON -JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
® If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:No natural
connection.
Other. (explain, if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet width (11).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
❑ Non -wetland waters (i.e., rivers, streams): linear feet, width (11).
❑ Lakes/ponds: acres.
❑ Other non -wetland waters: acres. List type of aquatic resource:
® Wetlands:0.69acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall 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:1:24,000 Waxhaw (2019) Monroe (2019) Quads.
® USDA Natural Resources Conservation Service Soil Survey. Citation:Web Soil Survey (2020).
® National wetlands inventory map(s). Cite name:USFWS NWI Wetlands Mapper (2020).
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date): .
or ❑ Other (Name & Date): Site photographs.
❑ Previous determination(s). File no. and date of response letter -
El Applicable/supporting case law:
❑ Applicable/supporting scientific literature:
❑ Other information (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT JD: This for represents potential isolated wetland WC.