JDForm - SD

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 .11) 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: NC 68 / NC 311 Interchange STIP U -5169 Evaluator: Menton
State:NC County /parish/borough: Guilford City: High Point
Center coordinates of site (lat /long in degree decimal format): Lat. 35.99869° N, Long. 79.98974° W.
Universal Transverse Mercator: 17S 591054 3984275
Name of nearest Nvaterbodv: West Fork Deep River
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Cape Fear River
Name of watershed or Hvdrologic Unit Code (III C): Deep 03030003
®i 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 .11) form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date {s):
SECTION H: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable eaters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined bv_ 33 CFR part 329) in the
review area. [Required]
❑ Waters subject to the ebb and flow of the tide.
Fj Waters are presently used, or have been used in the past, or may susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "eaters 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 waters' (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 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: 151 linear feet: 2.5 av e width (ft) and /or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: Established by OH4VM.
Elevation of established OHWM (if known): Established by RGL 05 -05 guidelines.
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:
Boxes checked below shall be supported by completing the appropriate sections in Section III below.
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).
3 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 HLAA and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections IILA.1 and
and Section IILD.1.; otherwise, see Section IH.B below.
1. TNW
Identifv TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that Nvetland 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 Rupunos 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 IH.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 IILB.1 for
the tributary, Section IILB.2 for any onsite wetlands, and Section IILB.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section IH.0 below.
1. Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 20 square miles
Drainage area: 25 acres
Average amlual rainfall: 42 inches
Average annual snowfall: 10 inches
(ii) Physical Characteristics:
(a) Relationship Nvith TNW:
❑ Tributary flows directl\• into TNW.
® Tributary flows through 4 tributaries before entering TNW.
Project waters are 30 (or more) river miles from TNW.
Project waters are 1 (or less) river miles from RPW.
Project waters are 30 (or more) 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:
Identifv flow route to TNW': UT to West Fork Deep River - West Fork Deep River - Deep River - Cape Fear River.
Tributary stream order, if knoNvn: 1't .
4 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 TNT'.

(b) General Tributary Characteristics (check all that apply):
Tributary is: ❑ Natural
❑ Artificial (man- made). Explain:
® Manipulated (man- altered). Explain: relocated stream channel into roadside ditch.
Tributary properties Nvith respect to top of bard. (estimate):
Average Nvidth: 2.5 feet
Average depth: 1 feet
Average side slopes: 2; 1.
Primar -• tributary substrate composition (check all that apply):
❑ Silts ® Sands ❑ Concrete
® Cobbles ® Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Tv_ pe /% cover:
® Other. Explain: rip -rap.
Tributary conditiou/stability [e.g., highly eroding, sloughing banks]. Explain: chaimel is stable.
Presence of run /riffle /pool complexes. Explain: Nveak.
Tributary geometry: Relatively straight
Tributar gradient (approximate average slope): 0 -2 %
(c) Flow:
Tributary provides for: Seasonal flow
Estimate average number of flow events in review area/year: 20 (or greater)
Describe flow regime: Moderate flow at time of field visit.
Other information on duration and volume:
Surface flow is: Confined. Characteristics:
Subsurface flow: Unknown. Explain findings:
❑ Dve (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 conmlunity
❑ other (list):
❑ Discontinuous OHWM. 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: ❑, Mean High Water Mark indicated bv_ :
❑ oil or scum line along shore objects ❑ sur ev to available datum,
❑ fine shell or debris deposits (foreshore) ❑ physical markings.
❑ physical marki igs /characteristics ❑ vegetation lines /changes in vegetation types.
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
Characterize tributary (e.g., water color is clear, discolored, oily water quality; general watershed characteristics, etc.).
Explain: water color is clear.
Identify specific pollutants, if known:
'A natural or man -made discontinuity in the OHWTvI does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the ( )HWTvI has been removed by development or agricultural practices). Where there is a break in the OHWl\r that is unrelated to the Nvaterbodv'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.

(h) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average Nvidth): Forested, 10 feet.
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other enviromnentall \•- sensitive species. Ex-plain findings:
❑ Aquatic /Nildlife 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 Netlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non -TNW:
Flow is: Pick List. Explain:
Surface flow is: Pick List
Characteristics:
Subsurface flow: Pick List. Explain findings:
❑ Dve (or other) test performed:
(c) Wetland Adjacency Determination with Non -TNW:
❑ Directh• abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological comlection. Explain: .
❑ Separated by berm/barrier. Explain:
(d) Proximity ( Relationship) to TNW
Project wetlands are Pick List river miles fi-om 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 knowir
(iii) Biological Characteristics. Wetland supports (check all that apply):
❑ Riparian buffer. Characteristics (type, average width):
❑ Vegetation type/percent cover. Explain:
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish/spawn areas. Explain findings:
❑ Other enviromnentall \•- sensitive species. Explain findings:
❑ Aquatic /wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary (if any)
All Ni etland(s) being considered in the cumulative analysis Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis.

For each Nvetland, specify the following:
Directiv abuts? (Y/N Size (in acres) Directiv abuts'? (Y/N Size (in acres)
Surrunarize 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 tributarv, in combination Niith 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 Niith its adjacent wetlands (if any), provide habitat and hfecycle 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 tributarv, in combination Niith its adjacent Ni etlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodhvebs"
• 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 III.D:
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 floe- directly or indirectly into TNWs.
❑, Tributaries of TNWs Nihere tributaries typically flow •ear- round are jurisdictional. Provide data and rationale indicating that
tributary is peremnral:
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: Good bed and bank, substrate sorting, and base flow presence. Wrack lines and hydric soils also present.

Provide estimates for jurisdictional Nvaters in the review area (check all that apply):
Zi Tributary waters: 151 linear feet 2.5 ave Nvidth (ft).
Other non - wetland waters: acres.
Identify types) of waters:
3. Non -RPWs" that floe- directly or indirectly into TNWs.
❑, Waterbody that is not a TNW or an RPW, but flows directl\• or indirectly into a TNW, and it has a significant ne�°us with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feet Nvidth (ft).
Other non - wetland waters: acres.
Identify types) of waters:
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑, Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Fj Wetlands directly abutting an RPW where tributaries typically flow year- round. Provide data and rationale
indicating that tributary is peremlial 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 111.13 and rationale in Section III.1).2, above. Provide rationale indicating that wetland is directly_
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
Wetlands that do not dtrecth- abut an RPW, but when considered in combination Niith the tributary to which thev are adjacent
and with similarly situated adjacent Netlands, have a significant ne�°us with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section 11I.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. 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 thev 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 11I.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. 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 ne�°us to conunerce (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:
Fj Other factors. Explain:
Identify water body and summarize rationale supporting determination:
'See Footnote 3.
9 To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.
10 Prior to asserting or declining C«VA 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 CRA Act Jurisdiction Following Rnpnnos.

Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
Other non - wetland waters: acres.
Identit'v tvpe(s) of waters:
❑ Wetlands: acres.
F. NON - JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
Fj 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 "STT: NCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
❑ Waters do not meet the "Signiticant 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 I urisdiction 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 "Signiticant Nex-us" standard, where such
a finding is required for jurisdiction (check all that apply):
❑, Non - wetland waters (i.e., rivers, streams): linear feet, Nvidth (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 Ni ith data sheets /delineation report.
❑ Data sheets prepared by the Corps:
Corps navigable waters' studv:
®� U.S. Geological Survey Hv_ drologic Atlas:
❑ USGS NHL) data.
® USGS 8 and 12 digit HUC maps.
®, U.S. Geological Survevmap(s). Cite scale & quad name: 1:24,000 Guilford.
®i USDA Natural Resources Conservation Service Soil Survey. Citation:Soil Survey for Guilford County, NC.
❑ National wetlands inventory map(s). Cite name:
State/Local wetland inventory_ map(s):
FEMA/FIRM maps:
100 -vear Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
®� Photographs: ® Aerial (Name & Date): 2010 DigitalGlobe.
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Applicable /supporting case law:
❑ Applicable /supporting scientific literature:
Fj Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD: This form represents intermittent SD.