R-5759_ADD_PJD Package_01102022 Signed.pdf

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
January 10, 2022
U.S. Army Corps of Engineers
Asheville Regulatory Field Office
ATTN: Lori Beckwith
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
J. ERIC BOYETTE
SECRETARY
SUBJECT: Addendum to the Preliminary Jurisdictional Determination (PJD) Package for the
following North Carolina Department of Transportation Project: STIP No. R-5759:
Widening of NC 115 (Statesville Road) from US 421 to 2nd Street in Wilkesboro, Wilkes
County, North Carolina.
Ms. Beckwith:
The North Carolina Department of Transportation (NCDOT) proposes to widen NC 115 (Statesville
Road) from US 421 to 2nd Street in Wilkesboro, Wilkes County, North Carolina (Appendix A, Figure 1).
A previous PJD (Action ID No. SAW-2019-01602) was issued for the original study area on August 28,
2019. Since then, the study area has been expanded in several areas and additional features were
determined to be within the revised project boundaries. This PJD request is for those features contained
within the study area additions. Below and attached are a brief description of the project, figures
depicting all features, and appropriate forms.
Three Oaks Engineering, Inc. (Three Oaks) staff members Byron Levan and Hayley Wood conducted
the site investigation within the study area additions on August 27, 2021. One potential jurisdictional
wetland, three potential streams, and one potential surface water (ponds, basins, and/or tributaries) were
identified within the study area additions (Tables 1-3; Appendix A, Figures 2-4). All new features are
located on Sheet 4 within Figures 2-4 and their feature names are highlighted in yellow. All features on
Sheets 1 -3 of these figures have already been verified under the original PJD. This project is located in
the Yadkin — Pee Dee River Basin (United States Geological Survey [USGS] Hydrologic Unit Code
[HUC] 03040101).
North Carolina Division of Water Resources (NCDWR) Stream Identification Forms were completed
for potential streams where jurisdictionality was in question. United States Army Corps of Engineers
(USACE) Wetland Determination Forms (wetland and upland) are included for Wetland WG (Appendix
B). Also included are a USACE ORM Data Entry Form; USACE Jurisdictional Request Form; USACE
PJD Form; and a USACE Waters Upload spreadsheet (Appendix Q. Please see the following PJD
Package:
Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Customer Service: 1-877-368-4968 801 STATESVILLE ROAD
DIVISION OF HIGHWAYS — DIVISION 11 NORTH WILKESBORO, NC 28659
Website: www.nedot.gov

Table 1. Potential new jurisdictional streams in the study area
Map
NCDWR
Best Usage
NCSAM
Stream Name
ID
Index
Classification
Classification
Rating
Length
Number
Unnamed Tributary
(UT) to Little Cub
SJ
12-41-1-(2)
C
Intermittent
X1
96
Creek
UT to Little Cub
SK
12-41-1-(2)
C
Intermittent
X
18
Creek
UT to Little Cub
SL-I
12-41-1-(2)
C
Intermittent
X
27
Creek
UT to Little Cub
SL-P
12-41-1-(2)
C
Perennial
X
157
Creek
Total
298
1 — Streams possessing characteristics conducive to them receiving moderate to high mitigation and functional rating values
are represented by an "X".
Table 2. Potential new jurisdictional wetlands in the study area
Map
NCWAM
Hydrologic
NCWAM Rating
Area
ID
Classification
Classification
WG
Headwater Forest
X1
Riparian
0.20
Total
0.20
1- Wetlands exhibiting characteristics conducive to them receiving moderate to high functional rating and mitigation
values are represented by an "X".
Table 3. Potential new surface waters in the study area
Jurisdictional
Ma ID
p
Area
Connection
BB
WG
0.1
Total
0.1

If you have any questions, require additional information, or would like to schedule a site visit, please
contact me at [phone] or by email at kjhininggncdot.gov. Alternatively, you can also contact
James Mason at Three Oaks at either [phone] or james.mason(abthreeoaksenizineering com.
Three Oaks is submitting this request on behalf of NCDOT. This is a request for concurrence with our
assessment. We appreciate your assistance on this project.
Sincerely,
Kevin Hining
Division 11 Environmental Officer
Cc: Dave Wanucha, NCDWR Winston-Salem Regional Office

Appendix A
Figures

Prepared For:
of NONiN �
P 49%
0
OF SapaSe
Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Vicinity Map
Wilkes County, North Carolina
Date: January 2022
Scale: 0 500 1,000 Feet
t
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure

Sheet 1
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Yadkin River SF j
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-------------------------
Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(USGS Topography)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
I � 1
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
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Figure
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Sheet 1 of 4

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R-5759 Addendum Study Area Potential Intermittent Stream Potential Surface Water
L _ Sheet Index Potential Perennial Stream
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- (�,� of NOFiN �49
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LLJ
of It o
Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(USGS Topography)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
I I j
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
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R-5759 Addendum Study Area Potential Intermittent Stream Potential Surface Water
L _ Sheet Index Potential Perennial Stream
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Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(USGS Topography)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
I r I
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure
2
Sheet 3 of 4

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R-5759 Addendum Study Area Potential Intermittent Stream Potential Surface Wa
L _ Sheet Index Potential Perennial Stream
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LLJ
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Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(USGS Topography)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
IIJI
Job No.:
19-601a
[D!rafwBy:
Checked By:
KMS
JM
Figure
2
Sheet 4 of 4

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Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(Aerial Imagery)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
I I I
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
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& Analysis
Figure
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Sheet 1 of 4

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Potential Wetland
Potential Surface Water
Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(Aerial Imagery)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
t I t
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
& Analysis
Figure
3
Sheet 2 of 4

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from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(Aerial Imagery)
Wilkes County, North Carolina
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Wetland
Surface Water
rmation & Analysis
Date: January 2022
Scale: 0 200 400 Feet
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Job No.:
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Checked By:
KMS
JM
Figure
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R-5759 Addendum Study Area Potential Intermittent Stream Potential Surface Water Rd
L _ Sheet Index Potential Perennial Stream rmation &A
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Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(Aerial Imagery)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
t I t
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure
3
Sheet 4 of 4

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R-5759 Addendum Study Area Potential Intermittent Stream Potential Surface Water
L _ Sheet Index Potential Perennial Stream ------------
rmation &Analysis
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- (�,� of NOFiN �49
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Fyr OF Sapaseo�
Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(Aerial Imagery)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 50 100 Feet
I I
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure
3
Sheet 4 of 4
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Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(LOAR)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
t I t
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure
4
Sheet 1 of 4

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of NONiN �
P 49oyv
0
OF SapaSe
Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(LiDAR)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
t I t
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure
4
Sheet 2 of 4

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Low: 929
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Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(LiDAR)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure
4
Sheet 3 of 4

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L _ Sheet Index Potential Perennial Stream �-
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OF Zppa`'eo
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Widening of NC115 (Statesville Rd.)
from US 421 to 2nd Street in
Wilkesboro (STIP No. R-5759)
Jurisdictional Features Map
(LiDAR)
Wilkes County, North Carolina
Date: January 2022
Scale: 0 200 400 Feet
I I I
Job No.:
19-601a
Drawn By:
Checked By:
KMS
JM
Figure
4
Sheet 4 of 4

Appendix B
Stream and Wetland Data Forms

NC DWQ Stream Identification Form Version 4.11
Date: 08/27/2021
Project/Site: R-5759 SJ
Latitude: 36.138689
Evaluator: Byron Levan - Three Oaks
county: Wilkes
Longitude:-81.105106
otal Points:
Stream is at least intermittent 29.25
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other
Name:
if 2: 19 or perennial if z 30
e.g. Quad
A. Geomorphology (Subtotal = 14.5 )
Absent
Weak
Moderate
Strong
la. Continuity of channel bed and bank
0
1
2
2. Sinuosity of channel along thalweg
0
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
3
4. Particle size of stream substrate
0
1
3
5. Active/relict floodplain
0
2_w
3
6. Depositional bars or benches
0
2
3
7. Recent alluvial deposits
0
2
3
8. Headcuts
0
1
2
le
9. Grade control
0
Ne1
T5w
10. Natural valley
1
1.5
11. Second or greater order channel
No =
Yes = 3
artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 8 )
12. Presence of Baseflow
0
2
3
13. Iron oxidizing bacteria
0
2
3
14. Leaf litter
1.5
0.5
0
15. Sediment on plants or debris
0
1
1.5
16. Organic debris lines or piles
0
.5
1
17. Soil -based evidence of high water table?
No = 0
Yes =
C. Biology (Subtotal = 6.75 ) if
18. Fibrous roots in streambed
2
1
0
19. Rooted upland plants in streambed
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0.5
1
1.5
24. Amphibians
0.5
1
1.5
25. Algae
0.5
1
1.5
26. Wetland plants in streambed
FACW = OBL =
1.5 Other = 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
BH: 40-60ft BW: 22ft Depth: 0-1 in. Stream has faced an
incredible amount of erosion.
Sketch:

NC DWQ Stream Identification Form Version 4.11
Date: 08/27/2021
Project/Site: R-5759 SK
Latitude: 36.135658
Evaluator: Byron Levan - Three Oaks
county: Wilkes
Longitude:-81.105543
otal Points:
Stream is at least intermittent 19.25
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other
Name:
if >- 19 or perennial if z 30
e.g. Quad
A. Geomorphology (Subtotal = 12 )
Absent
Weak
Moderate
Strong
la. Continuity of channel bed and bank
0
2
3
2. Sinuosity of channel along thalweg
0
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
2
3
4. Particle size of stream substrate
0
1
3
5. Active/relict floodplain
0
3
6. Depositional bars or benches
0
1
3
7. Recent alluvial deposits
0
3
8. Headcuts
0
2
3
9. Grade control
0
1
1.5
10. Natural valley
0
1
1.5
11. Second or greater order channel
No At
Yes = 3
artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 5.5 )
12. Presence of Baseflow
1
2
3
13. Iron oxidizing bacteria
1
2
3
14. Leaf litter
0.5
0
15. Sediment on plants or debris
0
1
1.5
16. Organic debris lines or piles
0
1.5
17. Soil -based evidence of high water table?
No = 0
Yes =*,,*
C. Biology (Subtotal = L75 ) if
18. Fibrous roots in streambed
3
2
0
19. Rooted upland plants in streambed
3
2
0
20. Macrobenthos (note diversity and abundance)
1
3
21. Aquatic Mollusks
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0.5
1
1.5
24. Amphibians
0.5
1
1.5
25. Algae
0.5
1 1
1.5
26. Wetland plants in streambed
FACW =
OBL = 1.5 Other = 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
BH: 1-3ft BW: 4-8ft Depth: 0-6in
Sketch:

NC DWQ Stream Identification Form Version 4.11
Date: 08/27/2021
Project/site: R-5759 SL-1
Latitude: 36.135573
Evaluator: Byron Levan - Three Oaks
county: Wilkes
Longitude:-81.104996
otal Points:
Stream is at least intermittent 1 g
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other
Name:
if >- 19 or perennial if z 30
e.g. Quad
A. Geomorphology (Subtotal = 12.5 )
Absent
Weak
Moderate
Strong
la. Continuity of channel bed and bank
0
1
2
2. Sinuosity of channel along thalweg
V
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
wIV
0
1
2
4. Particle size of stream substrate
0
1
3
5. Active/relict floodplain
1
3
6. Depositional bars or benches
0
2
3
7. Recent alluvial deposits
0
2
3
8. Headcuts
1
2
3
9. Grade control
wu
0.5
1.5
10. Natural valley
0
0.5
1
11. Second or greater order channel
No =
Yes = 3
artificial ditches are not rated; see discussions in manual T
B. Hydrology (Subtotal = 4.5 )
12. Presence of Baseflow
1
2
3
13. Iron oxidizing bacteria
1
2
3
14. Leaf litter
0.5
0
15. Sediment on plants or debris
1
1.5
16. Organic debris lines or piles
0
1
1.5
17. Soil -based evidence of high water table?
No = 0
Yes At
C. Biology (Subtotal = 2 ) V"qw
18. Fibrous roots in streambed
3
2
0
19. Rooted upland plants in streambed
3
2
0
20. Macrobenthos (note diversity and abundance)
1
3
21. Aquatic Mollusks
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0.5
1
1.5
24. Amphibians
0.5
1
1.5
25. Algae
0.5
1
1
1 1.5
26. Wetland plants in streambed
FACW = 0.75; OBL =
1.5 Other =
"perennial streams may also be identified using other methods. See p. 35 of manual.
IV
IV
Notes:
BH: 2-4ft BW: 3-5ft Depth: 0-3in
Sketch:

NC DWQ Stream Identification Form Version 4.11
Date: 08/27/2021
Project/Site: R-5759 SL-P
Latitude: 36.135622
Evaluator: Byron Levan - Three Oaks
county: Wilkes
Longitude:-81.105298
otal Points:
Stream is at least intermittent 32
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other
Name:
if >- 19 or perennial if z 30
e.g. Quad
A. Geomorphology (Subtotal = 17 )
Absent
Weak
Moderate
Strong
la. Continuity of channel bed and bank
0
1
2
2. Sinuosity of channel along thalweg
0
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
3
4. Particle size of stream substrate
0
1
3
5. Active/relict floodplain
0
2_w
3
6. Depositional bars or benches
0
2
3
7. Recent alluvial deposits
0
2
3
8. Headcuts
0
2
3
9. Grade control
0
1
1.5
10. Natural valley
0
7.57
1
11. Second or greater order channel
No = 0
Yes =
artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 9 )
12. Presence of Baseflow
0
1
2
13. Iron oxidizing bacteria
0
2
3
14. Leaf litter
1.5
0.5
0
15. Sediment on plants or debris
0
1
1.5
16. Organic debris lines or piles
0
1
1.5
17. Soil -based evidence of high water table?
No = 0
Yes At
C. Biology (Subtotal = 6 ) W"'W
18. Fibrous roots in streambed
2
1
0
19. Rooted upland plants in streambed
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0.5
1
1.5
24. Amphibians
0.5
1
1.5
25. Algae
0.5
1
1
1 1.5
26. Wetland plants in streambed
FACW = 0.75; OBL =
1.5 Other =
"perennial streams may also be identified using other methods. See p. 35 of manual.
IV
IV
Notes:
BH: 3-4ft BW: 4-6ft Depth: 0-8in
Sketch:

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: R-5759 NC-115 Improvements City/County: Wilkes Sampling Date: 08/27/2021
Applicant/Owner: NCDOT State: NC Sampling Point: WG-Wet
Investigator(s): Byron Levan & Hayley Wood Section, Township, Range: North Wilkesboro
Landform (hillside, terrace, etc.): Floodplain Local relief (concave, convex, none): concave Slope (%): 3
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.134495 Long:-81.102219 Datum: NAD 83
Soil Map Unit Name: Hatboro loam, 0 to 2 percent slopes, frequently flooded NWI classification: PEM1Ah
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
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:
This area has been modified historically to build a pond. The wetland now functions as a fringe wetland to the pond and stream. While significant
disturbance has historically occurred, vegetation, soil, and hydrology have been relatively stable for quite some time.
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)
x Surface Water (Al) x
True Aquatic Plants (614)
—Sparsely Vegetated Concave Surface (68)
x High Water Table (A2) —Hydrogen
Sulfide Odor (C1)
—Drainage Patterns (1310)
x Saturation (A3) _Oxidized
Rhizospheres on Living Roots (C3)
_Moss Trim Lines (B16)
—Water Marks (131) —Presence
of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
x 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)
x 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 x No
Depth (inches): 5
Water Table Present? Yes X No
Depth (inches): 0
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:
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: WG-Wet
Absolute
Dominant
Indicator
Tree
Stratum (Plot size: 30' radius )
% Cover
Species?
Status
Dominance Test worksheet:
1.
Acer rubrum
15
Yes
FAC
Number of Dominant Species
2.
Liquidambar styraciflua
10
Yes
FAC
That Are OBL, FACW, or FAC: 10 (A)
3.
Platanus occidentalis
10
Yes
FACW
Total Number of Dominant
4.
Acer negundo
5
No
FAC
Species Across All Strata: 11 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 90.9% (A/B)
7.
Prevalence Index worksheet:
40
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
20 20% of total cover:
8
OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 15' radius
)
FACW species x 2 =
1.
Salix nigra
10
Yes
OBL
FAC species x 3 =
2.
Acer negundo
10
Yes
FAC
FACU species x 4 =
3.
Liquidambar styraciflua
10
Yes
FAC
UPL species x 5 =
4.
Alnus serrulata
10
Yes
OBL
Column Totals: (A) (B)
5.
Prevalence Index = B/A =
6.
Hydrophytic Vegetation Indicators:
7.
_ 1 - Rapid Test for Hydrophytic Vegetation
8.
X 2 - Dominance Test is >50%
9.
3 - Prevalence Index is :53.0'
40
=Total Cover
_
4 - Morphological Adaptations' (Provide supporting
50% of total cover:
20 20% of total cover:
8
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5' radius )
_ Problematic Hydrophytic Vegetation' (Explain)
1.
Juncus effusus
35
Yes
FACW
'Indicators of hydric soil and wetland hydrology must be
2.
Carex spp
20
Yes
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3. Typha latifolia 20 Yes OBL
4.
Sparganium americanum
20
Yes
OBL
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 (1
9
m) tall.
10.
Herb - All herbaceous (non -woody) plants, regardless of
11.
size, and woody plants less than 3.28 ft tall.
95
=Total Cover
Woody Vine - All woody vines greater than 3.28 ft in
50% of total cover:
48 20% of total cover:
19
height.
Woody Vine Stratum (Plot size: 30' radius )
1.
Absent
0
2.
3.
4.
5.
Hydrophytic
=Total Cover
Vegetation
50% of total cover:
20% of total cover:
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: WG-Wet
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 Loc Texture Remarks
0-12 10YR 4/1 80 7.5YR 4/6 20 C 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)
—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)
_ 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, 147, 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, 147, 148)
—Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
3Indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches): Hydric Soil Present? Yes X No
Remarks:
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: R-5759 NC-1 15 Improvements City/County: Wilkes Sampling Date: 08/27/2021
Applicant/Owner: NCDOT State: NC Sampling Point: WG-Up
Investigator(s): Byron Levan & Hayley Wood Section, Township, Range: North Wilkesboro
Landform (hillside, terrace, etc.): Floodplain Local relief (concave, convex, none): convex Slope (%): 15
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.134506 Long:-81.102366 Datum: NAD 83
Soil Map Unit Name: Fairview sandy loam, 15 to 25 percent slopes NWI classification: None
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
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:
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 (614)
_Sparsely Vegetated Concave Surface (68)
_ High Water Table (A2) —Hydrogen
Sulfide Odor (C1)
—Drainage Patterns (1310)
_Saturation (A3) _Oxidized
Rhizospheres on Living Roots (C3)
_Moss Trim Lines (B16)
—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: WG-Up
Tree Stratum (Plot size: 30' radius )
1. Acer rubrum
2. Fagus grandifolia
3.
4.
5.
6.
7.
50% of total cover: 20
Sapling/Shrub Stratum (Plot size: 15' radius )
1. Fagus grandifolia
2. Acer rubrum
3.
4.
5.
6.
7.
8.
9.
50% of total cover: 8
Herb Stratum (Plot size: 5' radius )
1. Polystichum acrostichoides
2. Goodyera pubescens
3.
4.
5.
6.
7.
8.
9.
10.
11.
50% of total cover: 8
Woody Vine Stratum (Plot size: 30' radius )
1. Celastrus orbiculatus
2.
3.
4.
5.
Absolute
Dominant
% Cover
Species?
20
Yes
20
Yes
40 =Total Cover
20% of total cover:
idicator
Status
Dominance Test worksheet:
FAC
Number of Dominant Species
FACU
That Are OBL, FACW, or FAC:
2 (A)
Total Number of Dominant
Species Across All Strata:
7 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC:
28.6% (A/B)
Prevalence Index worksheet:
8
10 Yes FACU
15 =Total Cover
20% of total cover: 3
10 Yes FACU
5 Yes FACU
15 =Total Cover
20% of total cover: 3
15 Yes FACU
15 =Total Cover
50% of total cover: 8 20% of total cover:
Remarks: (Include photo numbers here or on a separate sheet.)
3
Total % Cover of: Multiply by:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1 - Rapid Test for Hydrophytic Vegetation
_2 - Dominance Test is >50%
_ 3 - Prevalence Index is :53.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must be
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft (1
m) tall.
Herb - All herbaceous (non -woody) plants, regardless of
size, and woody plants less than 3.28 ft tall.
Woody Vine - All woody vines greater than 3.28 ft in
height.
Hydrophytic
Vegetation
Present? Yes No X
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WG-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 Loc Texture
0-4
10YR 4/4
100
Loamy/Clayey
4-12
10YR 6/6
100
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 (Al2)
_Sandy Mucky Mineral (S1)
—Sandy Gleyed Matrix (S4)
—Sandy Redox (S5)
—Stripped Matrix (S6)
Dark Surface (S7)
_ 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, 147, 148)
Remarks
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, 147, 148)
—Very Shallow Dark Surface (F22)
Other (Explain in Remarks)
3Indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches): Hydric Soil Present? Yes No X
Remarks:
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

Appendix C
ORM Data Entry Form
JD Request Form
PJD Form
ORM Waters Upload Sheet

Preliminary ORM Data Entry Fields for New Actions
SAW - 2019 - 01602 BEGIN DATE [Received Date]:
Prepare file folder ❑ ❑
1. Project Name [PCN Form A2a]: R-5759 Addendum
2. Work Type: Private ❑ Institutional ❑ Government � Commercial
3. Project Description / Purpose [PCN Form 133d and Be]:
Widening of NC 115 (Statesville Road) from US 421 to 2nd Street in Wilkesboro, Wilkes County, North Carolina
4. Property Owner / Applicant [PCN Form A3 or A4]: NCDOT
5. Agent / Consultant [PCN Form A5 — or ORM Consultant ID Number]: James Mason, Three Oaks Engineering
6. Related Action ID Number(s) [PCN Form 135b]: SAW-2019-01602
7. Project Location - Coordinates, Street Address, and/or Location Description [PCN Form 131b]:
36.153164,-81.115521
8. Project Location -Tax Parcel ID [PCN Form 131a]: Multiple PINS
9. Project Location — County [PCN Form A2b]: Wilkes
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Wilkesboro
11. Project Information — Nearest Waterbody [PCN Form 132a]: Yadkin River/Fishing Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03040101
Authorization: Section 10 ❑ Section 404 ❑E Section 10 & 404
Regulatory Action Type:
❑Standard Permit
Nationwide Permit #
❑ Regional General Permit #
0 Jurisdictional Determination Request
❑Pre -Application Request
Unauthorized Activity
0 Compliance
❑ No Permit Required
Revised 20150602

urisdictional Determination Reauest
US Army Corps
of Engineers
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www. saw.usace.army.mil/Missions/RegulatoryPermitProgram/Contact/CountyLocator. aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
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
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
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: Multiple Parcels
City, State:
County:
Wilkesboro, NC
Wilkes
Parcel Index Number(s) (PIN): Multiple P I N's
B. REQUESTOR INFORMATION
Name: Kevin H i n i n
Mailing Address: 801 Statesville Rd
Telephone Number:
Electronic Mail Address
Select one:
North Wilkesboro, NC 28659
[phone]
[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. NCDOT Project
C. PROPERTY OWNER INFORMATION'
Name: Multiple Property Owners
Mailing Address:
Telephone Number:
Electronic Mail Address:
' Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION',4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: ❑ Owner ❑ Authorized Agents
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
❑✓ I intend to construct/develop a 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 construct/develop a projector 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 projector perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑ A Corps JD is required in order obtain my local/state authorization.
❑ I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
❑✓ I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓❑ Size of Property or Review Area 30.4 (211.3) acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude:
Longitude
36.153164
-81.115521
0 A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I Ix17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
■ Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Jurisdiction/
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 Approved Jurisdictional Determination Form'
✓❑ Vicinity Map
✓❑ Aerial Photograph
lv USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCWAM and/or NCWAM Assessment Forms and Rating Sheets
❑✓ NC Division of Water Resources Stream Identification Forms
❑ Other Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/re ug latorregdocs/JD/RGL_08-02_App A Prelim_ JD_ Form_fillable.pdf
' Please see http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD:
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Kevin Hining, 801 Statesville Rd. North Wilkesboro, NC 28659
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: SAW - 2019 - 01602,
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Wilkes City: Wilkesboro
Center coordinates of site (lat/long in degree decimal format):
Lat.: 36.153164 Long.:-81.115521
Universal Transverse Mercator: 17
Name of nearest waterbody: Yadkin River
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non -wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (i.e., Section
404 or Section 10/404)
WG
36.134651
-81.102324
0.20
Pot. Wetland WOOS
404/401
SJ
36.138689
-81.105106
96
Pot. Nan -wetland WOUS - Int Str.
404/401
SK
36.135658
—81.105543
18
Pot. Nan -Wetland WOUS - Int Str.
404/401
S L- 1
36.135573
-81.104996
27
Pot. Nan -wetland WOUS - Int Str.
404/401
SL—P
36.135622
—81.105298
157
Pot. Non-wetlandWOUS- Per.Str.
404/401
BB
36.134968
-81.102282
0.1
Pot. Non -wetland WOUS- Surface Water
404/401

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) for that review area based on an
informed decision after having discussed the various types of JDs and their
characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction notification" (PCN), or requests verification for a non -reporting NWP or
other general permit, and the permit applicant has not requested an AJD for the
activity, the permit applicant is hereby made aware that: (1) the permit applicant has
elected to seek a permit authorization based on a PJD, which does not make an
official determination of jurisdictional aquatic resources; (2) the applicant has the
option to request an AJD before accepting the terms and conditions of the permit
authorization, and that basing a permit authorization on an AJD could possibly result
in less compensatory mitigation being required or different special conditions; (3) the
applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including whatever mitigation requirements the Corps has
determined to be necessary; (5) undertaking any activity in reliance upon the subject
permit authorization without requesting an AJD constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the
review area affected in any way by that activity will be treated as jurisdictional, and
waives any challenge to such jurisdiction in any administrative or judicial compliance
or enforcement action, or in any administrative appeal or in any Federal court; and (7)
whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic
jurisdiction exists over aquatic resources in the review area, or to provide an official
delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD finds
that there "may be" waters of the U.S. and/or that there "may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
❑■ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:Vicinity Map, Project Study Area Map Topo Map, Aerial Map, Lidar Map
❑■ Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
❑■ U.S. Geological Survey map(s). Cite scale & quad name: 2019 Wilkesboro, NC 1:24,000; 2019 Roaring River, NC 1:24,000
❑■ Natural Resources Conservation Service Soil Survey. Citation: 1997 Wilkes County Soil Survey
❑ National wetlands inventory map(s). Cite name:
State/local wetland inventory map(s):
FEMA/FIRM maps:
100-year Floodplain Elevation is:
Photographs: ❑■ Aerial (Name & Date):
or ❑ Other (Name & Date):
.(National Geodetic Vertical Datum of 1929)
NCOneMap Orthoimagery
❑■ Previous determination(s). File no. and date of response letter: SAW-2019-01602, 8/28/19
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Digitally signed by Kevin
Kevin Hining Hining
Date: 2022.01.12
13:03:37-05'00'
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
1 Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

Yatlkln River
BA
NORTH CAROLINA
NORTH CAROLINA
Cow M Cotla
R3UB
muB
BB
NORTH CAROLINA
R3UB
SC
50
NORTH CAROLINA
NORTH CAROLINA
R45B
BF
NORTH CAROLINA
R45B
BG-1
SG-P
NORTH CAROLINA
NORTH CAROLINA
NORTH CAROLINA
—C
R3UB
SH
BI
NORTH CAROLINA
R3UB
MILE
8J
SK
NORTH CAROLINA
NORTH CAROLINA
R45B
R4SB
SL-1
BL-P
NORTHCAROLINA
NORTH CAROLINA
R45B
R3UB
WA
WB
NORTH CAROLINA
NORTH CAROLINA
NORTHCAROLINA
PFO
PFO
WC
WO
NORTH CAROLINA
PFO
PFO
WE
WF
NORTHCAROLINA
NORTH CAROLINA
NORTHCAROLINA
PFO
PFO
WG
BA
BB
NORTH CAROLINA
NORTH CAROLINA
PFO
L1
L1
RNERINE
RNERINE
RIVERINE
RIVERINE
RIVERINE
Ll0ear
Linear
Linear
Linear
Linear
419 FOOT
439 FOOT
712 FOOT
192 FOOT
49 FOOT
PJD404
PJD404
PJD404
PJD404
PJD404
RNERINE
RIVERINE
RIVERINE
RIVERINE
Linear
Linear
Linear
Linear
189 FOOT
49 FOOT
1987 FOOT
1]B FOOT
PJD404
PJD404
PJD404
PJD404
RIVERINE
RIVERINE
RIVERINE
RIVERINE
Linear
Linear
Linear
Linear
252 FOOT
96 FOOT
18 FOOT
27 FOOT
PJD404
PJD404
PJD404
PJD404
RIVERINE
RIVERINE
RIVERINE
RIVERINE
Linear
Area
Area
Area
15] FOOT
0.01 ACRE
0.04 ACRE
O.D6 ACRE
PJD404
PJD404
PJD404
PJD464
RIVERINE
RIVERINE
RIVERINE
RIVERINE
RIVERINE
RIVERINE
Area
Area
Area
Aree
Aree
Area
0.01 ACRE
0.36 ACRE
0.01 ACRE
0.20 ACRE
).02 ACRE
0.1 ACRE
PJD404
PJD404
PJD404
PJD404
PJD464
PJD404
NWPR Determine Cotle
38.18591502
36.1435fi029
36.1423fi385
38.14242014
-81.13445008 Vatlkn River
-81.104]3095 Yatlkie RiverlFiabieg Creak
-81.10309441 Yatlkie RiverlFiabieg Creak
-81.1028]319 Yatlkln RlverlFisbing Creak
36.14230895
36.16.11149
-81.10209055 Vatlki" RivxlFisbi,q Creek
-81.13388504 Vatlkin River
36.15640398
38.18023943
36,1609794
-81.11987667 Yatlkin River
-81.12438I Yadkin River
-81.1240]283 Vatlkin —
36.1fi544221
36.138889
36.135858
36.1355]3
-81.12453003 Vatlkie River
-61.105108 Like Cub Creak
-81.105543 Lika Cub Crcek
-81.104996 Like Cub Creek
36.135fi22
36.14363634
-81.105298 Like Cub Creek
-81.10511301 Vadkin River
36.1435119
36.14355266
-81.103-115 Yadkin River
-01.10312107 Vadkin River
36.1424250]
38.16122052
-01.10302722 Vadkin River
—I N23629 Vadkin River
36.16398856
36.134851
36.16545]91
36.1349fi800
-81.12599944 Vadkin River
-81A02324 Like Cub Creek
-01.13385fi]9 Yatlkin River
-61.10228200 Like Cub Creek