20220206 Ver 1_Wellesley 5 PCN Attachments_20220131

PCN Application Additional Information Package
Name: Wellesley 5
County: Johnston
Date: 1/31/22

Table of Contents
1) Agent Letter
2) Maps
A)Soils
B)Quad
3) Project Drawings
a) Impact Map
b) PUD Master Plan
c) Special Use Permit
d)Crossing Letter From Fire Department
4) Endangered Species
5) SH PO Documents
6) Neuse Buffer Determination Letter
7) PJD Package

December 21, 2021
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Mr. Chris Hopper
Re: Wellesley Phase 5, Johnston County
I, the undersigned, a duly authorized owner of record of the property/properties identified herein, do
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 and issuing a
determination associated with Waters of the U.S. subject to Federal jurisdiction under Section 404 of
the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. The property's PIN is
164600-10-6688.
Also, Mr. Wyatt Brown of Brown's Environmental Group, Inc. has my permission to act as my agent on
this property concerning wetlands and streams.

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Filed in JOHNSTON COUNTY, NC
CRAIG OLIVE, Register of Deeds
Filed 05/25/2018 03:13:20 PM
DEED BOOK: 5155 PAGE: 608-611
INSTRUMENT # 2018572084
Real Estate Excise Tax $0.00
Deputy/Assistant Register of Deeds mmoore
Cover Sheet
for
Special Use Permit
issued to
Wells Brothers, LLC
issued by
Johnston County Planning Department

Johnston County Planning & Zoning Department
309 E. Market Street
Smithfield, NC 27577
[phone]
COUNTY OF JOHNSTON
SPECIAL USE PERMIT
On the date(s) listed below, the Board of County Commissioners for Johnston met and held a public hearing to consider the following
application.
Applicants: Adams and Hodge Engineering, PC (Donnie Adams)
Landowners: Wells Brothers, LLC
Property Location: McLemore (SR 1514), Matthews (SR 1509), and Cleveland (SR 1010) Roads in Cleveland Township
Case #17-09
Parcel I.D. # 06F04023G, 06F04024F, 06F04023I, 06F04034, 061704067J, 06170403613, 061704067H,
06F04028G, 06F04028F, 061704034B, 06F04025I, 06FO4024G
Proposed use of property: To allow for a Planned Development -Housing
Meeting date(s): April and June 2017
Board of Commissioners of Johnston County finds to allow for a Planned Development -Housing
Finding of Facts for the Special Use Permit:
I . That the use or development is located, designed, and proposed to be operated so as to maintain or promote the public health,
safety, and general welfare;
Applicant: Wellesley is located in the very vibrant Cleveland School community and is designed to be a welcoming
haven for homeowners commuting to and from the Triangle area. Designed as a planned development community, a
variety of home styles will appeal to prospective homeowners. A greenway/sidewalk system creates a very pedestrian
friendly community allowing access to any number of parks as well as an amenity area that may include facilities for
swimming, tennis, basketball, and volleyball. Street trees and a 50' perimeter landscape buffer add to the creation of a
development that offers a retreat from the hectic pace of today's homeowner.
2. That the use of the development appears to comply with all required use and intensity regulations of Articles II & IV of the
Johnston County Land Development Code and the applicable specific standards in section 14-257 and with all applicable
regulations;
Applicant: Wellesley has been designed following Johnston County's Land Development Code and will comply with
all County, State, and Federal regulations. Density is as per County standards for the current zoning. Layout of right-
of-ways and lots following County and State guidelines. Utilities, including water, sewer, and storm, will follow
County, State, and Federal requirements as well.
3. That the use or development is located, designed, and proposed to be operated so as to maintain or enhance the value of
contiguous property, or that the use or development is a public necessity; Applicant: Wellesley is designed with adjacent
properties in mind. Pedestrian connections will be made to various adjacent properties to allow the community use of
the greenway/sidewalk system as well as the parks. The variety of home sites, sizes, and styles add diversity to the
community that will help enhanee/add to the property values. The main amenity area will have a pool that will allow
for swim competitions as well as rental facilities that will be available to the local community. Street trees and
landscape buffers that exceed County standards will add to the rural flavor of the local community.
4. That the use or development conforms with general plans for the physical development of the County's Planning jurisdiction,
the Design Manual, or other development policies as adopted by the Board of Contjnissioners.
Applicant: Wellesley conforms with the County's 2030 comprehensive plan in that it is located in an area that is noted
as a primary growth area containing regional, community, and neighborhood centers. This location calls for
residential development that includes a variety of housing types, open spaces, residential amenities, and a blending
with the rural flavor of the area. All aspects of the County's planning jurisdiction, strategic plan, and land
development code have been consulted and considered in the design of the planned development. Specific Land Uses:
APPLICANT: To allow for a Planned Development - Housing.

Special Use Conditions:
1. Permitted Uses: Planned Development - Housing
2. The Special Use Permit may be revoked with the violation of any Special Use Condition.
3. Limited to development of 243 single family detached dwellings.
4. This development shall meet the requirements of LDC CH 14 Art. 3 Div. 5 and DM Sec 7 (H)
5. Setbacks shall be:
a. 50' from adjacent perimeter parcels and roadways,
b. Internal development setbacks are: 20' front street, 12' side street, 5'side, 10' rear.
6. Provide Complete floodplain information
7. Provide Metes & bounds
8. Provide certifications in accordance with DM Sec 7 (L)
9. Provide entrance sign & street signs
10. Street name approval required
11. All lots shall access internal streets
12. Cul-de-sac lots shall have 20' minimum road frontage
13. Complete improvements or provide performance guarantee
14. Limited to the recordation of 200 lots until a second full service access is constructed
15. Stubout Street extension signage in accordance with LDC Sec. 14-75 (d) (3)
16. TIA Recommendations:
a. Cleveland Rd and Matthews Rd
i. A new traffic signal shall be required per NCDOT. New signal timings shall be coordinated with nearby signal at
SR 1514 (McLemore Road) via interconnected signal system; revisions required to the existing signal at SR 1514
shall be included with the signal integration and installation required by the TIA review.
b. Cleveland Rd and Site Drive # I
i. EB Cleveland Rd
1. Restripe existing thru-lane to right/thru lane
2. Add right -turn taper.
ii. WB Cleveland Rd
1. Left turn lane with a minimum 100' storage
iii. Northbound Site Drive #
I. Two-lane cross-section: one ingress, one egresses
2. 100' internal protected stern
c. Matthews Rd and Site Drive # 2/3
i. NB Matthews Rd
1. Left turn lane with a minimum 100' storage
ii. SB Matthews Rd
1. Left turn lane with a minimum 100' storage
iii. EB Site Drive #3
1. Two-lane cross-section: one ingress, one egresses
2. 100' internal protected stem
iv. WB Site Drive #2
I. Two-lane cross-section: one ingress, one egresses
2. 100' internal protected stem
d. McLemore Rd and West Wellesley/Site Drive #4
i. NB McLemore Rd
1. Left turn lane with a minimum 100' storage (to West Wellesley Drive)
ii. SB McLemore Rd
I. Left turn lane with a minimum 100' storage
iii. WB Site Drive #4
1. Two-lane cross-section: one ingress, one egresses
2. 100' internal protected stem
17. Provide final plat Street Disclosure Statement Certificate for street maintenance (DM Sec 7 (L) item 8)
18. Provide perimeter buffer in accordance with LDC See. 14-257(k)
19. Provide utility easements along all lot lines in accordance with LDC Sec. 14-75 (d) (3)
20. Coordinate with the US Postal Service for the design of and utilization of cluster box mail receptacle units:
a. CBU shall not impede the flow of traffic.
b. CBU shall not obstruct the operation and maintenance of utility services.
21. A driveway permit and subdivision design approval must be obtained prior to construction
22. All design aspects of the plans shall comply with the current NCDOT Standard Specifications for Roads and Structures,
NCDOT Subdivision Roads Minimuln Construction Standards, and Policy on Street and Driveway Access to North Carolina
Highways - ... _..__ .,_.-----
23. It will be determined at the time the driveway permit application is submitted if any road improvements will be required

LY. JVII L-JUMUu u- 0. ,U1ulculauvu \.unuVl riau Icyuucu
25. Stonnwater Compliance
26. Approval of water and sewer system
27. Reserve additional 10' of right of way along Cleveland Road.
*Changes in bold recommended by Planning Board
Gross Land Area: 162.4 acres
NOW, THEREFORE, BE IT RESOLVED by the Board of Commissioners of Johnston County that the Board of Commissioners
hereby approves
This the 24" day of May, 2018
County of Johnston By: Matthew K rkland, Interim Director of Planning
NORTH CAROLINA, JOHNSTON COUNTY
1, Stephanie Jill Richter, a Notary Public in and for said State and County, do hereby certify that
Matthew Kirkland (Interim Director of Planning), personally appeared before me this day and acknowledged the due execution of the
foregoing instrument.
WITNESS my, s&, �rAb•ial seal, this the day of 20Ln
.
a% ey
(SEAL) �.' l� )Ta9�-a•: �, K(:Tdw--,
Notary Publi
yBLIG ;'�V: commission expires:
y_n•.
Owners:
[is Brothers, LLC
NORTH CAROLINA, -JG�NLyjA�j COUNTY
I, ;5u,1xc +i r1At1°NiZ�I9A111 , a Notary Public in and for said State and County, do hereby certify that
_ 4WID IL We'1 S (Owners of Property), personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
WITNESS my hand and notarial seal, this the Z4& day of spy 20M.
z <,; -Ile.Notal'\' a �liC CE .3 04#Yt P#j I
�. PAy Comm. L"\,a.
�j My commission expires: I ,Z o P
(Not valid until fully executed and recorded)
NORTH CAROLINA - JOHNSTON COUNTY
The foregoing certificate/s of
Notary Publi"otaries Public is/are certified to be correct.
Filed for registration and recorded in the office in Book Page
This day of , 20 at o'clock M.
By
Register of Deeds Asst./Deputy Register of Deeds
Recorded in Ordinance Book , Page

Cleveland Fire Department
9039 Cleveland Road
Clayton, NC 27520
Emergency Phone: 911
Business Phone: [phone]
Fax: [phone]
January 21,2022
To whom it may concern,
I have been asked to give my opinion concerning the interconnectivity of the phases 4-6 of the
Wellesley Subdivision. In my professional opinion having access to all phases from Cleveland Rd or
Matthews Rd via the proposed stream crossing is extremely important for the safety of the residence.
This will allow for emergency vehicles to enter the subdivision and gain access to the residents should
an emergency block one of the access points. In the need of an evacuation the connectivity to a second
entrance could be the difference in effectively and safely making this happen. Should you require and
further information from me concerning the impact of the number access points to this development
please feel free to contact me.
Chris Ellington
Fire Chief
Cleveland Fire Department
9039 Cleveland Rd
Clayton NC 27520
919 989 1909 (Office)
919 291 3829 (Cell)

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Roy Cooper, Governor
■ ■■■
■■ ■ INC DEPARTMENT OF
■■�■i NATURAL AND CULTURAL RESOURCES
■ ■■
January 11, 2022
wyatt brown
Brown's Environmental Group, inc
242 Batten Farm Road
Selma, NC 27576
RE: Wellesley S/D 5
Dear wyatt brown:
❑. Reid Wilson, Secretary
Misty Buchanan
Deputy Director, Natural Heritage Program
The North Carolina Natural Heritage Program (NCNHP) appreciates the opportunity to provide
information about natural heritage resources for the project referenced above.
Based on the project area mapped with your request, a query of the NCNHP database indicates that
there are no records for rare species, important natural communities, natural areas, and/or
conservation/managed areas within the proposed project boundary. Please note that although there
may be no documentation of natural heritage elements within the project boundary, it does not
imply or confirm their absence; the area may not have been surveyed. The results of this query
should not be substituted for field surveys where suitable habitat exists. In the event that rare
species are found within the project area, please contact the NCNHP so that we may update our
records.
The attached `Potential Occurrences' table summarizes rare species and natural communities that
have been documented within a one -mile radius of the property boundary. The proximity of these
records suggests that these natural heritage elements may potentially be present in the project area
if suitable habitat exists. Tables of natural areas and conservation/managed areas within a one -mile
radius of the project area, if any, are also included in this report.
If a Federally -listed species is found within the project area or is indicated within a one -mile radius of
the project area, the NCNHP recommends contacting the US Fish and Wildlife Service (USFWS) for
guidance. Contact information for USFWS offices in North Carolina is found here:
httr)s://www.fws.gov/offices/Directory/ListOffices.cfm?statecode=37.
Please note that natural heritage element data are maintained for the purposes of conservation
planning, project review, and scientific research, and are not intended for use as the primary criteria
for regulatory decisions. Information provided by the NCNHP database may not be published
without prior written notification to the NCNHP, and the NCNHP must be credited as an information
source in these publications. Maps of NCNHP data may not be redistributed without permission.
The NC Natural Heritage Program may follow this letter with additional correspondence if a
Dedicated Nature Preserve, Registered Heritage Area, Land and Water Fund easement, or Federally -
listed species are documented near the project area.
If you have questions regarding the information provided in this letter or need additional assistance,
please contact Rodney A. Butler at rod ney.butler�ncdcr.gov or 919-707-8603.
Sincerely,
NC Natural Heritage Program
DEPAR7HEN7 OF NATURAL AND CULTURAL RESOURCES
121 W. JONES STREET. RALEIGH. NC 27603 • 1691 MAIL SERVICE CENTER. RALEIGH. NC 27609
OFC 919.707.9120 • FAX [phone]

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DEPARTMENT OF PUBLIC UTILITIES
POST OFFICE SOX 2263
SMITHFIELD, N.C. 27577
[phone]
April 7, 2020
David Rudolph Wells
223 George Wilton Dr.
Clayton, NC 27520
Subject: Neuse River Buffer Call
NBR# NB 20-008
Project Name: Wellesley (NC Pin# 164600-10-6688, 164500-19-6597, 164500-19-8987)
Location / Directions: Cleveland Rd. and Matthews Rd. behind Oakland Church.
Subject Stream: F-A Cow Branch (C; NSW)
Pond -A part of Cow Branch (C; NSW)
fond-B part of Cow Branch (C; NSW)
Determination Date: April 3, 2020 Staff: Charles Pender
Not.
�
Feature
Subject
Sub't�.
Sol{
Tbpo
.r
s
F-A
❑
®
Throughout.
n/a
®
®
35.33973
-78.31567
Throughout
Pond-
❑
n/a
®
❑
35,56446
-78.52346
A
Pond
B
❑
®
Throughout
n)a
®
®
35.56339
-78-52126
*EIIIP = Ephemeral /Interrrrittent/Perennial
Explanation: The feature(s) listed above that are checked "Subject" to the Johnston County Neuse Riparian
Buffer Ordinance (Section 14-393 Johnston County Code of Ordinances) has or have been approximately shown
on either the Soil Survey of Johnston County, North Carolina (1994) or the most recent version of the 1:24,000
Printed on recycled paper l**

(7.5 minute) quadrangle topographic maps prepared by the United States Geologic Survey (USGS), and have
been located on the property and possess characteristics that qualify it to be a stream. Each feature that is checked
"Not Subject" has been determined not to be a stream or is not present on the property. There may be other
streams located on your property that do not show up on the maps referenced above but still may be considered
jurisdictional according to the US Army Corps of Engineers and/or the North Carolina Division of Water
Resources.
This on -site determination shall expire five (5) years from the date of this letter. Landowners or affected
parties that dispute a determination made by Johnston County may request a determination by the
Director of the Division of Water Resources c/o the 401 and Buffer Permitting Unit, or its successor. An
appeal request must be made within sixty (60) days of the date of this letter or from the date the affected
party (including downstream and/or adjacent owners) is notified of this letter. A request for a
determination by the Director must be submitted in writing with a copy of this letter to:
North Carolina Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
This determination is final and binding unless, as detailed above, a request for an appeal has been made in
writing within sixty (60) days.
The owner/future owners should notify the Division of Water Resources (including any Local, State, and
Federal Agencies) of this decision concerning any future correspondences regarding the subject property
(stated above). This project may require a Section 404/401 Permit for the proposed activity. Any inquiries
should be directed to the US Army Corps of Engineers Raleigh Regulatory Field Office at [phone]
and the Division of Water Resources 401 & Suffer Permitting Unit at [phone].
If you have any questions regarding this determination, please feel free to contact Charles Pender at (919) 209-
8333 or via email at [e-mail].
Sincerely,
Charles Fender, Jr.
Engineering and Environmental Technician

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/Regulatoi yPermitPro2ram/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: not assigned
City, State:
County:
Johnston
Parcel Index Number(s) (PIN): 164600-10-6688
B. REQUESTOR INFORMATION
Name: Wyatt Brown Brown's Environmental C-d
Mailing Address: 242 Batten Farm Road
Telephone Number:
Electronic Mail Address:
Select one:
✓❑
Selma, NC 27576
919-524-5956
[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 INFORMATION
Name: WELLS BROTHERS LLC
Mailing Address: 223 GEORGE WILTON DR
CLAYTON, NC 27520-7081
Telephone Number: 919-763-2566 (Davis Wells)
Electronic Mail Address: [e-mail]
' 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.
See attached letter
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:
3 For NCDOT requests following the current NCDOT/USACE 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.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERNIINATION (JD) TYPE (Select One)
❑✓ I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓❑ Size of Property or Review Area —27.0 acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
0✓ Project Coordinates (Decimal Degrees): Latitude: 35.565423
Longitude:-78.52296
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 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. hl!p://www.saw.usace.army.mil/Missions/Repulatory-Permit-
Pro uam/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
F4Completed 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
F4 USGS Topographic Map
0 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)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
�J Other Assessment Forms
' www.saw.usace.gM.niil/Portals/59/docs/reaWatoa/relzdocs/JD/RGL 08-02 App A Prelim JD Form fillable.pdf
8 Please seehlt2://www.saw.usace.army.niil/Missions/Re ulatory-Permit-Proaram/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

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Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: ,June 2020
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: David Wells 223 george Wilton Dr. Clayton 27520
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Johnston City: Clayton
Center coordinates of site (lat/long in degree decimal format):
Lat.::3S, 5-4 3.3 Lang. 78. 5214
Universal Transverse Mercator:
Name of nearest waterbody: Middle Creek
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
Longitude
(decimal
Estimated amount
of aquatic resource
Type of aquatic
resource (i.e., wetland
Geographic authority
to which the aquatic
degrees)
degrees)
in review area
(acreage and linear
vs. non -wetland
waters)
resource "may be"
subject (i.e., Section
feet, if applicable)
404 or Section 101404)
79.�4-R-C
.053 ac.
wetland
404
2
33-
-1r�°
790 ft.
stream
404
3
35,5� J
79#sPi­
.017 ac.
wetland
404
4
2.20 ac.
pond
404
5
35,,sij °
79, b7d
2.17 ac.
pond
404
6
35-,.Z
78. Y20
85 ft.
stream
404

1)
2)
The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requester 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.
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:
I Maps, plans, plots or plat submitted by or on behalf of the PJD requester:
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:
Edmonson
0 Natural Resources Conservation Service Soil Survey. Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
❑■ Photographs: ❑ Aerial (Name & Date): Johnston County 2017
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later iurisdic#ional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
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.

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: June 2020
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: David Wells 223 george Wilton Dr. Clayton 27520
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Johnston City: Clayton
Center coordinates of site (lat/long in degree decimal format):
Lat.: 35 33.8 Long.: 78 31.3
Universal Transverse Mercator:
Name of nearest waterbody: Middle Creek
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
Longitude
(decimal
Estimated amount
of aquatic resource
Type of aquatic
resource (i.e., wetland
Geographic authority
to which the aquatic
degrees)
degrees)
in review area
(acreage and linear
vs. non -wetland
waters)
resource "may be"
subject (i.e., Section
feet, if applicable)
404 or Section 10/404)
1
3533.9
78 31.4
.053 ac.
wetland
404
2
3533.8
7831.3
790 ft.
stream
404
3
3533.8
7831.3
.017 ac.
wetland
404
4
3533,8
7831.3
2.20 ac.
pond
404
5
35 33.7
78 31.2
2.17 ac.
pond
404
6
35 33.8
78 31.2
85 ft.
stream
404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requester 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 `maybe"waters of the U.S. and/or that there `may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:
❑ Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
❑■ U.S. Geological Survey map(s). Cite scale & quad name:
Edmonson
❑o Natural Resources Conservation Service Soil Survey. Citation. -
National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMAIFIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
Photographs: ❑ Aerial (Name & Date): Johnston County 2017
or ❑ Other (Name & Date).
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified bV the Corps and should not be relied upon for later 'urisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
1AZ4111a,v n _�_
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
I 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.

DI
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V5&5
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Print Form
WETLAND DETERMINATION DATA FORM —Atlantic and Gulf Coastal Main Region
Project/Site: Wellsley Subdivision Section IV
Applicant[Owner: David Wells
Investigat0r(s): Daniel J. Bliley
Landform (hillslope, terrace, etc.): Ditch bottom
Subregion (LRR or MLRA):
Soil Map unit Name: Rains Sandy Loam
City/County: Johnston
Section, Township, Range:
Sampling Date: 03/15/2020
State: NC Sampling Point:
Local relief (concave, convex, none): concave
Lat: 35 33.8 Long: 7831.3
Are climatic 1 hydrologic conditions on the site typical for this time of year? Yes _
Are Vegetation El, Soil ®, or Hydrology ® significantly disturbed?
Are Vegetation 0, Soil El, or Hydrology naturally problematic?
Slope (%): '1 %
Datum:
NWI classification:
No ® (If no, explain in Remarks.)
Are "Normal Circumstances" present? Yes _
(If needed, explain any answers in Remarks.)
© No 0
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophyt o Vegetation Present? Yes ® No Q Is the Sampled Area
Hydric Soil Present? Yes ® No El
Wetland Hydrology Present? Yes ® No iF1 within a Wetland? Yes © No 0
Remarks:
wetlands are induced by construction of drainage ditches
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators minimum of two required
Primary Indicators minimum of one is required: check all that apply)
11 Surface Soil Cracks (136)
Q� Surface Water (Al)
_11 Water -Stained Leaves (Bg)
® Sparsely Vegetated Concave Surface (B8)
E1 High Water Table (A2)
© Aquatic Fauna (1313)
® Drainage Patterns (1310)
0 Saturation (A3)
Marl Deposits (1315) (LRR U)
�_ Moss Trim Lines (B16)
Water Marks (131)
Sediment Deposits
Hydrogen Sulfide Odor (C1)
Dry -Season Water Table (C2)
(132)
Drift Deposits (133)
Oxidized Rhizospheres on Living Roots (C3)
Presence of Reduced Iron (C4)
Crayfish Burrows (C8)
Saturation Visible
Algal Mat Crust
on Aerial Imagery (C9)
El
or (134)
Iron Deposits (B5)
_ Recent Iron Reduction in Tilled Soils (C6)
Thin Muck Surface (C7)
Geomorphic Position (D2)
Shallow
© Inundation Visible on Aerial Imagery (137)
Other (Explain in Remarks)
Aquitard (D3)
FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes ® No
Depth (inches): 0 - 2
Water Table Present? Yes ® No
® Depth (inches): 0 _ 6
Saturation Present? Yes No
includes capilla fringe)
Depth (inches): 0 -g
Wetland Hydrology Present? Yes ® No
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Interim Version

VEGETATION - Use scientific names of plants.
Sampling Point:
Absolute Dominant Indicator
Dominance Test worksheet:
Tree Stratum (Plot size: )
% Cover Species? Status
Number of Dominant Species
1
0
That Are OBL, FACW, or FAC: (A)
2.
0
3.
Total Number of Dominant
Species Across All Strata: (B)
4.
5
El
of Dominant Species
That
That Are OBL, FACW, or FAC: (AIB)
6.
©
7.
El
Prevalence Index worksheet:
= Total Cover
Total % Cover of: Multiply by:
Sapling Stratum (Plot size: )
OBL species x 1
1. Salix nigra
0 obl
FACW species x 2 -
2.
©
FAC species x 3 --
3.
13
FACU species x 4 =
4.
©
UPL species x 5 =
5.
®
Column Totals: (A) (B)
6.
0
7.
®
Prevalence Index = B/A =
= Total Cover
Hydrophytic Vegetation Indicators:
Shrub Stratum (Plot size: }
_ Dominance Testis >50%
1.
©
_ Prevalence Index is <_3.0'
2.
0
_ Problematic Hydrophytic Vegetation' (Explain)
3.
4.
'Indicators of hydric soil and wetland hydrology must
5.
be present, unless disturbed or problematic.
6•
11
Definitions of Vegetation Strata:
7.
El
Tree -- Woody plants, excluding woody vines,
Herb Stratum (Plot size: }
= Total Cover
approximately 20 ft (6 m) or more in height and 3 in.
(7.6 cm) or larger in diameter at breast height (DBH).
1. Juncus effuses
® facw
2. Carex ampFtibola
� facw
Sapling -Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and less
3.
El
than 3 in. (7.6 cm) DBH.
4
El
5,
Shrub - Woody plants, excluding woody vines,
approximately 3 to 20 ft (1 to 6 m) in height.
6
©
7.
Herb -All herbaceous (non -woody) plants, including
herbaceous vines, regardless of size. Includes woody
8.
ED
plants, except woody vines, less than approximately
9.
3 ft (1 m) in height.
10.
-
Woody vine - All woody vines, regardless of height.
11.
Q
12.
= Total Cover
Woody Vine Stratum (Plot size: }
1.
2.
Q
3.
Q
4.
11
5
ri
Hydrophytic
Vegetation
- Total Cover
Present? Yes ® No El
Remarks: (If observed, list morphological adaptations below)
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Interim Version

SOIL
Proflle Description: (Describe to the depth needed to document the indicator or
Sampling Point:
indicators.)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Lac Texture Remarks
0-2 10Yr4/2 sl
2 - 24
10YR 6/2
10YR 614
30 C m
scl
24 - 48
10Yr 7/2
1 CYR 5/6
40 C m
Sc
'Type: C=Concentration, D=De letion, RM=Reduced Matrix, CS=Covered or Coated Sand Grains. zLocation: PL=Pore Lining, M=Matrix_
H
dric Soil Indicators:
Histosol (Al)
OPolyvalue Below
Indicators for Problematic Hydric Soils3:
Histic Epipedon (A2)
Surface (S8) (LRR S, T, U)
Dark Surface (S9) (LRR S, T, U)
1 cm Muck (A9) (LRR O)
2 Muck 0)
Black Histic (A3)
_QThin
MLoamy Mucky Mineral (F1) (LRR O)
cm (Al (LRR S)
Reduced Vertic (F18) (outside MLRA 150A,B)
Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
Piedmont Floodplain Soils (F19) (LRR P, S, T)
Stratified Layers (A5)
Organic Bodies
Matrix (F3)
Redox
Anomalous Bright Loamy Soils (F20)
(A6) (LRR P, T, U)
5
L_1Redox
Dark Surface (F6)
(MLRA 153B)
®
cm Mucky Mineral (A7) (LRR P, T, U)
Depleted Dark Surface (F7)
Red Parent Material (TF2)
®_
Muck Presence (A8) (LRR U)
1 cm Muck P, T)
=Redox Depressions (F8)
Marl
Very Shallow Dark Surface (TF12) (LRR T, U)
El
(A9) (LRR
Depleted Below Dark Surface (A11)
(F10) (LRR U)
Depleted Ochric 151)
Other (Explain in Remarks)
Q
Thick Dark Surface (Al2)
(F11) (MLRA
Iron -Manganese Masses (F12) (LRR 0, P, T)
31ndicators of hydrophytic vegetation and
®.
F
Coast Prairie Redox (A16) (MLRA 150A)
Sandy Mucky Mineral (S1) (LRR D, S)
Umbric Surface (F13) (LRR P, T, U)
Delta Ochric (F17) (MLRA 151)
wetland hydrology must be present,
unless disturbed or problematic.
Sandy Gleyed Matrix (S4)
OReduced Vertic (1718) (MLRA 150A, 1508)
Sandy Redox (S5)
Piedmont Floodplain Soils (F19) (MLRA 149A)
Stripped Matrix (S6)
E Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153G, 153D)
r Dark Surface (S7) (LRR P, S, T, U)
Restrictive Layer (if observed):
Type:
Depth (inches):
soil profile in ditch bottom.
Hydric Soil Present? Yes 0 No El
US Amry Corps of Engineers Atlantic and Gulf Coastal Plain Region — Interim Version

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW -
Prepare file folder ❑
1. Project Name [PCN Form A2a]: Wellesley 5
Begin Date (Date Received):
Assign Action ID Number in ORM ❑
2. Work Type: ❑✓ Private ❑Institutional ❑Government ❑ Commercial
3. Project Description / Purpose [PCN Form 133d and 133e]:
-27 acre residential tract for an individual home -site S/D..
4. Property Owner / Applicant [PCN Form A3 or A41: WELLS BROTHERS LLC
5. Agent / Consultant [PNC Form A5 - or ORM Consultant ID Number]:
Wyatt Brown, Brown's Environmental Group, Inc
6. Related Action ID Number(s) [PCN Form 135b]:
7. Project Location- Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
35.56543,-78.52296 , located om Cleveland Road, Clayton NC
8. Project Location -Tax Parcel ID [PCN Form Bla]: 164600-10-6688
9. Project Location- County [PCN Form A2b]: Johnston
10. Project Location - Nearest Municipality or Town [PCN Form A2c]: Clayton
11. Project Information -Nearest Waterbody [PCN Form 132a]: UT to Middle Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03020201, Neuse
Authorization: Section 10 ❑ Section 404 ❑✓
Regulatory Action Type:
❑ Standard Permit
Nationwide Permit #
Regional General Permit #
Jurisdictional Determination Request
Section 10 and 404 ❑
❑ Pre -Application Request
❑ Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

December 21, 2021
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Mr. Chris Hopper
Re: Wellesley Phase 5, Johnston County
I, the undersigned, a duly authorized owner of record of the property/properties identified herein, do
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 and issuing a
determination associated with Waters of the U.S. subject to Federal jurisdiction under Section 404 of
the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. The property's PIN is
164600-10-6688.
Also, Mr. Wyatt Brown of Brown's Environmental Group, Inc. has my permission to act as my agent on
this property concerning wetlands and streams.