20220750 Ver 1_401 Application_20220526

Staff Review Form
NORTH CAROLINA
Envlronm¢ntcl Qvofiry
Updated September 4, 2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID#*
20220750
Version* 1
Is this project a public transportation project?*
Reviewer List:*
Select Reviewing Office: *
Submittal Type:*
Yes
• No
Colleen Cohn:eads\cmcohn
Raleigh Regional Office - [phone]
401 Application
Does this project require a request for payment to be sent?*
Yes
No
How much is owed?* $240.00
$570.00

Project Submittal Form
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Type: *
For the Record Only (Courtesy Copy)
New Project
Modification/New Project with Existing ID
More Information Response
Other Agency Comments
Pre -Application Submittal
Re-Issuance\Renewal Request
Stream or Buffer Appeal
Pre -Filing Meeting Date Request was submitted on:
4/25/2022
Project Contact Information
Name:
Ward Marotti
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: White Cross Rd./Boulder Creek Trail
Is this a public transportation project?
Yes
No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
County (ies)
Chatham
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Pre Construction Notification Form-
20.61 MB
WhiteCrossRd.red.pdf
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
PCN
Sign and Submit
By checking the box and signing box below, I certify that:
• I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief.

• I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
• I agree that submission of this online form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a
written signature; AND
• I intend to electronically sign and submit the online form.
Signature:
Submittal Date: Is filled in automatically.

o`1�F W a rq
I 1 T.
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1 c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑ No
For the record only for Corps Permit:
❑ Yes ❑ No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes ❑ No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below.
❑ Yes ❑X No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a.
Name of project:
White Cross Rd.
2b.
County:
Chatham
2c.
Nearest municipality / town:
Chapel Hill
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Scott Teagarden & Alejandro Lizardo
3b.
Deed Book and Page No.
2173/0269
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
227 Stagecoach Rd.
3e.
City, state, zip:
Chapel Hill, NC 27514
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑X Agent ❑ Other, specify:
4b.
Name:
4c.
Business name
(if applicable):
4d.
Street address:
4e.
City, state, zip:
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Lisa Long for Ward Marotti
5b.
Business name
(if applicable):
Spangler Environmental
5c.
Street address:
4338 Bland Rd.
5d.
City, state, zip:
Raleigh, NC 27609
5e.
Telephone no.:
919-875-4288
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
77097
1b.
Site coordinates (in decimal degrees):
Latitude: 35.867687 Longitude:-79.199777
1 c.
Property size:
13.95 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
Terrells Creek
2b.
Water Quality Classification of nearest receiving water:
WS-IV; NSW
2c.
River basin:
Cape Fear (03030002)
3.
Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The project area is occupied by forested land, and the surrounding areas are occupied by forested, agricultural, and residential land.
3b.
List the total estimated acreage of all existing wetlands on the property: 0
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 1,306
3d. Explain the purpose of the proposed project:
To provide a gravel access rd along the length of the property for use in future subdivision of the property.
3e. Describe the overall project in detail, including the type of equipment to be used:
Bulldozers, excavators, motor graders, off -road trucks, rollers, etc. will be used to clear and grade proposed roadway.
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
❑ Yes ❑X No ❑ Unknown
Comments:
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
❑ preliminary ❑ Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known): Chase Bergeson
Agency/Consultant Company: sEl
Other:
4d.
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Yes ❑X No ❑ Unknown
5b.
If yes, explain in detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes 0 No
6b.
If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑X Streams — tributaries ❑X Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1
Choose one
Choose one
Yes/No
-
W2
Choose one
Choose one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P
Culvert
S2
PER
Corps
9.38
34
S2 P
Rip rap stabilization
S2
PER
Corps
8.11
18
S3 P
Culvert
S3
INT
Corps
5.26
50
S4 P
Rip rap stabilization
S3
INT
Corps
9.38
21
S5
Choose one
S6
Choose one
3h. Total stream and tributary impacts
123
3i. Comments:
Total impacts in sq. ft. = 925 (0.02 acres)
Impact1 = 465 sq. ft
Impact 2 = 460 sq. ft.
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then indivi ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
O2
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
p1
Choose one
P2
Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman 0 Other: Jordan Lake
6b.
Buffer Impact
number —
Permanent (P) or
Temporary (T)
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet)
B1
Yes/No
B2
Yes/No
B3
Yes/No
B4
Yes/No
B5
Yes/No
B6
Yes/No
6h. Total Buffer Impacts:
6i. Comments: Buffer impacts are to Jordan Lake buffers and will be permitted through Chatham County.
Page 5 of 10

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The gravel access road was situated to avoid additional stream crossings to the south.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Appropriate S&EC methods will be utilized during construction to avoid additional impacts to aquatic resources.
2.
Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a.
Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ❑X No
2b.
If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c.
If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
El Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3.
Complete if Using a Mitigation Bank
3a.
Name of Mitigation Bank:
3b.
Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments:
4.
Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b.
Stream mitigation requested:
linear feet
4c.
If using stream mitigation, stream temperature:
Choose one
4d.
Buffer mitigation requested (DWQ only):
square feet
4e.
Riparian wetland mitigation requested:
acres
4f.
Non -riparian wetland mitigation requested:
acres
4g.
Coastal (tidal) wetland mitigation requested:
acres
4h.
Comments:
5.
Complete if Using a Permittee Responsible Mitigation Plan
5a.
If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
X Yes No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
Buffer impacts are to Jordan Lake buffers and will be permitted through Chatham County.
6h. Comments:
Page 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑X Yes ❑ No
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑X No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
0
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e.
Who will be responsible for the review of the Stormwater Management Plan?
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
Chatham County
3b.
Which of the following locally -implemented stormwater management programs
apply (check all that apply):
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑X Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑Yes 0 No
4.
DWQ Stormwater Program Review
4a.
Which of the following state -implemented stormwater management programs apply
(check all that apply):
❑Coastal counties
❑HQW
❑ORW
❑Session Law 2006-246
❑Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes 0 No
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1 a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ❑X No
use of public (federal/state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
El Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c.
If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
El Yes ❑X No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes ❑X No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4.
Sewage Disposal (DWQ Requirement)
4a.
Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat?
❑ Yes ❑X No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑ Yes ❑X No
5c. If yes, indicate the USFWS Field Office you have contacted.
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NHP database search
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
❑ Yes ❑X No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA FIRM map
Lisa Longue
Applicant/Agent's Printed Name
4/15/2022
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10

CHATHAM Cvurrrr
YVBtf! cAROLIHA
CHATHAM COUNTY
AUTHORIZED AGENT FOR FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PARCEL ID (PIN) 77097 PARCEL SIZE 13.95
STREET ADDRESS: 1220 White Cross Rd., Chapel Hill, NC
Please print:
Property Owner: Scott Teagarden
Property Owner: Alejandro Lizardo
The undersigned owner(s) of the above described property, do hereby authorize
Ward Marotti
(Contractor / Agent)
of Spangler Environmental, Inc.
(Name of consulting firm if applicable)
GoptY Puliq� h
s�
F 's
� v
m s
J�
Leedinp Flip dupe !o
• Healihw C,�ipittwo-
to act on my/our behalf and take all actions, Uwe could have taken if present, necessary for the processing, issuance
and acceptance of reviews, inspections, or permits and any and all standard and special conditions attached to
these approvals. The activities authorized include the following (Check all that apply):
_Q Check here for all of the below options.
Building Permit
Zoning Compliance Permits
_F71 Floodplain Determination
_F_J Soil Erosion & Sedimentation Control Permit
F-1 Permits to install, repair, evaluate, or expand onsite wastewater system(s)
Evaluation/inspection/permitting of a private drinking water well(s).
Riparian Buffer Review pursuant to §304 of the Chatham Co. Watershed Protection Ordinance.
Other:
Property Owner's Address (if different than property above):
227 Stagecoach Rd., Chapel Hill, NC 27514
Telephone: [phone]
E-mail: [e-mail]
We hereby certify the above information submitted in this application is true and accurate to the best of our
knowledge.
Owner Authorized Siinature Agent Authorized Signature
Date: 1 March 2022
Date: 1 March 2022
Revised 10/2017

urisdictional Determination Reauest
US Army Corps
of Engineers
Wilmington DHStrict
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/M ssions/Re._ ul�atoiyPermitProgram/Contact/Coun!yLocator. 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]
FaxNumber: [phone]
WILNIINGTONREGULATORY 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: 1220 White Cross Rd
City, State:
County:
Chapel Hill, NC
Chatham
Parcel Index Number(s) (PIN): 77097
B. REQUESTOR INFORMATION
Name: Sganaler Environmental. Inc.
Mailing Address: 4338 Bland Rd.
Telephone Number:
Electronic Mail Address
Select one:
✓❑
Raleigh, NC 27609
919-875-4288
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultanti
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: Scott Teagarden & Alejandro Lizardo
Mailing Address: 227 Stagecoach Rd.
Chapel Hill, NC 27514
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 CERTIFICATIONS,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.
Lisa Long (for Ward Marotti)
Print Name
Capacity: ❑ Owner ❑✓ Authorized Agents
5/17/2022
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 projector 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/iJSACE protocols, skip to Part E.
4 If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL 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 13.95 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:
35.867687
Longitude: -79.199777
zA legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 1 lx 17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. hlW://www.saw.usace.army.mil/Missions/Regulatoiy-Permit-
Pro gram/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
❑ 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)
zLandscape Photos (if taken)
NCSAM 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/regulatorv/regdocs/JD/RGL_08-02_App A Prelim JD_ Form_fillable.pdf
' Please see http://www.saw.usace.army.mil/Missions/Regulatoa-Permit-Program/Juiisdiction/
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 federaljurisdiction 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: Spangler Environmental (4338 Bland Rd. Raleigh, NC)
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: Chatham City: Chapel Hill
Center coordinates of site (lat/long in degree decimal format):
Lat.: 35.867687 Long.:-79.199777
Universal Transverse Mercator:
Name of nearest waterbody: TerrelS Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
■❑ Field Determination. Date(s): 1/11/2022
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)
SA
35.867582
-79.198774
469
Non -wetland
404
SB
35.867827
-79.198109
75
Non -wetland
404
SC
35.867526
-79.197602
326
Non -wetland
404
SD
35.867031
-79.193546
259
Non -wetland
404
SE
35.866866
-79.191975
177
Non -wetland
404

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:
0 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: 7.5 Minute Bynum, NC Quad (2019)
❑ Natural Resources Conservation Service Soil Survey. Citation: 2006 Soil Survey of Chatham County (Sheet 4)
❑ 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):
or ■❑ Other (Name & Date):
❑ Previous determination (s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
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.

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WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region
Project/Site: White Cross Rd/Boulder Creek Trail City/County: Chatham/Chapel Hill Sampling Date: 5/13/2022
Applicant/Owner: Spangler Environmental for Scott Teagarden State: NC Sampling Point: UP1
Investigator(s): Lisa Long Section, Township, Range:
Landform (hillside, terrace, etc.): floodplain Local relief (concave, convex, none): relatively flat Slope (%): 2
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 35.867389 Long:-79.199278 Datum: NAD83
Soil Map Unit Name: PsB—Pittsboro-Iredell complex, 2 to 8 percent slopes, stony NWI classification: N/A
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 (1314) —Sparsely
Vegetated Concave Surface (138)
_ High Water Table (A2)
_ Hydrogen Sulfide Odor (Cl) —Drainage
Patterns (1310)
—Saturation (A3)
—Oxidized Rhizospheres on Living Roots (C3) —Moss
Trim Lines (1316)
—Water Marks (131)
—Presence of Reduced Iron (C4) _
Dry -Season Water Table (C2)
—Sediment Deposits (132)
—Recent Iron Reduction in Tilled Soils (C6) —Crayfish
Burrows (C8)
_ Drift Deposits (133)
_Thin Muck Surface (C7) —Saturation
Visible on Aerial Imagery (C9)
_Algal Mat or Crust (134)
—Other (Explain in Remarks) —Stunted
or Stressed Plants (D1)
—Iron Deposits (135)
X
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:

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: UP1
Absolute
Dominant
Indicator
Tree Stratum (Plot size: )
% Cover
Species?
Status
Dominance Test worksheet:
1.
Ostrya virginiana
15
Yes
FACU
Number of Dominant Species
2.
Corns florida
15
Yes
FACU
That Are OBL, FACW, or FAC: 0 (A)
3.
Total Number of Dominant
4.
Species Across All Strata: 5 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 0.0% (A/B)
7.
Prevalence Index worksheet:
30
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
15 20% of total cover:
6
OBL species 0 x 1 = 0
Sapling/Shrub Stratum (Plot size:
)
FACW species 0 x 2 = 0
1.
Ostrya virginiana
15
No
FACU
FAC species 0 x 3 = 0
2.
Ligustrum sinense
40
Yes
FACU
FACU species 105 x 4 = 420
3.
Ligustrum lucidum
20
Yes
UPL
UPL species 110 x 5 = 550
4.
Corns florida
10
No
FACU
Column Totals: 215 (A) 970 (B)
5.
Prevalence Index = B/A = 4.51
6.
Hydrophytic Vegetation Indicators:
7.
_ 1 - Rapid Test for Hydrophytic Vegetation
8.
2 - Dominance Test is >50%
9.
_
3 - Prevalence Index is <-3.0'
85
=Total Cover
4 - Morphological Adaptations' (Provide supporting
50% of total cover:
43 20% of total cover:
17
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: )
_ Problematic Hydrophytic Vegetation' (Explain)
1.
Vinca minor
90
Yes
UPL
Indicators of hydric soil and wetland hydrology must be
2.
Lespedeza cuneata
10
No
FACU
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3.
4.
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
5.
more in diameter at breast height (DBH), regardless of
6.
height.
7.
Sapling/Shrub - Woody plants, excluding vines, less
8.
than 3 in. DBH and greater than or equal to 3.28 ft (1
9.
m) tall.
10.
Herb - All herbaceous (non -woody) plants, regardless of
11.
size, and woody plants less than 3.28 ft tall.
100
=Total Cover
Woody Vine - All woody vines greater than 3.28 ft in
50% of total cover:
50 20% of total cover:
20
height.
Woody Vine Stratum (Plot size: )
1.
2.
3.
4.
5.
Hydrophytic
=Total Cover
Vegetation
50% of total cover:
20% of total cover:
Present? Yes No X
Remarks: (Include photo numbers here or on a separate sheet.)
of
Eastern Mountains and Piedmont - Version 2.1

SOIL Sampling Point: UP1
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' Loc2
Texture Remarks
0-6 10YR 3/4 100
Loamy/Clayey
6-18 10YR 4/4 100
Loamy/Clayey
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
_ Histosol (Al)
_ Polyvalue Below Surface (S8) (MLRA
147, 148) _2 cm Muck (A10) (MLRA 147)
_Histic Epipedon (A2)
_Thin Dark Surface (S9) (MLRA 147, 148) _Coast Prairie Redox (A16)
_ Black Histic (A3)
—Loamy Mucky Mineral (F1) (MLRA 136) (MLRA 147, 148)
—Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
—Piedmont Floodplain Soils (F19)
—Stratified Layers (A5)
_ Depleted Matrix (F3)
(MLRA 136, 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
—Red Parent Material (F21)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
(outside MLRA 127, 147, 148)
_Thick Dark Surface (Al2)
_ Redox Depressions (F8)
_Very Shallow Dark Surface (F22)
—Sandy Mucky Mineral (S1)
_ Iron -Manganese Masses (F12) (LRR N, _ Other (Explain in Remarks)
Gleyed Matrix (S4)
MLRA 136)
_Sandy
—Sandy Redox (S5)
_ Umbric Surface (F13) (MLRA 122, 136) 3Indicators of hydrophytic vegetation and
_Stripped Matrix (S6)
_Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present,
Dark Surface (S7)
Red Parent Material (F21) (MLRA 127, 147, 148) unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No X
Remarks:
This data sheet is revised from Eastern Mountains and Piedmont Regional Supplement Version 2.0 to include the NRCS Field Indicators of Hydric
Soils, Version 8.0, 2016.

Photo 1: Upland soil sample
x
SPANGL,ER
ENVIRONMENTAL, INC.

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WATERSHED PROTECTION DIVISION
JEnvironmental Quality Department
CHAT HAM COUNTY P.O. Box 548
NORTH CAROLINA
Pittsboro, NC 27312
PHONE: [phone]
Fax: [phone] • E-mail: [e-mail] • Website: www.chathamnc.org
Nylaja Bachman
117 North Chatham Ave
Siler City, NC 27344
Project Name
October 27, 2017
Subdivision of Parcel # 77097
Location: 1220 White Cross Road
Subj ect
Features: 3 Intermittent, 2 Perennial
Dear Ms. Bachman,
Based on information which you provided on the Riparian Buffer Review Application, submitted
on October 23, 2017, staff within the Watershed Protection Division of the Chatham County
Environmental Quality Department completed a Riparian Buffer Review in accordance with
Chatham County Watershed Protection Ordinance Section 304(B) Field Delineations. This
Riparian Buffer Review was completed for two (2) lots to be subdivided from Parcel# 77097 that
is located inside of the Jordan Lake watershed.
Summary of Findings
Drew Blake completed the site review on October 27, 2017. Five (5) stream segments were
observed on the property. The five (5) stream segments were scored in accordance with NC
Division of Water Quality (DWQ) Methodology for Identification of Intermittent and Perennial
Streams and the Origins Version 4.11. Three (3) intermittent segments and two (2) perennial
segments were scored on the property. A 50-ft buffer will be required for all intermittent
segments. A 100-ft buffer will be required along both sides of the perennial segments, unless
that buffer is superseded by the mapped floodplain limits of Terrells Creek.
The following documents attached herein are provided for your records. If surface water
features were observed during the site review and were described above, exhibits 2 and 2.1 must
be provided to the surveyor on record and all features and required buffers described above must
be indicated on the property survey which should be provided to Ms. Kim Tyson (Land Use
Administrator) for review.
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 Chatham County, on parcels outside of the
Jordan Lake watershed, may submit a request for appeal in writing to the Watershed Review
Board. A request for a determination by the Watershed Review Board shall be made in
accordance with Section 304 of the Chatham County Watershed Protection Ordinance.
Landowners or affected parties that dispute a determination made by Chatham County, on
parcels inside the Jordan Lake watershed, shall submit a request for appeal in writing to NC

WATERSHED PROTECTION DIVISION
Environmental Quality Department
CHATHAM COUNTY P.O. Box 548
NORTH CAROLINA
Pittsboro, NC 27312
PHONE: [phone]
Fax: [phone] • E-mail: [e-mail] • Website: www.chathamnc.org
DWR, 401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC 27669-1650
attention of the Director of the NC Division of Water Quality.
Should this project result in any direct impacts to surface water features (i.e., crossing and/or
filling streams or wetlands) additional reviews may be necessary. Additionally, a Section
404/401 Permit may be required. Any inquiries regarding Section 404/401 permitting should be
directed to the Division of Water Resources (Central Office) at (919)-807-6364 and the US
Army Corp of Engineers (Raleigh Regulatory Field Office) at (919)-554-4884.
Respectfully,
c7�J•tau BAil
Drew Blake
Watershed Specialist

WATERSHED PROTECTION DIVISION
Environmental Quality Department
CHATHAM COUNTY P.O. Box 548
NORTH CAROLINA
Pittsboro, NC 27312
PHONE: [phone]
Fax: [phone] • E-mail: [e-mail] • Website: www.chathamnc.org
Table of Contents
Site Report/Analysis — Summary of Chatham County staff findings .....................................
Page 4
Exhibit 1 — Map indicating area reviewed by Chatham County staff .....................................
Page 5
Exhibit 2 — Aerial photograph indicating surface water features and required riparian buffers .......
Page 6
Exhibit 2.1 — Western Surface Water Features and required buffers .......................................
Page 7
NRCS Map — National Resources Conservation Service Soils Map of property .........................
Page 8
USGS Map — United States Geological Survey Topographic Map of property ..........................
Page 9
Chatham County Floodplain Determination Application ..................................................
Page 10
FEMA Map — Federal Emergency Management Agency Floodplain Map of property ...............
Page 11
NC DWQ Stream Identification Forms......................................................................
Page 12
Chatham County Riparian Buffer Application..............................................................
Page 1'1
Authorized Agent Form........................................................................................
Page 18
Authorization to Enter Property Form.......................................................................
Page 19
Receiptof Payment.............................................................................................
Page 20
Providedmaps...................................................................................................
Page 21
For additional questions regarding the Watershed Protection Ordinance or Riparian Buffers please contact:
Ms. Rachael Thorn — Watershed Protection Supervisor
Chatham County Environmental Quality Department
P.O. Box 548
Pittsboro, NC 27312
Phone: [phone]
Email: rachael.thomkchathamnc.org
For additional questions regarding the Minor Subdivision process please contact:
Ms. Kimberly Tyson
Chatham County Planning Department
P.O. Box 54
Pittsboro, NC 27312
Phone: [phone]
Email: kimberly.tvsonkchathamnc.org
For additional questions regarding soils and sanitary/septic systems please contact:
Ms. Anne Lowry
Chatham County Environmental Health Department
P.O. Box 130
Pittsboro, NC 27312
Phone: [phone]
Email: [e-mail]

In
CHATHAM COUNTY
NORTH CA KO LINA
�1 FOR OFFICE USE ONLY
Riparian Buffer Application Date: 10/23/17
Owner Name: Edward Bell
Land & Water Resources Division
Environmental Quality Department
Phone: [phone]
Agent Name: Infinite Land Desgin
Parcel 4: 77097 Planning Application (PL4): 20171728
Number of lots proposed: 2
Original parent tract acreage: 13.95
Received by staff member: KT
Check List:
® Fee $ 150.00 Paid with: ❑ Cash
IN Completed Tract Information Form
© Copy of Plat
X❑ Signed Right to Enter Form
X❑ Signed Owner's Agent Designation Form
Number of acres remaining:
Assigned to staff member: DB
❑ Check 4
® Credit Card
Site Review Completed on (Date): 1 0/27/1 7 Staff Initials: DB
Findings:
Reviewed entire 13.95 acre lot. Two (2) perennial, and four (4) intermittent stream segments
were found on the property. 50-ft buffers are required on the intermittent segments, 100-ft buffer on the perennial segments
Applicant contacted to mail or pickup (date):
Returned to applicant via:
Staff Initials:
❑ Mail X❑ Email ❑ Pickup Date: 10/27/17 Initials: DB
Minor Subdivision Packet to Applicant: ❑ Yes ❑ No Date: Initials:
Sent to Surveyor/Consultant: ❑ Email ❑ Pickup
Office Review Completed on:
Minor Subdivision approved:
Riparian buffers on plat approved by staff:
Date: Initials:
Initials:
Initials:
Initials:

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Office Use Only: Pl. 20 LP
r� APPLICATION FOR FLOOD PLAIN DETERMINATION Parr_ f by: C:ICft -.CA--cc _
Chatham County, North Carolina
Anoticant Informati.
Name
Address ?,,2r jam; r,
_ty�g— ! Lktll,, iC 27.
BEST 4ontact Number:
(_ftL!7_j - q62-
•, •;ter- ��
Name (If different from Applicant)
C re, clot rk 14 e i rs
Location of Property:
Property Address 127A W Lt i ke GYW--S Rj
Lot Number
Subdivision
Proposed Work (check one): Residential Construction Land Purchase Xsila Evaluation (Pore Test)
❑ Subdivide (See Planning Staff ifthis is selectod) ❑ Well ❑ Seplic Repalrllnstailation E]olhor
Additional lnforaraflow Will property be used for a nomresidenlial purpose? ❑ Yes ❑ No It yes, Soo Planning Staff
Pl-Ert5E READ AND SIGH
Masse atlach a drawing of In 8-11 y In location of the development activity, the 100•year flood plain, the d,slafice to a stream or river and other information
necessary to accurasety I the dale art acIM,ty on the property in relalwnship to the rioodatxe areas and property lines
The friar n shown fPMI,:eonl is U8 Wd on the location ofthe properly and deWopmenl as provided bylire applicatd The ,nfom,altonshown is based an
repulal ns in ffe to erminal� n of pernnl apfxovsl wtll be avalrrated based on the perrtul application sutnulled a+xl Iho regWat,or�s in effect al the limo
I here! a a pl ,,lion for Iho landowner or thyself aril that the Irdorination given rs correct to the best I Mnowle go
Appli Landowner (Pleaso Print ApplicanKandowner Signature Oiato
For Office Use Onl
Is there a "T" code in Parcel Type?
Yap 40 If yes, see Planning Ste#f far a:lsistanct
ID#:
Acroage:�-�1 Jordan Lako Watershed [Yes No�
_Parcel
Year Lot was created: t 4
_
n
_Watershed District; j�}� (U PZoning Distr€cUCUP: _
a _
Flood Plain Information
Rl orlon Buffer Information
Map # 1 l] i� {
Select ne of the boxes below based on the information provided by Applicant:
Mot
Flood 37 ,y
creator! hnrare 112312ilOt3 andsot it, s,rtrrltvlstnn of rand;
Zone
tf.in Jordan Luke Warerslrcrf: use Iho USGS Tapo and NRCS Soll Survey to look for streams and
ponds to buts or ,nth a M fact buffer IdontRy'Rivcrs' on USGS Topo only for 100 It hutfers tiro
Map Dato: 2-2 2007 Or
ephemeral;
❑ Stream(s) With 50' Buffor Pond(s) with 50' Bulrcr ❑ River or stream within 2500 feet of
The development activity is within 100
River with 100' ©utfer
feet of the 100-year flood plain?
Not rn Jordan Lako Wnrershc_d. use USGS Topo only
Ll Yes ❑ No [J Uncertaln
❑ strean,(s) with!io, D+ffcr ❑ Rrvcr or hbealn wrlhin arnn reel of River with 100' Buffer
If "Yes" or "Uncertain," talk to
❑ehtCirJ to Planning Stall N Ws Riparian 131A10r R by EQ Staff
Envlronmenial Quality Director.
wtllJ)n-subtFlyltted;_'ralk viaw
Flood Plain Elevation
OLgl fewer 10ages i crEalterlafig 1123120DR and no Ripailanu efile grin
Cltyyievr mutd have Riparian Buffer Review by EQ Staff prior to building permit Refer to Planning Staff
The Wevalren of the rlevelopMeN
❑Lot funder 10 acres In slzel created after 112312008: Riparan 13,Ater Review should already N!
ectrvilyls,
comiAeled Sec survey of Cdyviaw. Check for'T' code,
Riparian Buffer Review required by EQ Staff? O Yes [] No, if yes send to
Subdivision Administrator
AD0171014AL GUMMENTS JILL
Ls, _ -»h dk— -�1 -k - - ----
County Staff Signature
p Date
Revised OWf7J 114

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NC Division of Water Qualify -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4,11
SIC DWQ Stream identification Form Version 4.11
) !
Date., Q '�_' 1117
lProject/Site:
77
a
Latitude:
Evaluator:
unty:
(
Longitude:
Stream Points: :.':±Epherner
Stream is erennat least Intermittent
if? 19 or erennia!!fa 30*
am Dete adon (circle one)
Intermiiien erennial
Other
e.g. Quad Name:
A. Geomorphology (Subtotal =
Absent
Weak
Moderate
Strc
1 a- Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
l
3
4. Particle size of stream substrate
0
1
3
5. Activelrelict floodplain
0
1
3
6. Depositional bars or benches
0
Lij
2
3
7. Recent alluvial deposits
0
1 1
2
3
8. Headcuts
0
1
2
3
9. Grade control
0
0.
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hvdroloav (Subtotal
12. Presence of Baseflow
1
2 3
13. Iron oxidizing bacteria
0
2 3
14. Leaf litter
1.5
1
0.5 0
15. Sediment on plants or debris
0
b7jr
1 1.5
16. Organic debris lines or piles
0
0.5
1 1.5
17. Soil -based evidence of high water table?
No_145M2Yes
= 3
C; Ririlnov tSuhtntal = -
1 B. Fibrous roots in streambed
3
1 2
I
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
0
1
2
3
21, Aquatic Mollusks
10
1
2
3
22. Fish
10 1
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25, Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; 0 B L = 1.5
Other =
*perennial streams may also be identified using other methods. See p. 35 of manual,
Notes:
Sketch:
41

NC Division of Water Quality -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC DWQ Stream Identification Form Version 4.11
Date: 0 -�-7 Project/Site: 7o C1 7 Latitude:
Evaluator: County: �VLG7cle
Longitude:
Total Points: Stream 17et urination cine) Other
Stream P at least intermittent
if? 19 orMerennia! if? 30� 2 Ephemera !n ermittent erennial e.g. Quad Name:
A. Geornor polo (Subtotal = (13 )
Absent
Weak
Mod ate
Strong
1 a. Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
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
2
3
5. Activelrelict fleodplain
0
1
2
3
6. Depositionaf bars or benches
0
1
3
7. Recent alluvial deposits
1 0
1
3
8. Headcuts
CO-)3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
o.5
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
a artificial ditches are nat rated; see discussions in manual
B. Hvdroloav (Subtotal = )
12. Presence of Baseflow
0 1 2
3
13. Iron oxidizing bacteria
1 2
3
14. Leaf litter
1.5 1 0.5
0
15. Sediment on plants or debris
b 1
1.5
16. Organic debris lines or piles
0 .5 1
1,5
17. Soil -based evidence of high water table?
o - Yes = 3
C Rinlnnv Igiihfntai = 5 1 T
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
0 1
2 j
1 1
0
20. Macrobenthos (note diversity and abundance)
0
1 1
2
3
21. Aquatic Mollusks
01 1
1 1
2
3
22. Fish
0
0.51
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25, Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBt_ =1.5
Other = 0
*perennial streams may also be Identified using other methods. See p. 35 of manual.
Notes:
Sketch:
41

NC Division of Water Quality -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC DWQ Stream ldeatifca#ion Form Versiou 4.11 IV I L_.
Date: Q
/27 7 Project/Site: ? U l Latitude:
Evaluator. DR County: . Longitude:
Total Points: Stream Determination (circle one) Other
Stream is at least intermittent '}
'f7 18 i 1 if � 3n- o(, Ephemera ntermitien erenniaf e.g. Quad Name:
f _ or erenn a
A. Geomorphology (Subtotal =jL
Absent
Weak
Moderate
Strong
1 a. Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
1 0
1
2 1
3
3. In -channel structure: ex. riffle -pool, step -pool,
6 le- ool sequence
0
1
2O
3
4. Particle size of stream substrate
0
1
2
3
5. Activelralict tleodplain
0
1
2
3
6. Depositional bars or benches
0
1
2)
3
7. Recent alluvial deposits
0
1
2
3
8. hieadcuts
0
1
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hvdroloov (Subtotal = a. )
12. Presence of Baseflow
0 1
I
2
3
13. Iron oxidizing bacteria
0 1
2
3
14. Leaf litter
1.5 1
0.5)
0
15. Sediment on plants or debris
0 0.5
1
1.5
16. Organic debris lines or piles
0 0.5
1
1.5
17. Soil -based evidence of high water table?
No = 0
Yes = 3
C. Rininav (Subtotal = 17) l
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
3
1
0
20. Macrobenthos (note diversity and abundance)
0
1
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
IN
0.5
1
1.5
23, Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25, Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5
Other = 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
41

NC Division of Water Quality -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC ]DWQ Stream Identification Form Version 4.11 Is
Date: - YC4 21 U Project/Site: 7 7 Yi-77 Latitude:
Evaluator: County; Longitude:
Total Points: Stream Determination (cir Other
Stream Is at least intermittent
if?99oroerennialifa30* �j �.s- Ephemeral Intermittent erennia e.g. Quad Name:
A. Geomorphology (Subtotal =
Absent
Weak
Moderate
Strong
1 a, Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
2
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
2
4. Particle size of stream substrate
0
i
2
3
5. Active/relict floodplain
0
1
2
6. Depositionaf bars or benches
0
1
(-2).
3
7. Recent alluvial deposits
0
1
3
S. 1-leadcuts
I ro)1
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
I
0.5
Cl)1.5
11. Second or greater order channel
No = 0
Yes = 3
a artificial ditches are not rated; see discussions in manual
g_ Hvdrolnov (Subtotal = S 1
12. Presence of Baseflow
0 1
2 3
13. Iron oxidizing bacteria
1
2 3
14. Leaf litter
1.5 1
0
15, Sediment on plants or debris
b 0.5
1.5
16. Organic debris lines or piles
0 0.5
1.5
17. Soil -based evidence of high water table?
o =
Yes = 3
G. Hialoov (Subtotal = t n 1
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in stream bed
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
101
1
2
3
22, Fish
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25, Algae
0
0.5
1
1.5
26. Wetland plants in streambed
I=ACW = 0.75; OBL = 1.
Otl e -
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
41

NC Division of Water Quality -Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11
NC IDWQ Stream Identitteation Form Version 4.11
Date: IO -7 Project[Site: 7 C(17 Latitude:
Evaluator: County: G���Longitude:
Total Paints: Stream Determination (circle one) Other
Stream is of least intermittent '7
if? 19 or perennial if230* .G Ephemera rmitte Perennial e.g. Quad Name:
A. Geomorphology Subtotal = S � S }
Absent
Weak
Moderate
Strong
1 a. Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
L
3
4. Particle size of stream substrate
0
1
2
3
5. Active/relict fioodplain
0
1
2
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0
1
2
3
8. Headcuts
0
1 1
2
3
9. Grade control
0.5
1
1.
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No =
Yes = 3
a artificial ditches are not rated; see discussions in manual
R Hvrlroloav (Subtotal = 1, .' ]
12. Presence of Baseflow
0 j 1
2 3
13. Iron oxidizing bacteria
0 1
3
14. Leaf litter
1.5 1
0,5_3 0
15, Sediment on plants or debris
0 0.5
1 1.5
16 Organic debris lines or piles
0 0.5
1 1.5
17. Soil -based evidence of high water table?
o =
Yes = 3
C;_ RinInav (Subtotal = K 1
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21, Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
1
1.5
23. Crayfish 1
01
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25. Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL =1.5
Other = 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes;
Sketch:
41

iy"��• LAND & WATER RESOURCES DIVISION
CHATIFiAM COU.'VTY Environmental Quality Department
�onrrr caKol rvA
PHONE: [phone]
Webslte: www.chathamnc.org
Riparian Buffer Review Applicallon
SURFACE WATER IDENTIFICATION REQUEST
"Use cant for proiects 25 acres or less and 5 lots or less'.
Tract Information:
Parcel Identification Number(s) (AKPAR) 7 709
Total Acreage (area to be reviewed must be 25 acres or less):
Total number of new lots:.?
Watershed District (and name of creek if known):
Property Owner: �_ l '/—/
Location / Physical Address of Tract: 2 ZZa ��` CYrvJ.f
Directions from Pittsboro: J y
Subdivision Name (if applicable):
Owner's / Agent's Contact
Name:
Contact PhAe N6Lers- (h) (w)�� CI-j �?j-2-�08(c)
Mailing Address:
Please check one: ❑ 1 would like to pick up the completed Riparian Buffer Review at the County Office
❑ I wo a the completed Riparian Suffer Review mailed to me
would like the completed Riparian Buffer Review e-mailed to me
Neasqjm16cle with this request:
of Plat
tghi to Enter Property Form
ned Owner's Agent Designation Form (it applicable)
Fee (make checks payable to Chatham County) $50.00 Administrative fee plus
$50,00 per lot. Total paid: $ °'
v�
have read and understand the regulations of the Watershed Protection Ordinance, Section 304, and
agree to adhere to these associated policies and guidelines herein.
Owner/Agent Signature:
Applications can be mailed to: Planning Dept., PO Box 54, Pitisboro. NC 27312
For Questions, please contact: Lynn Richardson at 919-5,12-8207

CHATHAM COUNTY
NORTH CAROLINA
LAND & WATER RESOURCES DIVISION
Environmental Quality Department
Website: www.chalhamnc.org
PHONE: [phone]
AUTHORIZED AGENT FOR LEGAL REPRESENTATION FORM
PROPERTY LEGAL. DESCRIPTION:
LOT N0. ?-�, PARCEL ID (PIN) PARCEL SIZE I `'
STREET ADDRESS:
Please print:
Property Owner:
Property Owner:
Thejugders, ned, owner(s) of the above described property, do hereby authorize
.a
of
(Contractor/Agent) {Name of consulting firm if applicab
ON
to act on my/our behalf and take all actions, I/we could have taken if present, necessary for the
processing, issuance and acceptance of reviews, inspections, or permits and any and all standard and
special conditions attached to these approvals. The activities authorized include the following (initial all
that apply):
Building Permit
Zo Compliance Permits
lain Determination
Erosion and Sedimentation Control Permit
Permits to install, repair, evaluate, or expand onsite wastewater system(s)
_Fuatuation/inspection/permitting of a private drinking water well(s)
Riparian Buffer Review pursuant to §304 of the Chatham County Watershed Protection Ordinance
Other:
Property Owner's Address (if different than property above):
, "30 t ,121 ��e,i . tiC v� Z�v '6
Owner Telephone: 90 - 36E - 6 fit 5
Email:
We hereby certify the above information submitted in this application is
our�k�wedge,,
Own r Authortzed Signs ure Agent Authori2
Date: c t
Date: �Z
Applications can be mailed to: Planning Dept., PO Box 54, Pittsboro, NC 27312
For Questions, please contact: Lynn Richardson at 919-542-8207
Revised 3/2014
-.1
"Qv, lidl)"')

CHATHAM COUNTY
NORFH CAROLINA
LAND & WATER RESOURCES DIVISION
Website: www.chatharnnc.org
Environmental Quality Department
PRONE: [phone]
Authorization to Enter Property Form
date:IM17,oYl
PARCEL No. (AKPAR) 7
I, (print name) , as owner of the property
described above, or a a representative of the owner(s) do hereby convey permission to Chatham County
staff to enter the property at their convenience to conduct a surface water identification (SWID)
necessary to determine whether or not water features on my property are subject to the riparian buffer
regulations described in Section 304 of the Chatham County Watershed Protection Ordinance. The SWID
will be public record and on file at the Planning and Environmental Quality Departments, and may be
requested in the future for review by interested parties.
I understand that stream delineations for the property listed above will be made by County staff only
once and that if future subdivisions are proposed within this property boundary, it will require a surface
water identification by a private consultant at the property owner's expense.
(Print Owner's Name)
(Pri u orized Agent Name)
(Signature of Owner)
i n e f A thor' ed Agent)
(Date)
Who) Z0)
(Date)

CIIATTIAbl COWrY
yn�.I fAY.1f
Receipt Number:
Receipt Date:
Date Paid:
Full Amount:
Payment Details:
Amount Tendered:
Change / Overage:
Contact:
Parcel #:
FEE DETAILS:
Fee Description
Riparian Buffer Fee
Chatham County
RECEIPT OF PAYMENT
20177024
10/20/2017
10/20/2017
$150.00
Payment Method
Credit Card
Amount Tendered Check Number
$150.00
$150.00
$0.00
INFINITE LAND DESIGN, Address:132 N CHATHAM AVE
Payment Received By: Kimberly Tyson
Reference Number Amount Owing Amount Paid
PL20171728 $150.00 $150.00
If you have any questions please contact the appropriate department at the number
listed below:
Central Permitting 919-542-8230
Planning Department 919-542-8204
Environmental Health 919-542-8208 Environmental Quality 919-545-8343

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