20220908 Ver 1_JD Request with signature_20220705

Jurisdictional Determination Request
SINWR
US Army Corps
of En(Itnsers
WIMInglon 0191dd
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
to the appropriate Corps Field Office (or project manager, if known) via mail, electronic mail, or
facsimile. A current list of county assignments by Field Office and project manager can be
found on-line at: http://www.saw.usace.army.mil/Missions/Re ug l6toryPermitl3ra r�spx , by
telephoning: 910-251-4633, or by contacting any of the field offices listed below:
ASHEVILLE REGULATORY FIELD OFFICE
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]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Filth 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]
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jurisdictional Determination Request
INSTRUCTIONS:
All reguestors must complete Parts A, R, C, D, E and F.
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 G.
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 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
pp v�iid for the wetland conservation provisions of the Food Security Act of 1985, If you or
y6ur'fenarit rare 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,
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Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: 328 Old Garner Place Road
City, State: West End, North Carolina
County: Moore
Directions:
Parcel Index Number(s) (PIN): 20020574
B. REQUIE;STOR INFORMATION
Name: William Mullin
Mailing Address: MS f Midland Road
Telephone Number: 910 695 1043
Electronic Mail Address i; wmullin@)hcarterino.com
Select one:
I am the current property owner.
✓❑ I am an Authorized Agent or Environmental Consultant2
Interested Buyer or Under Contract to Purchase
❑ Other, please explain,
C. PROPERTY OWNER INFORMATION
1'
Name:
Mailing Address: l Gat -re.-- ?I qLe Rag
p _ g�sk 3y ��� 2�3?�
Telephone Number: 0 3 2 b 1.3
Electronic Mail Address: R-Fe+I& (cam Vn o+r,,,% 1 • Gorn
Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
A If available
Z Must attach completed Agent Authorization Form
3 if available
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Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION
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.
.Z�a,-d '4' FeI/4 ,)"
Property Owner (please print)
Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One;
2 7 -J vn e 24 Z2
Date
✓❑ I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUSs and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
❑ I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an approved JD (this may or may not include a survey plat).
I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
A For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
5 Waters of the United States
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Jurisdictional Determination Request
F. ALL REQUESTS
Map of Property or Project Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.
WSize of Property or Project Area 14.05 acres
Il1 verify that the property (or project) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.
G. JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests:
Completed and signed Preliminary Jurisdictional „Qetermination Form6.
W] Project Coordinates: 35.2938n Latitude -79,4995w Longitude
Maps (no larger than l 1x17) with Project Boundary Overlay:
WLarge and small scale traps that depict, at minimum; streets, intersections, towns
❑✓ Aerial Photography of the project area
7 USGS Topographic Map
W1 Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, L1DAR maps, FEMA floodplain maps)
& See Appendix A of this Form. From Regulatory Guidance Letter No, 08-02, dated June 26, 2008
Version, December 2013 Page 5