20220908 Ver 1_SAW_JD_Request_12-2013_fillable_form_20220705

Jurisdictional Determination Request
U5 Army Corps
of Engineers
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination QD) 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/RegulatoryPermitPro rg am.aspx , 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 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]
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Jurisdictional Determination Request
INSTRUCTIONS:
All requestors must complete Parts A, B, 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
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.
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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. REQUESTOR INFORMATION
Name: William Mullin
Mailing Address: 515 f Midland Road
Telephone Number: 910 695 1043
Electronic Mail Addressi: [e-mail]
Select one:
❑ 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:
Mailing Address:
Telephone Number:
Electronic Mail Addressi:
❑ Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
1 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.
Property Owner (please print)
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
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 WOUS5 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).
4 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.
❑✓ Size of Property or Project Area 14.05 acres
III 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 Determination Form6.
✓❑
Project Coordinates: 35.2938n
Latitude-79.4995w
Maps (no larger than 11x17) with Project Boundary Overlay:
Longitude
✓❑ Large and small scale maps that depict, at minimum: streets, intersections, towns
✓❑ Aerial Photography of the project area
✓❑ 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)
6 See Appendix A of this Form. From Regulatory Guidance Letter No. 08-02, dated June 26, 2008
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Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
❑ Wetland Data Sheets
Tributaries:
❑ USACE Assessment Forms
❑ Upland Data Sheets ❑ Other Assessment Forms
(when appropriate)
❑ Landscape Photos, if taken
❑ Field Sketch overlain on legible Map that includes:
■ All aquatic resources (for sites with multiple resources, label and identify)
■ Locations of wetland data points and/or tributary assessment reaches
■ Locations of photo stations
■ Approximate acreage/linear footage of aquatic resources
(2) Approved 7Ds including Verification of a Delineation:
❑ Project Coordinates:
Latitude
Longitude
Maps (no larger than 11xl7) with Project Boundary Overlay:
❑ Large and small scale maps that depict, at minimum: streets, intersections, towns
❑ Aerial Photography of the project area
❑ USGS Topographic Map
❑ Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
1987 Manual Regional Supplements and Data forms can be found at:
http://www.usace.army.mil/Missions/CivilWorks/RegulatorVProgramandPermits/reg supp.aspx
Wetland and Stream Assessment Methodologies can be found at:
http://Portal.ncdenr.org/c/document library/set file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&groupld=38364 and,
httD://www.saw.usace.armv.mil/Portals/59/docs/reRulatorv/Dublicnotices/2013/NCSAM Draft User Manual 130318.Ddf
8 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
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Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
❑ Wetland Data Sheets
Tributaries:
❑ USACE Assessment Forms
❑ Upland Data Sheets ❑ Other Assessment Forms
(when appropriate)
❑ Landscape Photos, if taken
❑ Field Sketch overlain on legible Map that includes:
• All aquatic resources (for sites with multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
• Approximate acreage/linear footage of aquatic resources
Supporting Jurisdictional Information (for Approved JDs only)
❑ Approved Jurisdictional Determination Form(s) (also known as "Rapanos
Form(s)")
❑ Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc. to navigable waters.
9 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
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Jurisdictional Determination Request
L REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT
Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps project manager for
review.
Due to storage limitations of our administrative records, the Corps requires that all hard -
copy submittals include at least one original Plat (to scale) that is no larger than 11"xl7"
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11"xl7", may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Document Format (PDF) file. Upon verification, the Corps can electronically sign these
plats and return them via e-mail to the requestor.
(1) PLATS SUBMITTED FOR APPROVAL
❑ Must be sealed and signed by a licensed professional land surveyor
❑ Must be to scale (all maps must include both a graphic scale and a verbal scale)
❑ Must be legible
❑ Must include a North Arrow, Scale(s), Title, Property Information
❑ Must include a legible WoUS Delineation Table of distances and bearings/metes
and bounds/GPS coordinates of all surveyed delineation points
❑ Must clearly depict surveyed property or project boundaries
❑ Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)
❑ When wetlands are depicted:
• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system
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Jurisdictional Determination Request
❑ When tributaries are depicted:
• Must include either a surveyed, approximate centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) of tributary
• Must identify each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area (using approximate
widths or surveyed OHWM)
• Must include name of tributary (based on the most recent USGS topographic
map) or, when no USGS name exists, identify as "unnamed tributary"
❑ all depicted WoUS (wetland polygons and tributary lines) must intersect or tie -to
surveyed project/property boundaries
❑ Must include the location of wetland data points and/or tributary assessment
reaches
❑ Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. "isolated wetlands", "non -
jurisdictional waters"). NOTE: An approved 7D must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.
❑ Must include and survey all existing conveyances (pipes, culverts, etc.) that
transport WoUS
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Jurisdictional Determination Request
(2) CERTIFICATION LANGUAGE
When the entire actual Jurisdictional Boundary is depicted:
include the following Corps Certification language:
"This certifies that this copy of this plat accurately depicts the boundary of the jurisdiction
of Section 404 of the Clean Water Act as determined by the undersigned on this date.
Unless there is a change in the law or our published regulations, the determination of
Section 404 jurisdiction maybe relied upon for a period not to exceed five (5) years from
this date. The undersigned completed this determination utilizing the appropriate Regional
Supplement to the 1987 U.S. Army Corps of Engineers Wetlands Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
When uplands may be present within a depicted Jurisdictional Boundary
include the following Corps Certification language:
"This certifies that this copy of this plat identifies all areas of waters of the United States
regulated pursuant to Section 404 of the Clean Water Act as determined by the
undersigned on this date. Unless there is change in the law or our published regulations,
this determination of Section 404 jurisdiction may be relied upon for a period not to exceed
five years from this date. The undersigned completed this determination utilizing the
appropriate Regional Supplement to the 1987 U.S. Army Corps of Engineers Wetlands
Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
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Jurisdictional Determination Request
(3) GPS SURVEYS
For Surveys prepared using a Global Positioning System (GPS), the Survey must include
all of the above, as well as:
❑ be at sub -meter accuracy at each survey point.
❑ include an accuracy verification:
One or more known points (property corner, monument) shall be located with the
GPS and cross-referenced with the existing traditional property survey (metes and
bounds).
❑ include a brief description of the GPS equipment utilized.
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