20221691 Ver 1_Debra Lane Form_JD Request_20221201

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.aimy.mil/Missions/Re ul�atoiyPermitProi4ram/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.
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Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: 9431 County Line RD
City, State:
Kernersville
County: Forsyth
Parcel Index Number(s) (PIN): 6897-10-1878.00
B. REQUESTOR INFORMATION
Name: Adam Carter. Wetland Solutions LLC
Mailing Address: PO BOX 244
Telephone Number:
Bunnlevel NC 28323
910 890 2779
Electronic Mail Address: [e-mail]
Select one:
❑ 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: Generation Development Company
Mailing Address: 5932 TARLETON DR
OAK RIDGE NC 27310
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
1 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).
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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.
Samuel Adam Carter
Print Name
Capacity: ❑ Owner ✓❑ Authorized Agent'
12/1 /2022
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a projector 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 project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑✓ A Corps JD is required in order obtain my local/state authorization.
❑ I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
' For NCDOT requests following the current NCDOT/USAGE 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.
s Must provide agent authorization form/letter signed by owner(s).
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Jurisdictional Determination Request
F. JURISDICTIONAL DETERNIINATION (JD) TYPE (Select One)
7 I am requesting that the Corps provide a preliminM 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 1 ac acres.
❑✓ The property boundary (or review area boundary) is clearly physically marked on the site.
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Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude:
36.138373
Longitude:-80.045001
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I Ix 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. hM2://www.saw.usace.4rmy.mil/Missions/Regulatoly-Permit-
Pro gram/Jurisdiction/
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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
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
NC Division of Water Resources Stream Identification Forms
hJ Other Assessment Forms
' www.saw.usace.4rmy.mil/Portals/59/docs/regulatory/readocs/JD/RGL 08-02_App A Prelim _JD_Form fillable.pdf
8 Please see hM2://www.saw.usace.4M.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to 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.
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U5 Army Corps
of Engineers
Wilmington District Survey Standards for iurisdictional Determinations
Please note that the approval and signature of survey plats will only be done in association with
an Approved Jurisdictional Determination. The Corps accepts both electronic and hardcopy
plats for signature, however this will be at the discretion of the project manager. If a hard copy
is submitted, the Corps requires that all hard -copy submittals include at least one original Plat
(to scale) that is no larger than I I"x17". Submitted plats must be legible, including labeling (the
use of match lines for larger tracts are encouraged). Additional copies of a plat, including those
larger than 11"x17", may also be submitted for Corps signature as needed. Prior to final
production of a plat, the Wilmington District recommends that the surveyor electronically
submit a draft of the survey to the Corps project manager for review.
PLATS SUBNHTTED FOR APPROVAL
Must be signed and sealed by a licensed professional land surveyor
Must be to scale (all maps must include an accurate graphic scale and verbal
scale)
❑ Must include a North Arrow, Scale(s), Title, Property Information
❑ 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)
F1Jurisdictional wetlands depicted on the survey should:
• Be labeled as Wetland Waters of the US, 404 wetlands, wetlands, etc.
• Include acreage (or square footage) of wetland polygons
• Identify each wetland polygon using an alphanumeric system
❑ Jurisdictional non -wetland waters (non -wetland tidal/navigable waters,
tributaries, impoundments, ditches, etc.) depicted on the survey should:
• Be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent waters (RPW), pond, etc.
• Mark the centerline of linear waters (tributaries), with
approximate widths to the Ordinary High Water Mark
(OHMW) OR a surveyed OHWM boundary of the tributary.
• List the linear footage of linear features and area (using
approximate widths)
• Mark the extent of OHMW for non -linear waters such as lakes,
ponds, etc.
• List the acreage of non -linear features
• Identify each feature using an alphanumeric system
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Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as non jurisdictional. Please
include the acreage and/or linear length of these features as appropriate.
❑ Must include a legible Waters of the United States (wetlands and other
waters) Delineation Table of distances and bearings/metes and bounds/GPS
coordinates of all surveyed delineation points
Must ensure that all depicted wetlands or other waters intersect or tie -to
surveyed project/property boundaries
CERTIFICATION LANGUAGE
❑ Plats submitted for Corps approval should include the following Certification language
when the entire actual Jurisdictional Boundary is depicted:
"This certifies that this copy of this plat accurately depicts the boundary of the jurisdiction
of the 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, 33 C.F.R. part 328
and other U.S. Army Corps of Engineers guidance."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
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❑ Plats submitted for Corps approval should include the following Certification language
when uplands may be present within a depicted Jurisdictional Boundary
"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, 33 C.F.R. part 328 and other U.S. Army Corps of Engineers guidance."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
GPS SURVEYS
For surveys prepared using a Global Positioning System (GPS), the survey must include all of
the above, as well as:
7 be at sub -meter accuracy at each survey point.
L� include an accuracy verification. One of more of the known points (property
corner, monument) shall be located with the GPS and cross referenced with the
existing traditional property survey (metes and bounds).
7 include a brief description of the GPS equipment utilized.
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