20230825 Ver 1_7832_Montgomery Farms_PCN_05.09.23_20230609

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Montgomery Farms
2. Work Type: ❑Private El Institutional ❑Government ❑✓ Commercial
3. Project Description/Purpose [PCN Form B3d and B3e]:
Attached
4. Property Owner/Applicant [PCN Form A3 or A41: Attached
5. Agent/Consultant [PNC Form A5 —or ORM Consultant ID Number]:
Brad Luckey, Pilot Environmental, Inc
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location—Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Arthur Minnis Road
36.005072/-79.115529
8. Project Location—Tax Parcel ID [PCN Form B 1 a]: Attached
9. Project Location—County [PCN Form A2b]: Orange
10. Project Location—Nearest Municipality or Town [PCN Form A2c]: Hillsborough
11. Project Information—Nearest Waterbody [PCN Form 132a]: New Hope Creek
12. Watershed/ 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03030002/Cape Fear
Authorization: Section 10 ❑ Section 404 ✓❑ Section 10 and 404 ❑
Regulatory Action Type:
❑ Standard Permit ❑Pre-Application Request
Z Nationwide Permit# ❑Unauthorized Activity
FRRegional General Permit# ❑Compliance
urisdictional Determination Request ❑No Permit Required
Revised 20150602

OF W A TF9
moo`' pG Office Use Only:
Corps action ID no.
o < DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s)of approval sought from the
Corps: ® Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit(NWP) number: NWP 14 or General Permit(GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes ® No
1d. Type(s)of approval sought from the DWQ (check all that apply):
® 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 For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑ Yes ® No ❑ Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation ❑ Yes ® No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes ® No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ® No
2. Project Information
2a. Name of project: Montgomery Farms
2b. County: Orange
2c. Nearest municipality/town: Hillsborough
2d. Subdivision name: Montgomery Farms
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s)on Recorded Deed: Montgomery Farm Ventures, LLC
3b. Deed Book and Page No. 8760/1300
3c. Responsible Party(for LLC if
Sam Longiotti
applicable):
3d. Street address: 2840 Plaza Place, Suite 100
3e. City, state, zip: Raleigh, NC 27612
3f. Telephone no.: [phone]
3g. Fax no.:
3h. Email address: [e-mail]
Page 1 of 12
PCN Form—Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ 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: Bradley Luckey
5b. Business name
(if applicable): Pilot Environmental, Inc.
5c. Street address: PO Box 128
5d. City, state, zip: Kernersville, NC 27285
5e. Telephone no.: 336.708.4997
5f. Fax no.:
5g. Email address: [e-mail]
Page 2 of 12
PCN Form—Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 9862507727
1 b. Site coordinates (in decimal degrees): Latitude: 36.00507 Longitude: -79.11553
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 66.25 acres
2. Surface Waters
2a. Name of nearest body of water(stream, river, etc.)to New Hope Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-V, NSW
2c. River basin: Cape Fear
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 site contains two agricultural structures and undeveloped wooded land and fields. The site is located within a rural
and residential area of Hillsborough, Orange County, North Carolina
3b. List the total estimated acreage of all existing wetlands on the property:
Wetland=0.205 ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial)on the property:
Streams=6,233 LF.
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to provide access to develop the site with Montomgery Farms, a single family
residenital neighborhood.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of Montgomery Farms, a 10 lot single family residential subdivision. In order
to facilitate the proposed development and access the site, it is necessary to have a stream and wetland crossing. To
facilitate the development of the site, clearing and grading the site is necessary. Graders, haulers, excavators and other
heavy equipment will be used during grading and construction of the site.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property/ ElYes [INo ElUnknown
project(including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? El Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Pilot Enviromental, Inc.
Name (if known): Bradley Luckey 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 ❑Yes ❑ No ® Unknown
this project(including all prior phases) in the past?
5b. If yes, explain in detail according to"help file" instructions.
Page 3 of 12
PCN Form—Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
Impacts to streams/wetlands, outside of those proposed in this application, are not anticipated as a result of the proposed
project.
Page 4 of 12
PCN Form—Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project(check all that apply):
® Wetlands ® Streams-tributaries ❑ 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. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number— Type of impact Type of wetland Forested (Corps-404, 10 Area of impact
Permanent(P)or (if known) DWQ—non-404, other) (acres)
Temporary T
W1 ® P ® T Fill/De-watering ❑ Yes ® Corps 0.08/0.01
® No ❑ DWQ
W2 ❑ P ❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P ❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P ❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W5 ❑ P ❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P ❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g.Total wetland impacts 0.08/0.01
2h. Comments: Wetland Impact 1 will permanently impact 0.08 acres of wetlands associated with road fill and temporarily
impact 0.01 acres of wetlands associated with de-watering and construction access. Areas of temporary impact will be
restored to similar pre-construction grades, stabilized with matting and native herbaceous seed mix. Mitigation is not
proposed for proposed wetland impacts.
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. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number- (PER)or (Corps-404, 10 stream length
Permanent(P)or intermittent DWQ—non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ® P ® T Fill/De-watering Unnamed ❑ PER ® Corps 7.3 83/14
® INT ❑ DWQ
S2 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S3 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P ❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacts 83/14
3i. Comments: Stream Impact 1 will permanently impact 83 linear feet(610 square feet)with road crossing fill and temporarily
impact 14 linear feet 106 square feet of stream channel with associated de-watering. Areas of temporary impact will be
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PCN Form—Version 1.3 December 10, 2008 Version

restored to similar pre-construction grades, stabilized with matting and native herbaceous seed mix. Mitigation is not
proposed for proposed stream impacts.
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 individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number— (if applicable) Type of impact Waterbody type Area of impact(acres)
Permanent(P)or
Temporary T
01 ❑ P ❑ T
02 ❑ P ❑ T
03 ❑ P ❑ T
04 ❑ P ❑ T
4f.Total open water impacts
4g. Comments: Open water impacts are not proposed.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
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:
Page 6 of 12
PCN Form—Version 1.3 December 10, 2008 Version

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.
❑ Neuse El Tar-Pamlico El Other: Jordan
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number— Reason Buffer Zone 1 impact Zone 2 impact
Permanent(P)or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
131 ❑ P ❑ T ❑ Yes
❑ No
B2 ❑ P ❑ T ❑ Yes
❑ No
B3 ❑ P ❑ T ❑ Yes
❑ No
6h. Total buffer impacts
6i. Comments:A buffer authorization will be obtained from local municipality prior to impacts occuring.
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 applicant has designed the proposed residential sub-division to avoid other impact to streams and wetlands. Initial
designs included accessing the site and crossing New Hope Creek, which would have resulted in significantly more square
feet of net loss of stream than proposed. The applicant has selected the stream crossing location in an area the stream is
narrow and straight with few meanders. The applicant designed the road crossing the utilize head/end walls and a 2.5:1 side
slope thus reducing the permanent impact to the stream and wetlands.
The remaining approximate 0.125 acres of wetlands and 6,133 linear feet of stream channel are being avoided.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The clearing limits will be staked and sediment erosion control devices will be used. If water is present during culvert
installation, then a temporary coffer dam will be installed upgradient of the proposed road crossing. During construction, water
will be pumped around the construction footprint. Appropriate stream bank protection will be provided in the channel during
road construction and all excess excavated material will be immediately removed from the stream bank/road crossing area.
Upon completion of the culvert installation, the temporary sand bag coffer dam will be removed and flow will be diverted
through the culvert. Following culvert installation, disturbed banks will be restored to similar pre-construction conditions,
matted and seeded/live staked.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes,mitigation is required by(check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
❑ Payment to in-lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
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PCN Form—Version 1.3 December 10, 2008 Version

3c. Comments: The applicant does not propose mitigation for impacts to streams or wetlands.
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: ❑warm ❑ cool ❑cold
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.
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 ❑ 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).
6h. Comments:
Page 8 of 12
PCN Form—Version 1.3 December 10, 2008 Version

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 ® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? low density%
2b. Does this project require a Stormwater Management Plan? ❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The project is low density. This estimate
accounts for anticipated impervious from lot development. Vegetative swales are proposed adjacent to road
infrastructure.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
® Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? Orange County
® Phase II
3b. Which of the following locally-implemented stormwater management programs ® NSW
❑apply (check all that apply): USMP
® Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ® No
attached?
4. DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply ❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ❑ Yes ❑ 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 9 of 12
PCN Form—Version 1.3 December 10, 2008 Version

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 ® 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 ❑ 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
letter.) ❑ Yes ® No
Comments: A NEPA or SEPA is not required as part of this project.
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 ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑ Yes ® 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 ® 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.
We are not aware of additional development that will result which will impact nearby downstream water quality.
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.
Impacts from wastewater generation are not proposed.
Page 10 of 12
PCN Form—Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat(Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ❑ Yes ® No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. ❑ Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The IPaC report for the site identifies the following federally protected species: Tri-colored Bat(NLEB) (T)and Atlantic
Pigtoe (T)as protected species that could be proximate to the site.
The project area contains a weakly defined intermittent stream located in a grass field with few interspersed trees.
Suitable habitat for Tricolored bat or Atlantic pigtoe are not located within the proposed project area. Therefore, we have
made a determination of no effect for these species.
6. Essential Fish Habitat(Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat. Best
management practices and the construction of stormwater ponds will prevent sediment from entering down-gradient
waterbodies which may contain fish.
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 ❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
We reviewed the SHPO Map (http://gis.ncdcr.gov/hpoweb/)to identify cultural resources of the site. The map does not
identify listed or eligible for listing properties on the site. Several surveyed/gone properties are identified on adjacent
property east and south of the project area. A copy of the map is included as an attachment.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s)did you use to make the floodplain determination? FEMA NHFL(Drawing 4, attached)
Digitally signed by Bradley Luckey
Bradley
DIN:cn=Bradley Luckey,o=Pilot
Enviromental,Inc.,ou,
Bradley S. Luckey, PWS Luckey email=[e-mail],c=US 05.09.23
Date:2023.05.09 19:35:19-04'00'
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 11 of 12
PCN Form—Version 1.3 December 10, 2008 Version

Environmental Services Proposal
Pilot Proposal 7832
March 15,2022
AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address: 5490 Montgomery Place
Orange County, NC 27278
Owner Information: Montgomery Farm Ventures, LLC
Address: 2840 Plaza Place, Suite 100
Raleigh, NC 27612
Telephone Number: [phone]
Fax Number:
E-mail Address: bmedlin lazaassociatesinc.com
JURISDICTIONAL DETERMINATION_REQUEST
D. PROPERTY ACCESS CERTIFICATION
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.
Print Name
Capacity: L'_/Owner —Authorized Agent
C-6- o -'�?;�
Date /f
ignature
5

�► LOT 5 � � � ?'�� 'L •� ;
UQ S
AREA 2 r 4.08 ACRES 22 40
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` I DISTURBANCE LIMITS (APPROX.) W W =
JURISDICTIONAL WETLANDS
JURISDICTIONAL
I • \ \ LOT 8 / � STREAM BUFFER Ir C) Lj N N
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JURISDICTIONAL IMPACTS SUMMARY TABLE O ~( ) o 0
LINEAR w L Of
•• ID DISTURBANCE AREA SF AC Z) > >
DURATION FEET (FT.) V)) w w
I 4.010ACRES l TEMPORARY 106 (0.01) 14 0 0
STREAM 0 d
CROSSING
PERMANENT 610 (0.01) 83 0 0
LOT 10
13.10 ACRES TEMPORARY 31 (0.01)
AREA # 1 �` WETLANDS z N M
JURISTDICTIONAL I PERMANENT 3,291 (0.08)
STREAM WETLAND / i�
ne
AND BUFFER IMPACTS .fit ��� J '� STREAM BUFFER IMPACT SUMMARY TABLE Ljm Ball tes,PA
SEE EXHIBIT #2 1 ,� `I, Associates, PA
ID DISTURBANCE DURATION AREA SF (AC)
221 Providence Road 919.929.0481
Chapel Hill,NC 27514 ballentineassociates.com
TEMPORARY ZONE 1: 711 ZONE 2: 758(0.02)
10p- STREAM 02) SCALE: AS NOTED
CROSSING PERMANENT ZONE ZONE 1: 4, 41 ( .111) DATE: 05 APR 23
��./'^r`-•— JOB NUMBER: 121015.00
DRAWN BY: D.A.H.
Q� SITE OVERVIEW REVIEWED BY: D.W.S.
C) 0 125 250
EXHIBIT
ARTHUR MINNIS RD. — -
- — — — GRAPHIC SCALE 1
IN FEET )

rR _- QP �����\�N •CARo
STREAM IMPACT I _ 5A0 O�O�ESS/0���%
610 SF (0.02 AC) I 70 ,
83 LF ZONE 2 FBUFFER
FU ER IMPACT NOT FOR CONSTRUINON
5p9 3,786 SF (0.09 AC) PROPOSED
V`FLJ`FL
STREAM BANK - ROAD GRADE FN �� •'•
(TYP.) '�i O '•, GINS .• `.�\���
508 N.
TEMPORARY
A BUFFER
IMPACTS (TYP PRECAST CONCRETE ON W•
HEAD WALL (TYP.)
Ld
501 Q 48 LF 42" RCP EARTH o
�BACKFILL
INV. IN: 500.0' 505 505
„oo=w = INV. OUT: 499.5'
o ry � ` °�� ' ZONE 1 BUFFER IMPACT
mow h m 8S `9c\ 5,411 SF (0.12 AC) \ \. I'
EXISTING o
w
es - / m DUAL CULVERT SECTION A-A PRECAST CONCRETE I� j GRADE W N
30 48 LF 60" RCP (BURIED 1' WING WALLS (TYP.) I
i° WITH NATIVE MATERIALS)
mph / INV. IN: 498.5' C
�o STREAM BOTTOM IN: 499.5' m
(INV. OUT: 498.0' = _
TEMPORARY BUFFER STREAM BOTTOM OUT: 499.0' X
IMPACTS (TYP.) \ / _ _ f -142" RCP W
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1. STREAM/WETLAND DELINEATION PROVIDED BY PILOT ENVIRONMENTAL, INC. DATE: 05 APR 23
2. DISTURBANCE IN/AROUND ALL JURISDICTIONAL WETLANDS/STREAM SHALL BE MINIMIZED AS MUCH AS JOB NUMBER: 121015.00
FEASIBLE. IMPACT EXHIBIT DRAWN BY: D.A.H.
3. ALL CONSTRUCTION SHALL BE CONDUCTED IN ACCORDANCE WITH NCDEQ & ORANGE COUNTY STANDARDS. are REVIEWED BY: D.W.S.
4. ALL TEMPORARY EROSION CONTROL MEASURES SHALL BE MAINTAINED IN PROPER WORKING CONDITION
THROUGHOUT CONSTRUCTION. �a o zo ao
5. INSTALL TEMPORARY SILT FENCE STONE OUTLETS AT LOW POINTS IN SILT FENCE AS NECESSARY. QZ EXHIBIT
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a United States Department of the Interior 4' ',
!, FISH AND WILDLIFE SERVICE
=RCH 3 �s Raleigh Ecological Services Field Office
Post Office Box 33726
Raleigh,NC 27636-3726
Phone: [phone] Fax: [phone]
In Reply Refer To: May 09, 2023
Project Code: 2023-0080030
Project Name: Montgomery Farms
Subject: List of threatened and endangered species that may occur in your proposed project
location or may be affected by your proposed project
To Whom It May Concern:
The enclosed species list identifies threatened, endangered, proposed and candidate species, as
well as proposed and final designated critical habitat, that may occur within the boundary of your
proposed project and/or may be affected by your proposed project. The species list fulfills the
requirements of the U.S. Fish and Wildlife Service (Service) under section 7(c) of the
Endangered Species Act (Act) of 1973, as amended(16 U.S.C. 1531 et seq.). If your project area
contains suitable habitat for any of the federally-listed species on this species list, the proposed
action has the potential to adversely affect those species. If suitable habitat is present, surveys
should be conducted to determine the species'presence or absence within the project area. The
use of this species list and/or North Carolina Natural Heritage program data should not be
substituted for actual field surveys.
New information based on updated surveys, changes in the abundance and distribution of
species, changed habitat conditions, or other factors could change this list. Please feel free to
contact us if you need more current information or assistance regarding the potential impacts to
federally proposed, listed, and candidate species and federally designated and proposed critical
habitat. Please note that under 50 CFR 402.12(e) of the regulations implementing section 7 of the
Act, the accuracy of this species list should be verified after 90 days. This verification can be
completed formally or informally as desired. The Service recommends that verification be
completed by visiting the ECOS-IPaC website at regular intervals during project planning and
implementation for updates to species lists and information.An updated list may be requested
through the ECOS-IPaC system by completing the same process used to receive the enclosed list.
The purpose of the Act is to provide a means whereby threatened and endangered species and the
ecosystems upon which they depend may be conserved. Under sections 7(a)(1) and 7(a)(2) of the
Act and its implementing regulations (50 CFR 402 et seq.), Federal agencies are required to
utilize their authorities to carry out programs for the conservation of threatened and endangered

05/09/2023 2
species and to determine whether projects may affect threatened and endangered species and/or
designated critical habitat.
A Biological Assessment is required for construction projects (or other undertakings having
similar physical impacts)that are major Federal actions significantly affecting the quality of the
human environment as defined in the National Environmental Policy Act(42 U.S.C. 4332(2)
(c)). For projects other than major construction activities, the Service suggests that a biological
evaluation similar to a Biological Assessment be prepared to determine whether the project may
affect listed or proposed species and/or designated or proposed critical habitat. Recommended
contents of a Biological Assessment are described at 50 CFR 402.12.
If a Federal agency determines, based on the Biological Assessment or biological evaluation, that
listed species and/or designated critical habitat may be affected by the proposed project, the
agency is required to consult with the Service pursuant to 50 CFR 402. In addition, the Service
recommends that candidate species, proposed species and proposed critical habitat be addressed
within the consultation. More information on the regulations and procedures for section 7
consultation, including the role of permit or license applicants, can be found in the "Endangered
Species Consultation Handbook" at:
http://www.fws.gov/endangered/esa-library/pdf/TOC-GLOS.PDF
Migratory Birds: In addition to responsibilities to protect threatened and endangered species
under the Endangered Species Act(ESA), there are additional responsibilities under the
Migratory Bird Treaty Act(MBTA) and the Bald and Golden Eagle Protection Act(BGEPA)to
protect native birds from project-related impacts.Any activity, intentional or unintentional,
resulting in take of migratory birds, including eagles, is prohibited unless otherwise permitted by
the U.S. Fish and Wildlife Service (50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)). For more
information regarding these Acts see https://www.fws.gov/birds/policies-and-regulations.php.
The MBTA has no provision for allowing take of migratory birds that may be unintentionally
killed or injured by otherwise lawful activities. It is the responsibility of the project proponent to
comply with these Acts by identifying potential impacts to migratory birds and eagles within
applicable NEPA documents (when there is a federal nexus) or a Bird/Eagle Conservation Plan
(when there is no federal nexus). Proponents should implement conservation measures to avoid
or minimize the production of project-related stressors or minimize the exposure of birds and
their resources to the project-related stressors. For more information on avian stressors and
recommended conservation measures see https://www.fws.gov/birds/bird-enthusiasts/threats-to-
birds.php.
In addition to MBTA and BGEPA, Executive Order 13186: Responsibilities of Federal Agencies
to Protect Migratory Birds, obligates all Federal agencies that engage in or authorize activities
that might affect migratory birds, to minimize those effects and encourage conservation measures
that will improve bird populations. Executive Order 13186 provides for the protection of both
migratory birds and migratory bird habitat. For information regarding the implementation of
Executive Order 13186, please visit https://www.fws.govibirds/policies-and-regulations/
executive-orders/e0-13186.php.

05/09/2023 3
We appreciate your concern for threatened and endangered species. The Service encourages
Federal agencies to include conservation of threatened and endangered species into their project
planning to further the purposes of the Act. Please include the Consultation Code in the header of
this letter with any request for consultation or correspondence about your project that you submit
to our office.
Attachment(s):
■ Official Species List
• Migratory Birds

05/09/2023 1
OFFICIAL SPECIES LIST
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Raleigh Ecological Services Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
[phone]

05/09/2023 2
PROJECT SUMMARY
Project Code: 2023-0080030
Project Name: Montgomery Farms
Project Type: Commercial Development
Project Description: Residential Development
Project Location:
The approximate location of the project can be viewed in Google Maps: https://
www.google.com/maps/(a)36.000335449999994,-79.11577206070277,14z
Counties: Orange County, North Carolina

05/09/2023 3
ENDANGERED SPECIES ACT SPECIES
There is a total of 3 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
Fisheries1, as USFWS does not have the authority to speak on behalf of NOAA and the
Department of Commerce.
See the "Critical habitats" section below for those critical habitats that lie wholly or partially
within your project area under this office's jurisdiction. Please contact the designated FWS office
if you have questions.
1. NOAA Fisheries, also known as the National Marine Fisheries Service (NMFS), is an
office of the National Oceanic and Atmospheric Administration within the Department of
Commerce.
MAMMALS
NAME STATUS
Tricolored Bat Perimyotis sub flavus Proposed
No critical habitat has been designated for this species. Endangered
Species profile:httpss://ecos.fws.gov/ecp/species/10515
CLAMS
NAME STATUS
Atlantic Pigtoe Fusconaia masoni Threatened
There is final critical habitat for this species.Your location does not overlap the critical habitat.
Species profile:https:Hecos.fws.gov/ecp/species/5164
INSECTS
NAME STATUS
Monarch Butterfly Danaus plexippus Candidate
No critical habitat has been designated for this species.
Species profile:https:Hecos.fws.gov/ecp/species/9743
CRITICAL HABITATS
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.
YOU ARE STILL REQUIRED TO DETERMINE IF YOUR PROJECT(S)MAY HAVE EFFECTS ON ALL
ABOVE LISTED SPECIES.

05/09/2023
MIGRATORY BIRDS
Certain birds are protected under the Migratory Bird Treaty Act!and the Bald and Golden Eagle
Protection Act2.
Any person or organization who plans or conducts activities that may result in impacts to
migratory birds, eagles, and their habitats should follow appropriate regulations and consider
implementing appropriate conservation measures, as described below.
1. The Migratory Birds Treaty Act of 1918.
2. The Bald and Golden Eagle Protection Act of 1940.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
The birds listed below are birds of particular concern either because they occur on the
USFWS Birds of Conservation Concern (BCC) list or warrant special attention in your
project location.To learn more about the levels of concern for birds on your list and how this
list is generated, see the FAQ below. This is not a list of every bird you may find in this location,
nor a guarantee that every bird on this list will be found in your project area. To see exact
locations of where birders and the general public have sighted birds in and around your project
area, visit the E-bird data mapping tool (Tip: enter your location, desired date range and a species
on your list). For projects that occur off the Atlantic Coast, additional maps and models detailing
the relative occurrence and abundance of bird species on your list are available. Links to
additional information about Atlantic Coast birds, and other important information about your
migratory bird list, including how to properly interpret and use your migratory bird report, can be
found below.
For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, click on the PROBABILITY OF PRESENCE
SUMMARY at the top of your list to see when these birds are most likely to be present and
breeding in your project area.
BREEDING
NAME SEASON
Bald Eagle Haliaeetus leucocephalus Breeds Sep 1 to
This is not a Bird of Conservation Concern(BCC)in this area,but warrants attention Jul 31
because of the Eagle Act or for potential susceptibilities in offshore areas from certain types
of development or activities.
Chimney Swift Chaetura pelagica Breeds Mar 15
This is a Bird of Conservation Concern(BCC)throughout its range in the continental USA to Aug 25
and Alaska.
Eastern Whip-poor-will Antrostomus voci ferns Breeds May 1
This is a Bird of Conservation Concern(BCC)throughout its range in the continental USA to Aug 20
and Alaska.

05/09/2023 2
BREEDING
NAME SEASON
Kentucky Warbler Oporornis formosus Breeds Apr 20
This is a Bird of Conservation Concern(BCC)throughout its range in the continental USA to Aug 20
and Alaska.
Prairie Warbler Dendroica discolor Breeds May 1
This is a Bird of Conservation Concern(BCC)throughout its range in the continental USA to Jul 31
and Alaska.
Prothonotary Warbler Protonotaria citrea Breeds Apr 1 to
This is a Bird of Conservation Concern(BCC)throughout its range in the continental USA Jul 31
and Alaska.
Red-headed Woodpecker Melanerpes erythrocephalus Breeds May 10
This is a Bird of Conservation Concern(BCC)throughout its range in the continental USA to Sep 10
and Alaska.
Rusty Blackbird Euphagus carolinus Breeds
This is a Bird of Conservation Concern(BCC)only in particular Bird Conservation Regions elsewhere
(BCRs)in the continental USA
Wood Thrush Hylocichla mustelina Breeds May 10
This is a Bird of Conservation Concern(BCC)throughout its range in the continental USA to Aug 31
and Alaska.
PROBABILITY OF PRESENCE SUMMARY
The graphs below provide our best understanding of when birds of concern are most likely to be
present in your project area. This information can be used to tailor and schedule your project
activities to avoid or minimize impacts to birds. Please make sure you read and understand the
FAQ "Proper Interpretation and Use of Your Migratory Bird Report" before using or attempting
to interpret this report.
Probability of Presence (■)
Each green bar represents the bird's relative probability of presence in the 10km grid cell(s) your
project overlaps during a particular week of the year. (A year is represented as 12 4-week
months.)A taller bar indicates a higher probability of species presence. The survey effort(see
below) can be used to establish a level of confidence in the presence score. One can have higher
confidence in the presence score if the corresponding survey effort is also high.
How is the probability of presence score calculated?The calculation is done in three steps:
1. The probability of presence for each week is calculated as the number of survey events in
the week where the species was detected divided by the total number of survey events for
that week. For example, if in week 12 there were 20 survey events and the Spotted Towhee
was found in 5 of them, the probability of presence of the Spotted Towhee in week 12 is
0.25.

05/09/2023 3
2. To properly present the pattern of presence across the year, the relative probability of
presence is calculated. This is the probability of presence divided by the maximum
probability of presence across all weeks. For example, imagine the probability of presence
in week 20 for the Spotted Towhee is 0.05, and that the probability of presence at week 12
(0.25) is the maximum of any week of the year. The relative probability of presence on
week 12 is 0.25/0.25 = 1; at week 20 it is 0.05/0.25 = 0.2.
3. The relative probability of presence calculated in the previous step undergoes a statistical
conversion so that all possible values fall between 0 and 10, inclusive. This is the
probability of presence score.
Breeding Season ( )
Yellow bars denote a very liberal estimate of the time-frame inside which the bird breeds across
its entire range. If there are no yellow bars shown for a bird, it does not breed in your project
area.
Survey Effort (1)
Vertical black lines superimposed on probability of presence bars indicate the number of surveys
performed for that species in the 10km grid cell(s) your project area overlaps. The number of
surveys is expressed as a range, for example, 33 to 64 surveys.
No Data (—)
A week is marked as having no data if there were no survey events for that week.
Survey Timeframe
Surveys from only the last 10 years are used in order to ensure delivery of currently relevant
information. The exception to this is areas off the Atlantic coast, where bird returns are based on
all years of available data, since data in these areas is currently much more sparse.
probability of presence breeding season I survey effort —no data
SPECIES JA1N1 I FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Bald Eagle
Non-BCC ■ iiii iiii Wi iiii ■ik ++++ ,dill 1111 IIII IIII
Vulnerable ++++
Chimney Swift +11+
BCC Rangewide ++1 Al 1+1l I I I I 1141 Jill11111111 Nis+ ++++ ++++
(CON) 11 1 111 1
Eastern Whip-Poor- ++++ ++++ TTT+ + I �■ ++++ ++++ ++++ ++++ ++++
will _.0 ��i� IL _
BCC Rangewide
(CON)Kentucky Warbler
BCC Rangewide ++++ ++++ ++++ ++1L+ TTTT Jill Jill III+ ++++ ++++ ++++ ++++
(CON)

05/09/2023 4
Prairie Warbler BCC Rangewide ++ I I I I I I I I I + *0 IN I!!! ul
,++* „++ ++++ ++++ ++++
(CON) yy
Prothonotary ++++ ++++ ++++ ++++ T+++ T11� ++++ +,++ ++++ ++++ ++++
Warbler
BCC Rangewide
(CON)
Red-headed Woodpecker ++++ 1 11 1 1 1 1 � 1010 **i+ HE 57i mill ++I$ ++l+ +110
BCC Rangewide
(CON) +
Rusty Blackbird ++++ ++++ ++++ +*++++ ++++ ++++ ++++ ++++ ++++ ++++ +*++ ++++
BCC-BCR
Wood Thrush BCC Rangewide ++++ ++++ ++++ +'" 0111 O + "*' +++1 +W 1+++ ++++ ++++
(CON) ___
Additional information can be found using the following links:
■ Birds of Conservation Concern https://www.fws.gov/program/migratory-birds/species
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/librarT�/
collections/avoiding-and-minimizing-incidental-take-migratory-birds
■ Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.pdf
MIGRATORY BIRDS FAQ
Tell me more about conservation measures I can implement to avoid or minimize impacts
to migratory birds.
Nationwide Conservation Measures describes measures that can help avoid and minimize
impacts to all birds at any location year round. Implementation of these measures is particularly
important when birds are most likely to occur in the project area.When birds may be breeding in
the area, identifying the locations of any active nests and avoiding their destruction is a very
helpful impact minimization measure. To see when birds are most likely to occur and be breeding
in your project area, view the Probability of Presence Summary. Additional measures or permits
may be advisable depending on the type of activity you are conducting and the type of
infrastructure or bird species present on your project site.
What does IPaC use to generate the list of migratory birds that potentially occur in my
specified location?
The Migratory Bird Resource List is comprised of USFWS Birds of Conservation Concern
(BCQ and other species that may warrant special attention in your project location.
The migratory bird list generated for your project is derived from data provided by the Avian
Knowledge Network (AKN). The AKN data is based on a growing collection of survey, banding,
and citizen science datasets and is queried and filtered to return a list of those birds reported as
occurring in the 10km grid cell(s)which your project intersects, and that have been identified as

05/09/2023 5
warranting special attention because they are a BCC species in that area, an eagle (Eagle Act
requirements may apply), or a species that has a particular vulnerability to offshore activities or
development.
Again, the Migratory Bird Resource list includes only a subset of birds that may occur in your
project area. It is not representative of all birds that may occur in your project area. To get a list
of all birds potentially present in your project area, please visit the Rapid Avian Information
Locator(RAIL)Tool.
What does IPaC use to generate the probability of presence graphs for the migratory birds
potentially occurring in my specified location?
The probability of presence graphs associated with your migratory bird list are based on data
provided by the Avian Knowledge Network(AKN). This data is derived from a growing
collection of survey, banding, and citizen science datasets.
Probability of presence data is continuously being updated as new and better information
becomes available. To learn more about how the probability of presence graphs are produced and
how to interpret them, go the Probability of Presence Summary and then click on the "Tell me
about these graphs" link.
How do I know if a bird is breeding,wintering or migrating in my area?
To see what part of a particular bird's range your project area falls within (i.e. breeding,
wintering, migrating or year-round), you may query your location using the RAIL Tool and look
at the range maps provided for birds in your area at the bottom of the profiles provided for each
bird in your results. If a bird on your migratory bird species list has a breeding season associated
with it, if that bird does occur in your project area, there may be nests present at some point
within the timeframe specified. If "Breeds elsewhere" is indicated, then the bird likely does not
breed in your project area.
What are the levels of concern for migratory birds?
Migratory birds delivered through IPaC fall into the following distinct categories of concern:
1. "BCC Rangewide" birds are Birds of Conservation Concern (BCC)that are of concern
throughout their range anywhere within the USA(including Hawaii, the Pacific Islands,
Puerto Rico, and the Virgin Islands);
2. "BCC - BCR" birds are BCCs that are of concern only in particular Bird Conservation
Regions (BCRs) in the continental USA; and
3. "Non-BCC -Vulnerable" birds are not BCC species in your project area, but appear on
your list either because of the Eagle Act requirements (for eagles) or(for non-eagles)
potential susceptibilities in offshore areas from certain types of development or activities
(e.g. offshore energy development or longline fishing).
Although it is important to try to avoid and minimize impacts to all birds, efforts should be made,
in particular, to avoid and minimize impacts to the birds on this list, especially eagles and BCC
species of rangewide concern. For more information on conservation measures you can
implement to help avoid and minimize migratory bird impacts and requirements for eagles,
please see the FAQs for these topics.

05/09/2023 6
Details about birds that are potentially affected by offshore projects
For additional details about the relative occurrence and abundance of both individual bird species
and groups of bird species within your project area off the Atlantic Coast, please visit the
Northeast Ocean Data Portal. The Portal also offers data and information about other taxa besides
birds that may be helpful to you in your project review.Alternately, you may download the bird
model results files underlying the portal maps through the NOAA NCCOS Integrative Statistical
Modeling and Predictive Mapping of Marine Bird Distributions and Abundance on the Atlantic
Outer Continental Shelf project webpage.
Bird tracking data can also provide additional details about occurrence and habitat use
throughout the year, including migration. Models relying on survey data may not include this
information. For additional information on marine bird tracking data, see the Diving Bird Study
and the nanotag studies or contact Caleb Spiegel or Pam Lorin.
What if I have eagles on my list?
If your project has the potential to disturb or kill eagles, you may need to obtain a permit to avoid
violating the Eagle Act should such impacts occur.
Proper Interpretation and Use of Your Migratory Bird Report
The migratory bird list generated is not a list of all birds in your project area, only a subset of
birds of priority concern. To learn more about how your list is generated, and see options for
identifying what other birds may be in your project area, please see the FAQ "What does IPaC
use to generate the migratory birds potentially occurring in my specified location". Please be
aware this report provides the "probability of presence" of birds within the 10 km grid cell(s)that
overlap your project; not your exact project footprint. On the graphs provided, please also look
carefully at the survey effort (indicated by the black vertical bar) and for the existence of the "no
data" indicator (a red horizontal bar).A high survey effort is the key component. If the survey
effort is high, then the probability of presence score can be viewed as more dependable. In
contrast, a low survey effort bar or no data bar means a lack of data and, therefore, a lack of
certainty about presence of the species. This list is not perfect; it is simply a starting point for
identifying what birds of concern have the potential to be in your project area, when they might
be there, and if they might be breeding (which means nests might be present). The list helps you
know what to look for to confirm presence, and helps guide you in knowing when to implement
conservation measures to avoid or minimize potential impacts from your project activities,
should presence be confirmed. To learn more about conservation measures, visit the FAQ "Tell
me about conservation measures I can implement to avoid or minimize impacts to migratory
birds" at the bottom of your migratory bird trust resources page.

05/09/2023 7
IPAC USER CONTACT INFORMATION
Agency: Pilot Enviromental, Inc
Name: Bradley Luckey
Address: 743 Park Lawn Court
City: Kernersville
State: NC
Zip: 27285
Email [e-mail]
Phone: [phone]

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Jurisdictional Determination Request
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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.g my.mil/Missions/Re ug latoI3 PermitProgram/Contact/CogptyLocator.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 WASHINGTON REGULATORY FIELD OFFICE
FIELD OFFICES US Army Corps of Engineers
US Army Corps of Engineers 2407 West Fifth Street
151 Patton Avenue,Room 208 Washington,North Carolina 27889
Asheville,North Carolina 28801-5006 General Number:[phone]
General Number:[phone] Fax Number:[phone]
Fax Number:[phone]
WILMINGTON REGULATORY FIELD OFFICE
RALEIGH REGULATORY FIELD OFFICE US Army Corps of Engineers
US Army Corps of Engineers 69 Darlington Avenue
3331 Heritage Trade Drive,Suite 105 Wilmington,North Carolina 28403
Wake Forest,North Carolina 27587 General Number:910-251-4633
General Number:[phone] Fax Number:[phone]
Fax Number:[phone]
INSTRUCTIONS:
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: Arthur Minnis Road
City, State: Hillsborough, NC
County: Orange
Parcel Index Number(s) (PIN): Please see attached
B. REQUESTOR INFORMATION
Name: Brad Luckey, Pilot Environmental, Inc
Mailing Address: 743 Park Lawn Court
Kernersville, NC 27284
Telephone Number: 336.310.4527
Electronic Mail Address: [e-mail]
Select one:
❑ I am the current property owner.
W1I am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other,please explain.
C. PROPERTY OWNER INFORMATION'
Name: Please see attached
Mailing Address:
Telephone Number:
Electronic Mail Address:
1 Must provide completed Agent Authorization Form/Letter.
z Documentation of ownership also needs to be provided with request(copy of Deed,County GIS/Parcel/Tax Record).
Version:May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION',4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps)to enter upon the property herein described for the purpose of conducting on-
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Please see attached
Print Name
Capacity: ❑ Owner [:]Authorized Agents
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
I intend to construct/develop a project or 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 project or 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:
3 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
a If there are multiple parcels owned by different parties,please provide the following for each additional parcel on a
continuation sheet.
s 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 61 .33 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: 36.005072
Longitude: -79.115529
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I Ix17 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.
ul 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.hgp://www.saw.usace.army.mil/Missions/Reaulatory-Permit-
Program/Jurisdiction/
Version:May 2017 Page 5

Jurisdictional Determination Request
zCompleted 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
W] USGS Topographic Map
Soil Survey Map
DOther 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
Other Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/re"latoM/re2docs/JD/RGL 08-02 Ann A Prelim JD Form_fillable.pdf
' Please see http://www.saw.usace.aimy.mil/Missions/Re ug latoiy-Permit-Prouam/Jurisdiction/
Principal Purpose:The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses:This information may be shared with the Department of Justice and other federal,state,and local
government agencies,and the public,and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination(AJD),which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure:Submission of requested information is voluntary;however,if information is not provided,the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version:May 2017 Pagc 6

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THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY.THEY HAVE NOT BEEN VERIFIED
BY THE USACE. THIS EXHIBIT INCLUDES GPS LOCATIONS OF DELINEATED FEATURES. DELINEATION Site Boundary
CONDUCTED BY PILOT PERSONNEL ON 05.06.22& 02.24.23.
Drawing 5 Wetland Map
2019 Satellite Imagery from ESRI � Montgomery Farms
and Pilot GPS Data Approximate 66.25-Acre Tract
Scale: 1" = 350' .111W Hillsborough, Orange County, NC
Date: 03.13.23 PILOT ENVIRONMENTAL INC
Pilot Project 7832.1

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THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY THE USACE. THIS EXHIBIT
INCLUDES GPS LOCATIONS OF DELINEATED FEATURES. DELINEATION CONDUCTED BY PILOT PERSONNEL ON 05.06.22 & 02.24.23.
Drawing 5 }, f Wetland Map
2019 Satellite Imagery from ESRI Montgomery Farms
and Pilot GPS Data -- i Approximate 66.25-Acre Tract
Scale: 1" = 350' P11.111W Hillsborough, Orange County, NC
Date: 03.13.23 PILOT ENVIRONMENTAL, INC Pilot Project7832.1

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THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY. THEY HAVE NOT BEEN VERIFIED BY THE USACE. THIS EXHIBIT
INCLUDES GPS LOCATIONS OF DELINEATED FEATURES. DELINEATION CONDUCTED BY PILOT PERSONNEL ON 05.06.22 & 02.24.23.
Drawing 5 =4 Wetland Map
2019 Satellite Imagery from ESRI t Montgomery Farms
and Pilot GPS Data -- i Approximate 66.25-Acre Tract
Scale: 1" = 350' P11.111w Hillsborough, Orange County, NC
Date: 03.13.23 PILOT ENVIRONMENTAL, INC Pilot Project7832.1

U.S. Army Corps of Engineers Requirement Control Symbol
WETLAND DETERMINATION DATA SHEET—Eastern Mountains and Piedmont Region EXEMPT
(Authority:AR 335-15,
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R paragraph 5-2a)
Project/Site: Montgomery Farms City/County: Hillsborough/Orange Sampling Date: 05.26.2022
Applicant/Owner: State: NC Sampling Point: DP-1
Investigator(s): Pilot Environmental, Inc Section,Township, Range: N/A
Landform(hillside,terrace,etc.): slope Local relief(concave,convex, none): None Slope(%): 2-3
Subregion(LRR or MLRA): LRR P, MLRA 136 Lat: 36.005420' Long: -79.117150' Datum: WGS-84
Soil Map Unit Name: Georgeville silt loam/GeC NWI classification: None
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 X No Is the Sampled Area
Hydric Soil Present? Yes X No within a Wetland? Yes X No
Wetland Hydrology Present? Yes X No
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)
X Saturation(A3) —Oxidized Rhizospheres on Living Roots(C3) —Moss Trim Lines(1316)
—Water Marks(B1) —Presence of Reduced Iron(C4) _Dry-Season Water Table(C2)
_Sediment Deposits(62) _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(64) —Other(Explain in Remarks) —Stunted or Stressed Plants(D1)
_Iron Deposits(135) —Geomorphic Position(D2)
_Inundation Visible on Aerial Imagery(137) —Shallow Aquitard(D3)
X Water-Stained Leaves(139) _Microtopographic Relief(D4)
Aquatic Fauna(B13) 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 X No Depth(inches): 0 Wetland Hydrology Present? Yes X No
includes capillary fringe)
Describe Recorded Data(stream gauge, monitoring well,aerial photos, previous inspections),if available:
Remarks:
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP-1
Absolute Dominant Indicator
Tree Stratum (Plot size: 30 ) %Cover Species? Status Dominance Test worksheet:
1. Platanus occidentalis 20 Yes FACW Number of Dominant Species
2. Acer rubrum 15 Yes FAC That Are OBL, FACW,or FAC: 6 (A)
3. Ulmus americana 15 Yes FACW Total Number of Dominant
4. Fraxinus pennsylvanica 10 No FACW Species Across All Strata: 7 (B)
5. Percent of Dominant Species
6. That Are OBL, FACW,or FAC: 85.7% (A/B)
7. Prevalence Index worksheet:
60 =Total Cover Total%Cover of: Multiply by:
50%of total cover: 30 20%of total cover: 12 OBL species 0 x 1 = 0
Saplinq/Shrub Stratum (Plot size: 15 ) FACW species 55 x 2= 110
1. Acer rubrum 5 Yes FAC FAC species 20 x 3= 60
2. Carya tomentosa 5 Yes UPL FACU species 0 x 4= 0
3. UPL species 5 x 5= 25
4. Column Totals: 80 (A) 195 (B)
5. Prevalence Index =B/A= 2.44
6. Hydrophytic Vegetation Indicators:
7. _1 -Rapid Test for Hydrophytic Vegetation
8. X 2-Dominance Test is>50%
9. X 3-Prevalence Index is:53.0'
10 =Total Cover 4-Morphological Adaptations'(Provide supporting
50%of total cover: 5 20%of total cover: 2 data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5 ) _Problematic Hydrophytic Vegetation' (Explain)
1. Carex intumescens 5 Yes FACW Indicators of hydric soil and wetland hydrology must
2. Fraxinus pennsylvanica 5 Yes FACW be present, unless disturbed or problematic.
3. Definitions of Four Vegetation Strata:
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
9 (1 m)tall.
10. Herb-All herbaceous(non-woody)plants, regardless
11. of size,and woody plants less than 3.28 ft tall.
10 =Total Cover Woody Vine-All woody vines greater than 3.28 ft in
50%of total cover: 5 20%of total cover: 2 height.
Woody Vine Stratum (Plot size: 30 )
1.
2.
3.
4.
5 Hydrophytic
=Total Cover Vegetation
50%of total cover: 20%of total cover: Present? Yes X No
Remarks: (Include photo numbers here or on a separate sheet.)
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point: DP-1
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 Loc Texture Remarks
0-18 10YR 4/1 80 7.5YR 4/6 20 C M Loamy/Clayey Prominent redox concentrations
'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) X 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)
—Sandy Gleyed Matrix(S4) MLRA 136)
—Sandy Redox(S5) _Umbric Surface(F13)(MLRA 122, 136) 31ndicators 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 X No
Remarks:
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont—Version 2.0

U.S. Army Corps of Engineers Requirement Control Symbol
WETLAND DETERMINATION DATA SHEET—Eastern Mountains and Piedmont Region EXEMPT
(Authority:AR 335-15,
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R paragraph 5-2a)
Project/Site: Montgomery Farms City/County: Hillsborough/Orange Sampling Date: 05.26.2022
Applicant/Owner: State: NC Sampling Point: DP-2
Investigator(s): Pilot Environmental, Inc Section,Township, Range: N/A
Landform(hillside,terrace,etc.): hillside Local relief(concave,convex, none): None Slope(%): 1-2
Subregion(LRR or MLRA): LRR P, MLRA 136 Lat: 36.005488' Long: -79.117061' Datum: WGS-84
Soil Map Unit Name: Oakboro silt loam/OaA NWI classification: None
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(B1) —Presence of Reduced Iron(C4) _Dry-Season Water Table(C2)
_Sediment Deposits(62) _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(64) —Other(Explain in Remarks) —Stunted or Stressed Plants(D1)
_Iron Deposits(135) —Geomorphic Position(D2)
_Inundation Visible on Aerial Imagery(137) —Shallow Aquitard(D3)
—Water-Stained Leaves(139) _Microtopographic Relief(D4)
Aquatic Fauna(B13) 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:
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP-2
Absolute Dominant Indicator
Tree Stratum (Plot size: 30 ) %Cover Species? Status Dominance Test worksheet:
1. Liriodendron tulipifera 20 Yes FACU Number of Dominant Species
2. Acer rubrum 15 Yes FAC That Are OBL, FACW,or FAC: 3 (A)
3. Carpinus caroliniana 5 No FAC Total Number of Dominant
4. Species Across All Strata: 6 (B)
5. Percent of Dominant Species
6. That Are OBL, FACW,or FAC: 50.0% (A/B)
7. Prevalence Index worksheet:
40 =Total Cover Total%Cover of: Multiply by:
50%of total cover: 20 20%of total cover: 8 OBL species 0 x 1 = 0
Saplinq/Shrub Stratum (Plot size: 15 ) FACW species 0 x 2= 0
1. Acer rubrum 5 Yes FAC FAC species 30 x 3= 90
2. Liquidambar styraciflua 5 Yes FAC FACU species 30 x 4= 120
3. UPL species 0 x 5= 0
4. Column Totals: 60 (A) 210 (B)
5. Prevalence Index =B/A= 3.50
6. Hydrophytic Vegetation Indicators:
7. _1 -Rapid Test for Hydrophytic Vegetation
8. 2-Dominance Test is>50%
9. -3 Prevalence Index is:53.0'
10 =Total Cover 4-Morphological Adaptations'(Provide supporting
50%of total cover: 5 20%of total cover: 2 data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5 ) _Problematic Hydrophytic Vegetation' (Explain)
1. Ligustrum sinense 5 Yes FACU Indicators of hydric soil and wetland hydrology must
2. Smilax glauca 5 Yes FACU be present, unless disturbed or problematic.
3. Definitions of Four Vegetation Strata:
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
9 (1 m)tall.
10. Herb-All herbaceous(non-woody)plants, regardless
11. of size,and woody plants less than 3.28 ft tall.
10 =Total Cover Woody Vine-All woody vines greater than 3.28 ft in
50%of total cover: 5 20%of total cover: 2 height.
Woody Vine Stratum (Plot size: 30 )
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.)
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point: DP-2
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 Loc Texture Remarks
0-3 7.5YR 4/6 100 Loamy/Clayey
3-18 5YR 4/6 100 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)
—Sandy Gleyed Matrix(S4) MLRA 136)
—Sandy Redox(S5) _Umbric Surface(F13)(MLRA 122, 136) 31ndicators 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 X No
Remarks:
ENG FORM 6116-4-SG,JUL 2018 Eastern Mountains and Piedmont—Version 2.0

PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: March 10, 2023
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Scott Edwards, Pilot Environmental, Inc.
Post Office Box 128, Kernersville, North Carolina 27285
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, Montgomery Farms, SAW 2023-
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: The site is located north of Arthur
Minnis Road,Hillsborough,Orange County,North Carolina. Agricultural structures are located on the southern-
central portion of the site. The remainder of the site contains fields and wooded land. The site is proposed for
development with a Ballentine Associates,PA.
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES
AND/OR AQUATIC RESOURCES AT DIFFERENT SITES)
State:North Carolina County/parish/borough: Orange County City: Hillsborough
Center coordinates of site (lat/long in degree decimal format): Lat.: 36.003814'Long.: -79.115529'
Universal Transverse
Mercator:WGS 84
Name of nearest waterbody: New Hope Creek
E. REVIEW PERFORMED FOR SITE EVALUATION(CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
[-] Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH"MAY BE"SUBJECT TO
REGULATORY JURISDICTION.
Site Latitude(decimal Longitude Estimated amount Type of aquatic Geographic authority to
Number degrees) (decimal degrees) of aquatic resources resources(i.e., which the aquatic resource
in review area wetland vs.non- "may be"subject(i.e.,
(acreage and linear wetland waters) Section 404 or Section
feet,if applicable 10/404
SA 36.004645 -79.117242 1,712 LF Non-wetland 404
SB 36.004583 -79.113211 990 LF Non-wetland 404
SBA 36.005410 -79.113717 113 LF Non-wetland 404
Sc 36.002223 -79.114056 2,739 LF Non-wetland 404
SD 36.003664 -79.113708 106 LF Non-wetland 404
SE 36.000870 -79.114376 212 LF Non-wetland 404
SF 36.000534 -79.115188 201 LF Non-wetland 404

SG 36.000519 -79.115632 160 LF Non-wetland 404
WA 36.005364 -79.117189 0.10-ac Wetland 404
WBA 36.005511 -79.113793 0.001-ac Wetland 404
WC 36.004197 -79.113001 0.01-ac Wetland 404
WD 36.000600 -79.113039 0.005-ac Wetland 404
WF 36.000148 -79.115527 0.098-ac Wetland 404
WG 36.000422 -79.115551 0.0004-ac 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 AID 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 AID 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 AID 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:
® 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: Drawing 1
® Natural Resources Conservation Service Soil Survey. Citation: Drawings 2 &2A
®National wetlands inventory map(s). Cite name: Drawing 3
❑State/local wetland inventory map(s):
®FEMA/FIRM maps: Drawing 4
❑ 100-year Floodplain Elevation is: (National Geodetic Vertical Datum of 1929)
®Photographs: ®Aerial(Name & Date):Drawing 5
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.
March 10, 2023
Signature and date of Regulatory Signature and date of person
staff member completing PJD requesting PJD (REQUIRED,
unless obtaining the signature
is impracticable)1
1 Districts may establish timeframes for requester to return signed PJD forms. If the requester 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.

�owardin_CoddHGM_CodelMeas_TypelAmountl Units lWaters_Typel Latitude Longitude l Local_Waterway
SA NORTH CAROLINA R5 RIVERINE Linear 1,712 FOOT DELINEATE 36.00464500 -79.11724200 New Hope Creek
SIB NORTH CAROLINA R5 RIVERINE Linear 990 FOOT DELINEATE 36.00458300 -79.11321100 New Hope Creek
SBA NORTH CAROLINA R4 RIVERINE Linear 113 FOOT DELINEATE 36.00541000 -79.11371700 New Hope Creek
SC NORTH CAROLINA R5 RIVERINE Linear 2,739 FOOT DELINEATE 36.00222300 -79.11405600 New Hope Creek
SD NORTH CAROLINA R4 RIVERINE Linear 106 FOOT DELINEATE 36.00366400 -79.11370800 New Hope Creek
SE NORTH CAROLINA R5 RIVERINE Linear 212 FOOT DELINEATE 36.00087000 -79.11437600 New Hope Creek
SF NORTH CAROLINA R4 RIVERINE Linear 201 FOOT DELINEATE 36.00053400 -79.11518800 New Hope Creek
SG NORTH CAROLINA R4 RIVERINE Linear 160 FOOT DELINEATE 36.00051900 -79.11563200 New Hope Creek
WA NORTH CAROLINA PFO DEPRESS Area 0.1 ACRE DELINEATE 36.00536400 -79.11718900 New Hope Creek
WBA NORTH CAROLINA PFO DEPRESS Area 0.001 ACRE DELINEATE 36.00551100 -79.11379300 New Hope Creek
WC NORTH CAROLINA PFO DEPRESS Area 0.01 ACRE DELINEATE 36.00419700 -79.11300100 New Hope Creek
WD NORTH CAROLINA PFO DEPRESS Area 0.005 ACRE DELINEATE 36.00060000 -79.11303900 New Hope Creek
WF NORTH CAROLINA PFO DEPRESS Area 0.098 ACRE DELINEATE 36.00014800 -79.11552700 New Hope Creek
WG NORTH CAROLINA PFO DEPRESS Area 0.0004 ACRE DELINEATE 36.00042200 -79.11555100 New Hope Creek

APPROVED JURISDICTIONAL DETERMINATION FORM
U.S.Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION(JD):03.13.2023
B. DISTRICT OFFICE,FILE NAME,AND NUMBER:Raliegh
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough:Orange City:Hillsborough
Center coordinates of site(lat/long in degree decimal format): Lat.36.004740'N,Long.-79.118323'�.
Universal Transverse Mercator:WGS 84
Name of nearest waterbody:New Hope Creek
Name of nearest Traditional Navigable Water(TNW)into which the aquatic resource flows:New Hope Creek
Name of watershed or Hydrologic Unit Code(HUC):03030002
Check if map/diagram of review area and/or potential jurisdictional areas is/are available upon request.
Check if other sites(e.g.,offsite mitigation sites,disposal sites,etc...)are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION(CHECK ALL THAT APPLY):
' Office(Desk)Detennination. Date:
Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There Are no "navigable waters of the U.S."within Rivers and Harbors Act(RHA)jurisdiction(as defined by 33 CFR part 329)in the
review area. [Required]
❑ Waters subject to the ebb and flow of the tide.
❑ Waters are presently used,or have been used in the past,or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are no"waters of the U.S."within Clean Water Act(CWA)jurisdiction(as defined by 33 CFR part 328)in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S.in review area(check all that apply):1
❑ TNWs,including territorial seas
❑ Wetlands adjacent to TNWs
❑ Relatively permanent waters(RPWs)that flow directly or indirectly into TNWs
❑ Non-RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated(interstate or intrastate)waters,including isolated wetlands
b. Identify(estimate)size of waters of the U.S.in the review area:
Non-wetland waters: linear feet: width(ft)and/or acres.
Wetlands: acres.
c.Limits(boundaries)of jurisdiction based on:Pick List
Elevation of established OHWM(if known):
2. Non-regulated waters/wetlands(check if applicable):3
Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:Pond constructed in uplands.
Boxes checked below shall be supported by completing the appropriate sections in Section III below.
z For purposes of this form,an RPW is defined as a tributary that is not a TNW and that typically flows year-round or has continuous flow at least"seasonally"
(e.g.,typically 3 months).
3 Supporting documentation is presented in Section HIT.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW,complete
Section III.A.1 and Section III.D.1.only;if the aquatic resource is a wetland adjacent to a TNW,complete Sections III.A.1 and 2
and Section III.D.1.;otherwise,see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is"adjacent':
B. CHARACTERISTICS OF TRIBUTARY(THAT IS NOT A TNW)AND ITS ADJACENT WETLANDS(IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands,if any,and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non-navigable tributaries of TNWs where the tributaries are"relatively permanent
waters"(RPWs),i.e.tributaries that typically flow year-round or have continuous flow at least seasonally(e.g.,typically 3
months).A wetland that directly abuts an RPW is also jurisdictional.If the aquatic resource is not a TNW,but has year-round
(perennial)flow,skip to Section III.D.2.If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation.Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial(and its adjacent wetlands if any)and a traditional navigable water,even
though a significant nexus finding is not required as a matter of law.
If the waterbody4 is not an RPW,or a wetland directly abutting an RPW,a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW.If the tributary has adjacent wetlands,the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands.This significant nexus evaluation that combines,for
analytical purposes,the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary,or its adjacent wetlands,or both.If the JD covers a tributary with adjacent wetlands,complete Section III.B.1 for
the tributary,Section III.B.2 for any onsite wetlands,and Section III.B.3 for all wetlands adjacent to that tributary,both onsite
and offsite.The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non-TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: Pick List
Drainage area: Pick List
Average annual rainfall: inches
Average annual snowfall: inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑Tributary flows directly into TNW.
❑Tributary flows through Pick List tributaries before entering TNW.
Project waters are Pick List river miles from TNW.
Project waters are Pick List river miles from RPW.
Project waters are Pick List aerial(straight)miles from TNW.
Project waters are Pick List aerial(straight)miles from RPW.
Project waters cross or serve as state boundaries.Explain:
Identify flow route to TNW5:
Tributary stream order,if known:
'Note that the Instructional Guidebook contains additional information regarding swales,ditches,washes,and erosional features generally and in the and
West.
s Flow route can be described by identifying,e.g.,tributary a,which flows through the review area,to flow into tributary b,which then flows into TNW.

(b) General Tributary Characteristics(check all that apply):
Tributary is: ❑Natural
❑Artificial(man-made). Explain:
❑Manipulated (man-altered). Explain:
Tributary properties with respect to top of bank(estimate):
Average width: feet
Average depth: feet
Average side slopes:Pick List.
Primary tributary substrate composition(check all that apply):
❑ Silts ❑ Sands ❑Concrete
❑Cobbles ❑Gravel ❑Muck
❑ Bedrock ❑Vegetation. Type/%cover:
❑Other.Explain:
Tributary condition/stability[e.g.,highly eroding,sloughing banks]. Explain:
Presence of run/riffle/pool complexes. Explain:
Tributary geometry:Pick List
Tributary gradient(approximate average slope): %
(c) Flow:
Tributary provides for:Pick List
Estimate average number of flow events in review area/year:Pick List
Describe flow regime:
Other information on duration and volume:
Surface flow is:Pick List. Characteristics:
Subsurface flow:Pick List. Explain findings:
❑Dye(or other)test performed:
Tributary has(check all that apply):
❑Bed and banks
❑OHWM'(check all indicators that apply):
❑ clear,natural line impressed on the bank ❑ the presence of litter and debris
❑ changes in the character of soil ❑ destruction of terrestrial vegetation
❑ shelving ❑ the presence of wrack line
❑ vegetation matted down,bent,or absent ❑ sediment sorting
❑ leaf litter disturbed or washed away ❑ scour
❑ sediment deposition ❑ multiple observed or predicted flow events
❑ water staining ❑ abrupt change in plant community
❑ other(list):
❑Discontinuous OHWM.1 Explain:
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction(check all that apply):
High Tide Line indicated by: 0 Mean High Water Mark indicated by:
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or debris deposits(foreshore) ❑physical markings;
❑ physical markings/characteristics ❑vegetation lines/changes in vegetation types.
❑ tidal gauges
❑ other(list):
(iii) Chemical Characteristics:
Characterize tributary(e.g.,water color is clear,discolored,oily film;water quality;general watershed characteristics,etc.).
Explain:
Identify specific pollutants,if known:
6A natural or man-made discontinuity in the OHWM does not necessarily sever jurisdiction(e.g.,where the stream temporarily flows underground,or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime(e.g.,flow over a rock outcrop or through a culvert),the agencies will look for indicators of flow above and below the break.
')bid.

(iv) Biological Characteristics. Channel supports(check all that apply):
❑ Riparian corridor. Characteristics(type,average width):
❑ Wetland fringe. Characteristics:
❑ Habitat for:
❑Federally Listed species. Explain findings:
❑Fish/spawn areas.Explain findings:
❑Other environmentally-sensitive species. Explain findings:
❑Aquatic/wildlife diversity. Explain findings:
2. Characteristics of wetlands adjacent to non-TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: acres
Wetland type. Explain:
Wetland quality. Explain:
Project wetlands cross or serve as state boundaries.Explain:
(b) General Flow Relationship with Non-TNW:
Flow is:Pick List.Explain:
Surface flow is:Pick List
Characteristics:
Subsurface flow:Pick List. Explain findings:
❑Dye(or other)test performed:
(c) Wetland Adjacency Determination with Non-TNW:
❑Directly abutting
❑Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm/barrier. Explain:
(d) Proximity(Relationship)to TNW
Project wetlands are Pick List river miles from TNW.
Project waters are Pick List aerial(straight)miles from TNW.
Flow is from:Pick List.
Estimate approximate location of wetland as within the Pick List floodplain.
(ii) Chemical Characteristics:
Characterize wetland system(e.g.,water color is clear,brown,oil film on surface;water quality;general watershed
characteristics;etc.). Explain:
Identify specific pollutants,if known:
(iii)Biological Characteristics. Wetland supports(check all that apply):
❑ Riparian buffer. Characteristics(type,average width):
❑ Vegetation type/percent cover. Explain:
❑ Habitat for:
❑Federally Listed species. Explain findings:
❑Fish/spawn areas.Explain findings:
❑Other environmentally-sensitive species. Explain findings:
❑Aquatic/wildlife diversity. Explain findings:
3. Characteristics of all wetlands adjacent to the tributary(if any)
All wetland(s)being considered in the cumulative analysis:Pick List
Approximately( )acres in total are being considered in the cumulative analysis.

For each wetland,specify the following:
Directly abuts?(Y/N) Size(in acres) Directly abuts?(Y/N) Size(in acres)
Summarize overall biological,chemical and physical functions being performed:
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical,physical,and biological integrity
of a TNW. For each of the following situations,a significant nexus exists if the tributary,in combination with all of its adjacent
wetlands,has more than a speculative or insubstantial effect on the chemical,physical and/or biological integrity of a TNW.
Considerations when evaluating significant nexus include,but are not limited to the volume,duration,and frequency of the flow
of water in the tributary and its proximity to a TNW,and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance(e.g.between a
tributary and its adjacent wetland or between a tributary and the TNW).Similarly,the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW,as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook.Factors to consider include,for example:
• Does the tributary,in combination with its adjacent wetlands(if any),have the capacity to carry pollutants or flood waters to
TNWs,or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary,in combination with its adjacent wetlands(if any),provide habitat and lifecycle support functions for fish and
other species,such as feeding,nesting,spawning,or rearing young for species that are present in the TNW?
• Does the tributary,in combination with its adjacent wetlands(if any),have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary,in combination with its adjacent wetlands(if any),have other relationships to the physical,chemical,or
biological integrity of the TNW?
Note:the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non-RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below,based on the tributary itself,then go to Section III.D:
2. Significant nexus findings for non-RPW and its adjacent wetlands,where the non-RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below,based on the tributary in combination with all of its
adjacent wetlands,then go to Section III.D:
3. Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW.Explain findings of
presence or absence of significant nexus below,based on the tributary in combination with all of its adjacent wetlands,then go to
Section III.D:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS.THE SUBJECT WATERS/WETLANDS ARE(CHECK ALL
THAT APPLY):
1. TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑TNWs: linear feet width(ft),Or, acres.
❑Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
❑ Tributaries of TNWs where tributaries typically flow year-round are jurisdictional.Provide data and rationale indicating that
tributary is perennial:
❑ Tributaries of TNW where tributaries have continuous flow"seasonally"(e.g.,typically three months each year)are
jurisdictional. Data supporting this conclusion is provided at Section III.B. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area(check all that apply):
Tributary waters: linear feet width(ft).
Other non-wetland waters: acres.
Identify type(s)of waters:
3. Non-RPWss that flow directly or indirectly into TNWs.
❑ Waterbody that is not a TNW or an RPW,but flows directly or indirectly into a TNW,and it has a significant nexus with a
TNW is jurisdictional.Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area(check all that apply):
❑ Tributary waters: linear feet width(ft).
❑_ Other non-wetland waters: acres.
Identify type(s)of waters:
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
Wetlands directly abutting an RPW where tributaries typically flow year-round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2,above.Provide rationale indicating that wetland is
directly abutting an RPW:
Wetlands directly abutting an RPW where tributaries typically flow"seasonally." Provide data indicating that tributary is
seasonal in Section III.13 and rationale in Section III.D.2,above.Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands that do not directly abut an RPW,but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands,have a significant nexus with a TNW are jurisidictional.Data supporting this
conclusion is provided at Section III.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non-RPWs that flow directly or indirectly into TNWs.
Wetlands adjacent to such waters,and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands,have a significant nexus with a TNW are jurisdictional.Data supporting this
conclusion is provided at Section III.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters.'
As a general rule,the impoundment of a jurisdictional tributary remains jurisdictional.
Demonstrate that impoundment was created from"waters of the U.S.,"or
Demonstrate that water meets the criteria for one of the categories presented above(1-6),or
❑ Demonstrate that water is isolated with a nexus to commerce(see E below).
E. ISOLATED[INTERSTATE OR INTRA-STATE]WATERS,INCLUDING ISOLATED WETLANDS,THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE,INCLUDING ANY
SUCH WATERS(CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
❑ Other factors. Explain:
Identify water body and summarize rationale supporting determination:
'See Footnote#3.
'To complete the analysis refer to the key in Section III.D.6 of the histructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category,Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

Provide estimates for jurisdictional waters in the review area(check all that apply):
Ll Tributary waters: linear feet width(ft).
Ll Other non-wetland waters: acres.
Identify type(s)of waters:
Wetlands: acres.
F. NON-JURISDICTIONAL WATERS,INCLUDING WETLANDS(CHECK ALL THAT APPLY):
❑ If potential wetlands were assessed within the review area,these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements.
® Review area included isolated waters with no substantial nexus to interstate(or foreign)commerce.
❑ Prior to the Jan 2001 Supreme Court decision in"SWANCC,"the review area would have been regulated based solely on the
"Migratory Bird Rule"(MBR).
® Waters do not meet the"Significant Nexus"standard,where such a finding is required for jurisdiction. Explain:Pond constructed
in uplands.
❑ Other:(explain,if not covered above):
Provide acreage estimates for non jurisdictional waters in the review area,where the sole potential basis of jurisdiction is the MBR
factors(i.e.,presence of migratory birds,presence of endangered species,use of water for irrigated agriculture),using best professional
judgment(check all that apply):
❑ Non-wetland waters(i.e.,rivers,streams): linear feet width(ft).
❑ Lakes/ponds: acres.
❑ Other non-wetland waters: acres.List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the"Significant Nexus"standard,where such
a finding is required for jurisdiction(check all that apply):
❑ Non-wetland waters(i.e.,rivers,streams): linear feet, width(ft).
® Lakes/ponds:0.31 acres.
❑ Other non-wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD(check all that apply-checked items shall be included in case file and,where checked
and requested,appropriately reference sources below):
® Maps,plans,plots or plat submitted by or on behalf of the applicant/consultant:
® Data sheets prepared/submitted by or on behalf of the applicant/consultant.
❑Office concurs with data sheets/delineation report.
❑Office does not concur with data sheets/delineation report.
❑ 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:
® USDA Natural Resources Conservation Service Soil Survey.Citation:
® National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
® FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑Aerial(Name&Date):
or❑Other(Name&Date):
❑ Previous determination(s). File no.and date of response letter:
❑ Applicable/supporting case law:
❑ Applicable/supporting scientific literature:
❑ Other information(please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD:Pond PA labeled on Drawing 5 is constructed in an upland area.

Sta ardin_CoddHGM_Cod+Aeas_TypdAmountl Units hNaters_Typd Latitude I Longitude 1Local_Waterway
PA NORTH CAROLINA U DEPRESS Area 0.31 ACRE UPLAND 36.00467500 -79.11867600 New Hope Creel

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