20240433 Ver 1_Eng_Form_6247_2023Nov17_20240319

U.S. Army Corps of Engineers (USACE)
Form Approved -
REQUEST FOR JURISDICTIONAL DETERMINATION (JD)
OMB No. 0710-0024
For use of this form, see Sec 404 CWA, Sec 10 RHA, Sec 103 MPRSA; the proponent agency is CECW-COR.
Expires 2024-04-30
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Authority Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and
Sanctuaries Act, Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332.
Principal Purpose The information that you provide will be used in evaluating your request to determine whether there are any aquatic resources
within the review area that are or that may be 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 or FOIA request as required by federal law. Your name and property
location where federal jurisdiction is to be determined will be included in any approved jurisdictional determination (AJD), which will
be made available to the public on the District's website and on the Headquarters USACE website.
Disclosure Submission of requested information is voluntary, however, if the information is not provided there may be some delay in
processing your request. Failure to provide this information will not result in an adverse action.
System of Record Notice (SORN): The information received is entered into our permit tracking database and a SORN has been
completed (SORN #A1145b) and may be accessed at the following website:
http://dpcid.defense.gov/Privacy/SORNsindex/DOD-wide-SORN-Article-View/Article/570115/al 145b-ce.aspxx
The Agency Disclosure Notice (ADN)
The Public reporting burden for this collection of information, 0710-0024, is estimated to average 10 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at
whs.mc-alex.esd.mbx.dd-dod-information-collections2-mail.mil. Respondents should be aware that notwithstanding any other provision of law, no
person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
1. To (District Name): Wilmington District
2. I am requesting a JD on property located at (Street Address): Intersection of NC 98 (Wait Ave.) and Moores Pond Road (SR 2057)
City/Township/Parish: East of Wake Forest County: Wake and Franklin state: North Carolina
Acreage of Parcel/Review Area for JD: 8 ac
Section: Township: Range:
Latitude (decimal degrees): 35.962906 Longitude (decimal degrees):-78.435272
(For linear projects, please include the center point of the proposed alignment.)
3. Please attach a survey/plat map and vicinity map identifying location and review area for the JD.
4. ❑ I currently own this property. I plan to purchase this property.
❑ I am an agent/consultant acting on behalf of the requester.
❑X Other (please explain):
I am the delegated responsible party directed to obtain an AJD by Brandon Jones, P.E., NCDOT Division 5 Engineer.
ENG FORM 6247, NOV 2023 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 2

5. Reason for 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 to 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.
❑ 1 believe that the site may be comprised entirely of dry land.
❑ Other:
I am requesting an AJD only within the construction limits of this project. This includes Right of Way and Easements.
6. Type of determination being requested:
❑X I am requesting an approved JD.
❑ I am requesting a preliminary JD.
❑ I am requesting a "no permit required" letter as I believe my proposed activity is not regulated.
❑ I am unclear as to which JD I would like to request and require additional information to inform my decision.
7. Typed or Printed Name: Christopher A. Murray Daytime Phone No.: [phone]
Company Name: North Carolina Dept. of Transportation Email Address: camurrayt&,ncdot.gov
Address: NCDOT, Division 5, 2612 N. Duke Street, Durham, NC 27704
By signing below, you are indicating that you have the authority, or are acting as the duly authorized agent of a person or entity with such authority, to
and do hereby grant Corps personnel right of entry to legally access the site if needed to perform the JD. Your signature shall be an affirmation that
you possess the requisite property rights to request a JD on the subject property.
g Christopher A. Murrayigitally signed by Christopher A. Murray
Signature: L Date: 3/19/2024
p Y Date: 2024.03.19 10:52:05-04'00'
ENG FORM 6247, NOV 2023 Page 2 of 2