Mallard_JD_Attachments_Compressed_UPDATED

Legend
Q Proposed Easement
Patterson
Springs
y
a
z
�a m
5 Y
u
m
C13`
E art
9
Grover
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6A -ll
'jstar '6s WOO.-,
Sources: Esri, HERE, DeLorme, USGS, Intermap, INCREMENT P, NRCan,
s Esri Japan, METI, Esri China (Hong Kong), Esri Korea, Esri (Thailand),
�o Mapmylndia, NGCC, © OpenStreetMap contributors, and the GIS User
Community
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rte•
Vicinity Map
Mallard Water Quality Improvement Site
0 0.5 1 2
Miles
1 in = 1 miles

Legend r
226
Q Proposed Easement z
Nl—
a Waste � y � !{}•' = ., '1 � ;C �,, ;>�
v
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Project Location Map
Mallard Water Quality Improvement Site
0 1,000 2,000 4,000F
eet res
r�r
1 in =
2,000 ft

National Wetlands Inventory Map
Mallard
Improvement
4y+ 125 250 500

c? m
0
LaJR
source- Esri, Digita apb(, N)P e, Earthstar G�eographics, C«NES/Airbus DS,
USDA, USm, AeroGRID, IGN, and the GIS User Community

Soils Map
Mallard
Improvement
4y+ 125 250 500

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
of
(Contractor J Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: Date:

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Arrny Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Property Owner (please print) Date
Property Owner Siilfnature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUS5 and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an approved JD (this may or may not include a survey plat).
Irl I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
4 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E
5 Waters of the United States
Version: December 2013 Page 4

p ®u
RECORLE IM FEE I — °'F f r?tl `_ 3T - ON
Excise Ta): 11 3140.00
Ta) Mc F No. Plclrtior o14-2-1-,
2121118-1211 B: 1725 R: 11E121
C 8/2E /2¢ :I EI E3:34:94 Rh Total Paigers : 111? F eers : 1815,121C
Dekna MU]1 Hari. i11 Regllster ofl Deeds. Cleveland Caunt"Nc
I 111111 11111111VIII 111111111111 III 1111111 illi VIII VIII 1111111 III 1111111111 VIII IIII I II
Reiciei ptm 16-14160 22116410IA36
lssued 0812617016 C1ei�ielandcRt ';
by Debra "LlI Hain`!], Register of ®eEcs
Exciser f mlc Lr i : 11340.00 Elxc.i sqr :ID 1H3I771
Real Estate Excise Tax
N C RTIH CARC UINA
G E N E RAL WAR RANTIY DEET D
Mz it aftE r necclrc it g la: Johr V. Sct wepF E, Jn.
Thif irstiumerI wEs FrEIFarElc ty: JoHr V. Scliwepre, A.
THIS DEE D mcICEl It ifl caN 011
RElaalcirc Tin -E, BaolI arlc
Plareel IC Elrtilier Ncl. Pcrtic n of Fla
GIRD NTOR
EI, Ly_E-in�\Aeen
Eu CIE ria N osis ReE VE s, Truslee of the N osis Heirrl ily Timit /
CnEIMEC t ar aclieemElrI, ca1Ed NO\ElmLer 12, '19c12 (1,131 Lnc i�icec int
est)
Dori= N. AUStEll, Huc- HInlir AtII ar RclLeros ustEl�lrc,ltlor
essorsj.
TimIlEEls o'lIhE T11errlas PLstell Hamily TIILsI ca,lEd JLiy 1,, JCI11 (1/11 urcivicElc it telElsl)
Patriaia R. Ac SItE11, L r manniElc Il'l/31 L ncivic Elc irilemE Il
H.O. Box 189
Eanl, N.C. 21810:81
ErvirerlmErlal Eanc& baliarge, ULC,
a NanNlanc LimitEd Liability CompElrly
3 ti'Z u I St n
The des iglnalior Gralr ICIn arc C ran lea aft us d herE it fl at 'r ClIUC E staid F artier , tt E it hE its, sucICIessciiis, E rd eisfligns, anis
`tall irCIUCEl airclLIE11, FILrlal, mEIEC/Lfir E, fe ini e or rEILtEI a rEcjuirEIC ty cclrtEXI,
WITS ESKTH, that RE Grant I r valL le is allion Faic Ly If E GrElrtEIEI, the rElceiplt all "hiclh i he]IELN
aakn ciwlE c gec , has arc t y th s piiE tEl E s clllgairl, fell aric cclrlvE y unto IMEI C-rElntEIEI in Tele sirr pl[EI, all ll -al
certaini loll an Fareel of larc an m r p rtic r1 EsclribEC Es fclllows:
Bering thud 412.4107 acirel a c rt shown in Flat Book 39, Paga A'171 ircorporrallcic E circin Ly nefeuenca and
Ext ibis "p"

2016-OCI7436 B: 1725 P: 1183 08/26A20'16 03:34:54 RM Rage 2 of 10
All or a Aortior ci th e ppaopEarty h erElir c t ON Ea c EsenibEac �A e s aclquirE c t y Grarltan t y in;Itrc ricint re cculc ec in Elcic k 'I E a7, l c E
'19"AC , Cleti E lanc CCiu my Registry,
A map shcwincl 11•e aho%E cesanibEC puciperty is naccurdec in F lai Elcak K1, Page 37, arc nefElmencilec wil1,ir this inslnumer I
T h e abo� E c esarit Era F nor erty ❑ c cies [fc cie's r at iricllu c e 1h Er pnirr ark rE sic E riae Oil ihEr G r ntal
TC HAVE A D TO HOLD the afane_laid Itd c parcel al lane anic all Flni\ilEge: arlc aFIFlurlenEll] aeis thellEltca tlElanclinc 1a t11El
GnaritEE iri fEe simple.
Arie the CnErlton cavElrian's with 'he Cnan'Ee, !hal Grcnilar is 9eiZEIC c11HE prerrisea in 1EIE1 simrllEl, Iles V ri t a comEly
thEu le SE iri Il :IiMPIE1, 1HE1 Iitle is rrl€ukelablEu arc free erid Clear of E11 EnCcrrtnarsea, and Ihe1 Cnenlan w1 urerit anc
delbr C the til lel acair sl tl'E IawfUI Cleims C11811 rlEwiclr;l wl'arraOEl\oer a>Cerltfcln VEl EXCIEIICIticirs hclllEli atERE
TItlE la 1 hEl pragerty h E neinat cave dE sciiit ed is SU t IEIC'l I o VEI lollowir C EIXc E p' is ria:
EasElmerils, ric hts till way e rc leairictiorn9 of rElaorc, if ar y. Easement to Dull Poweir Compla rata d in Book
Page 5'I 9, Clclvelair c COIL my Rlegislry
IN W ITNESS 1A HEIRIEICIFI, the Glnantor h as 1• c ccunito set his har c and seal, or if corporals, as- this
iristrumcrtlo Ill s ignled in its cicirploralla dame by ills c my authorizec officic rds1, lh re an f" st atave
wriltc r .
l,, (SEA L)
lIENTITI NAME; Thomais Austell family Trust Donis N. AUStEllll, T us e
dated July 11, aC11
By I 41
-'(SEAL)
TitlEu: H uani lin A ustel , T ustee
;f(SEAL.)
'RolbertNichoflsusteg, Truslee
STATE C Fl h C RTH CP ROLINA, C C UNTY OF CLEC ELAND
fcerlifyIhz1thElliollowirclpEuscirspersoralit' arplear4efe slcey, aah ackna"IedIcincltairriE1ha' hEansHEII
ciic ned tr a loregoir cldoaumen'l: DcrisN.AU9lEII,Hin ste OtEir Il lc AuslElli . r� i� t� s t c>es o 1
the Thomas Auste�.'1l Taimily T'ntis�d: catcc ,112 11
Wilresse rry hanc aric ollfiaiel stErripl or sEal, isthaay ci Au ust �ICI1E
Nalert' Pull �
Prirll Nolary Name; �i

2016-007436 B- 1725 P- 1184 C18/26A2016 03-34-54 RM Rage 3 of '10
I1.losr FaniIv Ti -u,,
Eugenia 46sS Reaves, Til_USlEia_____77
STAIE OF NCFTH CARCLIhA, CCUNTN CIF CLEVELAND
I c ertifA i h E I t h e fci llovA in g PER sc i ni si r e it Eior E i lly appeared bel c ie me this c ay, eiauh ? Ck nc
sigr Eid the Ic neping cociumenil: EgeniiE Mass Revives, TruStEe for Moss Failli I V
agi-ecimerit c z te( Nov. 12, 1992
Witress mN tanc End official slampl oii seal, ttis tte c August
My C c w rr issior EA plirEIS: —ali I
Noti=ublici —
Pr,n otary Name-,
Va
�l I E crsl­8
", �tl'c ""It ( 1 11 �l I
N"A
EAL)

2016-OCI7436 B- 1725 P- 1185 08/26A20'16 03.34.54 RM Rage 4 of '10
Pati ie is V Auv t (,I I. , I .A- I -F
Suszr Festall 1101 111,,.,,.
ACKNOWLEIDGN EINT ON ATTCIF NBY-IN--FACII
fl -M TEI CT!
CCUNTYCIF�y,�yj iE
i
1, C>tir1tt a U('0i allotaryPutIii
rerety ceirlify That Susari ALslell HcdcKiay, Atlorreiy-lr
t efare met til is da y, airic d e frig t y me c L 1y sw orn, says t
it s1 nL me rt fan aric iri behallf of I t e saic Ratricia FI. At
ackriati leidgEi sa id irisl nL rriEiril is cionta iried it ar instrL r
in tF a Office of the Reig is1 er a1 Defied s in the CaL rityl of ,
daffy of AL(,psi 210_L it Bcicik �S
Page $ and tha II this instrument was EXUL, tec ui
inistrumer t piantirig 1- im Rower of Attarriey.
i do fu r1 h er cerl ify that 1 h e said St_ sa ri A L sten Hciic way
arid arir eixed irisl m meirt for tE ei G L npose t1l erciri elxF res:
VV i1 r ass my 1- and aric aH icial seal, I h is til el U t �da of - U ":._.__ _ 2a Z(
0- /'-� Offi�iat`��ure of Nota ryl
ii br tV pelt ria rriel
�j My m slc a ire s:
Nctany PudliC
COM In 0.111lIdVOR
Nob ryFullk,"I?,i= nflq,d, �hCer0vf i
My Clorr 4r,'7 f!71

2016-007436 B- 1725 P- 1186 08/26A2016 03-34-54 RM Rage 5 of '10
Tti I
Gillil-riencing ,it vi found sictic. it comircir cornet cf I -at Clarks G. 111, Is 1-rol-crt, drscrlhod it
decd t(cilk IOS, page I 11 ailiil Ilial ­h-mas Austell F.Alli]V Trust propert, ilescril-cil III ileod look
Iti pi,pc I93(11 arc running N 316"'Y"ii W a cislarce 41 IW O' lo- a sp-im-, hoad and
N 4(1F51'_`I3" W a distance of 181.92* to -i sell 114 rcitar in the cold line hN a 1'ellco, 'I (,olllli-(-Il
corrcirof Davis, Austell rrd Sub.icict I'micit. l[c FI(inl anc pkicc oftuginriiw:
Thimr, with ti rerraiindi of the Aiisliell propaity, fIirli rom Tires its 6611ol, s:
(1) S 4 I"W"I'A" W a cis I an(e o I' ''I cit a scat #z ickir; (.1) 1 hencic S 014 `2 11,F"
48L.(4'bi) a sul 44 rdar; Q31' tlicirc(i S 44"0048" V I a distLirce cf-4i to I �'ct
roziclv;iy, 114,' N 410_5710,9" W a distair cc of I O'LIT 10 ser #4 iebar 11. sil of roat I
(5) N 24`23'23" W a Ic islaricc (if'224.912' to a see 44 reldar East aifiii roadie aN . (0)
A: I ( I I It
F a distan,(
sl a ricc of I 1 1.8.2, ici a scii V4 rchir Hilsl o, au rii iidiviiy*, ( A IN 34 , 1,111� I I 'k a it sllj 'C
Ici a seal 44 iiabar Misl of a roac v,,,Iy,- (18) N _'I31°_`I9'_' 1" W a c i< lance c f I (,' I "If (i a : et 44
East (if a rciaticimy; (% N 4 3',-,IT4" V I al clislancici of 4 5 X1.971 Ici a set 44 reh "t of I'm I
If 101; N f 2041"9" W a distair Cie of7ti 81' Ici a se'i #4 1 ebar Yk sl of a riciaidwa,
I F N 71-22'22" W a dislancici of 18.3_11" to a se #4 11 H, s�i of N roal­!V`'a 2)
Flasii irg it sell #4 iiebair all 121911" arc (icirill inuiii 8, a loftil c islancie el'246. sel -
it 3,' N 61110145 " w, riassir p a sci 1 #4 rci tair c ii I it- c m air lak plain M
I(Ad cislancie (i!F 352.-)1' io In poinii in thea carkirlinci of Ilhiffalo G -e 11 C()Illl
Austell, Sul:.jccut '11"mid and thri RCI)Liblic Serviccis o," Cat Ii C 1 .01) - of ,s
t. c: cik 41I -) 11, page 22;
0.981
-ell r
1" 1,� .
I k�, tile Ck'n'lerlilic I)f
T11(irclo, k%iJ 1110 PliciptHic Scivicicis of Carcidinas C rr(iFIcrty zirdlj()
au
F54'I 2 starve of 01_ 2, to a rom 11:
I' tiffak Creek, four calls as f5cilli IIF N 'L' " I�
r �Z
(2,) N 48-4 T4 H a ( isiiancci cif 'I 11 .1 c, a r, cilint; (3), 4 1 1 r d'stailce ol'_'6447' to, a
r.pinil; f4' N '23'48" E a cislance cul' 108.51' ici a point;
"Flicirccii, with file aforcirienticircd C11-airics G is pi-circrty, 11-rce calls ;is 1'011w,
(I ) IS ('2°{ 1'313" E, 1i as-ir g a set Ai4 rcill 011 on Ill ,it le cif (creek ait 54.1SII)'. passim, a set -4 r6al
on linen ai (iic Eci of swan- r wi an aiddifional 976.11' C linUil-tI, -it t0t',II dlStaIICC ol' to
.- - , ")
;,it ciaripuicd point iri , swamp,, (2) running Ilia 'al (ii W , 5
passim
—, !
isilamic of 291.00' to -ii compiled f1cillit in -11 17" 11, a Se t V4 rehir on
firia of edge of swairrip and Cal-tiril. iFg,
ista c MOW to a scl �Ii4 rubor ill the ('1111 line
to , , c,
by � llama, 'llc F.Iciint aric phic(i cii.1' bc�lainni ig, li i g a viii call' 42.407 acivHeltiv showr as
Tractt I olir a surtili entitled "AL "M 4PS , id T'do
Purcili Tracil Sutdivisicri to -.i Enviro in tal B tic
survey, cd � N limciii I- y A. 11 L C CIIpIl. f LS o e -rry
icy and Minor 'Siihdlvi�lon ofi killard
LIkinga. Ii dated Jum, 10. _10hi as
viers, In e.

201 6-OC17436 B- 1725 P- 1187 C18/26jI2O'16 03-34-54 RM Rage 6 of '10
A cecss Fiviscm cmil
CCITUTOM irg a111 --i set 414 rebziir or lire ricar flood plair, v ciciril corner ( I'that Thomas Austell
Firmly `Yrusl ppicircirty ciciscribcIT d(cid bacilr 1637, pang I q3 (I aircd Tn-ct I mid r imi it i -f
',� 61'2014-"' E of distairce of 449-11-11' to a set Ali rcitar arc S 02'--""1 F \V 2111.1118* t« a scl t"14
reb,iii, 1he poini zirc plica of b(ginnirg;
Thu r cv, runriii- g NN ithiii ilia tcl ciFfract 1, cighil calls -is i5cll~: (I ) tl°cflcc
c istair ce of 83.14'; licircie S -'12'41'59" H a cislan(ci ol, K1,38, (3; tl,,eiicc 4)
clistaircc 4 51q.86', 04' lFen(c S 513"9'`11'" E a disuirce ciff 1 U.30'. 0) fliciice 3-"40"46 F
distal cc calf 3513-1 6'. 0, thence S 19'0'48" E a distarcu (if 112.90'. (1) Ilit'lice 2 " i°�1 ' F a
disuircu c f «:1,91;1'; (I t h (I r ci e S 41°_` TO 9 " B a c i s I ar c e ci I" ]103.(13` to i p o i i i I I i i t I i c C 11 rnc.
of Tract I , it c Il c Aust(T] I f ruir cirty,
'ri, c ncci, m ir v ing , vit hi n thea bounds ol'thc Austell f rc r1c rty. 1wc] va dills & 1`0 11 k S:
(I) S (T -`TA" E a disilarmi cif x168.0]' to a sell 414 iicbar on llic West ripl 1, ) a1 Of I al gird
Diiivu-, (21' tilcincc S 26"1 (1'34" W a c i!Aall cut 40.09',lci a set 44 rdair ii it Ill c1\ I-1- o v, v (I
Mallarc Diiive; 11-cim N (]'-'17'27" W qii cistarce of 312,29% 114) Ih
disumcci of 118,31 (51) illicucui N 24'� 3'23" W a disiloincc of 2-2c,L60% (1( enc 1-08 sa
dislurcc of KleL]]'; (1) llEcnc( N 34'401'4C' W a dislanecii of 244.94'; l ilictice N 41 5 1
disivii(ic,i)fl81151.18';1l5l,tliciiiiceN4,1'LI7'44"WaiciflilanLcio"4((1.20':(I( thercc
�7" a distance 1i) F ( 8.z ff, (I I) It encci N 11'2222 " W -i disilanuc of`�- I tc, scl v
(12) N 021-21311 1 " 17- ,1 c isilairl of : 8.4" to a sell #4 iicibar J cc I-1.1 a ill ctal pil- C. tile
cen7mcr c(rucii(if"i-ral avc the Ausiell picper); <",\'
"flictive, vilh the cc uirion lire of"Fracil I arc the Aust lI cil-er�ly,
area 1)2",2"11" 1: '1 distal cc (A
uginni g. ha ring it 1- 1. 1 acrc<�. Beir o
1:1.'19' ?4- a set jJ4 rear, the poirl, and f.)acc of b
shove i i s 4C' A c c i ci s s F as c ty c nt en a s u ry c 1, ci ii I i ii I c c "A I L I I A)DSIII -t ,ani i lt I S t i r c i i i i ii I IVI i r o r
-at
SubdiNision c1* Mallard Puruliv,,ci Tracl Shit: iJ ivisiiir for Brvironrricih�aBirc
cv tuc June 10, 20116 as si irN cl by T irri c I h y. udolpl-, 11 LS of Dc, vbcri-i Fii v I r ce rs. I i i c.
��z

2016-007436 B- 1725 P- 1188 C18/26A2016 03-34-54 RM Rage 7 of '10
STATF, OYNCUTI-I CAMOILINA
COUNTY OF" LIFiVELAN 1)
TRUSI CEH1,11FIC
TIIC UM CTI-SiVii ed beirg the Intsicic ot'I'licTlicinvis
dalcd JuIN 11, 201 �l 1111-c "Trust") I-crctN curbBels14
S Pl.whirgu, LUC r1l. rsaw Ii NCGS
I. Thu Trust is in eXiS'lQYCL as 41 f dici d,- I c ,,ct I
gverning the l ciums,)fdic trust v,Ls excicut
T The n. mc c fc,, ch settlor cifilc Trust is: El
Au,,,IcII. Acikcrt P, ichcIs Austell
3. TI -c i , ne and iiddrcss 11 currant wicting
a. 1]
, c. ri,,, Na � LISW I I
L Hugh Ftanklir Austell
c. Robert Nichols Aiislcll
4. The trusteols) are authorized by 11 tru t s neral or ty ilic pro\ isions of
applicii)lc law (including, bul i of lin it t IS YC -H- (9 I S) to -('11, coll, cy.
FlIedg, ric rtgagc leas�, ian,,q� p r, tc, c i trol, or transter lilIC 10 tl-LISt
lirclicrty, ircluding reatpr p cx ep , limil(Tc by Ilic k Hox, Ing, (if'nouc. �o
indicaiie,': NONE
5. ilyTioust
1-cm-ccal le a �c fil hold the rowcr 1c, rcv( kc:
Duris 1Y. 1 is,
I I, h aIllk In A ustciill, Zubert IN MICISALISICH

2016-007436 B: 1725 P: 1189 C18/26A20'16 03:34:54 RM Rage 8 of '10
E ,
if the rc is more than one trusl eci l imed abova: Ila) 1he L r c ersigne d has 11-i c
aLthoril) to sign or otherwise aulhcnticale the ex'silenca oftha Trust with111ut
joinder of 111 ci c ci-truslecis, arc (b)1he unders'pad has thea aul l- c iiity to exercise
1he flawc rs listed above withoul joinder of 1he co -trustees.
T The lax a cr k antifical ion nLmber for the Trust is: U
(NOTE: This sac11ion rr.aiy bei leift blank if the laxpayelr icantifiaralion ruriber is
the scme as thea social scicurily, numtiar of a party 4a tho linisiI inslrL 11'CW A11c 11 rs
c oc umunl 's Io be rcic orded in 1he pL f l'c rcicord)
S. The Trust has not t Bien revoked, m odif cd cir am endue 'n any rvinr cr so a:- 1)
cause any of the reproscirIall ions caril a'rad in This Carl ifical ion 10 1)CjftC-0—rr-Ctq
Dciris N. Austell:, Trusleel
Frank:inAu'stel, riastac
Atslell✓Truslec
)executed, subscribeid aric swum to mei thea da)'�anid\ycian arove/w�iltun.
etp4''®i'
51011 F 1-11
f0 �/' j`°ii
W
WY of
CD Cy
U
y put\>G ZI
c

2016-007436 13- 1725 P- 1190 C18/26j120'l6 03-34-54 RM Rage 9 of '10
STATH OF NO RTH CARO LIN A
COUNTY 01"CIII]VIIIIAND
TRUS10ERTIV
Tht m-dersigred beirg ilic trusici( of Ilic Mas! 11
damped Nciveimb(i- 12, 1992 (11lic "Tris)") licicby t
Blanc & Elim hting(i, LIHC pirsuvint kii NC(jS 3((
Thc"ru,il i,, in eNisicricu fis Utho cater s(
Elciveriling 1h( turms cif Ilic trL,'l was CNC(
:
The roma cifecich -citilor of the Trust is:
-3. Thea raime wind addrcissof all ourrunt act,71
Z. EuguriaMos.-Rciumis
DATE:
4. 11a trustcie(s) aim ac 111oriA C' by ilhtriistl ir.,Arumcwt or by the prov],,iolls of
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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):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Cleveland City: Grover/Earl
Center coordinates of site (lat/long in degree decimal format): Lat. 35.194087 ° 1, Long. -81.492684 °
Universal Transverse Mercator:
Name of nearest waterbody: Buffalo Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Broad River
Name of watershed or Hydrologic Unit Code (HUC): 03050105100030
® 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) Determination. Date:
Field Determination. Date(s): 5/25/16, 5/26/16, 6/1/16
SECTION H: 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 M "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): t
❑ 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: 2295 linear feet: 5 width (ft) and/or acres.
Wetlands: acres.
c. Limits (boundaries) of jurisdiction based on: 1987 Delineation Manual
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:
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).
s Supporting documentation is presented in Section III.F.

SECTION HI: 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.l. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections HI.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 Ra
arsas 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 waterbody° 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 IILC 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.
5 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:
Tributary gradient (approximate average slope): %
(c) Flow:
Tributary provides for: Pick List
Estimate average number of flow events in review area/year:
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
❑ OHWM6 (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.' 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.
'Ibid.

(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 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:
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 HI.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 IILD:
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.
is Tributaries of TNWs where tributaries typically flow year-round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: Channel is second order, and demsonatrates characteristics of a perennial channel including continuous
bed and bank and substrate sorting; however, in several areas beaver dams are present across the channel, which obscures the
ability to sample substrate or macrobenthos. Additionally, stream scores 31 on NCDWR Stream Form. Ditching of the
channel and the adjacent stream (S02) have led to the deviation of the stream line from the way it is shown on the USGS
topographic quadrangle.

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: 2295 linear feet 5 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.
IN 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:
i Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B 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):"
® which are or could be used by interstate or foreign travelers for recreational or other purposes.
'See Footnote # 3.
9 To complete the analysis refer to the key in Section III.D.6 of the Instructional 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.

❑ 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:
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:
❑ 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:
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: 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:7.5-Minute series, Grover Quadrangle.
❑ 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: 1010' (National Geodectic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date):NCOneMap 2015 Orthoimagery.
or ® Other (Name & Date):USDA/NAIP 2012,2010, 2009, 2008, 2006, 2005; USGS 1999, 1994, 1991, 1989, 1983,
1973, 1971, 1961; USDA 1949 (all as part of an aerial photo decade package from a third -party data acquisition company).
❑ 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:

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):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC County/parish/borough: Cleveland City: Earl _
Center coordinates of site (lat/long in degree decimal format): Lat. 35.194087 ° , Long. -81.492684 ° W.
Universal Transverse Mercator: E: 455148.00; N: 3894678.06 (UTM Zone 17S)
Name of nearest waterbody: Buffalo Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Broad River
Name of watershed or Hydrologic Unit Code (HUC): 03050105100030
® 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) Determination. Date:
Field Determination. Date(s): 5/25/16, 5/26/16, 6/1/16
SECTION H: 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 M "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): t
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: 1,956 linear feet: 15 width (ft) and/or acres.
Wetlands: 27.69 acres.
c. Limits (boundaries) of jurisdiction based on: 1987 Delineation Manual
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:
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).
s Supporting documentation is presented in Section III.F.

SECTION HI: 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.l. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections HI.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 Ra
arsas 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 waterbody° 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.
5 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:
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
❑ OHWM6 (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.' 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 now
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.
'Ibid.

(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 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:
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 HI.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 IILD:
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: Stream is first order, flowing through large wetland. Stream displays characteristics of a perennial
stream, including continuous bed and bank and substrate sorting. Shown as a 'dashed blue line' (intermittent) on USGS
topographic quad map but the stream flow path has been significantly altered downstream from its confluence with SOI and its
actual flow path is different than indicated on USGS quad maps. Additionally, stream scored 37 on NCDWR Stream Form.
Of note are several large beaver dams across the ditched channel as it flows out to Buffalo Creek; these dams obscure features
suchs as particle size/sorting and macrobenthos sampling along the downstream portion of the stream.

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: 1,956 linear feet 15 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: Stream flows through a large wetland complex and into a ditched channel leading to
Buffalo Creek. The wetland surrounds the stream on both sides and terminates when the stream cuts down into
the ditched channel.
Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section III.B and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW: S02, a perennial stream or RPW, flows through the wetland area and drains to Buffalo Creek. The
origin of S02 is at the outfall of a blocked culvert that formerly drained the wetland; upstream waters (within the wetland)
are now perched and ponded above the culvert, and it is not possible to see the upstream end of the pipe.
Provide acreage estimates for jurisdictional wetlands in the review area: 27.69 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.
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.9
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
'See Footnote # 3.
9 To complete the analysis refer to the key in Section III.D.6 of the Instructional Guidebook.

❑ 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:
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:
❑ 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:
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: 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:7.5-Minute series, Grover Quadrangle.
❑ 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: 1010' (National Geodectic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date):NCOneMap 2015 Orthoimagery.
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.

or ® Other (Name & Date):USDA/NAIP 2012,2010, 2009, 2008, 2006, 2005; USGS 1999, 1994, 1991, 1989, 1983,
1973, 1971, 1961; USDA 1949 (all as part of an aerial photo decade package from a third -party data acquisition company).
❑ 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: