20180349 Ver 1_Buffer and/or Stream Determination_20170818

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Water Resources
Environmental Quality
August 18, 2017
Mr. Brad Luckey
Pilot Environmental Inc.
P.O. Box 128
Kernersville, NC 27285
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: On -Site Determination for Applicability to the Mitigation Rules (15A NCAC 2H .0500)
Subject Property: Twin Lakes Community, Alamance County
Dear Mr. Luckey:
On August 10, 2017, at your request, Sue Homewood conducted an on-site determination to review features
located on the subject project for stream determinations with regards to the above noted state regulations.
David Bailey with the US Army Corps of Engineers was also present during the site visit.
The Division acknowledges the areas and boundaries identified as jurisdictional wetlands by the USAGE.
The attached map accurately depicts all stream determinations conducted during the site visit.
Please note that at the time of this letter, all perennial stream channels and jurisdictional wetlands found on
the property are subject to the mitigation rules cited above. These regulations are subject to change in the
future. In addition, the Jordan Lake Buffer Rules may apply to some streams at this location, please be sure
to contact the local government for further information regarding the Jordan Lake Buffer Rules.
The owner (or future owners) should notify the Division (and other relevant agencies) of this decision in
any future correspondences concerning this property. This on-site determination shall expire five (5) years
from the date of this letter.
Landowners or affected parties that dispute a determination made by the Division or Delegated Local
Authority that a surface water exists and that it is subject to the buffer rule may request a determination by
the Director. A request for a determination by the Director shall be referred to the Director in writing c/o
401 & Buffer Permitting Branch, 1650 Mail Service Center, Raleigh, NC 27699-1650. Individuals that
dispute a determination by the Division or Delegated Local Authority that "exempts" surface water from
the buffer rule may ask for an adjudicatory hearing. You must act within 60 days of the date that you
receive this letter. Applicants are hereby notified that the 60 -day statutory appeal time does not start until
the affected party (including downstream and adjacent landowners) is notified of this decision. The
Division recommends that the applicant conduct this notification in order to be certain that third party
appeals are made in a timely manner. To ask for a hearing, send a written petition, which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, N.C. 27699-6714. This determination is final and binding unless you ask for a
hearing within 60 days.
State of North Carolina I Environmental Quality
450 West Hanes Mill Road, Suite 300 1 Winston-Salem, North Carolina 27105
336-776-9800

This letter only addresses the applicability to the mitigation rules and the buffer rules and does not approve
any activity within Waters of the United States or Waters of the State or their associated buffers. If you
have any additional questions or require additional information, please contact me at 336-776-9693 or
sue.homewood@—ncdenr.gov.
Sincerely,
Sue Homewood
Winston-Salem Regional Office
Enclosures: USGS Topo Map
Pilot Environmental Stream Map
Cc: Lutheran Retirement Ministries, property owner ([e-mail])
David Bailey, USACE Raleigh Regulatory Field Office (via email)
DWR, Winston-Salem Regional Office

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Drawing 1, t USGS Topographic Map
�' Twin Lakes
USGS Topographic Map ` f Approximate 13 Acre Tract
Gibsonville, NC Quadrangles ir,
Scale: 1" - 2 000' Burlington, Alamance County, NC
■IL1)T Rr41A4MMIMTAL.Irf, Pilot Project 2729

'+ FLAG NUMBERS/INFO
w� WETLAND FLAGS =
STREAM FLAGS =
Stream/Pond Flags = Origins
Wetland Flags = 18
Total Flags = 18
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WA 1-3 /
WA 4-6 `
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Site Boundary
Perennial Stream
Wetland
Culvert
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE PRELIMINARY AND APPROXIMATE. THEY sal -s Flag Number
HAVE NOT BEEN VERIFIED BY THE USACE AND/OR THE NCDEQ-DWR. THEY HAVE NOT BEEN SURVEYED DP -1 0 Data Point
OR GEOLOCATED.
Drawing 5
Aerial Imagery from ESRI
and Pilot Field Notes
Scale: 1" = 250'
Date: 7.25.17
PIL11 I-�
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Wetland Map
Twin Lakes
Approximate 13 Acre Tract
Burlington, Alamance County, NC
Pilot Project 2729

SAW -2018-00284
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2018-00284 County: Alamance U.S.G.S. Quad: NC-Gibsonville
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner: Lutheran Retirement Ministries of Alamance
Attn: Pamela Fox
Address: 3701 Wade Coble Drive
Burlington, NC 27215
Size (acres) 14.067 Nearest Town Burlington
Nearest Waterway UT to Ingle Creek River Basin Cape Fear
USGS HUC 03030002 Coordinates 36.081555 N, -79.529101 W
Location description: The project area is located between US Hwy 70 (South Church Street) and West Heritage Drive,
approximately 0.1 mile northwest of the intersection of US Hwy 70 and University Drive, including portions of 3823 and 3929
South Church Street, in Burlington, Alamance County, North Carolina. The project area is shown as the "Project Area
Limits" on the attached survey entitled "Wetlands Delineation, Twin Lakes: Griffin Tract", Sheets 1 and 2.
Indicate Which of the Following Apply:
A. Preliminary Determination
❑ There appear to be waters on the above described project area/property, that may be subject to Section 404 of the Clean Water
Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). The waters have been
delineated, and the delineation has been verified by the Corps to be sufficiently accurate and reliable. The approximate boundaries
of these waters are shown on the enclosed delineation map dated MAP DATE. Therefore this preliminary jurisdiction
determination may be used in the permit evaluation process, including determining compensatory mitigation. For purposes of
computation of impacts, compensatory mitigation requirements, and other resource protection measures, a permit decision made
on the basis of a preliminary JD will treat all waters and wetlands that would be affected in any way by the permitted activity on
the site as if they are jurisdictional waters of the U.S. This preliminary determination is not an appealable action under the
Regulatory Program Administrative Appeal Process (Reference 33 CFR Part 331). However, you may request an approved JD,
which is an appealable action, by contacting the Corps district for further instruction.
❑ There appear to be waters on the above described project area/property, that may be subject to Section 404 of the Clean Water Act
(CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). However, since the waters
have not been properly delineated, this preliminary jurisdiction determination may not be used in the permit evaluation process.
Without a verified wetland delineation, this preliminary determination is merely an effective presumption of CWA/RHA
jurisdiction over all of the waters at the project area, which is not sufficiently accurate and reliable to support an enforceable
permit decision. We recommend that you have the waters on your project area/property delineated. As the Corps may not be able
to accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can
be verified by the Corps.
B. Approved Determination
❑ There are Navigable Waters of the United States within the above described project area/property subject to the permit
requirements of Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act
(CWA)(33 USC § 1344). Unless there is a change in law or our published regulations, this determination may be relied upon for
a period not to exceed five years from the date of this notification.
® There are waters on the above described project area/property subject to the permit requirements of Section 404 of the
Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ We recommend you have the waters on your project area/property delineated. As the Corps may not be able to accomplish
this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by
the Corps.
❑ The waters on your project area/property have been delineated and the delineation has been verified by the Corps. The
approximate boundaries of these waters are shown on the enclosed delineation map. If you wish to have the delineation surveyed,
the Corps can review and verify the survey upon completion. Once verified, this survey will provide an accurate depiction of all
areas subject to CWA and/or RHA jurisdiction on your property which, provided there is no change in the law or our published
regulations, may be relied upon for a period not to exceed five years.

SAW -2018-00284
® The waters have been delineated and surveyed and are accurately depicted on the plat signed by the Corps Regulatory
Official identified below on 2/9/2018. Unless there is a change in the law or our published regulations, this determination
may be relied upon for a period not to exceed five years from the date of this notification.
❑ There are no waters of the U.S., to include wetlands, present on the above described project area/property which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
❑ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (CAMA).
You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to determine their
requirements.
Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material, construction or
placement of structures, or work within navigable waters of the United States without a Department of the Army permit may
constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If you have any questions
regarding this determination and/or the Corps regulatory program, please contact David Bailey at [phone] X 30 or
David.E.B ailev2 na,usace.armv.mil.
C. Basis For Determination: See the AuDroved Jurisdictional Determination Form dated 2/9/2018.
D. Remarks: None.
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination 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 request
a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B.
above)
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this determination you
must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 10M15
Atlanta, Georgia 30303-8801
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by 4/10/2018.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
Digitally signed. BAILEYent, o.=DoD, 83736
ou=PKI
�'C5J7r� DN: c=US, o=BAIL Government, ou=8373ou=PKI,
ou=USA, cn=BAILEY.DAVID.E.1379283736
Corps Regulatory Official: Date: 2018.02.0913:41:13-os'oo'
Date of JD: 2/9/2018 Expiration Date of JD: 2/8/2023
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so,
please complete the Customer Satisfaction Survey located at http://corpsmapu.usace.army.mil/cm apex/f'?p=136:4:0
Copy furnished:
Sue Homewood, NCDEQ-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston-Salem, NC 27105
Brad Luckey, Pilot Environmental, Inc., P.O. Box 128, Kernersville, NC 27285

SAW -2018-00284
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Lutheran Retirement Ministries of Alamance
File Number: SAW -2018-00284
Date: 2/9/2018
Count Attn: Pamela Fox
Attached is: See Section below
PROFFERED PERMIT Standard Permit or Letter of ermission A
RED PERMIT Standard Permit or Letter of ermission B
DENIAL C
LAPPROVED
JURISDICTIONAL DETERMINATION D
INARY JURISDICTIONAL DETERMINATION E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.gM.mil/Missions/CivilWorks/Re"latoryPro2ramandPermits.aspx
or the Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.

SAW -2018-00284
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division
Mr. Jason Steele, Administrative Appeal Review Officer
attn: David E. Bailey
CESAD-PDO
Raleigh Regulatory Field Office
U.S. Army Corps of Engineers, South Atlantic Division
3331 Heritage Trade Drive, Suite 105
60 Forsyth Street, Room 1OM15
Wake Forest, North Carolina 27587
Atlanta, Georgia 30303-8801
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportunit to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant oragent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, David Bailey, 69 Darlington Avenue, Wilmington, North Carolina
28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Administrative Appeal
Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

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THIS CERTIFIES THAT THIS COPY OF THIS PLAT ACCURATELY DEPICTS THE
BOUNDARY OF THE JURISDICTION OF THE SECTION 404 OF THE CLEAN WATER
ACT AS DETERMINED BY THE UNDERSIGNED ON THIS DATE_ UNLESS THERE IS
CHANGE IN THE LAW OR OUR PUBLISHED REGULATIONS, THE DETERMINA71ON
OF SECTION 404 JURISDICTION MAY BE RELIED UPON FOR A PERIOD NOT TO
EXCEED FIVE YEARS FROM THIS DATE. THE UNDERSIGNED COMPLETED
THIS DETERMINATION UTILIZING THE APPROPRIATE REGIONAL SUPPLEMENT TO
THE 1987 U.S" ARMY CORPS OF ENGINEERS WETLAND DELINEATION MANUAL,
33 C.F.R. PART 329 AND OTHER U"S" ARMY CORPS OF ENGINEERS GUIDANCE.
Regulvtwy QFIICipI i�g - -
Title Regulatory Project Manager
[ante 2/9/2018
USAGE Action ID SAW -2018-00284
AREA WITHIN PROJECT LIMITS:
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NOTES:
THE LOCATION OF WETLANDS FLAGS
IPLACED BY OTHERSI IS SHOWN PER
AN ACTUAL FIELD SURVEY, GRIENTED
TO PROPERTY MONUMENTATION
RECOVERED, AS SHOWN"
THIS MAP DGE5 N07 CONSTITUTE A
BOUNDARY SURVEY OF THE SUBJECT
PROPERTY. ALL BOUNDARY
INFORMATION IS SHOWN PER DB 2878
PG 611, OB 1185 PC 187, PB 73
PG 384, PB 68 PG 177, AND PER A.
SURVEY BY SACKS SURVEYING S
MAPPING DATED 26 JULY. 2017.
THERE MAYBE EASEMENTS,
RIGHTS-01:_WAY, OR OTHER OATTERS
AFFECTING THIS PROPERTY WHICH ARE
NOT SHOWN HEREON -
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ACCORDING TO FERIA FLOOD 1NSURANCE
RATE MAP COMMUNITY PANEL
13710864400-K, EFFECTIVE 18
JUNE, 2007, A PORTION OF -THIS
PROPERTY LIES WITHIN THE 100 -YEAR
FLOOD ZONE (ZONE 'AE'}, AS SHOWN
THERE ARE IMPROVEMENTS TO THIS
PROPERTY WHICH ARE NOT SHOWN"
TOTAL AREA OF ALL WETLANDS ON
SITE = ID.143 5q.Fl.lG"233 Ac Y t
LEGEND;
IPF IRON PIPE FOUND
RBF MAGNETIC NAIL FOUND
P!L PROPERTY LINE
C/L CENTERLINE
AW AVERAGE WIDTH
IV WETLANDS FLAG FOUND
t CENTERLINE, PROP LINE OR
OTHER UNMARKED STATION
RIW RIGHT-OF-WAY
N/F NOW OR FORMERLY
SHEET i of 2 (Site Overview)
WETLANDS DELINEATION
Twin Lakes' Griffin Tract
PROPERTY OF. LUTHERAN RETIREMENT
MINISTRIES OF ALAMANCE COUNTY, INC.
3823 & .3929 S. CHURCH ST,
BOONE STATION Twp. ALAMANCE Co., N.C.
02 AUCUST, 2017
SCALE i INCH = 200 FEET
7pp P rup 2/70 •p0 pr0
REVISIONS: 8-10-17 - REVISED PER PEI COMMENTS BARGRAFkI inch• 20011.
8-14-17 - REVISED PER USACE COMMENTS DRAWING FILE NAME: TW-GRIFFIN-WET.DWC
i
15•" 72.ss' '
N 88'47'03• W
NOTES:
THE LOCATION OF WETLANDS FLAGS
IPLACED BY OTHERSI IS SHOWN PER
AN ACTUAL FIELD SURVEY, GRIENTED
TO PROPERTY MONUMENTATION
RECOVERED, AS SHOWN"
THIS MAP DGE5 N07 CONSTITUTE A
BOUNDARY SURVEY OF THE SUBJECT
PROPERTY. ALL BOUNDARY
INFORMATION IS SHOWN PER DB 2878
PG 611, OB 1185 PC 187, PB 73
PG 384, PB 68 PG 177, AND PER A.
SURVEY BY SACKS SURVEYING S
MAPPING DATED 26 JULY. 2017.
THERE MAYBE EASEMENTS,
RIGHTS-01:_WAY, OR OTHER OATTERS
AFFECTING THIS PROPERTY WHICH ARE
NOT SHOWN HEREON -
I 1C
TriTSi Q
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ACCORDING TO FERIA FLOOD 1NSURANCE
RATE MAP COMMUNITY PANEL
13710864400-K, EFFECTIVE 18
JUNE, 2007, A PORTION OF -THIS
PROPERTY LIES WITHIN THE 100 -YEAR
FLOOD ZONE (ZONE 'AE'}, AS SHOWN
THERE ARE IMPROVEMENTS TO THIS
PROPERTY WHICH ARE NOT SHOWN"
TOTAL AREA OF ALL WETLANDS ON
SITE = ID.143 5q.Fl.lG"233 Ac Y t
LEGEND;
IPF IRON PIPE FOUND
RBF MAGNETIC NAIL FOUND
P!L PROPERTY LINE
C/L CENTERLINE
AW AVERAGE WIDTH
IV WETLANDS FLAG FOUND
t CENTERLINE, PROP LINE OR
OTHER UNMARKED STATION
RIW RIGHT-OF-WAY
N/F NOW OR FORMERLY
SHEET i of 2 (Site Overview)
WETLANDS DELINEATION
Twin Lakes' Griffin Tract
PROPERTY OF. LUTHERAN RETIREMENT
MINISTRIES OF ALAMANCE COUNTY, INC.
3823 & .3929 S. CHURCH ST,
BOONE STATION Twp. ALAMANCE Co., N.C.
02 AUCUST, 2017
SCALE i INCH = 200 FEET
7pp P rup 2/70 •p0 pr0
REVISIONS: 8-10-17 - REVISED PER PEI COMMENTS BARGRAFkI inch• 20011.
8-14-17 - REVISED PER USACE COMMENTS DRAWING FILE NAME: TW-GRIFFIN-WET.DWC

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THIS CERTIFIES THAT THIS COPY OF THIS PLAT ACCURATELY DEPICTS THE
FiA1 !VA13 9' 2q, TOTAL LENGTH OF STREAM "5A" BOUNDARY OF THE JURISDICTION OF THE SECTION 404 OF THE CLEAN WATER
�' '00 = 392.6 LINEAR FEET •I-
IEICCLUDES fi0" CTAP CULVERT] ACT AS DETERMINED BY THE UNDERSIGNED ON THIS GATE. UNLESS THERE IS
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2A 17 'E \ I AREA OF STREAM "5A" OF SECTION 404 JURISDIC71ON MAY BE RELIED UPON FOR A PERIOD NOT TO
�Og^ i 4 a 2295 Sq to05AC-1 ./- EXCEED FIVE YEARS FROM THIS DATE_ THE UNDERSIGNED COMPLETED
SA9CULV P" yt" Al2 AI THIS DETERMINATION UTILIZING THE APPROPRIATE REGIONAL SUPPLEMENT TO
NETLANO AREA "WA -I to WA -3" THE 1987 U.S. ARMY CORPS OF ENGINEERS WETLAND DELINEATION MANUAL,
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SHEET 2 of 2 (Wetlands Detail)
WETLANDS DELINEATION
Twin Lakes= Griffin Tract
PROPERTY OF- LUTHERAN RETIREMENT
MINISTRIES OF ALAMANCE COUNTY, INC.
3823 & 3929 S. CHURCH ST.
E30ONE STATION Twp. ALAMANCE Co., N.C.
02 AUGUST, 2017
SCALE 7 INCH = 40 FEET
Q a 20 .0 4o 150
BAR GRAPH I T7reh = 40 f f

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): February 9, 2018
B. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District, Twin Lakes / Lutheran Retirement Ministries / 3823
and 3929 South Church Street / Burlington / Alamance County / residential, SAW -2018-00284
C. PROJECT LOCATION AND BACKGROUND INFORMATION: The project area is located between US Hwy 70 (South
Church Street) and West Heritage Drive, approximately 0.1 mile northwest of the intersection of US Hwy 70 and University Drive,
including portions of 3823 and 3929 South Church Street, in Burlington, Alamance County, North Carolina.
State: North Carolina County/parish/borough: Alamance County City: Burlington
Center coordinates of site (lat/long in degree decimal format): Lat. 36.0815550727777°N, Long. -79.5291014302104° W
Universal Transverse Mercator: 17 632436.46 3993995.46
Name of nearest waterbody: UT to Ingle Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows:
Name of watershed or Hydrologic Unit Code (HUC): Haw, 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) Determination. Date:
® Field Determination. Date(s): 7/26/2017
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There _ "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 W "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 waters2 (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: 393 linear feet, 6 wide, and/or acres.
Wetlands: 0.18 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:
SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
Boxes checked below shall be supported by completing the appropriate sections in Section III below.
s 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.

-2 -
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:
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 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:
(b) General Tributary Characteristics (check all that apply):
^ 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.

-3 -
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: --
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: -
Estimate average number of flow events in review area/year: rick List
Describe flow regime:
Other information on duration and volume:
Surface flow is: rs . 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
❑ changes in the character of soil
❑ shelving
❑ vegetation matted down, bent, or absent
❑ leaf litter disturbed or washed away
❑ sediment deposition
❑ water staining
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
❑ the presence of litter and debris
❑ destruction of terrestrial vegetation
❑ the presence of wrack line
❑ sediment sorting
❑ scour
❑ multiple observed or predicted flow events
❑ abrupt change in plant community
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply):
❑ High Tide Line indicated by: ❑ 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:
(iv) Biological Characteristics. Channel supports (check all that apply):
❑ Riparian corridor. Characteristics (type, average width):
❑ Wetland fringe. Characteristics:
'A 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.

-4-
❑ 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:

-5-
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 III.D:
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:
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 IIID:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet, wide, Or acres.
❑ Wetlands adjacent to TNWs: acres.
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 SA is a blue line stream on the USGS topo map, drains out of a pond that is also on the
USGS topo map, has a bed and banks, OHWM (line impressed on bank, shelving, subsrtrate sorting), leaves washed
away in channel), was determined to be perennial by the applicant's consultant and agreed upon by NC Division of
Water Resources.
❑ 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: 393 linear feet 6 wide.
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
3. Non-RPWss that flow directly or indirectly into TNWs.
'See Footnote # 3.

-6-
❑ 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, wide.
❑ 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:
Wetland WA is a contiguous wetland unit that extends to the banks of Stream SA.
❑ 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: 0.18 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 IILC.
Provide estimates for jurisdictional wetlands in the review area: acres
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:
Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet, wide.
❑ Other non -wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
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.

-7-
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, wide.
❑ 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, wide.
❑ 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: 1:24K; Gibsonville
® USDA Natural Resources Conservation Service Soil Survey. Citation: Alamance Co. Soil Survey
❑ 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): ESRI 2014
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): LiDAR (NC Floodmaps)
B. ADDITIONAL COMMENTS TO SUPPORT JD: