20190424 Ver 1_JD Request - Authorization Form (USACOE)_20190403

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION3"
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on-
site inves[igations, if necessary, and issuing ajurisdictional determination pursuant [o Section
404 of the Clean W a[er Act and/or Section 10 of the Rivers and Harbors Act of I 899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of Ihe owner of record of the property.
T/�/NRGI� Fi�/NAICJNLS Tp�✓E(S
Print Name
Capaciry: ❑✓ Owner ❑Au[horizedAgenP
.3-2G-iq �
Date n A
i
E. REASON FOR JD REQUEST: (Check as many as applicable)
I intend ro constructldevelop a project or perform activi[ies on this parcel which would be
esigned to avoid sll aquatic resources.
� I in[end to construcUdevelop a project or perform activities on this parcel which would be
designed to avoid alljurisdictional aquatic resources under Corps authority.
❑ I intend to construct/develop a projec[ or perform activities on this parcel which may
require au[horization from the Corps, and the JD would be used to avoid and minimize
impacts tojurisdictional aquatic resources and as an initial step in a future permitting
rocess.
�/ I intend [o cons[rucUdevelop a project or perform activities on [his parcel which may
require authorization from [he Corps; [his request is accompanied by my permi[ application
and the JD is to be used in the permitting process.
� I intend to construcUdevelop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and Flow of
the tide.
BA Corps JD is required in order obtain my local/state au[horization.
I intend to contestjurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
� Other:
' For NCDOT requests following [he curtent NCDOT/USACE prorowls, skip to Part E.
° ifihtte are multiple parcels owned by differenl penies, pleese provide the kllowing for wch addilionel percel on e
wnlinua�ion sheet.
' Must provide agent authorira[ion form/letter signed by oxmer(s).
Version: May 2077 Page 3

AGENT AUTHORIZATION FORM
Name: Pinnacle Financial Partners. Ina (POC: Dannv Broachl
Address: 3950 Premier Drive. Sui[e 210. Hieh Point NC 27265
Project Name/Description: RoadwaY Improvements [o Prescot Glen Parkwav
Dace: March_26, 2019
The Deparunent of lhe Army
U.S. Army Cotps of Engineers, Wilming[on Disvic[
Attention: Catherine Janicvak
Re: Wetiand Related Consulting and Permitting
Ms. Higgins:
Pinnacle Financial Pertners. Inc, hereby designates md authorius Kimley-Hom and Associates,
Inc, ro act in their behalf as their agent solely for the purpose of processing Jurisdictional
De[ertninations, Section 404 permits/Section 401 Water Quality Certifications applica[ions, and [o
furnish upon reques[ supplemental information in support of applications, etc. from this day
forward until successful completion of the permitting process or revocetion by Pinnacle Finencial
Partners. inc.
Authoriud tltis the 26� day of /,A.tti/ ,��.
Oenny E Broach Senior Vice Preaident ��i�✓ C�G<
Pinnecle Financia(Partners,lnc.
Authorized Representative
(PrintNeme)
Pinnacle Financial Pertners,lnc.
Authorized Representetive
(Signature)
Cc: Karen Higgins
NC Division of Warer Resources
40l & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650