20190700 Ver 1_W-5706C PJD Package_Signed_05302019_Flat_20190530

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
May 30, 2019
U.S. Army Corps of Engineers
ATTN: Liz Hair
Wilmington Regulatory Field Office
69 Darlington Ave.
Wilmington, NC 28403
JAMEs H. TROGDON, III
SECRETARY
SUBJECT: Preliminary Jurisdictional Determination Package (PJD) for STIP No. W-5706C —
Proposed Roundabout at the Intersection of NC 410 and NC 41 in Dublin, Bladen
County, North Carolina.
Ms. Hair:
The North Carolina Department of Transportation (NCDOT) proposes to construct a roundabout at the
intersection of NC 410 and NC 41 in Dublin, Bladen County, North Carolina. Below and attached are a
brief description of the project, figures depicting all features, and appropriate forms.
Three Oaks Engineering (Three Oaks) had initially completed wetland and stream delineations for the
project in November 2017. At that time, it was determined that no potential jurisdictional features were
located within the study area. However, recently, WK Dickson was performing jurisdictional resource
assessments for a utility project that ran through the area and identified a potential area of concern in the
southeast quadrant of the roundabout project.
Field work was conducted on April 25, 2019 by Three Oaks staff member Jim Mason to investigate this
area (Figure 1). During that visit, one potential wetland was delineated in the southeast quadrant of the
study area (Table 1; Figures 2-4). This wetland is connected to Bear Ford Swamp by an extensive ditch
system (approximately 4,000 feet of ditching). No other potential jurisdictional features were identified
within the study area.
United States Army Corps of Engineers (USACE) wetland determination forms (wetland and upland)
are included for the potential jurisdictional wetland, along with a North Carolina Wetland Assessment
Method (NCWAM) form. Please see the following PJD Package, which is being submitted in
conjunction with the Nationwide Permit No. 14 application for the project.
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
HIGHWAY DIVISION 6
PO BOX 1150
FAYETTEVILLE, NC 28302
Telephone: [phone]
Customer Service: 1-877-368-4968
Website: www.nedot.gov
Location:
500 TRANSPORTATION DRIVE
FAYETTEVILLE, NC 28301

Table 1. Characteristics of potential jurisdictional wetlands in the study area
Map ID
N'CWAM
NCW.A-1 Rating
Hydrologic
Area (ac.)
Classification
Classification
'v'wrA
Headwater Forest
High
Riparian
0.08
Total
0.08
If you have any questions, require additional information, or would like to schedule a site visit, please
contact James Rerko by phone at [phone] or email at jjrerkogncdot.gov. This is a request for
concurrence with our assessment. We appreciate your assistance on this project.
Sincerely, '
&aw
James R rko
Division 6 Project Development and Environmental Analysis Engineer
Cc: Joanne Steinhuis, NCDWR

Appendix A
Figures

�C,1�IEEQI,y�. Prepared For:
4 L+I 6f7
CM
Sp
y
*43 ] 514
NC 410 and NC 41
Roundabout
Near Elizabethtown
Vicinity Map
Bladen County, North Carolina
Date:
May 2019
Scale: 0 250 500 Feet
t � �
Job No.:
17-024
Drawn By:
Checked By:
JSM
NH
Figure

a
rissoj
bIaden
C tN"n1711N1 i
C0�7c
Legend '%
USGS The National Map: National Boundaries Dataset, 3DEP
W-5706C Study Area Elevation Program, Geographic Names Information System, National
Hydrography/Dataset, National Land Cover Database, National
Potential Wetland WOUS Structure`sMataset, and National Transportation Dataset; USGS Global
Streams NHD Ecosystems; U.S. Census Bureau TIGER/Line data; USFS Road Data,
Natu\a�Earth Data; U.S. Department of State Humanitariae.Inforation
Wetlands - NWI UniRand NOAA National Centers for Environmental Information, U.S.
Coastal Relief Model. Data refreshed October 2.01'8--
���INEf�iyc.
Z A
Cb
Ste'
Prepared For:
of enwrrr e
w~ 9qd�
P +:T
NC 410 and NC 41
Roundabout
Near Elizabethtown
Topographic Map
Bladen County, North Carolina
Date: May 2019
Scale: 0 125 250 Feet
Job No.:
17-024
Drawn By:
Checked By:
JSM
NH
Figure

��61�1EFRI,y Prepared For:
1ti L+7 �n F. HnArx e
W
NC 410 and NC 41
Roundabout
Near Elizabethtown
Jurisdictional Resources Map
Bladen County, North Carolina
Date: May 2019
Scale: 0 125 250 Feet
� i 1
Job No.:
17-024
Drawn By:
Checked By:
JSM
NH
Figure

N
WA
Faul_Brisson Rd
r
NC_41 H� W
Legend i wA
W-5706C Study Area o
.c
Potential Wetland WOUS =v�
U
Value
High : 156.102
c
Low : 91.554 CIO
- n
4Ef,�j Prepared For
o pTH NC 410 and NC 41 Figure
Roundabout
Near Elizabethtown
;r. wigb� LiDAR Map 4
3�1`� `kr OF
la��SR Bladen County, North Carolina
Date:
May 2019
Scale:
0 125 250 Feet
I r I
Job No.:
17-024
Drawn By:
Checked By:
JSM
NH

Appendix B
Wetland Data Forms

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site: W-5706C - NC 41at NC 410 Roundabout City/County: Dublin/Bladen Sampling Date: 4/25/2019
Applicant/Owner: NCDOT State: NC Sampling Point: WA WET
Investigator(s): Jim Mason - Three Oaks Engineering Section, Township, Range: ---
Landform (hillslope, terrace, etc.): depression Local relief (concave, convex, none): concave Slope (%): 0-2
Subregion (LRR or MLRA): LRR P, MLRA 133A Lat: 34.642711 Long: -78.736020 Datum: NAD 83
Soil Map Unit Name: Pantego loam (Pe)/Norfolk loamy fine sand, 0 to 2 percent slopes (NoA) NWI classification: PFO
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances' present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes X No within a Wetland? Yes X No
Wetland Hydrology Present? Yes X No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
❑ Surface Soil Cracks (136)
❑ Sparsely Vegetated Concave Surface (138)
Primary Indicators (minimum of one is required; check all that apply)
❑✓
Surface Water (Al) El Aquatic Fauna (1313)
Q
High Water Table (A2)
11 Marl Deposits (B15) (LRR U)
0 Drainage Patterns (610)
❑✓
Saturation (A3)
Hydrogen Sulfide Odor (Cl)
❑✓ Moss Trim Lines (1316)
❑
Water Marks (61)
1❑-f
I --I Oxidized Rhizospheres along Living Roots (C3)
❑ Dry -Season Water Table (C2)
❑
Sediment Deposits (132)
Presence of Reduced Iron (C4)
0 Crayfish Burrows (C8)
❑
Drift Deposits (133)
1Q-f
I --I Recent Iron Reduction in Tilled Soils (C6)
II Saturation Visible on Aerial Imagery (C9)
E
Algal Mat or Crust (134)
❑✓ Thin Muck Surface (C7)
✓Q Geomorphic Position (D2)
E
Iron Deposits (65)
0 Other (Explain in Remarks)
❑ Shallow Aquitard (D3)
a
Inundation Visible on Aerial Imagery
(137)
II FAC-Neutral Test (D5)
Q
Water -Stained Leaves (139)
II Sphagnum moss (D8) (LRR T, U)
Field Observations:
Surface Water Present? Yes X
No Depth (inches): 0.5-2
Water Table Present? Yes X
No Depth (inches): 0
Saturation Present? Yes X
No Depth (inches): 0
Wetland Hydrology Present? Yes X No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

VEGETATION (Four Strata) — Use scientific names of plants.
Sampling Point: WA WET
Absolute
Dominant Indicator
Dominance Test worksheet:
Tree Stratum (Plot size: 30 feet )
% Cover
Species?
Status
Number of Dominant Species
1
Liquidambar styraciflua
50
YES
FAC
That Are OBL, FACW, or FAC: 10 (A)
2
Quercus nigra
15
NO
FAC
Total Number of Dominant
3•
Fraxinus enns Ivanica
p y
15
NO
FACW
Species Across All Strata: 10 (g)
4.
Percent of Dominant Species
5•
That Are OBL, FACW, or FAC: 100 (A/g)
6.
Prevalence Index worksheet:
7
Total % Cover of: Multiply by:
8
80
= Total Cover
OBL species x 1 =
50% of total cover:
40
20% of total cover:
16
FACW species x 2 =
Sapling/Shrub Stratum (Plot size: 30 feet
)
FAC species x 3 =
1
Acer rubrum
10
YES
FAC
FACU species x 4 =
2
Clethra alnifolia
10
YES
FACW
UPL species x 5 =
3
Cyrilla racemiflora
10
YES
FACW
Column Totals: (A) (B)
4
Magnolia virginiana
10
YES
FACW
Prevalence Index = B/A =
5
Hydrophytic Vegetation Indicators:
6•
_ 1 - Rapid Test for Hydrophytic Vegetation
7.
X 2 - Dominance Test is >50%
8•
3 - Prevalence Index is 53.0'
40
= Total Cover
_
Problematic Hydrophytic Vegetation (Explain)
50% of total cover:
20
20% of total cover:
8
Herb Stratum (Plot size: 30 feet )
'Indicators of hydric soil and wetland hydrology must
1
Arundinaria tecta
10
YES
FACW
be present, unless disturbed or problematic.
2
Osmunda regalis
5
YES
OBL
Definitions of Four Vegetation Strata:
3'
Tree — Woody plants, excluding vines, 3 in. (7.6 cm) or
4.
more in diameter at breast height (DBH), regardless of
5
height.
6.
Sapling/Shrub — Woody plants, excluding vines, less
7.
than 3 in. DBH and greater than 3.28 ft (1 m) tall.
8.
Herb — All herbaceous (non -woody) plants, regardless
g.
of size, and woody plants less than 3.28 ft tall.
10.
Woody vine — All woody vines greater than 3.28 ft in
11.
height.
12.
15
= Total Cover
50% of total cover:
7.5
20% of total cover:
3
Woody Vine Stratum (Plot size: 30 feet
)
1
Smilax rotundifolia
5
YES
FAC
2
Toxicodendron radicans
5
YES
FAC
3
Vitis rotundifolia
5
YES
FAC
4.
5•
Hydrophytic
15
= Total Cover
Vegetation
50% of total cover:
7.5
20% of total cover:
3
Present? Yes X No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

SOIL
Sampling Point: WA WET
Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loc Texture Remarks
0-8 10YR 2/1 100 Fine Sand Muck Presence
8-16+ 10YR 3/1 100
Fine Sand
C=Concentration. D=DeDletion. RM=Reduced Matrix. MS=Masked Sand Grains. 2Location: PL=Pore Linina. M=Matrix.
Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.)
Indicators for Problematic Hydric Soils':
❑
Histosol (Al)
0
Polyvalue Below Surface (S8) (LRR S, T, U)
1 cm Muck (A9) (LRR O)
❑
Histic Epipedon (A2)
0
Thin Dark Surface (S9) (LRR S, T, U)
T❑
LJ 2 cm Muck (A10) (LRR S)
❑
Black Histic (A3)
D
Loamy Mucky Mineral (F1) (LRR O)
Reduced Vertic (F18) (outside MLRA 150A,B)
❑
Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
Piedmont Floodplain Soils (F19) (LRR P, S, T)
Stratified Layers (A5)
Depleted Matrix (F3)
T�-I
LJ Anomalous Bright Loamy Soils (F20)
❑
Organic Bodies (A6) (LRR P, T, U)
D
Redox Dark Surface (F6)
(MLRA 153B)
D✓
5 cm Mucky Mineral (A7) (LRR P, T, U)
Muck Presence (A8) (LRR U)
Depleted Dark Surface (F7)❑
Redox Depressions (F8)
Red Parent Material (TF2)
uI Very Shallow Dark Surface (TF12)
❑
1 cm Muck (A9) (LRR P, T)
E]
Marl (F10) (LRR U)
1-1 Other (Explain in Remarks)
❑
Depleted Below Dark Surface (Al 1)
F�
Depleted Ochric (F11) (MLRA 151)
Thick Dark Surface (Al2)
El
Iron -Manganese Masses (F12) (LRR O, P, T)
3Indicators of hydrophytic vegetation and
Coast Prairie Redox (A16) (MLRA 150A)
D Umbric Surface (F13) (LRR P, T, U)
wetland hydrology must be present,
❑
Sandy Mucky Mineral (S1) (LRR O, S)
Delta Ochric (F17) (MLRA 151)
unless disturbed or problematic.
Sandy Gleyed Matrix (S4)
Reduced Vertic (F18) (MLRA 150A, 150B)
❑
Sandy Redox (S5)
Piedmont Floodplain Soils (F19) (MLRA 149A)
Stripped Matrix (S6)
Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D)
2✓ Dark Surface (S7) (LRR P, S, T, U)
Restrictive Layer (if observed):
Type
Depth (inches):
Remarks:
Hydric Soil Present? Yes X No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site: W-5706C - NC 41at NC 410 Roundabout City/County: Dublin/Bladen Sampling Date: 4/25/2019
Applicant/Owner: NCDOT State: NC Sampling Point: WA UPL
Investigator(s): Jim Mason - Three Oaks Engineering Section, Township, Range: ---
Landform (hillslope, terrace, etc.): hillslope Local relief (concave, convex, none): none Slope (%): 2-4
Subregion (LRR or MLRA): LRR P, MLRA 133A Lat: 34.642797 Long: -78.735833 Datum: NAD 83
Soil Map Unit Name: Pantego loam (Pe)/Norfolk loamy fine sand, 0 to 2 percent slopes (NoA) NWI classification: Upland
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances' present? Yes X No
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
II Surface Soil Cracks (136)
❑ Sparsely Vegetated Concave Surface (138)
Primary Indicators (minimum of one is required; check all that apply)
❑
Surface Water (Al) El Aquatic Fauna (1313)
Q
High Water Table (A2)
Marl Deposits (B15) (LRR U)
❑ Drainage Patterns (610)
❑
Saturation (A3)
11---If
Hydrogen Sulfide Odor (Cl)
❑ Moss Trim Lines (1316)
❑
Water Marks (61)
1L---If
I --I Oxidized Rhizospheres along Living Roots (C3)
❑ Dry -Season Water Table (C2)
❑
Sediment Deposits (132)
Presence of Reduced Iron (C4)
❑ Crayfish Burrows (C8)
❑
Drift Deposits (133)
1Q-f
I --I Recent Iron Reduction in Tilled Soils (C6)
II Saturation Visible on Aerial Imagery (C9)
E
Algal Mat or Crust (134)
❑ Thin Muck Surface (C7)
Q Geomorphic Position (D2)
E
Iron Deposits (65)
0 Other (Explain in Remarks)
❑ Shallow Aquitard (D3)
a
Inundation Visible on Aerial Imagery (137)
II FAC-Neutral Test (D5)
a
Water -Stained Leaves (139)
II Sphagnum moss (D8) (LRR T, U)
Field Observations:
Surface Water Present? Yes
No X Depth (inches): 0
Water Table Present? Yes
No X Depth (inches): '12
Saturation Present? Yes
No X Depth (inches): '12
Wetland Hydrology Present? Yes No X
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

VEGETATION (Four Strata) — Use scientific names of plants.
Sampling Point: WA UPL
Absolute
Dominant Indicator
Dominance Test worksheet:
Tree Stratum (Plot size: 30 feet )
% Cover
Species?
Status
Number of Dominant Species
1
Pinus taeda
40
YES
FAC
That Are OBL, FACW, or FAC: 8 (A)
2
Quercus nigra
40
YES
FAC
Total Number of Dominant
3•
r
Li uidambast raciflua
q y
25
YES
FAC
Species Across All Strata: 8 (B)
4
Fraxinus pennsylvanica
10
NO
FACW
Percent of Dominant Species
5
That Are OBL, FACW, or FAC: 100 (A/B)
6.
Prevalence Index worksheet:
7
8
Total % Cover of: Multiply by:
115
= Total Cover
OBL species x 1 =
50% of total cover:
57.5
20% of total cover:
23
FACW species x 2 =
Sapling/Shrub Stratum (Plot size: 30 feet
)
FAC species x 3 =
1
Liquidambar styraciflua
10
YES
FAC
FACU species x 4 =
2
Clethra alnifolia
10
YES
FACW
UPL species x 5 =
3
Vaccinium sp.
5
NO
-
Column Totals: (A) (B)
4
Prevalence Index = B/A =
5•
Hydrophytic Vegetation Indicators:
6.
_ 1 - Rapid Test for Hydrophytic Vegetation
7•
X 2 - Dominance Test is >50%
8•
3 - Prevalence Index is 53.0'
25
= Total Cover
_
Problematic Hydrophytic Vegetation (Explain)
50% of total cover:
12.5
20% of total cover:
5
Herb Stratum (Plot size: 30 feet )
'Indicators of hydric soil and wetland hydrology must
1
Arundinaria tecta
5
YES
FACW
be present, unless disturbed or problematic.
2.
Definitions of Four Vegetation Strata:
3•
Tree — Woody plants, excluding vines, 3 in. (7.6 cm) or
4.
more in diameter at breast height (DBH), regardless of
5
height.
6•
Sapling/Shrub — Woody plants, excluding vines, less
7.
than 3 in. DBH and greater than 3.28 ft (1 m) tall.
8.
Herb — All herbaceous (non -woody) plants, regardless
g.
of size, and woody plants less than 3.28 ft tall.
10.
Woody vine — All woody vines greater than 3.28 ft in
11.
height.
12.
5
= Total Cover
50% of total cover:
2.5
20% of total cover:
1
Woody Vine Stratum (Plot size: 30 feet
)
1
Smilax rotundifolia
15
YES
FAC
2
Vitis rotundifolia
10
YES
FAC
3.
4.
5•
Hydrophytic
25
= Total Cover
Vegetation
50% of total cover:
12.5
20% of total cover:
5
Present? Yes X No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

SOIL
Sampling Point: WA UPL
Description: (Describe to the depth needed to document the indicator or
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loc
0-2 7.5YR 3/4 100
2-8 10YR 3/1
8-16+ 10YR 2/1
50 10YR 6/1 50
100
C=Concentration. D=DeDletion. RM=Reduced Matrix. MS=Masked Sand Grains.
the absence of indicators.
Texture
Remarks
Fibric
Fibric Organic Material
Loamy Sand
Sand grains were not covered 70% or greater
Loamy Sand
Not saturated at all
2Location:
PL=Pore Linina. M=Matrix.
Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.)
Indicators for Problematic Hydric Soils':
❑
Histosol (Al)
E]
Polyvalue Below Surface (S8) (LRR S, T, U)
1 cm Muck (A9) (LRR O)
❑
Histic Epipedon (A2)
F]
Thin Dark Surface (S9) (LRR S, T, U)
T❑
LJ 2 cm Muck (A10) (LRR S)
❑
Black Histic (A3)
D
Loamy Mucky Mineral (F1) (LRR O)
Reduced Vertic (F18) (outside MLRA 150A,B)
❑
Hydrogen Sulfide (A4)
0
Loamy Gleyed Matrix (F2)
Piedmont Floodplain Soils (F19) (LRR P, S, T)
Stratified Layers (A5)
D
Depleted Matrix (F3)
T�-I
LJ Anomalous Bright Loamy Soils (F20)
❑
Organic Bodies (A6) (LRR P, T, U)
D
Redox Dark Surface (F6)
(MLRA 153B)
❑
5 cm Mucky Mineral (A7) (LRR P, T, U)
Muck Presence (A8) (LRR U)
D
Depleted Dark Surface (F7)❑
Redox Depressions (F8)
Red Parent Material (TF2)
uI Very Shallow Dark Surface (TF12)
❑
1 cm Muck (A9) (LRR P, T)
E]
Marl (F10) (LRR U)
1-1 Other (Explain in Remarks)
❑
Depleted Below Dark Surface (Al 1)
F­1
Depleted Ochric (F11) (MLRA 151)
Thick Dark Surface (Al2)
D
Iron -Manganese Masses (F12) (LRR O, P, T)
31ndicators of hydrophytic vegetation and
Coast Prairie Redox (A16) (MLRA 150A)
D Umbric Surface (F13) (LRR P, T, U)
wetland hydrology must be present,
❑
Sandy Mucky Mineral (S1) (LRR O, S)
Delta Ochric (F17) (MLRA 151)
unless disturbed or problematic.
Sandy Gleyed Matrix (S4)
Reduced Vertic (F18) (MLRA 150A, 150B)
❑
Sandy Redox (S5)
Piedmont Floodplain Soils (F19) (MLRA 149A)
Stripped Matrix (S6)
Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D)
❑ Dark Surface (S7) (LRR P, S, T, U)
Restrictive Layer (if observed):
Type
Depth (inches):
Hydric Soil Present? Yes No X
Remarks:
8-16+ layer would meet Dark Surface indicator if the 0-2 fibric organic material layer was not
considered.
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0

NC WAM WETLAND ASSESSMENT FORM
Accompanies User Manual Version 5
USACE AID#: NCDWR #:
Project Name W-5706C Date of Evaluation 4/25/2019
Applicant/Owner Name NCDOT Wetland Site Name WA
Wetland Type Headwater Forest Assessor Name/Organization J. Mason - Three Oaks Engineering
Level III Ecoregion Southeastern Plains Nearest Named Water Body Bear Ford Swamp
River Basin Lumber USGS 8-Digit Catalogue Unit 03040203
County Bladen NCDWR Region Wilmington
C' Yes r No Precipitation within 48 hrs? Latitude/Longitude (deci-degrees) 34.642711,-78.736020
Evidence of stressors affecting the assessment area (may not be within the assessment area)
Please circle and/or make note on last page if evidence of stressors is apparent. Consider departure from reference, if
appropriate, in recent past (for instance, approximately within 10 years). Noteworthy stressors include, but are not limited
to the following.
• Hydrological modifications (examples: ditches, dams, beaver dams, dikes, berms, ponds, etc.)
• Surface and sub -surface discharges into the wetland (examples: discharges containing obvious pollutants, presence of nearby
septic tanks, underground storage tanks (USTs), hog lagoons, etc.)
• Signs of vegetation stress (examples: vegetation mortality, insect damage, disease, storm damage, salt intrusion, etc.)
• Habitat/plant community alteration (examples: mowing, clear -cutting, exotics, etc.)
Is the assessment area intensively managed? (' Yes r No
Regulatory Considerations - Were regulatory considerations evaluated? r Yes e- No If Yes, check all that apply to the assessment area.
Anadromous fish
Federally protected species or State endangered or threatened species
NCDWR riparian buffer rule in effect
Abuts a Primary Nursery Area (PNA)
Publicly owned property
N.C. Division of Coastal Management Area of Environmental Concern (AEC) (including buffer)
Abuts a stream with a NCDWQ classification of SA or supplemental classifications of HQW, ORW, or Trout
Designated NCNHP reference community
Abuts a 303(d)-listed stream or a tributary to a 303(d)-listed stream
What type of natural stream is associated with the wetland, if any? (check all that apply)
r Blackwater
C' Brownwater
Tidal (if tidal, check one of the following boxes) (' Lunar (' Wind ( Both
Is the assessment area on a coastal island? C' Yes r No
Is the assessment area's surface water storage capacity or duration substantially altered by beaver? (' Yes r No
Does the assessment area experience overbank flooding during normal rainfall conditions? C' Yes r No
1. Ground Surface Condition/Vegetation Condition — assessment area condition metric
Check a box in each column. Consider alteration to the ground surface (GS) in the assessment area and vegetation structure
(VS) in the assessment area. Compare to reference wetland if applicable (see User Manual). If a reference is not applicable,
then rate the assessment area based on evidence of an effect.
GS VS
r A r A Not severely altered
(' B (' B Severely altered over a majority of the assessment area (ground surface alteration examples: vehicle tracks, excessive
sedimentation, fire -plow lanes, skidder tracks, bedding, fill, soil compaction, obvious pollutants) (vegetation structure
alteration examples: mechanical disturbance, herbicides, salt intrusion [where appropriate], exotic species, grazing,
less diversity [if appropriate], hydrologic alteration)
2. Surface and Sub -Surface Storage Capacity and Duration — assessment area condition metric
Check a box in each column. Consider surface storage capacity and duration (Surf) and sub -surface storage capacity and
duration (Sub). Consider both increase and decrease in hydrology. A ditch <_ 1 foot deep is considered to affect surface water only,
while a ditch > 1 foot deep is expected to affect both surface and sub -surface water. Consider tidal flooding regime, if applicable.
Surf Sub
r A r A Water storage capacity and duration are not altered.
r B r B Water storage capacity or duration are altered, but not substantially (typically, not sufficient to change vegetation).
C' C r C Water storage capacity or duration are substantially altered (typically, alteration sufficient to result in vegetation
change) (examples: draining, flooding, soil compaction, filling, excessive sedimentation, underground utility lines).
3. Water Storage/Surface Relief — assessment area/wetland type condition metric (skip for all marshes)
Check a box in each column for each group below. Select the appropriate storage for the assessment area (AA) and the wetland
type (WT).
AA WT
3a. (' A (' A Majority of wetland with depressions able to pond water > 1 foot deep
r B r B Majority of wetland with depressions able to pond water 6 inches to 1 foot deep
r C r C Majority of wetland with depressions able to pond water 3 to 6 inches deep
(' D (' D Depressions able to pond water < 3 inches deep
3b. r A Evidence that maximum depth of inundation is greater than 2 feet
r B Evidence that maximum depth of inundation is between 1 and 2 feet
r C Evidence that maximum depth of inundation is less than 1 foot

4. Soil Texture/Structure - assessment area condition metric (skip for all marshes)
Check a box from each of the three soil property groups below. Dig soil profile in the dominant assessment area landscape
feature. Make soil observations within the 12 inches. Use most recent National Technical Committee for Hydric Soils guidance for
regional indicators.
4a. (e A Sandy soil
r B Loamy or clayey soils exhibiting redoximorphic features (concentrations, depletions, or rhizospheres)
(' C Loamy or clayey soils not exhibiting redoximorphic features
(� D Loamy or clayey gleyed soil
(' E Histosol or histic epipedon
4b. re A Soil ribbon < 1 inch
(_ B Soil ribbon >- 1 inch
4c. r A No peat or muck presence
(e B A peat or muck presence
5. Discharge into Wetland - opportunity metric
Check a box in each column. Consider surface pollutants or discharges (Surf) and sub -surface pollutants or discharges (Sub).
Examples of sub -surface discharges include presence of nearby septic tank, underground storage tank (UST), etc.
Surf Sub
re A re A Little or no evidence of pollutants or discharges entering the assessment area
C` B C` B Noticeable evidence of pollutants or discharges entering the wetland and stressing, but not overwhelming the
treatment capacity of the assessment area
C` C C` C Noticeable evidence of pollutants or discharges (pathogen, particulate, or soluble) entering the assessment area and
potentially overwhelming the treatment capacity of the wetland (water discoloration, dead vegetation, excessive
sedimentation, odor)
6. Land Use - opportunity metric (skip for non -riparian wetlands)
Check all that apply (at least one box in each column). Evaluation involves a GIS effort with field adjustment. Consider sources
draining to assessment area within entire upstream watershed (WS), within 5 miles and within the watershed draining to the
assessment area (5M), and within 2 miles and within the watershed draining to the assessment area (2M). Effective riparian buffers
are considered to be 50 feet wide in the Coastal Plain and Piedmont ecoregions and 30 feet wide in the Blue Ridge Mountains ecoregion.
WS 5M 2M
F A F A F A >_ 10% impervious surfaces
F B F B F B Confined animal operations (or other local, concentrated source of pollutants)
F C F C F C >_ 20% coverage of pasture
FI D FI D FI D >_ 20% coverage of agricultural land (regularly plowed land)
F E F E F E >_ 20% coverage of maintained grass/herb
F F F F FI F >_ 20% coverage of clear-cut land
F G F G F G Little or no opportunity to improve water quality. Lack of opportunity may result from little or no disturbance in
the watershed or hydrologic alterations that prevent dainage and/or overbank flow from affectio the
assessment area.
7. Wetland Acting as Vegetated Buffer- assessment area/wetland complex condition metric (skip for non -riparian wetlands)
7a. Is assessment area within 50 feet of a tributary or other open water?
(- Yes t: No If Yes, continue to 7b. If No, skip to Metric 8.
7b. How much of the first 50 feet from the bank is weltand? (Wetland buffer need only be present on one side of the water body. Make
buffer judgment based on the average width of wetland. Record a note if a portion of the buffer has been removed or disturbed.)
C' A z 50 feet
C' B From 30 to < 50 feet
C' C From 15 to < 30 feet
C' D From 5 to < 15 feet
C' E < 5 feet or buffer bypassed by ditches
7c. Tributary width. If the tributary is anastomosed, combine widths of channels/braids for a total width.
e- 5 15-feet wide e- > 15-feet wide e- Other open water (no tributary present)
7d. Do roots of assessment area vegetation extend into the bank of the tributary/open water?
e- Yes e- No
7e. Is tributary or other open water sheltered or exposed?
e-` Sheltered - adjacent open water with width < 2500 feet and no regular boat traffic.
e- Exposed - adjacent open water with width > 2500 feet or regular boat traffic.
8. Wetland Width at the Assessment Area - wetland type/wetland complex condition metric (evaluate WT for all marshes
and Estuarine Woody Wetland only; evaluate WC for Bottomland Hardwood Forest, Headwater Forest, and Riverine Swamp
Forest only)
Check a box in each column. Select the average width for the wetland type at the assessment area (WT) and the wetland complex at the
assessment area (WC). See User Manual for WT and WC boundaries.
WT WC
to A to A >_ 100 feet
r B r B From 80 to < 100 feet
r C r C From 50 to < 80 feet
r D r D From 40 to < 50 feet
r E r E From 30 to < 40 feet
(7 F C' F From 15 to < 30 feet
(- G C' G From 5 to < 15 feet
r H r H < 5 feet

9. Inundation Duration — assessment area condition metric (skip for non -riparian wetlands)
Answer for assessment area dominant landform.
to A Evidence of short -duration inundation (< 7 consecutive days)
C- B Evidence of saturation, without evidence of inundation
(' C Evidence of long -duration inundation or very long -duration inundation (7 to 30 consecutive days or more)
10. Indicators of Deposition —assessment area condition metric (skip for non -riparian wetlands and all marshes)
Consider recent deposition only (no plant growth since deposition).
t: A Sediment deposition is not excessive, but at approximately natural levels.
C' B Sediment deposition is excessive, but not overwhelming the wetland.
C' C Sediment deposition is excessive and is overwhelming the wetland.
11. Wetland Size — wetland type/wetland complex condition metric
Check a box in each column. Involves a GIS effort with field adjustment. This metric evaluates three aspects of the wetland area: the
size of the wetland type (WT), the size of the wetland complex (WC), and the size of the forested wetland (FW) (if applicable, see User
Manual). See the User Manual for boundaries of these evaluation areas. If assessment area is clear-cut, select "K" for the FW column.
WT WC FW (if applicable)
C' A C' A C' A >_ 500 acres
C' B C' B C' B From 100 to < 500 acres
CC C' C C' C From 50 to < 100 acres
C' D C' D C' D From 25 to < 50 acres
C' E C' E C' E From 10 to < 25 acres
C' F C' F C' F From 5 to < 10 acres
G G G G G G From 1 to < 5 acres
C' H C' H C' H From 0.5 to < 1 acre
C' I C' I C' I From 0.1 to < 0.5 acre
C' J C' J C' J From 0.01 to < 0.1 acre
C' K C' K C' K < 0.01 acre or assessment area is clear-cut
12. Wetland Intactness — wetland type condition metric (evaluate for Pocosins only)
C A Pocosin is the full extent (z 90%) of its natural landscape size.
C B Pocosin is < 90% of the full extent of its natural landscape size.
13. Connectivity to Other Natural Areas — landscape condition metric
13a. Check appropriate box(es) (a box may be checked in each column). Involves a GIS effort with field adjustment. This
evaluates whether the wetland is well connected (Well) and/or loosely connected (Loosely) to the landscape patch, the contiguous
metric naturally vegetated area and open water (if appropriate). Boundaries are formed by four -lane roads, regularly maintained utility
line corridors the width of a four -lane road or wider, urban landscapes, fields (pasture open and agriculture), or water > 300 feet wide.
Well Loosely
C' A C' A >_ 500 acres
C' B G B From 100 to < 500 acres
C' C C' C From 50 to < 100 acres
C' D C' D From 10 to < 50 acres
G E C' E < 10 acres
(' F (' F Wetland type has a poor or no connection to other natural habitats
13b. Evaluate for marshes only.
C" Yes C" No Wetland type has a surface hydrology connection to open waters/stream or tidal wetlands.
14. Edge Effect — wetland type condition metric (skip for all marshes and Estuarine Woody Wetland)
May involve a GIS effort with field adjustment. Estimate distance from wetland type boundary to artificial edges. Artificial edges include
non -forested areas >_ 40 feet wide such as fields, development, roads, regularly maintained utility line corridors and clear -cuts. Consider
the eight main points of the compass. Artificial edge occurs within 150 feet in how many directiions? If the assessment area is clear-cut,
select option "C."
C' A 0
C'B 1to4
GC 5to8
15. Vegetative Composition — assessment area condition metric (skip for all marshes and Pine Flat)
[i A Vegetation is close to reference condition in species present and their proportions. Lower strata composed of appropriate
species, with exotic plants absent or sparse within the assessment area.
C B Vegetation is different from reference condition in species diversity or proportions, but still largely composed of native species
characteristic of the wetland type. This may include communities of weedy native species that develop after clearcutting or
clearing. It also includes communities with exotics present, but not dominant, over a large portion of the expected strata.
l C Vegetation severely altered from reference in composition, or expected species are unnaturally absent (planted stands of non -
characteristic species or at least one stratum inappropriately composed of a single species), or exotic species are dominant in
at least one stratum.
16. Vegetative Diversity — assessment area condition metric (evaluate for Non -tidal Freshwater Marsh only)
G A Vegetation diversity is high and is composed primarily of native species (<10% cover of exotics).
(' B Vegetation diversity is low or has > 10% to 50% cover of exotics.
(' C Vegetation is dominated by exotic species (>50% cover of exotics).

17. Vegetative Structure — assessment area/wetland type condition metric
17a. Is vegetation present?
0 Yes (' No If Yes, continue to 17b. If No, skip to Metric 18.
17b. Evaluate percent coverage of assessment area vegetation for all marshes only. Skip to 17c for non -marsh wetlands.
C' A Z 25% coverage of vegetation
r B < 25% coverage of vegetation
17c. Check a box in each column for each stratum. Evaluate this portion of the metric for non -marsh wetlands. Consider structure
in airspace above the assessment area (AA) and the wetland type (WT) separately.
AA WT
EL o (± A (� A Canopy closed, or nearly closed, with natural gaps associated with natural processes
C' B C' B Canopy present, but opened more than natural gaps
U C C f C Canopy sparse or absent
o (^ A (` A Dense mid-story/sapling layer
v? Cc B (+ B Moderate density mid-story/sapling layer
(' C C' C Mid-story/sapling layer sparse or absent
C" A r A Dense shrub layer
2 (i B (* B Moderate density shrub layer
2
U) f" C r C Shrub layer sparse or absent
f A C' A Dense herb layer
6 B Q B Moderate density herb layer
C' C (` C Herb layer sparse or absent
18. Snags — wetland type condition metric (skip for all marshes)
(— A Large snags (more than one) are visible (> 12-inches DBH, or large relative to species present and landscape stability).
Ce B Not A
19. Diameter Class Distribution — wetland type condition metric (skip for all marshes)
t— A Majority of canopy trees have stems > 6 inches in diameter at breast height (DBH); many large trees (> 12 inches DBH) are
present.
(� B Majority of canopy trees have stems between 6 and 12 inches DBH, few are > 12-inch DBH.
C' C Majority of canopy trees are < 6 inches DBH or no trees.
20. Large Woody Debris — wetland type condition metric (skip for all marshes)
Include both natural debris and man -placed natural debris.
C' A Large logs (more than one) are visible (> 12 inches in diameter, or large relative to species present and landscape stability).
(+ B Not A
21. Vegetation/Open Water Dispersion — wetland type/open water condition metric (evaluate for Non -Tidal Freshwater
Marsh only)
Select the figure that best describes the amount of interspersion between vegetation and open water in the growing season. Patterned
areas indicate vegetated areas, while solid white areas indicate open water.
A rB CSC C'D
6
22. Hydrologic Connectivity — assessment area condition metric (evaluate for riparian wetlands and Salt/Brackish Marsh only)
Examples of activities that may severely alter hydrologic connectivity include intensive ditching, fill, sedimentation, channelization,
diversion, man-made berms, beaver dams, and stream incision. Documentation required if evaluated as B, C, or D.
G A Overbank and overland flow are not severely altered in the assessment area.
C' B Overbank flow is severely altered in the assessment area.
C' C Overland flow is severely altered in the assessment area.
( D Both overbank and overland flow are severely altered in the assessment area.
Notes

NC WAM Wetland Rating Sheet
Accompanies User Manual
Version 5.0
Wetland Site Name WA
Date
4/25/2019
Wetland Type Headwater Forest
Assessor Name/Organization ison -
Three Oaks Engine
Notes on Field Assessment Form (Y/N)
NO
Presence of regulatory considerations (Y/N)
NO
Wetland is intensively managed (Y/N)
Assessment area is located within 50 feet of a natural tributary or other open
water (Y/N)
NO
Assessment area is substantially altered by beaver (Y/N)
NO
Assessment area experiences overbank flooding during normal rainfall conditions
(Y/N)
NO
Assessment area is on a coastal island (Y/N)
NO
Sub -function Rating Summary
Function Sub -function
Metrics
Rating
Hydrology Surface Storage and Retention
Condition
HIGH
Sub -Surface Storage and Retention
Condition
HIGH
Water Quality Pathogen Change
Condition
LOW
Condition/Opportunity
LOW
Opportunity Presence? (Y/N)
NO
Particulate Change
Condition
HIGH
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Soluble Change
Condition
HIGH
Condition/Opportunity
HIGH
Opportunity Presence? (Y/N)
YES
Physical Change
Condition
LOW
Condition/Opportunity
LOW
Opportunity Presence? (Y/N)
YES
Pollution Change
Condition
NA
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Habitat Physical Structure
Condition
HIGH
Landscape Patch Structure
Condition
LOW
Vegetation Composition
Condition
HIGH
Function Rating Summary
Function Metrics/Notes
Rating
Hydrology Condition
HIGH
Water Quality Condition
MEDIUM
Condition/Opportunity
MEDIUM
Opportunity Presence? (Y/N)
YES
Habitat Condition
HIGH
Overall Wetland Rating HIGH

Appendix C
JD Request Form
PJD Form

urisdictional Determination Reauest
US Army Corps
of Engineers
Mirnington District
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.army.mil/Missions/Re ug latoDyPertnitProgram/Contact/CounlyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: Multiple Parcels
City, State: Dublin, NC
County: Bladen
Parcel Index Number(s) (PIN): Multiple PIN's
B. REQUESTOR INFORMATION
Name: James Rerko
Mailing Address: PO BOX 1150
Fayetteville, NC 28302
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
Select one:
I am the current property owner.
I am an Authorized Agent or Environmental Consultant'
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: Multiple Property Owners
Mailing Address:
Telephone Number:
Electronic Mail Address:
' Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION' 4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: ❑ Owner ❑ Authorized Agents
Date
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
✓❑ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑ I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a projector perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑ A Corps JD is required in order obtain my local/state authorization.
❑ I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)
❑✓ I am requesting that the Corps provide a preliminary JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓❑ Size of Property or Review Area 15.3 acres.
❑ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
❑✓ Project Coordinates (Decimal Degrees): Latitude:
Longitude
34.643355
-78.736007
❑� A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 11 x 17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. http://www.saw.usace.army.mil/Missions/Re ug latory-Permit-
Pro gram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
✓❑ Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDs, please complete an Approved Jurisdictional Determination Form'
❑ Vicinity Map
✓❑ Aerial Photograph
✓❑ USGS Topographic Map
❑ Soil Survey Map
✓❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
❑ Landscape Photos (if taken)
7 NCWAM and/or NCWAM Assessment Forms and Rating Sheets
❑ NC Division of Water Resources Stream Identification Forms
❑ Other Assessment Forms
' www.saw.usace.army.mil/Portals/59/docs/re_ug latory/re,gdocs/JD/RGL 08-02_App_A_Prelim _JD_Form _fillable.pdf
' Please see http://www.saw.usace.army.mil/Missions/Re ug latory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the proj ect area subject to federal jurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: May 30, 2019
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: James Rerko, PO Box 1150, Fayetteville, NC 28302
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Bladen city: Dublin
Center coordinates of site (lat/long in degree decimal format):
Lat.: 34.643355 Long.:-78.736007
Universal Transverse Mercator: 17
Name of nearest waterbody: Bear Ford Swamp
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non -wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (i.e., Section
404 or Section 10/404)
WA
34.642711
-78.736020
0.08 acre
Wetland
Section 404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) for that review area based on an
informed decision after having discussed the various types of JDs and their
characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction notification" (PCN), or requests verification for a non -reporting NWP or
other general permit, and the permit applicant has not requested an AJD for the
activity, the permit applicant is hereby made aware that: (1) the permit applicant has
elected to seek a permit authorization based on a PJD, which does not make an
official determination of jurisdictional aquatic resources; (2) the applicant has the
option to request an AJD before accepting the terms and conditions of the permit
authorization, and that basing a permit authorization on an AJD could possibly result
in less compensatory mitigation being required or different special conditions; (3) the
applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including whatever mitigation requirements the Corps has
determined to be necessary; (5) undertaking any activity in reliance upon the subject
permit authorization without requesting an AJD constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the
review area affected in any way by that activity will be treated as jurisdictional, and
waives any challenge to such jurisdiction in any administrative or judicial compliance
or enforcement action, or in any administrative appeal or in any Federal court; and (7)
whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic
jurisdiction exists over aquatic resources in the review area, or to provide an official
delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD finds
that there "may be"waters of the U.S. and/or that there "may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
0 Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:Vicinity Map, Topographic Map, Jurisdictional Features Map, LIDAR Map
F■ Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
0
OR
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
U.S. Geological Survey map(s). Cite scale & quad name:
1:24,000 1987 Dublin, NC
Natural Resources Conservation Service Soil Survey. Citation: 1990 Bladen County Soil Survey
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
100-year Fioodplain Elevation is:
Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date).
(National Geodetic Vertical Datum of 1929)
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
A13 May 30, 2019
iature and datts of
;on requ � rig PJD
QUIREf�, unless obtaining
signature is impracticable)'
1 Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.