20191158 Ver 1_PCN Form Submission_20190829

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02*10n of Water R"Ourc"
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance into the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
Change only if needed.
BIMS # Assigned *
Version#*
20191158
1
Is a payment required for this project?*
* No payment required
What amout is owed?*
* Fee received
r $240.00
r Fee needed - send electronic notification
r $570.00
Reviewing Office* Select Project Reviewer*
Fayetteville Regional Office - [phone] Chad Turlington:eads\ccturlington
Information for Initial Review
1a. Name of project:
Bolton Carthage Road Wetland
1a. Who is the Primary Contact?*
Charles Bolton
1 b. Primary Contact Email:*
[e-mail]
Date Submitted
8/29/2019
Nearest Body of Water
Little River
Basin
Cape Fear
Water Classification
WSIII HOW
Site Coordinates
Latitude:
35.2688
A. Processing Information
County (or Counties) where the project is located:
Moore
Is this project a public transportation project?*
r Yes r No
Longitude:
-79.5544
1a. Type(s) of approval sought from the Corps:
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1 b. What type(s) of permit(s) do you wish to seek authorization?
P Nationwide Permit (NWP)
F- Regional General Permit (RGP)
r- Standard (IP)
1c. Primary Contact Phone:*
[phone]

1c. Has the NWP or GP number been verified by the Corps?
r' Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
P 401 Water Quality Certification - Regular
F Non -404 Jurisdictional General Permit
F Individual Permit
29 - Residential Developments
1e. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
F 401 Water Quality Certification - Express
F Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r- No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r- Yes r No
19. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r- Yes r- No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r' Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
Q Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
C Yes r- No
2. Owner Information
2a. Name(s) on recorded deed:
Charles and Mary Bolton
2b. Deed book and page no.:
book 5090 and page 463
2c. Responsible party:
2d. Address
Street Address
NA
Address Line 2
PO Box 880
city
West End
Postai / Zip Code
27673
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
State / Province / R icn
NC
Country
USA
2f. Fax Number:
r- Yes r No
r- Yes r No

1b. Subdivision name:
(ff appmpiate)
1c. Nearest municipality/town:
West End
2. Project Identification 1
2a. Property Identification Number:
10.02 acre portion of 00020651
2c. Project Address
Street Address
3715 Carthage Road
Address Line 2
city
West End
Postal / Zip Code
27376
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Little River
3b. Water Resources Classification of nearest receiving water:*
WSIII HQW
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12 -digit HUC in which the project is located.
03030004
4. Project Description and History
2b. Property size:
10.02
State / Ftwince / Fegzm
NC
Cbuntry
USA
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The project site is a cleared building lot with adjacent forested woodlots. The surrounding area is rural residential. The project parcel is a 10 acre site that has been subdivided off from
a larger parcel and prepared for a single family home. The home we be the only residence build on the 10 acre lot. The lot is mostly cleared of all woody and herbaceous vegetation in
the area of the proposed house and entrance driveway. Portions of the lot have selected canopy trees remaining, there is no to little understory or herbaceous layer on a majority of the
10 acres. The bulk of the lot is pine scrub oak upland, there are several small areas of forested wetland on the eastern and southeastern portions of the site. An dirt access road was
created to access the lot in order to prepare it for construction. The developing party was unaware of the wetland on the site and crossed a forested finger of wetland with a 0.099 acre
dirt logging trail in the western portion of the parcel.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
f Yes F No f Unknown
4d. Attach an 8 1/2 X11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
topo quad map.pdf
169.03KB
4e. Attach an 8 1/2 X11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
soil map.pdf 156.84KB
4f. List the total estimated acreage of all existing wetlands on the property:
2.12 acres
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
The purpose of this project is to provide access to a parcel for a single residence via a driveway entrance road. the entrance road was established during logging and brush removal
activities on the parcel. Bolton Builders then realized there was a wetland area that was crossed by the previous activities and selected that spot for the parcels driveway access so as
to not further disturb the wetland. The current crossing is 0.099 of an acre of wetland impact and approximately 20-25 feet wide over its length.
In order to minimize wetland disturbance Bolton Builders proposes to reduce the existing crossing to 12 feet wide and 0.044 of an acre and keep that crossing as a driveway area.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The proposed project is a 12 foot wide driveway access to a 10+/- acre lot. A20-25 foot wide access was previously established by the land developer who crossed a wetland finger not
believing it to be a regulated during early site prep and logging/brush removal stages. This access trail totaled approximately 0.099 acres of wetland fill. Heavy equipment such as
excavators and other logging equipment were utilized in preparation of the access.
In order to reduce the fill area to 12 feet wide and 0.044 of and acre small excavators will remove any fill materials that were placed in the wetland to establish the logging crossing and
return areas outside of the proposed driveway to original grade. A culvert pipe will be placed under the driveway to maintain connectivity of the wetland on the northern and southern
side of the proposed driveway. Silt fences and other erosion control devices will be utilized to minimize runoff on the site.
4j. Please upload project drawings for the proposed project.
wet map Carthage Rd012.pdf 790.17KB
Temp Wetland Impact Area for lot surveys.pdf 103.95KB
Temp Wetland Impact.pdf 102.85KB
proposed impact area.pdf 52.83KB

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r WA
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): William Mullin
Agency/Consultant Company: Dr. J.H. Carter III and Associates Inc.
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
V Wetlands r Streams -tributaries r Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
2a1 Reason(?) 2b. Impact type * (?) 2c. Type of W. * 2d. W. name * 2e. Forested * 2f. Type of 2g. Impact
Jurisdicition*(?) area*
2g. Total Temporary Wetland Impact
0.055
2g. Total Wetland Impact
0.099
2g. Total Permanent Wetland Impact
0.044
2h. Comments:
the e>asting crossing is 0.099 acre of wetland impact, it will be reduced to 0.044 of an acre of wetland impact from fill and a culvert
will keep the
bisected wetland connected.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Measures take to minimize impact to the wetland area will be to remove 0.055 acre of existing fill dirt and narrow the proposed driveway to 12 feet
wide. As the earlier access road was established in a wetland unknowingly minimization was not considered. In order to reduce any additional impacts
to the wetland rather then establish a second wetland crossing and completely remove the initial ebsting crossing it is proposed that the current
wetland crossing and fill foot print be reduced. There by leaving the forested structure of the wetland in place in the remaining port
ions of the wetland.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Silt fences and other best management practices will be placed on the project area in order to keep sediment from entering the wetland areas.
driveway access
P
NON-NCWAM TYPES
PFO1
Yes
Corps
0.044
(acres)
1
driveway access
T
NON-NCWAM TYPES
PFO1
Yes
Corps
0.055
(acres)
2g. Total Temporary Wetland Impact
0.055
2g. Total Wetland Impact
0.099
2g. Total Permanent Wetland Impact
0.044
2h. Comments:
the e>asting crossing is 0.099 acre of wetland impact, it will be reduced to 0.044 of an acre of wetland impact from fill and a culvert
will keep the
bisected wetland connected.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Measures take to minimize impact to the wetland area will be to remove 0.055 acre of existing fill dirt and narrow the proposed driveway to 12 feet
wide. As the earlier access road was established in a wetland unknowingly minimization was not considered. In order to reduce any additional impacts
to the wetland rather then establish a second wetland crossing and completely remove the initial ebsting crossing it is proposed that the current
wetland crossing and fill foot print be reduced. There by leaving the forested structure of the wetland in place in the remaining port
ions of the wetland.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Silt fences and other best management practices will be placed on the project area in order to keep sediment from entering the wetland areas.

2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
it is significantly less then a tenth of an acre as such mitigation is not proposed.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
it is in Moore County which does not have any buffered riparian systems.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
O Yes O No
Comments:
It is a single family home on a 10 acre lot, it will not have excessive paved or impervious areas.
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B.0200)?*
r^ Yes r No
2b Provide an explanation of the violation(s):
there have not been any violations issued for the project. it is an after the fact permit application however.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?
r- Yes r No
3b. If you answered "no," provide a short narrative description.
This is a single family residence, the entire 10 acre parcel will be utilized for the the single residence.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r- Nor NIA
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated
at a treatment plant, list the capacity available at that plant.
The site will utilize a private sewer system
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*

r Yes r No f Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
source maps and on site investigation of the parcel by JCA biologists
Consultation Documentation Upload
USFWS Concurrence 07-15-19 (LRK 20651).pdf 135.54KB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
available mapping and on site investigations by JCA biologists. There is no open water on the parcel.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
available mapping and on line data search
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
available mapping and online FEMA map analysis
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
3779 Info (2).pdf 2.93MB
SAW_JD_Request_12-2013_fillable_form.pdf 291.29KB
sig pages.pdf 52.56KB
agent pg signed Info (2)-2.pdf 548.71 KB
Signature
*
P By checking the box and signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
William Mullin
Signature

Z✓l"V�
Date
8/26/2019

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. a PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner:
_3779 n�_� Vj��-s
Property Owner: ! - M 1 y
The undersigned, registered property owners of the above noted property, do hereby authorize
YA-�---
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Properly Owner's Address (if different than property above):
17-r- .��� �r+'4 IJ 273 7
0 ~
Telephone: 1 I t7 - 79 3 — !tel
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
✓�' � ' X17 ► �.t
Authorized Signatute
�nzed Signature
Date: d —. % f Date: k�aI --'� 147

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. a PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner:
_3779 n�_� Vj��-s
Property Owner: ! - M 1 y
The undersigned, registered property owners of the above noted property, do hereby authorize
YA-�---
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Properly Owner's Address (if different than property above):
17-r- .��� �r+'4 IJ 273 7
0 ~
Telephone: 1 I t7 - 79 3 — !tel
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
✓�' � ' X17 ► �.t
Authorized Signatute
�nzed Signature
Date: d —. % f Date: k�aI --'� 147

OBFER TQ PURCHASE AND CONTRACT - VACANT LOTA AHD
�t�onsult "Gstdelittes" (farm 12G) for Odmxx is C=pleft O's form]
Buyer
for tae and does not nava
ptme Pial
NOTE: This contract is iat�d � tw s �g yi era the Pm4 ty m sale involves
inmmyediate plans to subdivkie If Seller is Buyers buiWe
and recorded W� kh die ragida of deeds as of the date of the Cetdsract• New Cons
PmP y p1°d or to cknitsg, use the standard Oft to Purabase and Coab'art--
the cam uucdoo of s new ssn81a family dwelling lm tine the Offer to Ptsrcbase ami Canttaat (Foto► 2-1) weth the New Com
(Form NO -'I) or, if tine cossbn�cdon is �°md+
Addaadttm (Form 2A3-7). Of kn m "CbW ®d Sellar WO
Far vaiusW c, receipt suf�a Y pPw o c Ste tWmhemofdaeGk9 Offer T PmchAm md Carat and any add�dz,m
agrees to sell and oatyvery tate PtOPCtY on tite terms and carsddidvn:
or mom msdc in acmnifflm with its terms (tom the "Cx"14")
1. TERMS AND DEFOMWS. The terms listed below shag bane the reapaetme 1? dm as net Borth a jsveztt to tach
tam {a) "SAWN: LT -C
T.�.C.8.J.M. Bates -s
(b) "gr+Ya''; C.tyaslsa 8. $oltots G. Bgitora
The PrWesty shall mcbuda
all slyer nal estate desat'lyed below '°� �' � thenoo inctn�dinB the
Cc,� located then can
the �
Nom- ff the Pmpelty WiU i-nrhute a (fie) hm*8 cart S� 1) wits cot ofi
��) Homde porowum is, the Additimel Provisions
Ad WAM (Staedam+d Foryrm 281 l-Twith this offer•
Stmd per; 3715 Rcaarl gip; 27376
City: that Bud North Camlina -
aav=+s s
NOTE: Govaumamtai authaxity over taxes. . sc31oa1 siis:tr cis. utilities =-d... mad
Legal Du=iPdm (CamphOs ALL HiociJSectio�n Subdivis 0WCOadW to 030 .s,alaGt Pian -
Plat Refe yea: I.ot/[Jnit , as abawn on Plaa Boo1r Hde
The -
or odhecr of the Pr+nperty
�s: .0.02 Pt►s:tioa Amer P� :00420551
other dwaiptioa: Lot 51 Gsetriasrx Pines *10.0 Aa--
ss. 5090 atrw d63
Same or ail of ft Property may be daAmIed in Do d Beak
(d) Prtee*;
S 1001000.00
$ lI A
S W A
S XGA
S
S 10oto00.00
pstd to U.S. Dolian WOO the foliowmg tremas:
BY DUE DfUGENCE nE Me& payable and dohvtaed to Sellar by dam Effiecdw Dewe.
BY DM IAL EARNEST MONEY DEpoS1T mde paymbiv a d � ctax*
Atmt tum m Pah 1(f) by ❑ cash C] p
0 wire trar:�rfrf', 0 "--tr c , ErTI m ❑ wi b tlda otter OR. M wi hm
five (5) days of the Effective Dere of this Coatut. made payable and ddivend to
BY (ADDrnDNAL) EARNEST MONEY D IT
Escmw Agent named is ParagWh IM by crab, offbcw bank aWJ4 wtm transfer or
eiecaonic tmnsfe'r no km than S ppm. an
27ME AWING OF TSE N&M''V(Z balat�ee and ail obligations of Seller aas the
BY ASSL'M YON of dye unpaid pr�cipal in acaudance with ft suached
existing loan(s) socnaed by a deed of truss on the Property
,AM Assumption Add=s (Stesdard Form 2 -k6 -T) -
BY SELLER FMANC iu ac=jdaam with dw a aached Sellar Fitumc'ing Adbcz&t
(Standard Farm 2AS-T)•som or alt of which may be paid
BALANCE of the Pta�chase Price in each at
with " prooeaas of* xWW loan)•
Mon.
Ttmia farmjoinDy � edby:Page 1 of 11
Nortb CarolinaBearAte" Nsr* Caralba Asseciation of REALTQBS�, r
Buyer initials
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STANDARD FORM 12-T
Revised 71281$
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('bq�{ �� yYry YO{1CP

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. a PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner:
_3779 n�_� Vj��-s
Property Owner: ! - M 1 y
The undersigned, registered property owners of the above noted property, do hereby authorize
YA-�---
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Properly Owner's Address (if different than property above):
17-r- .��� �r+'4 IJ 273 7
0 ~
Telephone: 1 I t7 - 79 3 — !tel
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
✓�' � ' X17 ► �.t
Authorized Signatute
�nzed Signature
Date: d —. % f Date: k�aI --'� 147

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
0 &V-lPs _r_. aZ)L_F64�
Prnnertv liwner (nlease print)
8
Date
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
0 I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
❑ I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
F1I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUS5 and provide an 4prp oved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
MI am requesting that the Corps delineate the boundaries of all WoUS on a property/proiect
area and provide an approved JD (this may or may not include a survey plat).
QI am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
For NCDOT requests following the current NCDOT/USAGE protocols, skip to Part E.
5 Waters of the Unted States
Version: December 2013 Page 4

C. PROPERTY OWNER LNFORNIATION
Name:
Mailing Address:
Telephone -Niunber=
Electronic Mail Address=
❑ Proof of CNmership Attached (e -g- a copy of Deed. County GIS,-Parcel'Tax Record data)
1 If available
2 Must attach completed Agent Authorization Form
3 if available
Version: December 2013 Page 3
Jurisdictional Determination Request
D. PROPERTY OXI NER CERTIFICATION a
I, the undersigned, a duly authorized ox�ner of record of the property/properties identified herein,
do 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 mi Vestigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899-
Property- O,kvnier (please print) Date
Property- Owner Signature

PROPERTY OANNER LNFORAL&TION'
Name:
Mailing Address:
Telephone Number:
Ekmonic Mail Address':
%3
(mat
Proof of Ownership Attached (e.g. a copy of Deed. County GISIParceVrax Record data)
1 H available
Z Must attach completed Agent Authmization form
If available --
Version December 2013 2013 Page 3
Jurisdictional Determination Request
D. PROPERTY OWNER CERTMCATIO-i4
I. the undersigned. a duly authorized owner of record of the propertyfprope ues identified herein,
do 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
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act andjor Section 10 of the Rivers and Harbors Act of
1899.
Y/-bt�
/ �
I
Prey �r (please pmt) Date
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CARTHAGECopyright:© 2013 National Geographic Society, i-cubed/0 240 480120 Feetwetlanddirt drivewayTopographic Mapping for Carthage Road Wetland Delineation as prepared by Dr. J.H. Carter III and Associates Inc.Wetland LineParcel Boundary
CARTHAGESource: USDA Natural Resources Conservation Service/0 240 480120 Feetdirt drivewayNRCS Soils Mapping for Carthage Road Wetland Delineation as prepared by Dr. J.H. Carter III and Associates Inc.Wetland LineParcel BoundaryVauclues loamy sand 8-15% slopeAiley loam sand 8-15% slopeBibb soils
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Carthage Road Wetland Delineation as prepared by Dr. J.H. Carter III and Associates Inc.
Wetland Line
Parcel Boundary
0 120 240 480 Feet

wetland fill area 0.099 acre
CARTHAGE/
0 120 24060 Feet
Temporary Wetland Impact Area Drawing for Carthage Road Wetland as prepared by Dr. J.H. Carter III and Associates Inc.
Wetland Line
Parcel Boundary
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wetland fill area 0.044 acre
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0 30 60 120 Feet
Final Wetland Impact Area Drawing for Carthage Road Wetland as prepared by Dr. J.H. Carter III and Associates Inc.

wetland fill area 0.099 acreCARTHAGE/
0 40 8020 Feet
Temporary Wetland Impact Area Drawing for Carthage Road Wetland as prepared by Dr. J.H. Carter III and Associates Inc.
Wetland Line
Parcel Boundary
Jurisdictional Determination Request

Version: December 2013 Page 1

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
to the appropriate Corps Field Office (or project manager, if known) via mail, electronic mail, or
facsimile. A current list of county assignments by Field Office and project manager can be
found on-line at: http://www.saw.usace.army.mil/Missions/RegulatoryPermitProgram.aspx , by
telephoning: 910-251-4633, or by contacting any of the field offices listed below:

ASHEVILLE REGULATORY FIELD OFFICE
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]

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]
______________________________________________________________________

Jurisdictional Determination Request

Version: December 2013 Page 2

INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E and F.
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 G.
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 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.

Jurisdictional Determination Request

Version: December 2013 Page 3

A. PARCEL INFORMATION

Street Address: _______________________________________________
City, State: _______________________________________________
County: _______________________________________________
Directions: _______________________________________________
_______________________________________________

Parcel Index Number(s) (PIN): ___________________________________
___________________________________

B. REQUESTOR INFORMATION

Name: _________________________________________
Mailing Address: _________________________________________
Telephone Number: _________________________________________
Electronic Mail Address 1: _________________________________________

Select one:

I am the current property owner.

I am an Authorized Agent or Environmental Consultant 2

Interested Buyer or Under Contract to Purchase

Other, please explain.

C. PROPERTY OWNER INFORMATION

Name: ________________________________________
Mailing Address: ________________________________________
________________________________________
Telephone Number: ________________________________________
Electronic Mail Address 3: ________________________________________

Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)

1 If available
2 Must attach completed Agent Authorization Form
3 If available
Jurisdictional Determination Request

Version: December 2013 Page 4

D. PROPERTY OWNER CERTIFICATION 4

I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do 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
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.

________________________ _____________________
Property Owner (please print) Date

_________________________________________________________________________
Property Owner Signature

E. JURISDICTIONAL DETERMINATION TYPE

Select One:

I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.

I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.

I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUS 5 and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.

I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an approved JD (this may or may not include a survey plat).

I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).

4 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
5 Waters of the United States
Jurisdictional Determination Request

Version: December 2013 Page 5

F. ALL REQUESTS

Map of Property or Project Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.

Size of Property or Project Area ________________ acres

____ I verify that the property (or project) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.

G. JD REQUESTS FROM CONSULTANTS OR AGENCIES

(1) Preliminary JD Requests:

Completed and signed Preliminary Jurisdictional Determination Form 6.

Project Coordinates: ____________Latitude ____________Longitude

Maps (no larger than 11x17) with Project Boundary Overlay:

Large and small scale maps that depict, at minimum: streets, intersections, towns

Aerial Photography of the project area

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)

6 See Appendix A of this Form. From Regulatory Guidance Letter No. 08-02, dated June 26, 2008
Jurisdictional Determination Request

Version: December 2013 Page 6

Delineation Information (when applicable)7:

Wetlands: Tributaries:
Wetland Data Sheets 8 USACE Assessment Forms

Upland Data Sheets Other Assessment Forms
(when appropriate)

Landscape Photos, if taken

Field Sketch overlain on legible Map that includes:

 All aquatic resources (for sites with multiple resources, label and identify)
 Locations of wetland data points and/or tributary assessment reaches
 Locations of photo stations
 Approximate acreage/linear footage of aquatic resources

(2) Approved JDs including Verification of a Delineation:

Project Coordinates: ___________Latitude __________ Longitude

Maps (no larger than 11x17) with Project Boundary Overlay:

Large and small scale maps that depict, at minimum: streets, intersections, towns

Aerial Photography of the project area

USGS Topographic Map

Soil Survey Map

Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)

7 1987 Manual Regional Supplements and Data forms can be found at:
http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits/reg_supp.aspx
Wetland and Stream Assessment Methodologies can be found at:
http://portal.ncdenr.org/c/document_library/get_file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&groupId=38364 and,
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/publicnotices/2013/NCSAM_Draft_User_Manual_130318.pdf
8 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Jurisdictional Determination Request

Version: December 2013 Page 7

Delineation Information (when applicable):

Wetlands: Tributaries:
Wetland Data Sheets 9 USACE Assessment Forms

Upland Data Sheets Other Assessment Forms
(when appropriate)

Landscape Photos, if taken

Field Sketch overlain on legible Map that includes:

• All aquatic resources (for sites with multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
• Approximate acreage/linear footage of aquatic resources

Supporting Jurisdictional Information (for Approved JDs only)

Approved Jurisdictional Determination Form(s) (also known as “Rapanos
Form(s)”)

Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc. to navigable waters.

9 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.

Jurisdictional Determination Request

Version: December 2013 Page 8

I. REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT

Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps project manager for
review.

Due to storage limitations of our administrative records, the Corps requires that all hard-
copy submittals include at least one original Plat (to scale) that is no larger than 11”x17”
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11”x17”, may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Document Format (PDF) file. Upon verification, the Corps can electronically sign these
plats and return them via e-mail to the requestor.

(1) PLATS SUBMITTED FOR APPROVAL

Must be sealed and signed by a licensed professional land surveyor

Must be to scale (all maps must include both a graphic scale and a verbal scale)

Must be legible

Must include a North Arrow, Scale(s), Title, Property Information

Must include a legible WoUS Delineation Table of distances and bearings/metes
and bounds/GPS coordinates of all surveyed delineation points

Must clearly depict surveyed property or project boundaries

Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)

When wetlands are depicted:

• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system

Jurisdictional Determination Request

Version: December 2013 Page 9

When tributaries are depicted:

• Must include either a surveyed, approximate centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) of tributary
• Must identify each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area (using approximate
widths or surveyed OHWM)
• Must include name of tributary (based on the most recent USGS topographic
map) or, when no USGS name exists, identify as “unnamed tributary”

all depicted WoUS (wetland polygons and tributary lines) must intersect or tie-to
surveyed project/property boundaries

Must include the location of wetland data points and/or tributary assessment
reaches

Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. “isolated wetlands”, “non-
jurisdictional waters”). NOTE: An approved JD must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.

Must include and survey all existing conveyances (pipes, culverts, etc.) that
transport WoUS

Jurisdictional Determination Request

Version: December 2013 Page 10

(2) CERTIFICATION LANGUAGE
When the entire actual Jurisdictional Boundary is depicted:

include the following Corps Certification language:

When uplands may be present within a depicted Jurisdictional Boundary:

include the following Corps Certification language:

“This certifies that this copy of this plat accurately depicts the boundary of the jurisdiction
of Section 404 of the Clean Water Act as determined by the undersigned on this date.
Unless there is a change in the law or our published regulations, the determination of
Section 404 jurisdiction may be relied upon for a period not to exceed five (5) years from
this date. The undersigned completed this determination utilizing the appropriate Regional
Supplement to the 1987 U.S. Army Corps of Engineers Wetlands Delineation Manual.”
Regulatory Official: _____________________________________
Title: _____________________________________
Date: _____________________________________
USACE Action ID No.: _____________________________________

"This certifies that this copy of this plat identifies all areas of waters of the United States
regulated pursuant to 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,
this determination 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 Wetlands
Delineation Manual.”
Regulatory Official: _____________________________________
Title: _____________________________________
Date: _____________________________________
USACE Action ID No.: _____________________________________

Jurisdictional Determination Request

Version: December 2013 Page 11

(3) GPS SURVEYS

For Surveys prepared using a Global Positioning System (GPS), the Survey must include
all of the above, as well as:

be at sub-meter accuracy at each survey point.

include an accuracy verification:
One or more known points (property corner, monument) shall be located with the
GPS and cross-referenced with the existing traditional property survey (metes and
bounds).

include a brief description of the GPS equipment utilized.

July 15, 2019

Chuck Bolton
Bolton Builders
4317 Seven Lakes Plaza
West End, NC 27376

Re: 10 acre portion of undeveloped land Carthage Road (LRK: 20651), West End, Moore
County, North Carolina

Dear Mr. Bolton:

This is in response to your request for an assessment of any potential impacts to red-cockaded
woodpeckers (Dryobates borealis = Picoides borealis) associated with the development of the
subject property. The U.S. Fish and Wildlife Service (Service) offers the following comments in
support of Section 9 of the Endangered Species Act of 1973 (16 U.S.C. 1531-1543) (Act) and the
Service’s Private Lands Guidelines found in Appendix 5 of the Service’s Recovery plan for the
red-cockaded woodpecker (Picoides borealis): second revision (U.S. Fish and Wildlife Service
2003). A site visit was conducted by staff of Dr. J.H. Carter and Associates Inc. on July 11, 2019.

Based upon the site visit, there are no red-cockaded woodpecker cavity trees on this property
which lies outside of any known red-cockaded woodpecker clusters. However, recovery efforts
for this species are underway and may result in groups becoming reestablished in areas currently
unoccupied by this species. The cumulative loss of foraging and nesting habitat caused by
residential and commercial construction is one of the primary threats to the continued existence of
the red-cockaded woodpecker in the Pinehurst/Southern Pines/West End area. Therefore, as plans
are made to develop this property, I encourage you to minimize the removal of any mature
longleaf pine trees greater than 8 inches in diameter, take measures to prevent damage to the bole
and root system of the remaining longleaf pines and to landscape with plant species native to the
Sandhills ecosystem.

The results of this survey are valid for a period of 1 year from the date this letter was issued.
However, this determination must be reconsidered if the project design is subsequently modified
or if new information becomes available. Please use this letter as necessary to inform all
potentially affected parties of this finding. If you have any comments or questions, please don’t
hesitate to contact me at [phone] ext. 10.

Sincerely,
Susan Ladd Miller
Fish and Wildlife Biologist