ENG XXXX Preliminary Jurisdictional Determination Form

U.S. Army Corps of Engineers (USACE) The proponent agency is CECW-CO-R. Form Approved

OMB No. 0710-xxxx

Expires: xx-xx-xxxx

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION

(PJD) FORM BACKGROUND INFORMATION

The public reporting burden for this collection of information, OMB Control Number 0710-xxxx, is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR REQUEST TO THE ABOVE EMAIL.

PRIVACY ACT STATEMENT

Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act, Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on this form will be used in evaluating the application for a permit. 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. Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and/or instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned. System of Record Notice (SORN). The information received is entered into our permit tracking database and a SORN has been completed (SORN #A1145b) and may be accessed at the following website: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570115/a1145b-ce.aspx

BACKGROUND INFORMATION

1. REPORT COMPLETION DATE FOR PJD: 29-JUL-2020 (JD END DATE)

2. NAME AND ADDRESS OF PERSON REQUESTING PJD: (FOLDER APPLICANT(s))

Derf, Fred A.
Fredco
123 Main Street
Unit 12g
Smallville, KS 12345

Doe, Jane
P. O. Box 456
Metropolis, NY 98765

Doe, John
456 Rt 3
Nowhere, ME 00000

3. DISTRICT OFFICE, FILE NAME, AND NUMBER: (FOLDER District, Project Name, DA Number)

CRREL, PETE - Test NWPR #1, CRREL-2020-00134

4. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: (FOLDER Project Location)

(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR AQUATIC RESOURCES AT DIFFERENT SITES)

State: CT County/parish/borough: New London County City:

Center coordinates of site (lat/long in degree decimal format):

Lat.: 41.470618^o Long.: -72.14756^o

Universal Transverse Mercator: 18

Name of nearest waterbody: Falls Brook

5. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY): (JD Closure Method)

	Office (Desk) Determination. Date: (?)
	Field Determination. Date(s): (?)

TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY JURISDICTION. (AR Page)

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) (COWARDIN ??)	Geographic authority to which the aquatic resource "may be" subject (i.e., Section 404 or Section 10/404)
My MJD	41.464411	-72.149437	92.56 acres	Lacustrine	Section 10/404
PJD Water #2	41.423665	-72.083798	76032 feet	Riverine	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 "pre­construction 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:

___	Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
___	Map: ____________________________.
___	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: ____________________________.
	___	USGS NHD data.
	___	USGS 8 and 12 digit HUC maps.
___	U.S. Geological Survey map(s). Cite scale & quad name: ____________________________.
___	Natural Resources Conservation Service Soil Survey. Citation: __________________________.
___	National wetlands inventory map(s). Cite name: ____________________________.
___	State/local wetland inventory map(s): ____________________________.
___	FEMNFIRM maps: ____________________________
___	100-year Floodplain Elevation is: _______________. (National Geodetic Vertical Datum of 1929)
	___	Photographs:	___	Aerial (Name & Date): ____________________________.
	___	or	___	Other (Name & Date): ____________________________.
___	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		Signature and date of person requesting PJD (REQUIRED, unless obtaining the signature is impracticable)1

¹ Districts may establish timeframes for requester to return signed PJD forms. If the requester 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.

ENG XXXX, DATE

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