20051213 Ver 1_Complete File_20050718

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July 18, 2005
Halifax County
DWQ Project No. 051213
APPROVAL of 401 Water Quality Certification
Mr. R.E. Greene, Jr., P.E. Division Engineer
NCDOT, Division 4
509 Ward Boulevard
PO Box 3165
Wilson, NC 27895
Dear Mr. Greene:
You have our approval, in accordance with the conditions listed below, for the following impacts for the purpose of
upgrading NC 903 in Halifax County.
Impact Locations Stream Impacts - Permanent Fill
(Linear Feet) Wetland Impacts-Permanent Fill
(acres)
Site 1 20 .017
The project shall be constructed in accordance with your application dated received July 7, 2005. After reviewing
your application, we have decided that the stream impacts described are covered by General Water Quality
Certification Numbers 3404 and 3366. This certification corresponds to the Nationwide Permit 14 and the
Nationwide Permit 33 issued by the Corps of Engineers. In addition, you should acquire any other federal, state or
local permits before you proceed with your project including (but not limited to) Sediment and Erosion Control,
Non-Discharge and Water Supply Watershed regulations. This approval will expire with the accompanying 404
permit, unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the
new owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying
with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the
conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed. The
responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the Division of
Water Quality upon completion of the project.
2.) During the construction of the project, no staging of equipment of any kind is permitted in waters of the U.S., or
riparian buffers.
3.) Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
One
fthCarolina
N6
Transportation Permitting Unit Atara!!y
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
An Fnual OnnnrinnihdANrmafiva Arfinn Fmnlnvar _ Ella/_ Anr rlarillOO/ Pnef Cnnciimar Panar
4.) The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.
5.) Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
conditions.
6.) All mechanized equipment operated near surface waters must be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
7.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
8.) The outside buffer, wetland or water boundary located within the construction corridor approved by this
authorization shall be clearly marked by highly visible fencing prior to any land disturbing activities. Impacts
to areas within the fencing are prohibited unless otherwise authorized by this certification.
9.) There shall be no excavation from or waste disposal into jurisdictional wetlands or waters associated with this
permit without appropriate modification of this permit. Should waste or borrow sites be located in wetlands or
stream, compensatory mitigation will be required since it is a dilrect impact from road construction activities.
10.) Heavy equipment must be operated from the banks rather than in the stream channel in order to minimize
sedimentation and reduce the likelihood of introducing other pollut4nts into the stream.
11.) Placement of culverts and other structures in waters, streams, and wetlands must be placed below the elevation
of the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20 percent of the
culvert diameter for culverts having a diameter less than 48 inches, to allow low flow passage of water and
aquatic life. Design and placement of culverts and other structures including temporary erosion control
measures shall not be conducted in a manner that may result in dis-equilibrium of wetlands or stream beds or
banks, adjacent to or upstream and down stream of the above structures. The applicant is required to provide
evidence that the equilibrium shall be maintained if requested in writing by DWQ.
12.) If the above condition (#11) is unable to be met, due to bedrock or other limiting features encountered during
construction, please contact the NCDWQ for guidance on how to proceed and to determine whether or not a
permit modification will be required.
13.) No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened.
14.) The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or
other materials be dredged from the wetted stream channel under authorization of this permit, except in the
immediate vicinity of the culverts.
15.) All work shall be performed during low or normal flow conditions.
16.) All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1.
17.) A copy of this Water Quality Certification shall be posted on the construction site at all times. In addition, the
Water Quality Certification and all subsequent modifications, if any, shall be maintained with the Division
Engineer and the on-site project manager.
18.) For the area at Site 1 being impacted due to site dewatering activties, the site shall be graded to its
preconstruction contours and revegetated with native vegetation.
1P
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition that conforms
to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, RO. Box 27447,
Raleigh, N.C. 276 1 1-7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please contact Christina Breen at [phone].
Sincerely,
2/ C c I'
Alan W. Klimek,
I'
JEH/cmb
Attachment
cc: Mr. Bill Biddlecome, US Army Corps of Engineers, Washington Field Office
Mr. Jamie Sherri, Division 4 Environmental Officer, 509 Ward Blvd., Wilson, NC 27895
NC DWQ Raleigh Regional Office
Central Files
File Copy
c:\Correspondence\20050therProjects\D WQ051213\071805 wgc.doc
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S'I Al l: OF Nowvi I CAROLINA tiosk, p)
DEPARTMENT OF TRANSPORTATION
's'?? ?o
MICHAEL F. EASLEY LYNDO TIPPE I ?`s O
Govt:KNOrt St C'RFTARY
DIVISION 4
4
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July 1, 2005
Mr. Bill Biddlccombc
U.S. Anny Corps of Engineers
Washington Regulatory Field Office
Post Ott ice Box 1000
Washington, North Carolina 27889-1000
(Two Copies)
Ms. Christina Breen
Wetlands/401 Unit
NC DENR Division of Water Quality
2321 Crabtree Blvd
Raleigh, NC 27604
(Seven Copies)
051213

SUBJECT: Halifax County, Upgrade ot'NC 903 from two lanes to three lanes starting
4.3 miles west of Halifax
State Project Number: 4CR.10421
Dear Sirs:
The North Carolina Department cif Transportation (NCDOT) proposes to widen NC 903
from a two lane road to a three lane road to reduce future maintenance needs and increase
traffic safety. This activity will result in impacts to a strearri due to the replacement and
extension of a crossline pipe to facilitate travel lane and shoulder widening. The NCDOT
anticipates that the pipe replacement activity will be authorized under Nationwide Permit
(NWP) 14 and temporary losses to the waters will be minimized by the use of sheet pile
cofferdams being placed within the proposed 0.017 acre impact area. The sheet pile
cofferdams will be removed immediately upon completion of the crossline pipe
replacement. This application is also intended as request for written authorization from
the NC Division of Water Quality to replace the pipe under General Water Quality
Certificate # 3375 (NWP 14). The following information is being provided to satisfy
Nationwide Permit Condition 13 (Fetlelwl Rc Disler January 15, 2002) and Condition I of
General Water Quality Certificate # 3375.
Post Office Box 3165. Wilson. North Carolina 27895-3165
Phonc 1252) 6237-6164 Fax [phone]
APPLICATION INFORMATION
Enclosed please find the Pre-construction Notification (P('N) Form and supporting
documentation for the above retcrenced project.
In accordance with North Carolina General Statute 143-215.3D(e) the following
infonnation is being provided to facilitate payment of tees associated with the appropriate
Water Quality Certificate:
• Certificates being requested: #3375 (NWP 14) and #3366 (NWP 33)
• State Projcct Numhcr : 4CR.10421
• Amount of fee: $200
PROJECT INFORMATION
Road Name SR Numhcr Project Length Classification
fmilcs)
NC 903 NC 903 0.28 Rural
River Basin:
lm)
ID
----
--

W;ter Quality Designation

New Impervious Surface
Roanoke 2; 211
? -- C N A
Buffer Rules -- -- Buffer rise Designation
---
No Not Applicable
PnNcclcd SpecicS PIVSC l Mappcd Ilisloric Propeltles
- No
-- -- - No
PIPE REPLACEMENT INFORMATION
Site (Station) -- 18430 -1--
--- Map Status Shown Oil [Opt) only
[xisling VIP --Proposed-- CMP
Diameter On) 30 Dian,rlcr 4'
Length (li) 50
- ---- --- Length 70
Construction
Method -
Pu
ny,
;uuulld - Dc,+;ncring
*
sheet pile
Dr,i
ce
Burial Depth 14 Inches --- ----- - Substrate Sandy loam
Construction Date ASAP -- - Duration One week
Impacts (fl.) _20-pipe,: -rip-rap protection : -tempolmy
Comments Dcwatering, il'necdcd. ,rill he acconlpliShcd by the use ofShccl piles. Sheet Piles will he placed within the
proposed 0 Ol7 acne impact area.
Within 15 111nk111g d- UI the of the plpC I'Clllacelllelll all cl,llerdanls will he entirely removed and natural stream
Restoration flan contours will he restored and ,ceded. Temporary sill screens placed in intennitlent channels will he cleaned and
renu,ved following,rgcLtion establishment.
?. - ,cnuoncu concrcle pipe. k Ivrl' i ur rg;nru metal pipe: t ntl'A e unugat,'d metal pipe arch: * 11 needed.
FEDERALLY-PROTECTED SPECIES AND CULTURAL RESOURCES
The Fish and Wildlife Service (FWS) currently list tour federally protected species for
Halifax County (Table 1).
Table 1- Federally Protected Species of Halifax County

Common Name
Scientific Name Federal
Status Habitat
Present Biological
Conclusion
Red-cockaded
woodpecker l'icoides borealis E N No Effect
Bald eagle (llaliaeolls
lcttcocc(hhcdtus) E N No Effect
Dwarf wedge mussel .41(ismidonta hetcrodon E N No Effect
Tar spiny mussel Ellil)tio sminstcn;saIla E N No Effect
No element occurrences are listed on the NHP database "-]thin one mile of the project
area. During the onsitc visit, it vas determined that there was no habitat suitable for the
Bald eagle nor were there pine U-ces suitable for RCW toraging or nesting are in, or
adjacent to, the project area. There was also no habitat suitable for the Dwarf wedge
mussel or Tar spiny mussel. This project is not likely to jeopardize the continued
existence of any of the federally protected species listed in Halifax County.
No sites eligible for listing on the National Register occur within the area of potential
effect. This project will not affect listed or eligible historic properties.
MINIMIZATION INFORMATION
Impacts will be minimized by strict enforcement of Best Management Practices for the
protection of surface waters and wetlands. restrictions against the staging of equipment in
or adjacent to waters of the US, and coordination (includim-, a pre-construction meeting)
with the Division Environmental Officer.
MITIGATION INFORNIAT11'ON
Mitigation for stream and wetland impacts will be provided by the North Carolina
Ecosystem Enhancement Program ( E1') per the Memorandum ol'Agreement dated July
22, 2003. Total wetland impacts (0.017 acres) and total strcam impacts (20 LF) will be
reported to the EEP following the end of the quarter as required by the September 1, 2004
guidance from the U.S. Army Corp of Engineers District Office in Wilmington.
If you have any questions or recd any additional infonnatic:-n, please contact Jamie
Guerrero at [phone] or Jamie Shern at [phone]. Your time and effort arc
appreciated.
Respectfully yours,
/ ?) `
R. E. Greene, ,I r., PE
Division Engineer, Divisib) 4
cc: Mr. James F. Sherri, Division Environmental Officer
Mr. Ronnie Keeter, P.E.. District I Engineer
Mr. Bryant Bunn. P. F., NCDOT Division Maintenance Engineer
Mr. Franz Enders, P.E., Assistant District 1 Engineer
Ms. Katie Simmons, Roadside Environmental Field Operations Technician
JLwg?gUVRJ
JUL 0 7 2005
Office Use Only: rU1NDSglypS"MW ? Fonn Version May 2002
USACE Action ID No. DW 12 13
ttt any parucuiar item is not applicable to this protect, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14 N \N 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section Viii and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (sec the top of page 2 for further details), check here: ?
if. Applicant Information
Owner/Applicant Information
Name: Mr. R.E. Greene, P.E., Division Engineer
Mailing Address: No!-th Carolina Department of Transportation/Division 4
P.O. Box 3165
Wilson, NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: rgreene(cOot.state. nc.us
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Mr. Jamie Shern
Company Affiliation: Division Environmental Officer
Mailing Address: North Carolina Department of Transportation/Division 4
P.O. Box 3165
Wilson NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: ishern(c?,,dot.state. nc.us
Page 5 of' 12
Ill. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USAGE requires information to be submitted on sheets no larger than 11 by 17-inch frornat,
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be infornied that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: NC 903
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): N/
4. Location
County: Halifax Nearest Town: Halifax
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): NC 903 west from Halifax.
Project located 4.6 miles from Halifax.
5. Site coordinates, if available (UTM or Lat/Long): Darlington Quad: 36.3612 N 77.6665W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): N/
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Quankey Creek (DWQ
ID#23-30 C)
8. Rivcr Basin: Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://li2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Rural agricultural industrial
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: Road
grading, drainage, base paving and erosion control using heavy construction equipment
backhoe, excavator, dump truck bulldozer, grader).
11. Explain the purpose of the proposed work:- To widen existing two lane section to three
lanes to connect existing three lane sections and provide turning lanes for left turns
IV. Prior Project History
if jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USAGE Action ID Number, DWQ Projcct Number, application date, and date pen-nits and
certifications were issued or withdrawn. Provide photocopies of previously issued pennits,
certifications or other useful intonnation. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). Ifthis is a NCDOT project,
list and describe pe?-?mits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N/A
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
N/A
V1. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to detenmine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intennittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation t*onns should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Pagc 7 of 12
I . Provide a written description of the proposed impacts: Add fill to widen roadway
2. Individually list wctland impacts below:
Wetland Impact
Site Number
(indicate on map)
hype of Impact* Area of
Impact
(acres) Located within
100-year I--loodplain**
(yes'no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
l FIII 0.017 0 Freshwater marsh

-,.,, 11111, CE 1cpain1crY anu lucnury IcnlporarY 1111i"acts. Impacts include. but are not limited to: mechanised clearing, grading, fill,
excavation, flooding, ditching-drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Fnlergencv Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or f:FMA-approved local floodplain neaps. Maps arc available through the FEMA Map Service Ccnter at 1-800-158-9616, or
online at lilt . IV" ?N tcnw.!,' .
*** List a wctland type that hest describes wetland to be impacted (c.('., ticshwatcrsalhvater marsh, forested wctland, bca\rr pond,
Carolina Bay• hog. etc.) Indicate if lecd:uul is isolated (determination ol'isolatiou to he made by 1, SACE only).
List the total acreage (estimated) of all existing wetlands on the property: N/
Total area of wetland impact proposed: 0.017
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma 1)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
( leasespecify)
18 +30 -L- 42" CMP 20 UT to Quankey Creek 4 feet Intermittent

* List each it,, - t I I '
I ac separate y an( rdentlfy temporary impacts. Impacts rncludc. but are not limited to: culverts and associated rip-rap,
darns (separately list impacts due to both structure and flooding), relocation (include linear feet bct'ore and after, and net loss/gain),
stabilization activities (cement Nall, rip-rap, crib wall, gabions, etc.), excavation, ditching straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear ti,otprint firr both the original and relocated strcanns must be included.
** St•carn names can be fiwnd on USGS topographic maps. It' it stream has no merle, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are alailahle through the USGS at 1-800-358-9616, or onfine at
"'" W.tisgs,gilV. Sexual internet sites also allow direct download and printing of USGS neaps (e.g., lNelv.topozorle.crnn,
N1\% wy m )1 uestxolll, etc.). - - -
Cumulative impacts (linear distance in feet) to all streams on site: 20
Page 8 of 12
1. Provide a written description of the proposed impacts:_ Add fill to widen roadway
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indica(e on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
I Fill 0.017 0 Freshwater marsh

--- - ----......,...°...",,••°•"! °„? ,.,..,,u.y -iiitnn-y nnpacts. nnpacrs nmcruue, nut are not limned to: mechanized clearing, grading, till,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at hnp:%,vvwwkrna.i"ov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, hog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: N/A
Total area of wetland impact proposed: 0.017
3. Individually list all intennittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma)

18 + 30 -L-
Type of Impact*

42" CMP Length of
Impact
(linear feet)

20
Stream Name**

UT to Quankey Creek Average Width
of Stream
Before Im act

4 feet Perennial or
Intennittent?

(please secif )
Intermittent

* List each inmpact s epar•nel and identif t
y y emporary nnpacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can he found on USGS topographic maps. If' a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named strearn into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
o\'. Several internet sites also allow direct download and printing of USGS maps (e.g., wW\V.topozone CPrmm,
N'\\'w,rl all UCSI. corn, ctc.).
Cumulative impacts (linear distance in feet) to all streams on site: 20
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

(indicate on map)
Type of Impact* Area of
Impact

(acres)
Name of Waterbody
(if applicable)
( Type of Waterbody

(lake, pond, estuary, sound,
bay, ocean, etc.)

linrlaCL ,cpaiaiay unu wcnuiy temporary impacts. Impacts include, but are not limited to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any snaps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
V11. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
All wetlands or surface waters not affected b the project will be protected from unnecessar
encroachment. No staging of construction equipment will be allowed in or near wetlands or
waters of the U.S. Strict enforcement of sedimentation and erosion control Best Manan ement
Practices for the protection of wetlands and surface waters will be enforced during project
construction.
V111. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
Page 9 of 12
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
littp://h2o.enr.state.nc.us/ncwetiands/stn-ngide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify Roanoke )?
Yes ? No ® If you answered "yes", provide the following infortnation:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact

(square feet)
Multiplier
Required
Mitigation
1 3
2 1.5
Total
[ Vll%; I VARMUS out JV ree[ perpenaicuiar trom near hank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 1 1 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or.0260.
X1. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Temporary dewatering and all appropriate best management practices for sediment and erosion
control will be implemented during pipe replacement
X11. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
X111. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
ATqMe-ant/Agent's Siodature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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COUNTY: Halifax S I TE: NC 903
SCALE: 1" = 50' Franz Enders 4/20/05
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action 1D. 200511631 County: Halifax USGS Quad: Darlington O
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner / Authorized Agent: NCDOT, Division IV
Address: ATTN: Jamie Shern, Environmental Officer
Post Office Box 3165
Wilson, North Carolina 27896
Telephone No.: [phone]
Size and location of property (water body, road name/number, town, etc.): The project is located on NC 903 Highway
just west of Pierces Crossroads and crossing an unnamed tributary to Quankey Creek which flows to the Roanoke
River.
Description of projects area and_activity: The project will consist of widening an existing two lane section to a three
lane and provide turning lanes for left turns, impacts will be 0.017 acres of section 404 wetlands and 20 linear feet
of stream. NOTE: see additional special conditions.
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
? Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number:
Nationwide Permit Number: NW #14 Permit
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted plans. Any violation of the attached conditions or deviation from your submitted plans may subject the
permittee to a stop work order, a restoration order and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are
under construction) or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Quality (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact William Wescott of the Washington Regulatory Field Office at [phone] ext. 31.
Corps Regulatory Official ??o T PAU,S- Date: 10/04/2005
Expiration Date of Verification: 03/18/2007
1[A@[gVfflJ
OCT 6 2005
PAWH
yy?j? AND 3T EOf M A?? QUALITY
Page 1 of 2
Determination of Jurisdiction:
ENzased on preliminary information, there appear to be waters of the US including wetlands within the above described project area.
This preliminary determination is not an appealable action under the Regulatory Program Administrative Appeal Process
(Reference 33 CFR Part 331).
? There are Navigable Waters of the United States within the above described project area subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
® There are waters of the US and/or wetlands within the above described project area subject to the permit requirements of Section
404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
? The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued . Action ID
Basis of Jurisdictional Determination: This site exhibits wetland criteria as described in the 1987 Corns Wetland Delineation
Corps Regulatory Official:
Date 10/04/2005
;U1,S.
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST BE
ATTACHED TO THE FILE COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
Copy Furnished: ,r
NC Division of Water Quality
USACE--Tom Walker

Page 2 of 2
Additional Special Condition
Action I.D. # 200511631 NCDOT, Division 4, NC 903
a) The unavoidable impacts to 0.017 acres of riparian freshwater marsh and 20 linear
feet of stream associated with this project shall be mitigated by NCDOT by providing
0.034 acres of restoration equivalent riparian wetlands and 40 linear feet of stream
restoration in the Roanoke River basin (Hydrologic Cataloging Unit 03010107). For
wetlands, a minimum of 1:1 (impact to mitigation) must be in the form of wetland
restoration. NCDOT shall provide a plan to the USACE for addressing this mitigation
requirement by November 4, 2005. It is recommended that NCDOT provide this
mitigation in accordance with the procedures suggested in our letter dated 1 September
13, 2004 from Mr. Ken Jolly to Dr. Gregory J. Thorpe.
Action ID Number:200511631 County:Halifax
Permittee: NCDOT, Division IV
Date Permit Issued: 10/4/2005
Project Manager: William Wescott
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
WASHINGTONREGULATORY FIELD OFFICE
Post Office Box 1000
Washington, North Carolina 27889
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. If you fail to comply with this permit you are subject to permit suspension,
modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee
Date
CESAW-RG-W DATE: 10/04/2005
MEMORANDUM FOR RECORD
SUBJECT: Consideration of Compensatory Mitigation and Potential Impacts to Endangered Species, Cultural Resources
and Essential Fish Habitat.
1. Action ID. 200511631
2. Project Name and Location: NC 903 Highway road widening, located west of Pierces Crossroads.
3. Mitigation [Section 404(b)(1) Guidelines].
a. Has applicant avoided and minimized impacts to the maximum practicable extent? YES
If NO, Explain:
b. Is compensatory mitigation necessary? YES
Explain: in-lieu payment to NCEEP at a 2:1 restoration ratio for 0.017 acres of freshwater marsh impacts
and 20 linear feet of stream impacts.
4. Endangered Species (Section 7 of the ESA).
a. Will any threatened or endangered species or their critical habitats be affected by this project? NO
If YES, describe steps taken to address concerns:
5. Cultural Resources (Section 106 of the NHPA).
a. Will any Cultural Resources be impacted by this project? NO
b. If YES, describe steps taken to address concerns:
6. Essential Fish Habitat (50 CFR Part 600, Magnuson-Stevens Act).
a. Is this a project that "may adversely affect essential fish habitat"? NO
b. If YES, describe steps taken to address concerns:
Corps Regulatory Official: ? J- ?.,Of p,?.?.
JURISDICTIONAL DETERMINATION Revised 8/13/04
U.S. Army Corps of Engineers
DISTRICT OFFICE: CESAW-RG-W
FILE NUMBER: 200511631
PROJECT LOCATION INFORMATION:
State: North Carolina
County: Halifax
Center coordinates of site (latitude/longitude): N 36.3612/ W-77.6665
Approximate size of area (parcel) reviewed, including uplands: 1.0 acres.
Name of nearest waterway: Quankey Creek
Name of watershed: Roanoke River Basin
JURISDICTIONAL DETERMINATION
Completed: Desktop determination Date: 10/4/2005
Site visit(s) ? Date(s):
Jurisdictional Determination (JD):
? Preliminary JD - Based on available information, ? there appear to be (or) ? there appear to be no "waters of the United States" and/or
"navigable waters of the United States" on the project site. A preliminary JD is not appealable (Reference 33 CFR part 331).
Approved JD -An approved JD is an appealable action (Reference 33 CFR part 331).
Check all that apply:
? There are "navigable waters of the United States" (as defined by 33 CFR part 329 and associated guidance) within the reviewed area.
Approximate size of jurisdictional area:
There are "waters of the United States" (as defined by 33 CFR part 328 and associated guidance) within the reviewed area.
Approximate size of jurisdictional area: 0.017 acres.
There are "isolated, non-navigable, intra-state waters or wetlands" within the reviewed area.
Decision supported by SWANCC/Migratory Bird Rule Information Sheet for Determination of No Jurisdiction.
BASIS OF JURISDICTIONAL DETERMINATION:
A. Waters defined under 33 CFR part 329 as "navigable waters of the United States":
The presence of waters that are subject to the ebb and flow of the tide and/or are presently used, or have been used in
the past, or may be susceptible for use to transport interstate or foreign commerce.
B. Waters defined under 33 CFR part 328.3(a) as "waters of the United States":
(1) The presence of waters, which are currently used, or were used in the past, or may be susceptible to use in
interstate or foreign commerce, including all waters which are subject to the ebb and flow of the tide.
? (2) The presence of interstate waters including interstate wetlands .
? (3) The presence of other waters such as intrastate lakes, rivers, streams (including intermittent streams), mudflats, sandflats, wetlands,
sloughs, prairie potholes, wet meadows, playa lakes, or natural ponds, the use, degradation or destruction of which could affect interstate
commerce including any such waters (check all that apply):
? (i) which are or could be used by interstate or foreign travelers for recreational or other purposes.
? (ii) from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
? (iii) which are or could be used for industrial purposes by industries in interstate commerce.
(4) Impoundments of waters otherwise defined as waters of the US.
(5) The presence of a tributary to a water identified in (1) - (4) above.
[? (6) The presence of territorial seas.
10 (7) The presence of wetlands adjacent' to other waters of the US, except for those wetlands adjacent to other wetlands.
Rationale for the Basis of Jurisdictional Determination (applies to any boxes checked above). 1f the jurisdictional water or wetland is not
itself a navigable water of the United States, describe connection(s) to the downstream navigable waters. If B(1) or B(3) is used as the Basis of
Jurisdiction, document navigability and/or interstate commerce connection (i.e., discuss site conditions, including why the waterbody it
navigable and/or how the destruction of the waterbody could affect interstate or foreign commerce). If B(2, 4, S or 6) is used as the Basis of
Jurisdiction, document the rationale used to make the determination. IfB(7) is used as the Basis of Jurisdiction, document the rationale used to
make adjacency determination: This site exhibits wetland criteria as described in the 1987 Corps Wetland Delineation Manual and is adjacent to
an unnamed tributary which flows to Quankey Creek, a tributary of the Roanoke River.
Lateral Extent of Jurisdiction: (Reference: 33 CFR parts 328 and 329)
Ordinary High Water Mark indicated by: ? High Tide Line indicated by:
? clear, natural line impressed on the bank ? oil or scum line along shore objects
? the presence of litter and debris ? fine shell or debris deposits (foreshore)
? changes in the character of soil ? physical markings/characteristics
? destruction of terrestrial vegetation ? tidal gages
shelving ? other:
? other:
Mean High Water Mark indicated by:
? survey to available datum; ? physical markings; ? vegetation lines/changes in vegetation types.
Wetland boundaries, as shown on the attached wetland delineation map and/or in a delineation report prepared by: NCDOT
Basis For Not Asserting Jurisdiction:
The reviewed area consists entirely of uplands.
? Unable to confirm the presence of waters in 33 CFR part 328(a)(1, 2, or 4-7).
? Headquarters declined to approve jurisdiction on the basis of 33 CFR part 328.3(a)(3).
[? The Corps has made a case-specific determination that the following waters present on the site arc not Waters of the United States:
? Waste treatment systems, including treatment ponds or lagoons, pursuant to 33 CFR part 328.3.
? Artificially irrigated areas, which would revert to upland if the irrigation ceased.
? Artificial lakes and ponds created by excavating and/or diking dry land to collect and
retain water and which are used exclusively for such purposes as stock watering, irrigation, settling basins, or rice growing.
? Artificial reflecting or swimming pools or other small ornamental bodies of water created
by excavating and/or diking dry land to retain water for primarily aesthetic reasons.
? Water-filled depressions created in dry land incidental to construction activity and pits excavated in dry land for the purpose of
obtaining fill, sand, or gravel unless and until the construction or excavation operation is abandoned and the resulting body of water
meets the definition of waters of the United States found at 33 CFR 328.3(a).
? Isolated, intrastate wetland with no nexus to interstate commerce.
? Prior converted cropland, as determined by the Natural Resources Conservation Service. Explain rationale:
? Non-tidal drainage or irrigation ditches excavated on dry land. Explain rationale:
? Other (explain):
DATA REVIEWED FOR JURSIDICTIONAL DETERMINATION (mark all that apply):
El Maps, plans, plots or plat submitted by or on behalf of the applicant.
Data sheets prepared/submitted by or on behalf of the applicant.
? This office concurs with the delineation report, dated , prepared by (company):
? This office does not concur with the delineation report, dated prepared by (company):
? Data sheets prepared by the Corps.
? Corps' navigable waters' studies:
U.S. Geological Survey Hydrologic Atlas:
U.S. Geological Survey 7.5 Minute Topographic maps: Darlington
U.S. Geological Survey 7.5 Minute Historic quadrangles:
? U.S. Geological Survey 15 Minute Historic quadrangles:
USDA Natural Resources Conservation Service Soil Survey:
National wetlands inventory maps:
State/Local wetland inventory maps:
FEMA/FIRM maps (Map Name & Date):
? 100-year Floodplain Elevation is: (NGVD)
?' Aerial Photographs (Name & Date):
Other photographs (Date):
[] Advanced Identification Wetland maps:
Site visit/determination conducted on:
Applicable/supporting case law:
E] Other information (please specify):
'Wetlands are identified and delineated using the methods and criteria established in the Corps Wetland Delineation Manual (87 Manual) (i.e., occurrence of
hydrophytic vegetation, hydric soils and wetland hydrology).
2ne tern "adjacent" means bordering, contiguous, or neighboring. Wetlands separated from other waters of the U.S. by man-made dikes or barriers, natural river
berms, beach dunes, and the like arc also adjacent.
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A
licant: NCDOT, Division IV File Number: 200511631 Date: 10/4/2005
At tached is:D See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of A
permission)
PROFFERED PERMIT (Standard Permit or Letter of permission) B
PERMIT DENIAL C
APPROVED JURISDICTIONAL DETERMINATION D
PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I - The following identifies'yO' W rights,and optto&regarding wi administrative appeal oftlie ' bove
decision. Additional information mayr be fo itid af;http://ww N.usace.army.millincllfutictions/cw/ce_ c_?vo e or
Corps feg ulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request that the
permit be modified accordingly. You must complete Section II of this form and return the form to the district engineer. Your
objections must be received by the district engineer within 60 days of the date of this notice, or you will forfeit your right to appeal
the permit in the future. Upon receipt of your letter, the district engineer will evaluate your objections and may: (a) modify the
permit to address all of your concerns, (b) modify the permit to address some of your objections, or (c) not modify the permit
having determined that the permit should be issued as previously written. After evaluating your objections, the district engineer
will send you a proffered permit for your reconsideration, as indicated in Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because,pf certain terms and conditions therein, you
may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section 11 of this form
and sending the form to the division engineer. This form must be received by the division engineer within 60 days of the date of
this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division engineer
within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or
provide new information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the date of
this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers Administrative
Appeal Process by completing Section II of this form and sending the form to the division engineer. This form must be received by
the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps
regarding the preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved
JD (which may be appealed), by contacting the Corps district for farther instruction. Also you may provide new
information for further consideration by the Corps to reevaluate the JD.
t

tTESTFOR APPEAL or OBJECTIONS TO i?,N INITIAL PItOFF? ?D PERMIT
SECTION II-- REQ,
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your
objections to an initial proffered permit in clear concise statements. You may attach additional information to
this form to clarify where your reasons or objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps
memorandum for the record of the appeal conference or meeting, and any supplemental information that the
review officer has determined is needed to clarify the administrative record. Neither the appellant nor the Corps
may add new information or analyses to the record. However, you may provide additional information to clarify
the location of information that is already in the administrative record.
POINT Ol CONTACT'FOR QUES'T'IONS OR -INFORMATION:
If you have questions regarding this decision If you only have questions regarding the appeal process you
and/or the appeal process you may contact: may also contact:
US Army Corps of Engineers Mr. Michael Bell, Administrative Appeal Review Officer
attn: William Wescott CESAD-ET-CO-R
Post Office Box 1000 U.S. Army Corps of Engineers, South Atlantic Division
Washington, North Carolina 27889 60 Forsyth Street, Room 9M15
252) 975-1616 ext. 31 Atlanta, Georgia 30303-8801
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any
government consultants, to conduct investigations of the project site during the course of the appeal process. You
will be provided a 15 day notice of any site investigation, and will have the opportunity to participate in all site
investigations.
Date: Telephone number:
Signature of appellant or agent.
DIVISION ENGINEER:
Commander
U.S. Army Engineer Division, South Atlantic
60 Forsyth Street, Room 9M15
Atlanta, Georgia 30303-3490