20150542 Ver 2_USACE Permit_20150615

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2015-01244 County: Rockingham U.S.G.S. Quad: NC-RUFFIN
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: NC Department of Transportation
attn: Richard Hancock
Address: 1598 Mail Service Center
Ralei�h, NC, 27699-1598
Size (acres) 0.89 Nearest Town Ruffin
Nearest Waterway Wolf island Creek River Basin Upper Dan
USGS HUC 03010]03 Coordinates 36.481639 N, -79.558133 W
Location description: The site is located along SR 1767 (Mavf�eld Road) over Wolf Island Creek at NCDOT Brid�e 110 in
Rockingham County, North Carolina.
Description ofprojects area and acrivity: This authorization is for the discharge of clean fill material associated with an existing
bridge replacement proiect. Impacts include permanent impacts to 42 linear feet (0.03 acre) of stream channel for bank
stabilization and temporarv impacts to 34 linear feet (0.02 acre) for construction access and dewaterin� needed to construct
the new bridge to NCDOT standards.
Applicable Law: � Secrion 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Nationwide Pennit Number: NWP 14 Linear Transportation Proiects.
SEE ATTACHED RGP or NWP GENERAL, REGIONAL AND SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application and attached information dated and received 6/12/2015 via e-mail. Any violation of
the attached conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration
order, a Class I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expirarion 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 expirarion 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
acrivity 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 verificarion 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 David Bailev at 919-554-4884 ext. 30 or David.E.Bailev2(c�usace.armv.mil.
BAILEY.DAVID.E.137 g„"�'�s'��,°��o p:Fm�°�°'o�pop'o���K,
Corps Regulatory OfficiaL• 92s3�36 �� "�� Date: 6/15/2015
Expiration Date of Verification: 03/l8/2017
Copy furnished:
Dave Wanucha, NCDENR-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston Salem NC 27105

Determination of Jurisdiction:
A. ❑ Based 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).
B. ❑ 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.
C. � 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.
D. ❑ The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued . Action ID: SAW- .
Bas1s Fo1' Detet'minatiOn: The site exhibits features with Ordinarv High Water. The waters on site include Wolf Island
Creek - a Relatively Permanent Water (RPW), which flows to the Dan River, a Traditionall� Navigable Water. This
determination is based on an office verification bv David E. Bailev (USACE) on 6/15/2015.
Remarks:
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination 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 request
a certified wetland determination from the local office of tbe Natural Resources Conservation Service, prior to starting work.
F. Appeal5 Inf01'matl0n (This information applies only to approved jurisdictional determinations as indicated in B
and C above).
This correspondence constitutes an approved jurisdictional determination far the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this determination you
must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlanric Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1OM15
Atlanta, Georgia 30303-8801
Phone: [phone]
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by 7/14/2015.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
Corps Regulatory Official: BAILEY.DAVID.E.1379283736 grLe,p,=ob,,,==,,bo,00 ��������^��^��tr�A���t13J9=83J3fi
David E. Bailey
Date of JD: 6/15/2015 Expiration Date of JD: 6/15/2020

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
NCDOT File Number: SAW-2015-01244 Date: 6/15/2015
Attached is:
❑ INITIAL PROFFERED PERMIT Standard Permit or Letter of permissi
n PROFFERED PERMIT (Standard Permit or Letter of permission)
PERMiT DENIAL
APPROVED JURISDICTIONAL DETERMINATION
PRELiMINARY JURiSDICTIONAL DETERMINATION
See Section below
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SECTION I- The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.army.miUMissions/CivilWarks/Re u,g latoryProgramandPermits.aspx
ar the Coms re�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 wark 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
tbat 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 jurisdicrional determinations associated with the
permit.
• APPEAL: lf you choose to decline the proffered permit (Standard ar LOP) because of certain terms and conditions therein,
you may appeal the declined 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 norice.
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 norice.
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 fonn to the district engineer. This form
must be received by the division engineer within 60 days of the date of this norice.

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 further instrucrion. Also you may provide new informarion for further considerarion by the
Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
R�ASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons far appealing the decision or your objections to an initial
proffered pennit 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 infortnation that the review officer has determined is needed to
clarify the administrarive 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.
PO1NT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the If you only have questions regarding the appeal process you may
appeal process you may contact: also contact:
District Engineer, Wilmington Regulatory Division, Attn: Mr. Jason Steele, Administrative Appeal Review Officer
attn: David Bailey CESAD-PDO
Raleigh Regulatory Field Office U.S. Army Corps of Engineers, South Atlantic Division
3331 Iieritage Trade Drive, Suite 105 60 Forsyth Street, Room 1OM15
Wake Forest, North Carolina 27587 Atlanta, Georgia 30303-8801
Phone: [phone]
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 an site investi ation, and will have the o ortuni to artici ate in all site investi ations.
Date: Telephone number:
Si nature of a ellant or a ent.
For appeals on Initial Prof'fered Permits send this form to:
District Engineer, Wilmington Regulatory Division, attn: David Bailey, 69 Darlington Avenue, Wilmington, North Carolina
28403
For Permit denials, Proffered Permits and approved JuYisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, attn: Mr. Jason Steele, Administrative Appeal
Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

Action ID Number: SAW-2015-01244 County: Rockingham
Permittee: NCDOT (attn: Richard Hancock)
Project Name: NCDOT / B5341 / SR 1767 / Bridge 110 / Division 7/ Rockingham County
Date Verification Issued: 6/15/2015
Project Manager: David E. Bailey
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
attn: David Bailey
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
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