20161083 Ver 1_2016-02228 NW 14_20161212

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2016-02228 County: Guilford U.S.G.S. Quad: NC-HIMESVILLE
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Perrnittee: NCDOT
Attn: Jerrv Parker
Address: P.O. Box 14996
Greensboro, NC 27415
Size (acres) 0_5 Nearest Town Kimesville
Nearest Waterway UT to South Prong Stinking Quarter Creek River Basin Cape Fear
USGS HUC 03030002 Coordinates 35.953518 N, -79.554925 W
Location description: The site is located alon� SR 3121 (Ferguson Road) over an Unnamed Tributary (UT) to South PronE
Stinkin� Quarter Creek at NCDOT Bridge 254 in Guilford County, North Carolina.
Description of projects area and activity: This authorization is for the discharge of clean fill material associated with replacinE
an existinE brid�e with two 10 x 7 foot reinforced concrete box culverts with 1-foot and 2-foot sills. Imuacts include permanent
impacts to 561inear feet (0.01 acre) of stream channel for culvert installation and 51 linear feet (0.01 acre) of stream channel
for bank stabilization, and temporary impacts to 3 linear feet (0.01 acre) of stream channel for construction access and
dewatering.
Applicable Law: � Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number or Nationwide Permit 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 via email 11/3/2016, and additional
information received via e-mai112/7/2016. 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 expiration date identified below unless the nationwide autharization 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 Qualiry Certification. You
should contact the NC Division of Water Resources (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 in Morehead City, NC, at [phone].
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 David Bailey at 919-554-4884 ext. 30 or David.E.Bailey2na,usace.army.mil.
Digitally signed by
BAILEY.OAVIDEI3]9383]36
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COTpS RVgUlULOIy O�1ICIUL <n=BNILEY.DAVIQE.13]9183Afi Date: 12/12/2016
Dare: 2016.12.1214:04:50 -OS'00'
Expiration Date of Verification: 03/18/2017
Copy furnished:
Dave Wanucha, NCDEQ-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston-Salem, NC 27105

SAW-2016-02228
Special Conditions:
1. In order to compensate for impacts associated with this permit, mitigation shall be provided in accordance
with the provisions outlined on the most recent version of the attached Compensatory Mitigation
Responsibility Transfer Form. The requirements of this form, including any special conditions listed on
this form, are hereby incorporated as special conditions of this permit authorization.
2. This USACE permit does not authorize you to take a threatened or endangered species, in particular, the
Northern Long-eared Bat (NLEB) (Myotis septentrionalis). In order to legally take a listed species, you
must have separate authorization under the Endangered Species Act (ESA) (e.g., a Biological Opinion
(BO) under the ESA, Section 7, with "incidental take" provisions with which you must comply). The U.S.
Fish and Wildlife Service's (USFWS's) Programmatic BO titled "Northern Long-eared Bat (NLEB)
Programmatic Biological Opinion for North Carolina Department of Transportation (NCDOT) Activities
in Eastern North Carolina (Divisions 1-8)," dated March 25, 2015, and adopted on May 4, 2015, contains
mandatory terms and conditions to implement the reasonable and prudent measures that are associated
with "incidental take" that are specified in the BO. Your authorization under this USACE permit is
conditioned upon your compliance with all the mandatory terms and conditions (incorporated by reference
into this permit) associated with incidental take of the BO. Failure to comply with the terms and conditions
associated with incidental take of the BO, where a take of the listed species occurs, would constitute an
unauthorized take, and would also constitute non-compliance with your USACE permit. The USFWS is
the appropriate authority to determine compliance with the terms and conditions of its BO and with the
ESA.
Digitally signed by
BAILEY.DAVI D.E.1379283736
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CO�S RP.gUlatOIy OffIC1aL �n=BAILEY.DAVID.E.1379283736 Date: 12/12/2016
Date:2016.12.12 13:59:48-OS'00'
Expiration Date of Verification: 03/18/2017

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatorv Miti�ation Responsibilitv Transfer Form
Permittee: NCDOT Action ID: SAW-2016-02228
Project Name: NCDOT / Bridge 254 / SR 3121 / Ferguson Road / Guilford County / Division 7 County: Guilford
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that to the U.S. Army Corps of Engineers (USACE) Project Manager identified on page two is in receipt of a signed copy of this
form before conducting authorized impacts, unless otherwise specified below. If more than one mitigation Sponsor will be
used to provide the mitigation associated with the permit, or if the impacts and/or the mitigation will occur in more than one
8-digit Hydrologic Unit Code (HUC), multiple forms will be attached to the permit, and the separate forms for each Sponsor
and/or HUC must be provided to the appropriate mitigation Sponsors.
Instructions to Sponsor: The Sponsor must verify that the mitigation requirements (credits) shown below are available at the
identified site. By signing below, the Sponsor is accepting full responsibility for the identified mitigation, regardless of
whether or not they have received payment from the Permittee. Once the form is signed, the Sponsor must update the bank
ledger and provide a copy of the signed form and the updated bank ledger to the Permittee, the USACE Project Manager, and
the Wilmington District Mitigation Office (see contact information on page 2). The Sponsor must also comply with all
reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted Impacts Requiring Mitigation* 8-digit HUC and Basin: 03030002, Cape Fear River Basin
Stream Imaacts (linear
Warm Cool
56
Wetland Im
Cold I Rioarian Riverine I Rioarian Non-Riverine I Non-Riparian I Coastal
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
ipensatory Mitigation Requirements:
Stream Mitigation (credits)
Warm Cool Cold
112
8-dieit HUC and Basin:
Wetland
Cape Fear River Basin
n (credits
Riparian Riverine � Riparian Non-Riverine � Non-Riparian � Coastal
Mitigation Site Debited: NCDMS
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCDMS, list NCDMS. If the NCDMS
acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsibility for
providing the mitigation identified in this document (see the table above), associated with the USACE Permittee and Action
ID number shown. I also verify that released credits (and/or advance credits for NCDMS), as approved by the USACE, are
currently available at the mitigation site identified above. Further, I understand that if the Sponsor fails to provide the
required compensatory mitigation, the USACE Wilmington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the mitigation requirements.
Mitigation Sponsor Name:
Name of Sponsor's Authorized Representative:
Signature of Sponsor's Authorized Representative Date of Signature
Page 1 of 2 Form Updated 23 November, 2015

USACE Wilmington District
Compensatory Mitigation Responsibility Transfer Form, Page 2
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the USACE is in receipt of the signed form, the
Permittee is no longer responsible for providing the mitigation identified in this form, though the Permittee remains
responsible for any other mitigation requirements stated in the permit conditions.
• Construction within jurisdictional areas authorized by the permit identified on page one of this form can begin only after
the USACE is in receipt of a copy of this document signed by the Sponsor, confirming that the Sponsor has accepted
responsibility for providing the mitigation requirements listed herein. For authorized impacts conducted by the North
Carolina Department of Transportation (NCDOT), construction within jurisdictional areas may proceed upon permit
issuance; however, a copy of this form signed by the Sponsor must be provided to the USACE within 30 days of permit
issuance. NCDOT remains fully responsible for the mitigation until the USACE has received this form, confirming that the
Sponsor has accepted responsibility for providing the mitigation requirements listed herein.
• Signed copies of this document must be retained by the Permittee, Mitigation Sponsor, and in the USACE administrative
records for both the permit and the Bank/ILF Instrument. It is the Permittee's responsibility to ensure that the USACE
Project Manager (address below) is provided with a signed copy of this form.
• If changes are proposed to the type, amount, or location of mitigation after this form has been signed and returned to
the USACE, the Sponsor must obtain case-by-case approval from the USACE Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios may be applied, as per current District guidance
and a new version of this form must be completed and included in the USACE administrative records for both the permit
and the Bank/ILF Instrument.
Comments/Additional Conditions:
This form is not valid unless signed below by the USACE Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor should provide copies of this form along with an updated bank ledger to:1) the Permittee, 2J the USACE
Project Manager at the address below, and 3J the Wilmington District Mitigation Office, Attn: Todd Tugwell, 11405 Falls
of Neuse Road, Wake Forest, NC27587 (email: [e-mail]. Questions regarding this form or any of the
permit conditions may be directed to the USACE Project Manager below.
USACE Project Manager: David Bailey
USACE Field Office: Raleigh Regulatory Field Office
Email:
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
[e-mail]
_ Digitally signed by BAILEY.DAVID.E.1379283736
� / DN: c=US, o=U.S. Government, ou=DoD, ou=PKl,
V ou=USA, rn=BAILEY.DAVID.E.1379283736
Date: 2016.12.12 14:00:10 -OS'00'
USACE Project Manager Signature
December 12, 2016
Date of Signature
Current Wilmington District mitigation guidance, including information on mitigation ratios, functional assessments, and
mitigation bank location and availability, and credit classifications (including stream temperature and wetland groupings) is
available at http://ribits.usace.armv.mil.
Page 2 of 2
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so, please complete the
Customer Satisfaction Survey located at our website at http://re�ulatory.usacesurvey.com/ to complete the survey online.

Determination of Jurisdiction:
A. ❑ There are waters, including wetlands, on the above described project area that may be subject to Section 404 of the Clean
Water Act (CWA) (33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). This preliminary
determination is not an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part
331). However, you may request an approved JD, which is an appealable action, by contacting the Corps district for further
instruction. Please note, if work is authorized by either a general or nationwide permit, and you wish to request an appeal of an
approved JD, the appeal must be received by the Corps and the appeal process concluded prior to the commencement of any work
in waters of the United States and prior to any work that could alter the hydrology of waters of the United States.
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 (RHA) (33 USC § 403) and 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.
C. � There are waters within the above described project area that are 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 ar 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- .
Basis For Determination: The site exhibits waterbodies with ordinarv high water. The waters on site includes UT to
South Prong Stinking Quarter Creek, a Relatively Permanent Water (RPV� that flows via South Prong Stinkin� Quarter
Creek (RP� and Stinking Quarter Creek (RPV� to Bid Alamance Creek, an RPW that becomes a Traditionally Navi�able
Water. This determination is based on an office verification bv David E. Bailey (USACE) on 12/12/2016.
Remarks: The waters subiect to this determination are onlv those authorized to be impacted bv the attached Nationwide
Permit verification.
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 the Natural Resources Conservation Service, prior to starting wark.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in B
and C above).
This correspondence constitutes an approved jurisdictional determination for 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 Atlantic 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 2/10/2017.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
.-� �f�' V Digitally signed by BAILEY.DAVID.E.1379283736
i':/ ` � DN: r-U5, o=U.S. Government, ou=DoD, ou=PKl,
ou=USA, cn=6AILEY.DAVID.E.1379283736
Corps Regulatory Official: oate:zo,e.,z.,z,a:oo:za-osoo�
David E. Bailey
Date of JD: 12/12/2016 Expiration Date of JD: 12/12/2021

NOTIFiCATION OF ADIVIINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
NCDOT File Number: SAW-2016-02228 Date: 12/12/2016
Attached is:
❑ INITIAL PROFFERED PERMIT (Standard Permit or Letter of permissi
n PROFFERED PERMIT (Standard Pei�nit or Letter of permissionl
PERMIT DENIAL
APPROVED JURISDICTIONAL DETERMINATION
PRELIMINARY JURiSDICTIONAL DETERMINATION
See Section below
/�
C
0
0
0
SECTION I- ThE following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be fo�nld at or http://www.usace.ai7l�y.�nil/Missions/CivilW�orl<s/Re�ulator_��gran�andPei7nits.aspx
or the Coms re�ularions 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 pennit docLiment and return it to the district engineer for final
authorization. If you received a Letter of Pennission (LOP), you may accept the LOP and your worlc 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, inchiding its tern�s and conditions, and approved jurisdictioi�al deten�inations associated with the
permit.
OBJECT: If you object to the pennit (Standard or LOP) becatise of certain terms and conditions therein, yoLi may request
that the permit be modified accordingly. You mtiist coinplete Section II of this fonn and rettilrn 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 yoll will
forfeit your right to appeal the permit in the firture. Upon receipt of your letter, the district engineer will evaluate yo«r
objections and may: (a) modify the pennit to address all of your concerns, (b) inodify the per��it to address some of your
objections, ar(c) not modify the permit having detei7nined that the permit should be issued as previously written. After
evaluating your objections, the district engineer wil] 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), yotii may accept the LOP and your work is atitthorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the pern�it in its enrirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional detenninations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or 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 imist 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 pennit under the Corps of Engineers Admiuistrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This forn� must be received by the division
engineer within 60 days of the date of tlzis notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You inay accept or appeal the approved JD or provide new
infonr�ation.
ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Coips 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, yotil 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 t17e 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 further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SECTION II - RE UEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
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 recard.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR 1NFORMATION:
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 Heritage 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 oriuni to artici ate in all site investi ations.
Date: Telephone number:
Si nature of a ellant ar a ent.
For appeals on Initial Proffered 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 Jurisdictional 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-2016-02228 County: Guilford
Permittee: NCDOT (attn: Jerry Parker)
Project Name: NCDOT / Bridge 254 / SR 3121 / Ferguson Road / Guilford County / Division 7
Date Verification Issued: 12/12/2016
Project Manager: David E. Bailev
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 E. 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