20090079 Ver 1_401 Application_20090109

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09-0079

John A.K. Tucker, P.E.
Consulting Engineer

Letter of Transmittal

To: NC DENR
Wetlands Unit

Date: 01/16/2009
Project: Stone Property
Attention:

We are sending the following:

Prints ./ Photocopies ./ By Mail By UPSIFEDEX
./ Originals Show Dwgs By Hand By Pickup
Disk Other By Email By Fax

For your:

.f Approval As Requested For Your Action
Your Use For Review and Comment Other (See Remarks)

Quantity Description
2 Pre-construction Notification
2 US Army Corps of Engineers 404 Certification and NWP 14
2 Vicinity Maps
1 Check in the amount $200

Remarks:

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JAN 2 1 2009

DENR - WATERaUAU~8AANCH
WETLANDS AND STORMWAl"E

Copy:

Signed:
John A.K. Tucker, P .E.

P.D. Box 297, Fuquay-Varina, NC 27526 [phone] FAX [phone] [e-mail]

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JAN 2, 1 2.009
OENR - WA1ER~~~ aAANCH
WEflANOS f\ND STOR

09-0079

Office Use Only:
Corps action 10 no.
DWQ project no,
Form Version 1.3 Dec 102008

Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a, Type(s) of approval sought from the x Section 404 Permit D Section 10 Permit
Corps:
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? xVes DNo
1d. Type(s) of approval sought from the OWQ (check all that apply):
x 401 Water Quality Certification - Regular D Non-404 Jurisdictional General Permit
D 401 Water Quality Certification - Express D Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
xVes DNo xVes DNo
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation DVes xNo
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h xVes DNo
below.
1 h. Is the project located within a NC OCM Area of Environmental Concern (AEC)? DVes xNo
2. Project Information
2a. Name of project: Driveway Culvert for Richard Stone
2b. County: Beaufort
2c. Nearest municipality I town: Belhaven
2d. Subdivision name: NA
2e. NCOOT only, T.I.P. or state NA
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: Richard L. Stone
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 806 East Academy Street
3e, City, state, zip: Fuquay Varina, NC 27526
3f. Telephone no.: 919 552 2700
3g. Fax no.:
3h. Email address:

Page 1 of 10
peN Form - Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: o Agent o Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f, Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
Sa. Name: John A.K. Tucker, P.E.
5b. Business name John A.K. Tucker, P.E. - Consulting Engineer
(if applicable):
5c. Street address: PO Box 297
5d, City, state, zip: Fuquay Varina, NC 27526
5e. Telephone no.: 9195670483
Sf. Fax no.: 9195673611
5g. Email address: [e-mail]

Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1 a, Property identification no. (tax PIN or parceIID): 6691-81-4809
1 b. Site coordinates (in decimal degrees): 35.4085 N -76.6556W
1 c, Property size: ,5 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc,) to Pamlico River
proposed project:
2b. Water Quality Classification of nearest receiving water: SA;HQW,NSW
2c. River basin: Tar Pamlico
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Existing Residential Lot in a residential community
3b. List the total estimated acreage of all existing wetlands on the property:
.15 ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
Install approx 15 If of driveway culvert to access the property
4. Jurisdictional Determinations
4a, Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / x Yes DNo D Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type x Preliminary DFinal
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: USACE
Name (if known): Ms. Wheeler Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Fall 2006
5. Project History
5a. Have permits or certifications been requested or obtained for DYes xNo D Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? DYes xNo
6b, If yes, explain.

Page 3 of 10
peN Form - Version 1.3 December 10, 2008 Version

c. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
x Wetlands D Streams - tributaries D Buffers
D Open Waters D Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d, 2e, 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temoorarv (T)
W1 x pDT Fill DYes x Corps .0035
x No xDWQ
w2DpDT DYes D Corps
DNo DDWQ
W3 D pDT DYes D Corps
DNo DDWQ
W4 D pDT DYes D Corps
DNa DDWQ
W5 D pDT DYes D Corps
DNo DDWQ
W6 DpDT DYes D Corps
DNo DDWQ
2g. Total wetland impacts .0035
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404,10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 D pDT DPER o Corps
DINT DDWQ
S2 D pDT DPER D Corps
DINT DDWQ
S3 D pDT DPER D Corps
DINT DDWQ
S4DpDT DPER D Corps
DINT DDWQ
S5 D pDT DPER D Corps
DINT DDWQ
S6 DpDT DPER D Corps
DINT DDWQ
3h. Total stream and tributary impacts
3i. Comments:

Page 4 of 10
peN Form - Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
T emporarv (T)
01 D pDT
02 D PDT
03 D pDT
04 DpDT
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond 10 Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required? DYes DNo If yes, permit 10 no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If anv impacts require mitigation, then you MUST fill out Section 0 of this form.
6a. D Neuse D Tar-Pamlico D Other:
Project is in which protected basin? D Catawba D Randleman
6b. 6c. 6d. 6e. 6f, 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
T emporarv (T) impact reauired?
B1 D pDT DYes
DNo
B2 D pDT DYes
DNo
B3 D pDT DYes
DNo
6h. Total buffer impacts
6i. Comments:

Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Width of Driveway has been minimized to avoid impacts
1 b, Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Sedimentation and erosion control devices will be used to prevent impacts
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for DYes xNo
impacts to Waters of the U.S, or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): D DWQ D Corps
D Mitigation bank
2c. If yes, which mitigation option will be used for this D Payment to in-lieu fee program
project?
D Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type I Quantity
3c, Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. DYes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: D warm Dcool Dcold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f, Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
Sa. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.

Page 6 of 10
peN Form - Version 1,3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires DYes DNo
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:

Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified DYes xNo
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why. DYes ONo
Comments:
2. Stormwater Manaaement Plan
2a. What is the overall percent imperviousness of this project? 6%
2b. Does this project require a Stormwater Management Plan? DYes xNo
2c, If this project DOES NOT require a Stormwater Management Plan, explain why: Less 0.1 ac disturbed
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
o Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? o DWQ Stormwater Program
x DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? Beaufort County
x Phase II
3b. Which of the following locally-implemented stormwater management programs ONSW
o USMP
apply (check all that apply): o Water Supply Watershed
o Other:
3c. Has the approved Stormwater Management Plan with proof of approval been DYes x No
attached?
4. DWQ Stormwater Program Review
x Coastal counties
4a. Which of the following state-implemented stormwater management programs apply o HQW
o ORW
(check all that apply): o Session Law 2006-246
o Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? x Yes No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? x Yes ONo
5b, Have all of the 401 Unit submittal requirements been met? x Yes ONo

Page 8 of 10
PCN Form - Version 1.3 December 10,2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the DYes xNo
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an DYes DNo
environmental document pursuant to the requirements of the National or State
(North Carolina) Environmental Policy Act (NEPAlSEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval DYes DNo
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, DYes xNo
or Riparian Buffer Rules (15A NCAC 2B ,0200)?
2b. Is this an after-the-fact permit application? DYes xNo
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in DYes xNo
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. 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.
On site septic permit

Page 9 of 10
peN Form - Version 1.3 December 10, 2008 Version

, .
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or DVes xNo
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act Ves xNo
impacts?
If yes, indicate the USFWS Field Office you have contacted. D Raleigh
5c. D Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6. Essential Fish Habitat (Corps Requirement)
6a, Will this project occur in or near an area designated as essential fish habitat? DVes x No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation DVes xNo
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b, What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 1 DO-year floodplain? xVes DNo
8b. If yes, explain how project meets FEMA requirements: Above base flood elevation
8c, What source(s) did you use to make the floodplain determination? FEMA Maps
dltj/~ 01/05/2009
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)

Page 10 of 10

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT

Action ID. SA W-2009-00024

County: Beaufort

USGS Quad: NC-Ransomville

Property Owner / Authorized Agent: Richard Stone
Address: 806 East Academv Street
FUQuav Varina. North Carolina
27526

GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION

~~@~nw~~

JAN 2 1 2009

DENR.WA~~~~~8RANCH
Telephone No.: 919-552-2700 WETLANOSANOST
Size and location of property (water body, road name/number, tOWll, etc.): Property is 0.5 acres ad iacent to the
Pamlleo River on Chambers Point Rnad in the Pamlieo Beach Communi in the town of Belbaven Beanfnrt
County. North Carolina.

Applicable Law: 0 Section 404 (Clean Water Act, 33 USC 1344)
o Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Pennit Number: _
Nationwide Pennit Number: 14

Your work is authorized by the above referenced permit provided it is accomplished in strict ac<:ordance with the attached
conditions and your suhmitted plans. Any violation of the attached conditions or deviation from your submitted plans may subject the
pennittee to a stop work order, a restoration order and/or appropriate legal action.
This verification will remain valid untit the expiration date identified below unless the nationwide authorization is modified,
suspended or revnked. If, prior to the expiration date identified below, the nationwide permit authorization is reissOed and/or
modified, this verification will remain valid until the expiratinn 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 uo 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 permi~ will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification nr revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities suhject to Section 404 (as indicated above) may also require an individual Section 40 I Water Quality Certification. Yon
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 in Washington, 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/pennits.
If there are any questions regarding this verification, any of the conditions of the Penn it, or the Corps of Engineers regulatory
program, please contact Emily Jernigan [phone] ex 28.

Corps Regulatory Official M ~ r~ '
Expiration Date of Verification: 01/1J201l

Date: 01/1212009

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 Satismction Survey located at our website at htlt>://re..latmv.usacesurvev.com/ to complete the survey
online.

Page 1 of2

Determination of Jurisdiction:

[gJ Based on preliminary infonnation, there appear '" be waters of the US including wetlanw. 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).

o 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.

o There are wale" of the US andlor wetlanw. within the above described project area subject to the penn it requirements of Section
404 of the Clean Water Act (CW A)(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.

o The jurisdictional areas within tbe above described project area have been identified und" a previous action. Please reference
jurisdictional determination issued _' Action ID _

Basis of Jurisdictional Determination: This site exhibits wetland criteria as described in the 1987 Corps Wetland Delineation
Manual and is adiacent to the Pamli~ River.

Appeals Information (This information applies only to approved jurisdictional determinations.)

Attached to this verification is an approved jurisdictional determination. If you are not in agreement with that approved jurisdictional
determination, you can make an administrative appeal under 33 CFR 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
fonn to the following address:

District Engineer, Wilmington Regulatory Division
Attn:Emily Jernigan, Project Manager,
Washington Regulatory Field Office
Post Office Box 1000
Washington, North Carolina 27889

In onl" for an RF A '" be accepted by the Corps, the Corps must detennine 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 District Office within 60 days of the date of the NAP. Should you
decide to submit an RF A form, it must be received at the above address by 03/12/2009.

"It is not necessary tn snbmit an RF A fonn to the District Office if yon do not object to the detennination in this correspondence."
Corps Regulatory Offidal: [,tnA' ~ 1), r
Date 01/12/2009 E(, Piratio~e 01/;2/2014

SURVEY PLATS, FIELD SKETCH, WETIAND DELlNEA nON FORMS, PROJECT PLANS, ETC., MUST BE
A TT ACHED TO THE FILE COpy OF THIS FORM, IF REQUIRED OR A V AILABLE.

Copy Furnished:
Mr. John Tucker

Page 2 of2

Action ID Number:SA W-2009-00024

County:Beaufort

Permittee: Mr. Richard L. Stone

Date Verification Issued: 01/12/2009

Project Manager: Emilv Jerni2'an

Upon completion of the activity authorized by tbis permit and any mitigation required by tbe permit,
sign this certification and return it to the following address:

US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
WASHINGTON REGULATORY 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
Eugineers representative. If you fail to comply witb tbis 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

DA TE: 01/12/2009

MEMORANDUM FOR RECORD

SUBJECT: Consideration of Compensatory Mitigation and Potential Impacts to Endangered Species, Cultural Resources
and Essential Fish Habitat.

1. Action ID. SA W-2009-00024

2. Project Name and Location: Richard L. Stone

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? NO

Explain: A

culvert.

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: ~ ~\ .9/'---1 ~_______

. .

Attached is:E
INITIAL PROFFERED PERMIT (Standard Permit or Letter of
permission)
PROFFERED PERMIT (Standard Permit or Letter of ermission)
PERMIT DENIAL
APPROVED JURISDICTIONAL DETERMINATION
PRELIMINARY JURISDICTIONAL DETERMINATION

File Number: SA W-2009-
00024

See Section below
A

B
C
D
E

· ACCEPT: If you received a Standard Pennit, you may sign the penn it document and return it to the district engineer for final
autho,iza'ion. If you received a Lette, of Pennission (LOP), you may accept the LOP and your wo,k is authorized. Y 00' signature
on the Stand",d Pennit 0' acceptance of the LOP means that yoo accept the pennit in its entirety, and waive all ,ights to appeal the
penn it, including its tenns and conditions, and approved jurisdictional detenninations associated with the permit.

· OBJECT: If you ohject to the pennit (Standard 0' LOP) because of certain tenns and conditions therein, you may request that the
pennit be modified accordingly. You must complete Section II of this fonn and return the fonn to the district engineer. Your
ohjections must be received by the district engineee within 60 days of the date of this notice, 0' you will folfeit you, eight to appeal
the pennit in tbc future. Upon ,eceipt of you, lettee, the dist,ict engineee will evalnate ynur objections and may: (a) modifY the
pennit to address all of your concerns, (b) modify the pennit to address some of your objections, or (c) not modify the penn it
baving detennined that the penn it should be issued as preViOUSly written. Aftee evaluating you, objection~ the district engin..,
will send you a proffered penn it for your reconsideration, as indicated in Section B below.

You may accept or object to the permit.

B: PROFFERED PERMIT: You may accept or appeal the permit

· ACCEPT: If you received a Standard Penn it, you may sign the pennit document and return it to the district engineer for final
authotization. If you received a Lettee of Penn i" ion (LOP), you may accept the LOP and your wurk is authoeized. You, signature
on the Standard Pennit or acceptance of the LOP means that you accept the penn it in its entirety, and waive all rights to appeal the
pennit, including its tenns and conditions, and approved jurisdictional detenninations associated with the pennit.

· APPEAL: If you choo," to decline the proffered pennit (Stand"'d 0' LOP) becau," of certain teems and conditions therein, you
may appeal the declined pennit under the Corps of Engineers Administrative Appeal Process by completing Section II of this fonn
and sending the fonn to the division engineer. This fonn must be received by the division engineer within 60 days of the date of
this notice.

C: PERMrr D ENIAL: You may appeal the denial of a pennit undee the Co",s of Engineees Administrative Appeal Process by
compi"in g Section 1I of this fonn and sending the fonn to tbe division enginee'. This fonn must be reccived by the division engineec
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 Co",s to accept an appeuved 10. Failu,e to notifY the Co",s 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 wi'b 'he approved JD, you may appeal the approved JD unde' the Co",s of Engioeers Admioistrative
Appeal Pmce" by completing Sectioo 1I of this fonn and sending the fonn to the disttict engineer. This ronn must be ""'eived by
the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JURiSDICTIONAL DETERMINA TION: You do not need to respond to the Corps
regarding the preliminary JD. lbe 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.

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 fonn 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 detennined 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 alread in the administrative record.
POIN1iOFCON$~ 1":
If you have questions regarding this decision If you only have questions regardiug the appeal process you
and/or the appeal process you may contact: may also contact:
Emily Jernigan Mr. Mike Bell, Administrative Appeal Review Officer
U.S. Army Corps of Engineers 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
[phone] ex 24 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 si Ie investigation, and will have the opportunity to Participate in al I site
investigations.

Date:

Telephone number:

Signature of appellant or agent.

For appeals on Initial Proffered Permits and approved Jnrisdictional Determinations send this form to:

District Engineer, Wilmington Regulatory Division, Attn:Emily Jernigan, Project Manager, Washington
Regulatory Field Office, Post Office Box 1000, Washington, North Carolina 27889

For Permit denials and Proffered Permits send this form to:

Division Engineer, Commander, U.S. Army Engineer Division, Sonth Atlantic, Attn: Mr. Mike Bell,
Administrative Appeal Offieer, CESAD-ET-CO_R, 60 Forsyth Street, Room 9MIS, Atlanta, Georgia
30303-8801

John A.K lucker, fJ .t..
Consulting Engineer
P,Q. Box 297 Fuquay-Varina, North Carolina 27526

~~@~n\VJ~~

JAN 2 1 2009

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