20191326 Ver 1_USACE Permit_20191113

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2015-01508 County: Alamance U.S.G.S. Quad: NC -Mebane
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Nova Triad Partners, LLC
Attn: Andy Dreyfus
Address: 206 North Spruce Street, Suite 2B
Winston Salem, NC 27101
Size (acres) —34.5 Nearest Town Mebane
Nearest Waterway UT to Little Haw Creek River Basin Cape Fear
USGS HUC 03030002 Coordinates 36.070801,-79.284134
Location description: The pro*ect is located between South 5th Street and I-40, and between Mebane Airport Road and Terrell
Street, at 1117 South 5th Street in Mebane, Alamance County, North Carolina.
Description of projects area and activity: This verification authorizes the permanent discharge of fill material into 147 linear feet
of stream channel (128 linear feet are a loss of waters of the US from culvert fill, 19 linear feet are associated with a rip rap
dissipater pad) and 0.025 acre of wetlands, and the temporary discharge of fill material into 23 linear feet of stream channel,
necessary for the installation of one road crossing for The Villas on 5th residential development.
Applicable Law(s): ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: NWP 29. Residential Developments
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the enclosed
Conditions, your application signed and dated 9/25/2019, and additional information provided via email on 11/4/2019, and the
enclosed plans C1 1 of 2 and 2 of 2 dated 11/1/2019. 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 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 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 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 E. Bailey at [phone], Ext. 30or David.E.Bailey2Ausace.army.mil.
Corps Regulatory Official:
Date: 2019.11.1312:54:28
-05'00'
Date: 11/13/2019
Expiration Date of Verification: 03/18/2022

SPECIAL CONDITIONS
1. Please note that this project is considered cumulative with all current and future phases of The
Villas on 5th development with respect to compensatory mitigation and Nationwide Permit
thresholds. As such, impacts permitted for this project (SAW-2015-01508) are considered
cumulative with impacts proposed for future phases. Current cumulative impacts to waters of the
US for The Villas on 5th single and complete project include permanent impacts (loss of waters) to
128 linear feet (0.015 acre) of stream channel and 0.025 acre of wetlands. This amounts to a total
loss of waters of the US of 0.04 acre.
Corps Regulatory Official:
Expiration Date of Verification: 03/18/2022
Date: 2019.11.13
12:54:12-05'00'
Date: 11/13/2019
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 hqp:HcolpsmUu.usace.gM.mil/cm_Mex/Pp=136:4:0.
Copy furnished:
Michael Brame, Pilot Environmental, Inc, P.O. Box 128, Kemersville, NC 27285
Sue Homewood, NCDEQ-DWR, 450 W. Hanes Mill Rd, Suite 300, Winston-Salem, NC 27105

VILLAS ON 5TH STREET
PARCEL DATA:
PARCEL ID: 163985 & 164156
TOTAL ACREAGE: 35.11 AC. +/-
DEEDREF: D.B. 3595,PG.904
D.B. 1117, PG. 221
PLAT REF: P.B. 71 PG. 288
EXISTING ZONING: CU R-6 _
EXISTING USE: VACANT
PROPOSED USE: SINGLE FAMILY I
TOTAL NUMBER OF UNITS: 106 III
TOTAL LF OF STREETS: 6,549 LF I
LOT DATA: 1 I II
R-6 LOTS: 106 III
DENSITY: 3.09 UNITS/AC. I
AREA IN LOTS: 20.00 AC+/-
AREA IN R/W: 7.78 AC +/-
PUBLIC RECREATION SPACE REQUIRED:
1/35 AC/ LOT =106 LOTS/35 = 3.03 AC. f REQUIRED
PRIVATE COMMON AREA/OPEN SPACE
PROVIDED: 6.46AC,+/-(19.71%)
LOT DIMENSIONAL REQUIREMENTS:
R-61 MIN. LOTAREA=6,WOSF
MIN. LOT WIDTH AT BUILDING LINE=56 FT. r
TYPICAL. LOT WIDTH AT BUILDING LINE = 58 FT.
MIN. LOT WIDTH AT STREET=35 FT.
HRONT SETBACK = 20 FT.
SIDE SETBACK = 5 FT.
MIN. SEPARATION=I5 FT. j
SIDE STREET SETBACK =10 FT. 1 I
REAR SETBACK = 20 FT. WITH THE EXCEPTION OF
LOTS 95-100, 1 I \ \ 1
REAR SETBACK OF LOTS 95-100 TO BE 15 FT. \I \ 1
\poq
1 ion
GENERAL PLAN NOTES: II I
THIS MAP DOES NOT MEET G.S. 47-30 AND IS NOT FOR RECORDING. 1 I TIMOTHY & MICHELE PAGE
THIS PROPERTY IS SUBJECT TO ANY EASEMENTS, AGREEMENTS, OR RIGHTS -OF -WAY OF RECORD PRIOR PARCELID: 163988
G. 599
TO THE DATE OF THIS MAP AND WHICH WERE NOT VISIBLE AT THE TIME OF INSPECTION. ZONED:
23,P&R-2 \
ZONED: MHP & R-20
THIS MAP WAS PREPARED WITHOUT THE BENEFIT OF A TITLE REPORT AND DOES NOT NECESSARILY 1 1 RESIDENTIAL \
INDICATE ALL ENCUMBRANCES UPON THIS PROPERTY. j i1
BOUNDARY TAKEN FROM SURVEY BY ALLRED LAND SURVEYING, PLLC. 1 IAMES & MARIA OAKLEY 1
PARCELID: 163773
I j
NO SURVEYING OR SUBSURFACE INVESTIGATIONS PERFORMED BY STOLTZFUS ENGINEERING, INC. D.B. ID34, PG. 466
ZONED: R-20 I
THIS PROPERTY IS NOT LOCATED IN A FLOOD PLAIN PER FIRM MAP 37109814001 EFFECTIVE DATE: VACANT
SEPTEMBER 6, 2006 \
PROPOSED PROPERTY TO BE SERVED BY CITY OF MEBANE PUBLIC WATER AND SANITARY SEWER. ALL MARIE RAY \ 11
CONSTRUCTION TO BE TO CITY OF MEBANE AND NCDOT STANDARDS AND SPECIFICATIONS AS RE VOCABLE TRUST 1.1
APPLICABLE. PARCEL ID:163768 LL
D.B. 2NED PG.7NCDO69
13
CONSTRUCTION
DRIVEWAY PERMITS REQUIRED WITH BOND FOR ROAD IMPROVEMENTS, PRIOR TO ZONED: R-20 15 14 O 60
CONSTRUCTION.NCDOT ENCROACHMENTS AGREEMENT REQUIRED FOR UTILITY CONSTRUCTION, PRIOR VACANT
TO CONSTRUCTION. 16
A FLOOD STUDY WILL BE PROVIDED ON ALL DRAINAGE WAYS HAVING A CONTRIBUTING AREA OF 5 \ _
ACRES OR MORE. \
1 � 43 44
ZONINGSPECIALCONDITIONS:p-
SITE: F
1. AT THE TIME OF DEVELOPMENT, THE PROPERTY OWNER IS TO FILE FOR VOLUNTARY ANNEXATION INTO THE CITY 19
OF MEBANE FOR PARCEL NUMBER 164156. 40 C
2. POSTED SPEED LIMIT FOR ALL INTERNAL STREETS TO BE 25 MPH WITH THE EXCEPTION OF CAMERON DRIVE.
3, THE PROPOSED AMENITIES INCLUDE AT A MINIMUM A COMMUNITY CABANA, POOL, GARDEN AREA, GREEN &
OPEN SPACE. THE AMENITIES TO BE INSTALLED BEFORE THE FINAL PLAT IS RECORDED FOR PHASE 3.
4.THE DEVELOPMENT WILL PROVIDE A 6' PRIVACY FENCE ALONG THE REAR OF LOTS 76-81. THE FENCE SHALL BE ' 21
PLACED A MINIMUM OF IS' INSIDE OF THE PROPERTY LINE. THERE SHALL ALSO BE A 6' PRIVACY FENCE ALONG
THE COMMON PROPERTY LINE WITH PARCEL N 164153, THE FENCE SHALL BE PLACED ON THE 10' TYPE "B"
LANDSCAPE BUFFER RATHER THAN ON SAID PROPERTY LINE.
S. BASED ON THE ON -SITE PRIVATE AMENITIES PROVIDED FOR ENJOYMENT OF THE COMMUNITY RESIDENTS, THE 22
APPLICANT REQUESTS THAT THE PUBLIC RECREATION AREA REQUIREMENT BE WAIVED FOR THE DEVELOPMENT 25
AND INCORPORATED WITH THE RE -ZONING CONDITIONS. 24
PHASE 2
CITY OF MEBANE
ALAMANCE COUNTY, NORTH CAROLINA
— �_ __ / — � •FFTHST• � I
6v9ICRIw \
I \ I
I \� KEN & NANEY BERRY
PARCELID: 163992
O.B. 1121,0 I /
STEINBICKER ZONED:OFFCE I
ow � MARIOLA LUCIANO OFFICE I
PARCELID:163993 1 MAGGIE McGEE
\D.B. 2692, PG. 793 PARCEL ID: 164153
�\ ZONED: O& I 1 i i D.B. 1155, PG. 243 \ VACANT
ZONED: R-6 & R-20
RESIDENTIAL
78 \
79�11,
/ $ NUDSWA \ \ � 74
58 pUg\ II11 11
73
EX. COMMON
AREA „A„
p 1 O 1111\1Q1 MEBANE ARCELILIMITED :16415PARTNERSHIP
PARCELID: 164155
55 \ D.B.PG. 405
P.B.60,60, PG.70
ZONED: /
' Z APARTMENTS
10 Ow 1 O 1�11 �11 0 0 54
0 9
A a 53 �u�111 1
- \I\\ I 1 72 8 v MEBANE LIMITED PARTNERSHIP
IICRIw _ , _ s+ t 65 \11 O q / I I PARCEL ID: 164157
\ _
J p 1 409
O 1 O D.B.0, G. 2
52 1 \III Y � g` P.B.. 60, PG. 32
1� 71 m N / I ZONED: R-6
66 1 li\\ 6 / APARTMENTS
m48 49 N\\ 111t. 70 / 0
46 1 COMMON q 8
33
0
PROP.
_
DR COMMON/
NO pUBlIC RIw AREA' /
© © 69 00 99
NupS Icaw 31 32 w o _ ............. �
THE NCDOT.
.. ,
7. LOTS ADJACENT TO CAMERON LANE SHALL HAVE NO DIRECT ACCESS TO CAMERON LANE. SPECIFICALLY LOTS
THREES INVESTMENTS, LT
6]-69 AND LOTS 95-100.
PARCEL ID: 163757
CAMERDN
65 pUB
X.
D.B. 1399, PG. 802
• /
STORMWATEI
8. THE DEVELOPER SHALL PROVIDE A REASONABLE ACCESS POINTTO CAMERON LANE EXTENSION FOR THE ADJOINING
SOUTHERN PROPERTY AS APPROVED BY CITY OF MEBANE STAFF. THE ACCESS SHALL BE PROVIDED ASA 50, PUBLIC
ZONED: R-20
VACANT
'-
+` /
/
POND
RIGHT-OF-WAY THAT IS UNIMPROVED WITH 10' CONSTRUCTION EASEMENTS ON EACH SIDE FOR FUTURE CONSTRUCTION,
AT NO COST TO THE CITY OR THE ADJOINING LAND OWNER FOR THE DEDICATION OF THE LAND.
FUTURE COMMON
' /
ARCHITECTURAL:
AREA "G"
I AREA RESERVED FOR FUTURE
1. HOMES MAY BE SLAB ON GRADE, CRAWL SPACE OR MAY HAVE A BASEMENT FLOOR DEPENDING ON
DEVELOPMENT
TOPOGRAPHIC CONDITIONS OR PROGRAM.
PROP.
EX. COMMON
2, HOMES WILL HAVE FRONT LOADED GARAGES. THE GARAGES MAY BE A ONE OR TWO CAR GARAGE.
COMMON
AREA"C"
AREA "F"
3. HOME EXTERIORS MAY BE A COMBINATION OF MATERIALS SUCH AS BRICK, STONE AND HARDI-PLANK WITH
MASONRY ACCENTS. NO VINYL SIDING.
PROP.
MARY GRAVES HEIRS
PARCEL ID: 163986
4. HOMES WILL PROVIDE 30 YEAR ARCHITECTURAL SHINGLES.
STORM WATER
D.B. 85, PG. 373
ZONED: B-2
5. HOMES WILL PROVIDE PROJECTED EAVES.
BMP
VACANT
THESE DRAWINGS ARE INSTRUMENTS OF SERVICE AND SHALL REMAIN THE PROPERTY OF
THE ENGINEER. THESE DRAWINGS ARE PROTECTED UNDER COPYRIGHT LAWS AND MAY
NOT BE REPRODUCED IN PART OR IN WHOLE WITHOUT THE SPECIFIC WRITTEN CONSENT
OFTHEENGINEER.
©2019 STOLTZFUS ENGINEERING, INC.
JAMES & LEAH PORTER
REVOC TRUST
PARCELID:163756
D.B. 3182, PG. 776
ZONED: M-1
VACANT
MARTHA WADE \\
REV OC L ID 1 TRUST \
PARCEL ID: 63984
D.B .ONED:3056, G. 553
ZONED: 11-
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PARCEL I D: 163986
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ZONED: B-2
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STREAM CROSSING CLASS
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SAND BAGS
PROPOSED DISTURBANCE LIMITS
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TEMPORARY CROSSING -"PUMP AROUND" FOR CULVERT
INSTALLATION
NOTES
1) EROSION STONE TO BE "CUSS I" RIP -RAP UNLESS DESIGNATED DIFFERENTLY ON
CONSTRUCTION PLAN.
2) PUMP AND LINE SIZE TO BE DETERMINED BY THE CONTRACTOR USING THE BASE FLOW
SHOW N ON THE CONSTRUCTION PLANS.
3) MATERIAL SPECIFICATIONS
SANDBAGS: SANDBAGS SHALL CONSIST OF MATERIALS WHICH ARE RESISTANT TO
ULTRAVIOLET RADIATION, TEARING AND PUNCTURE, AND WOVEN TIGHTLY ENOUGH TO
PREVENT LEAKAGE OF FILL MATERIAL. (i.e. SAND, FINE GRAVEL, ETC.)
CONSTRUCTION SEQUENCE FOR CULVERT CROSSING -PUMP AROUND
1) INSTALL PUMP AND LINE TO PUMP FLOW FROM AREA UPSTREAM OF TEMPORARY STREAM
CROSSING TO AREA DOWNSTREAM OF CONSTRUCTION AREA. BEGIN PUMPING AND
CONTINUING PUMPING WHILE WORKING WITHIN THE STREAM.
3)INSTALL DOWNSTREAM TEMPORARY STONE DAM AND FILTER FABRIC TO PRE—
BACKFLOW INTO CONSTRUCTION AREA,
3) INSTALL PROPOSED EARTH BERMS ALONG TOP OF BANK ON EACH SIDE OF THE
CONSTRUCTION AREA.
4) INSTALL DEWATERING BASIN OR SILT BAG AT TOP OF BANK. DEWATER CONSTRCTION
AREA BETWEEN TEMPORARY DAM USING TEMP. SEDIMENT TRAP.
5) UPON CONSTRUCTION COMPLETION, REMOVE TEMPORARY DAMS, FILTER FABRIC.
DEPRESS TEMPORARY DAM BOTTOMS INTO STREAM BED UNTIL TOP OF
RIP RAP IS LEVEL WITH STREAM BOTTOM.
6) UPON STABILIZATION OF CLEARED AREAS, REMOVE TEMPORARY EARTH BERM, SEDIMENT
WALL
(SEED AIL
THIS SHEET)
(SEED ALL
THIS SHEET)
RIP -RAP PAD; TOP OF PAD
TO BE FLUSH WITH INVERT
SO NOT TO OBSTRUCT
STREAM FLOW.
CULVERT
CROSS-SECTION #1
GENERAL NOTES:
1, PROPERTY TO BE SERVED BY CITY OF MEBANE PUBLIC WATER AND SEWER.
2. ALL CONSTRUCTION TO BE TO CITY OF MEBANE STANDARDS AND SPECIFICATIONS.
3. 5' SIDEWALK TO BE LOCATED ON ONE SIDE OF PUBLIC STREETS.
4. CONTRACTOR TO LOCATE ALL EXISTING UTILITIES PRIOR TO CONSTRUCTION.
5. AREA DETERMINED BY D.M.D. METHOD.
6. THIS MAP DOES NOT MEET G.S. 47-30 AND IS NOT FOR THE RECORDATION OR CONVEYANCE OF
PROPERTY.
7. THIS MAP 15 SUBJECT TO ANY EASEMENTS, AGREEMENTS, OR RIGHTS OF WAY RECORDED PRIOR
TO THE DATE OF THIS MAP W HIGH WERE NOT VISIBLE AT THE TIME OF INSPECTION.
8. THIS MAP HAS BEEN PREPARED WITHOUT THE BENEFIT OF A TITLE REPORT AND DOES NOT
NECESSARILY INDICATE ALL ENCUMBRANCES ON THE PROPERTY.
9. DIP SANITARY SEWER AND WATER PIPE TO CLASS 50.
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Action ID Number: SAW-2015-01508
County: Alamance
Permittee: Nova Triad Partners, LLC (Attn: Andy Dreyfus)
Project Name: Villas on 5th / McGee Farm / 1117 South 5th Street / Mebane / Alamance County / residential
Date Verification Issued: 11/13/2019
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 E. Bailey
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
or
[e-mail]
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

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 including wetlands, 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 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: _.
Basis For Determination: See the Approved Jurisdictional Determination form dated 11/13/2019.
Remarks: None.
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 work.
F. Appeals Information (This information applies only to approved jurisdiction determinations as indicated in B and C
above).
This correspondence constitutes an approved jurisdiction 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: Phillip Shannin, Review Officer
60 Forsyth Street SW, Room 10M15
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 1/12/2020 .
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
i��'"" Date: 2019.11.13
Corps Regulatory Official: 12:53:03-05'00'
David E. Bailey
Date of JD: 11/13/2019 Expiration Date of JD: 11/13/2019

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Nova Triad Partners, LLC (Attn: Andy DreyfusDLeyfusj File Number: SAW-2015-01508 Date: 11/13/2019
Attached
is:
See Section below
PROFFERED PERMIT Standard Permit or Letter of ermission
A
RED PERMIT Standard Permit or Letter of ermission
B
DENIAL
LAPPROVED
C
JURISDICTIONAL DETERMINATION
D
INARY JURISDICTIONAL DETERMINATION
E
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.q=.mil/Missions/CivilWorks/Re ugulatoryProjzramandPermits.aspx
or the Corps regulations 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 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 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 district 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 further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.

SECTION II - REQUEST 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 record.
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 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
Mr. Phillip Shannin, Administrative Appeal Review Officer
Attn: David E. Bailey
CESAD-PDO
Raleigh Regulatory Office
U.S. Army Corps of Engineers, South Atlantic Division
U.S Army Corps of Engineers
60 Forsyth Street, Room 10M15
3331 Heritage Trade Drive, Suite 105
Atlanta, Georgia 30303-8801
Wake Forest, North Carolina 27587
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 any site investigation, and will have the opportuni to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: David E. 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. Phillip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]