20191746 Ver 1_PCN Form Submission_20191219

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes IT No
Change only if needed.
BIMS # Assigned
20191746
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office *
Wilmington Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Shingletree
1a. Who is the Primary Contact?*
Dana A. Lutheran
1b. Primary Contact Email:*
[e-mail]
Date Submitted
12/19/2019
Nearest Body of Water
Shingletree Swamp
Basin
Lumber
Water Classification
c;sw
Site Coordinates
Latitude: Longitude:
33.92533-78.58315
A. Processing Information
County (or Counties) where the project is located:
Brunswick
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
* Nationwide Permit (NWP)
* Regional General Permit (RGP)
7 Standard (IP)
Version#*
1
What amout is owed?*
IT $240.00
r $570.00
Select Project Reviewer*
Robb Mairs:eads\rlmairs2
1c. Primary Contact Phone:*
[phone]
V

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
29 - Residential Developments
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - E)press
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner W Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Henry Bennett
2b. Deed book and page no.:
2807/698
2c. Responsible party:
2d.Address
Street Address
6205 Old Shallotte Rd. NW
Address Line 2
City
Ocean Isle Beach
Rstal / Zip Code
28469
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
State / Ravines, / Rion
NC
Country
US
2f. Fax Number:
r Yes r No
r Yes r No
3. Applicant Information (if different from owner)

3a. Name:
Sidney Dudley
3b. Business Name:
Pulte Home Company, LLC
3c.Address
Street Address
4000 Faber Place Drive
Address tine 2
Ste. 110
City
North Charleston
Postal / Zip Cork
29405
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Dana A. Lutheran
4b. Business Name:
Southern Environmental Group, Inc. (SEGi)
4c.Address
Street Address
5315 South College Road
Address tine 2
Suite E
city
Wilmington
Postal / Zip Code
28412
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Auth signed.pdf
State / Rovince / Ibgion
SC
Country
us
3e. Fax Number:
State / Rovince / Region
NC
Country
us
4e. Fax Number:
232.61 KB
C. Project Information and Prior Project History u
1. Project Information
1b. Subdivision name:
(if appropriate)
NA
1c. Nearest municipality/town:
Shallotte
2. P2. jeor�ct Identification
2a. Property Identification Number:
22500038, 22500040,2250003901,
2b. Property size:
2250003906 and 2250003907
-94 AC
2c. Project Address
Street Address
Shingletree Road NW
Address Dne 2
QY
State / Rovince / Region
Calabash
Postal / Zip Code
Country
3. Surface Waters

3a. Name of the nearest body of water to proposed project:*
Shingletree Swamp
3b. Water Resources Classification of nearest receiving water:*
C'sw
3c. What river basin(s) is your project located in?*
Lumber
3d. Please provide the 12-digit HUC in which the project is located.
030402060701
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The majority of the site (i.e. Parcels 22500038 and 22500040) was logged in 2011, thus only larger hardwoods and pines remain, in those areas.Since that time, those areas have been
regularly mowed, which has prevented smaller trees and shrubs from propagating. The smaller tracts (2250003901, 3906 and 3907) contain natural, woody vegetation. There is a
uniform, 4' wide ditch that bisects the property (see attached PJD). Land use in the vicinity is mostly undeveloped land. There is a Brunsvdck County municipal building to the south of
the tract and, to the east, is part of Crow Creek Golf Course.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Henry Bennett UDAR Map 070919.pdf 350.08KB
Henry Bennett Topo Map 070919.pdf 869.85KB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
Henry Bennett Soils Map 070919.pdf 276.44KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.11 AC
4g. List the total estimated linear feet of all existing streams on the property:
NA
4h. Explain the purpose of the proposed project:*
The purpose of this project is construct a 295 lot, high density, single-family, residential subdivision, which consists of roads, infrastructure, such as sewer, water and electric,
stormwater management best management practices (BMPs) and attendant features, such as an amenities center.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The ditch (RPW) will either be filled, with clean earthen dirt, or excavated, depending on the location. Large machinery, such as excavators, dump trucks and front end loaders, will be
used to complete the work.
4j. Please upload project drawings for the proposed project.
Shingletree Wetland Impact Map 12-19-19.pdf 426.47KB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved t^ Not Verified r Unknown f N/A
Corps AID Number:
SAW-2019-01355
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): David M. Scibetta
Agency/Consultant Company: SEGi
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made bythe Corps or DWR
See attached JD
5d1. Jurisdictional determination upload
SAW-2019-01355 AJD.pdf
6. Future Project Plans
896.63KB
6a. Is this a phased project?*

r Yes
r No
Are anyother NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed projector related activity?
This is a single and complete project.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands r Streams -tributaries f Buffers
W Open Waters r Pond Construction
4.Open Water Impacts
$a. Sited# 4a1. Impact Reason 4b. Impact type 4c. Name of wat,rbody 4d. Activity type 4e. Wate rbody type 4f. Impact area
_111 Subdivision P none Fill Ditch 0.11
4g. Total temporary open water Impacts:
0.00
4g. Total open water impacts:
0.11
4h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
4g. Total permanent open water impacts:
0.11
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Due to the way the RPW bisects the property, avoidance is not possible. Additionally, since the feature is only a conveyance of water, avoidance and
minimization efforts were not a)plored.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The Applicant will ensure that SREC measures are installed, which should eliminate impacts outside the proposed fill limits.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Impacts to RPWs do not require mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
The site is not within one of North Carolina's Riparian Buffer River Basins.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
Comments:
This is a high density stormvoter project. Thus, stormwater will be collected and treated, prior to discharging off -site. A NC DEMLR Stormwater Permit and Brunswick County Stormwater
Permit are being sought concurrently with this request for authorization to impact the RPW.
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No

2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
r Yes f• No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
This project is not part of a phased development and does not require future impacts to be viable. This project will not provide access to currently land
locked property. Additionally, the implementation of strict sediment and erosion control BMPs, during construction, and stormwater BMPs, which are
intended to treat runoff, from built upon areas, before discharging into downstream receiving water, should ensure no unauthorized impacts, to
downstream receiving waters, takes place.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated
at a treatment plant, list the capacity available at that plant.
Sewer and water will be provided by municipal services.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
SEGi utilized their knowledge of the area and relied upon the fact that the vegetation on the site, has been managed. Thus, it is unlikely that the
proposed project would adversely affect either ES or DCH.
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
This site is not adjacent or abutting a waterbody that would support EFH.
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 status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
The site is not located with a designated National Historic Area and there are no known historical or potentially significant historical structures within
the project limits (see attached NC SHPO GIS Map).
7c. Historic or Prehistoric Information Upload

8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year flood plain?*
r^ Yes r No
8c. What source(s) did you use to make the floodplain determination?*
Brunswick County Flood Map (see attached)
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Flood and SHPO Exhibits.pdf
Signature
rJ By checking the box and signing below, I certify that:
121.68KB
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Dana A. Lutheran
Signature
9a to'f. LOr. gA
Date
12/19/2019
v
U

5F—Gj
AUTHORIZATION FORM
TR-1 53.85 ACRES PLAT 32/538, TR-3 28.65 ACRES PLAT
PROPERTY LEGAL DESCRIPTION: 32/538 57.11 AC US-17 T-B 1.42 AC PLAT X/338 OFF SR 1320
LOT NO. PLAN NO. PARCEL I.D. 22500038, 22500039, 22500040, 2250003907
STREET .ADDRESS: Shin letree Road NW
Property Owner (please print): Henry and Amelia Bennett
The undersigned, registered property owner of the above noted property, does hereby authorize
Southern Environmental Group, Inc. (SEGi) to act on their behalf in matters regarding areas of
environmental concern.
Property Owner's Address (if different than property above):
6205 Old Shallotte Rd. NW
Ocean Isle Beach, NC 28469
Telephone:
i ..c -::I
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge. M
Proper Owner Authorized Signature SEGi Authorized Signature
f� ary 3en Y\ 1+
Print Name
7-1
Date
David Scibetta
Print Name
7/9/2019
Date

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Project Area - -136.7 ac.
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1 inch = 600 feet Feet 140 ac. Henry Bennett Property
Map Source: USGS TopoView Service, Calabash, Brunswick Co., N.C.
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DEVELOPMENT RESOURCE GROUP, LLC
1101 JOHNSON AVENUE, SUITE 300A
MYRTLE BEACH, SC 29577
843-839-3350 1 DRGPLLC.COM
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JOB NO: 19.138
APPROXIMATE RPW LOCATION SCALE: 1" =120'
DRAWN BY: JCP
1179.21 LF
GRAPHIC SCALE DATE: 12/6/2019
120 0 60 120 240 480
( IN FEET)
1 inch = 120ft.
EXHIBIT

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2019-01355 County: Brunswick County U.S.G.S. Quad: Calabash
NOTIFICATION OF JURISDICTIONAL DETERNIINATION
Property Owner/Applicant: Henry Bennett
Address: 6205 Old Shallotte Rd NW
Ocean Isle Beach, NC, 28469
Telephone Number: [phone]
E-mail Address: amy bennettl(&hotmail.com
Size (acres) 140 acres
Nearest Waterway Shin0etree Swamp
USGS HUC 03040206
Nearest Town Calabash, NC
River Basin Lower Pee Dee
Coordinates Latitude: 33.928291
Longitude:-78.587446
Location description: This 140 acre site consists of 4 undeveloped and lightly forested parcels in Calabash, Brunswick
County, NC. (Parcel ][Ds: 22500038, 22500039, 22500040, 2250003907)
Indicate Which of the Following Apply:
A. Preliminary Determination
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). The
waters, including wetlands, have been delineated, and the delineation has been verified by the Corps to be sufficiently accurate
and reliable. Therefore this preliminary jurisdiction determination maybe used in the permit evaluation process, including
determining compensatory mitigation. For purposes of computation of impacts, compensatory mitigation requirements, and other
resource protection measures, a permit decision made on the basis of a preliminary JD will treat all waters and wetlands that
would be affected in any way by the permitted activity on the site as if they are jurisdictional waters of the U.S. 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.
There are wetlands on the above described property, 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). However, since the
waters, including wetlands, have not been properly delineated, this preliminary jurisdiction determination may not be used in the
permit evaluation process. Without a verified wetland delineation, this preliminary determination is merely an effective
presumption of CWA/RHA jurisdiction overall of the waters, including wetlands, at the project area, which is not sufficiently
accurate and reliable to support an enforceable permit decision. We recommend that you have the waters of the U.S. on your
property delineated. As the Corps may not be able to accomplish this wetland delineation in a timely manner, you may wish to
obtain a consultant to conduct a delineation that can be verified by the Corps.
B. Approved Determination
_ There are Navigable Waters of the United States within the above described property 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 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.
X There are Waters within the above described 140 acre 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.
Page 1 of 2

SAW-2019-01355
_ We recommend you have the waters of the U.S. on your property delineated. As the Corps may not be able to accomplish
this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by
the Corps.
X The Waters on your 140 acre project have been delineated and the delineation has been verified by the Corps. We strongly
suggest you have this delineation surveyed. Upon completion, this survey should be reviewed and verified by the Corps. Once
verified, this survey will provide an accurate depiction of all areas subject to CWA jurisdiction on your property which, provided
there is no change in the law or our published regulations, may be relied upon for a period not to exceed five years.
_ The waters of the U.S., including wetlands, have been delineated and surveyed and are accurately depicted on the plat signed
by the Corps Regulatory Official identified below on . Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
_ There are no waters of the U.S., to include wetlands, present on the above described project area which are subject to the permit
requirements of Section 404 of the Clean Water Act (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.
X The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (,CAMA).
You should contact the Division of Coastal Management in Wilmington, NC [phone] to determine their requirements.
Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material, construction or
placement of structures, or work within navigable waters of the United States without a Department of the Army permit may
constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If you have any questions
regarding this determination and/or the Corps regulatory program, please contact Gary Beecher at [phone] or
Garv.H.BeecherC&u sace. army.mil.
C. Basis For Determination: This site exhibits RPW's that have Ordinary High Water marks and are hydraulically
connected to Shingle Tree Creek,
D. Remarks: There are no Jurisdictional 404 Wetlands on this 140 acre site.
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 for Approved Jurisdiction Determinations (as indicated in Section B. above)
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: Philip Shannin, Appeal Review Officer
60 Forsyth Street SW, Room 10M15
Atlanta, Georgia 30303-8801
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 November 23, 2019.
It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence.

SAW-2019-01355
Corps Regulatory Official:
Date: September 25, 2019 Expiration Date: September 25, 2024
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 our Customer Satisfaction Survey, located online at
httl2:Hcorpsmapu.usace.army.mil/cm aj2ex/f?p=136:4:0.
Copy Furnished via e-mail to:
David Scibetta
SEGI
5315 South ColleLye Road, Suite E
Wilmington, NC 28412
[phone]
dschibeetaAse2ims

SAW-2019-01355
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant:
File Number:
Date:
Henry Bennett
SAW-2019-01355
September 25, 2019
Attached
is:
See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission)
A
PROFFERED PERMIT (Standard Permit or Letter of permission)
B
PERMIT DENIAL
C
APPROVED JURISDICTIONAL DETERMINATION
D
PRELIMINARY JURISDICTIONAL DETERMINATION
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at http://www.usace.army.miUMissions/CivilWorks/RegulatoryProgramandPermits.aspx or
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 division engineer. This form must be received by
the division engineer within 60 days of the date of this notice.

SAW-2019-01355
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. Philip Shannin, Administrative Appeal Review Officer
Attn: Gary Beecher
CESAD-PDO
U.S. Army Corps of Engineers, South Atlantic Division
60 Forsyth Street, Room 10M15
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 any site investigation, and will have the opportunity to participate in all site investigations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: Gary Beecher, 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. Philip Shannin,
Administrative Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

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