20030237 Ver 1_COMPLETE FILE_20030303

4O?Q? WATFR?
D
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan Klimek, P.E., Director Division of Water Quality
March 13, 2003
DWQ # 03-0237
Surry County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
City of Mount Airy
Post Office Box 70
Mount Airy, NC 27030
To Whom It May Concern:
On March 3, 2003 the Division of Water Quality (DWQ) was notified by receipt of your application
regarding your plan to fill waters for the purpose of a river crossing in Surry County. Approval from DWQ is
required to disturb these areas. Please provide 7 copies of the following information and refer to the DWQ #
listed above in your reply. Please show these on maps of suitable scale (for instance V = 100 feet) so we can
begin to determine your projects' compliance with 15A NCAC 2H.0500.
Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring
payment of a fee for all 401 applications, as indicated on page two of the PCN application form. The
fee for applications is $200 for projects impacting less than an acre of wetlands and less then 150
linear feet of streams. For projects impacting one or more acres of wetlands or 150 or more feet of
streams, the fee is $475. In order to process your request, you must send a check in the appropriate
amount made payable to N.C. Division of Water Quality. However, if this is just a courtesy copy
please let us know.
2. Please provide (7) copies of the enclosed new PCN application and other relative information.
Please telephone John Hennessy at 919-733-5694 if you have any questions or would require copies of
our rules or procedural materials. This project will remain on hold as incomplete in accordance with 15A NCAC
2H .0505(c). The processing time for this application will begin when this information is received. If we do not
hear from you by writing within three (3) weeks we will assume you no longer want to pursue the project and
will consider it withdrawn.
ly,
,h R. Dorney
1 Water Quality C rtifcation Program
JRD/bs
cc: Winston-Salem DWQ Regional Office
Raleigh Corps of Engineers
Central Files
File Copy

N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
(919) 733-17AR (nhnnA). 919-733-6893 (fax). (htto://h2o.enr.state.nc.us/ncwetlands

DEM 1D* 03023 7 ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
ElLgNDI
WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING w
DIVISION OF ENVIRONMENTAL MANAGE MEMt' GROup
NC DEPARTMENT OF ENVIR0NMl5h%#ir TH
US ARMY CORPS OF ENGINEERS AND NATURAL RESOURCVAIrp.
2003 - TN REGULATORY FIELD OFFICE 4401 Reedy Creek Road 6508 Falls of The Nauss Road Raleigh, North Carolina 27607
Raleigh, NC 27615-8846 ATTN. MR. JOHN DORNEY QUALln'SECTI
Telephone [phone] V?
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT'.
PLEASE PRINT:
I - Owners Name: C ITY Or MOUNT Al KY-
2. Owners Address POST OI--FICE WX 10 Mou"r A RY ?_ 2"I0p
3. Owners Phone Number (Home): 33& -78& - 3501
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
SAME AS 6-8301--
5. Location of work (MUST ATTACH MAP) County: SuRtzr
Nearest Town or City_ MOL(Or Al Rr
Specific Location (include road numbers, landmarks, etc.): 59 11(00 CITY VIe.W DR%VE
b. Name of Closest Stream/River: AKAIZAT. R1VEIZ
T River Bas1n ; YADIeI s.l PeF-Tx'
8. Is this project located Ina watershed classified as Trout, SA, HQW, CIRW, WS 1, or WS II? YES [ ]NO [?j
9. Have any Sectlon 404 permits been previously requested for use on this property? YES [ a NO [V/
If yes, explain
10. Estimated total number of acres of waters of die U.S., including wetlands, located on project site: -_Q
11. Number of acres of waters of the U.S., Including wetlands, impacted by the proposed project:
Filled:- _
Drained:
Flooded:
GROUP Excavated: 15 ACRE
WEf LANDS ?? Total Impacted - 5 ,4eaL*F-5
MAR 0 3 2003
WATER QUALITY SE011ON
12. Description of proposed work (Attach PLANS-8 112" X I 1 " drawings only): THis Pr=1Z - I is Fog
A V%Vele CEClSS4.4 0ML-Y CPKjf OF E0 iNEc2S SrAFP HAS l-?T?12MtrtED tJQ?
Jnl? n?i??s o1.1 THF_ P1ECi srrE
13. Purpose of proposed work: r.XTe "D Smwalz. SC-4RvtG!? TO P2L,),JFc r SITE.
14. State reasons why the applicant believes that this activity must be carried out In wetlands. Also, note measures taken to
minimize wetland Impacts. THE. p"Lt r' W,ay TV S--KV G THE P2c2JCCT- VV T-t-I SE.Lv&lz-
SEL9VrlF= 1s Ty C4ZOSS T! lr- r2tvE? _ _
1 S. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES[ ] NO[,/]
RESPONSES FROM THE USFWS ANA/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties In the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 - Additional Information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B - If available, representative photograph of wetlands to be Impacted by project
C. If delineation was performed by a consultant, include all data sheets relevant to the placemenr of the
delineation line.
D. If a storm water management plan is required for this project, attach copy.
E. What Is land use of surrounding property? ?ESt1JeuTI?J. /?? ST-I D>`lA>~?
F. If applicable, what Is proposed method of sewage disposal? _.M LAW ICI S S
Owner's Signature ? Dam
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200320281 County: Surry
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property
Owner City of Mount Airy
Attn: Ms. Tammy Johnson
Address Post Office Box 70
Mount Airy, NC 27030
Telephone Number 336-786-3526
Authorized
Agent NA
Address
Telephone Number
Size and Location of Property (waterbody, Highway name/number, town, etc.): The property is
located southeast of City view Drive, approximately. 1000 feet east of East Pine Street, in Mount Airy,
Surry County, North Carolina.
Basis for Determination: The site contains no wetlands or stream channels except the Ararat River,
which is located along the properties western boundary. The Ararat River is in the Yadkin River Basin.
Indicate Which of the Following Apply:
There are waters of the U.S., to include wetlands, on the above described property which we strongly suggest
should be delineated and surveyed. The surveyed wetland lines must be verified by our staff before the Corps will
make a final jurisdictional determination on your property.
Because of the size of your property and our present workload, our identification and delineation of your wetlands
cannot be accomplished in a timely manner. You may wish to obtain a consultant to obtain a more timely
delineation of the wetlands. Once the consultant has flagged a wetland line on the property, Corps staff will
review it, and, if it is accurate, we strongly recommend that you have the line surveyed for final approval by the
Corps. The Corps will not make a final jurisdictional determination on your property without an approved survey.
The waters of the U.S., to include wetlands, on your lot have been delineated, and the limits of the Corps
jurisdiction have been explained to you. 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 There are no waters of the U.S., to include wetlands, present on the above described property, except the Ararat
River adjacent to the western edge of the site, 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.
Placement of dredged or fill material in wetlands on this property without a Department of the
Army Permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A
permit is not required for work on the property restricted entirely to existing high ground. If you
have any questions regarding the Corps of Engineers regulatory program, please contact
- Todd Tugwell at telephone number (919) 876 - 8441 extension 26
Project Manager Signature \I az
Date December 20, 2002
tion I.A-te December 20, 2007
SURVEY PLAT OR FIELD SKETCH OF THE DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORM MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
A licant: City of Mount Airy File Number: 200320281 Date: 12/20/2002
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
X 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://usace.army.mil/inet/functions/cw/cecwo/reg 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. --ce.
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.
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DEM ID:
ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOIN'T' FORM. FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
?- z
o
W WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
C-D o DIVISION OF ENVIRONMENTAL MANAGEMENT
C., NC DEPARTMENT OF ENVIRONMENT, HEALTH
c+? US ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES
C 3 REGULATORY FIELD OFFICE 4401 Reedy Creek Road
6508 Falls of The Neuse Road Raleigh, North Carolina 27607
?
Raleigh, NC 27615-6646 ATTIC., MR. JOHN DORNEY
w
Telephone [phone]
-
r ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD 13E SENT TO THE CORPS OF ENOINEE,RS.
!WC
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMEN I.
PLEASE PRINT:
I- Owners Name: C I TY 01= MOUNT W 9r
2. Owners Address POST OF-FICI= L3DX -to , MoLt"r N RY IIC Z-70 C -
3. Owners Phone Number (Home): 33& ?8& - 3501
4. IF Applicable: Agent's name or responsible corporate offlclal, address, phone number:
5. Location of work (MUST ATTACH MAP) County: Suizgy,
Nearest Town or City: Mnuor AIRY
Speclflc Location (Include road numbers, landmarks, etc.): SR I-1GC) CITY VIEW Dfz%VE.
6. Name of Closest Stream/River: AIZAI-AT Ri VE fZ
7. River Basin ; YA la ?.1 Pe.E_)FZ
8. Is this project located In a watershed classified as Trout, SA, HQW, ORW, WS 1, or WS 11? YES [ ] NO [?]
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [V/ ]
If yes, explain
10. Estimated total number of acres of waters of the U.S., Including wetlands, located on project site:
11. Number of acres of waters of the U.S., Including wetlands, Impacted by the proposed project:
Filled:.
Drained:
Flooded.
Excavated: 0.5 ACRES _.--
Total Impacted,. C). 5 ,6,C4eF 5
12. Description of proposed work (Attach PLANS-8 112" X 1 I " drawings only): THIS Pe-iz -I IS Eg&
A ?%ve R CeCSS I L167 Di4 L-Y . CDKI' OF EQ rs I NgG25 STAFF HAS nt 1t12M /N ED NQ
W _ ?_n4 s 00 T"1-4F1= P?q i Gi ?rE
13. Purpose of proposed work: h Xre! ia D Sew EIZ ScRvl GE TO Pr2c,j6 CT SITE .
14. State reasons why the applicant believes that this activity must be carried out In wetlands. Also, note measures taken to
minimize wetland impacts. THE pM Ltr W,d`1 To SElevC- THE pleL e?cT w iTH SF?vErz
y16E IS* TO G2 OSS TH t= r2r y E I~ _
I S. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES [ ] NO [ ?[
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 - Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B - If available, representative photograph of wetlands to be Impacted by project
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation fine.
D. If a storm water management plan Is required for this project, attach copy.
E. What Is land use of surrounding property? ?ESIDei,1Tr,?15?-I???rN Srr7UT1p??
F. If applicable, what Is proposed method of sewage disposa .M U N In
poy S'r5 V-k-M
Owner's Signature paw
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200320281 County: Surry
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property
Owner City of Mount Airy
Attn: Ms. Tammy Johnson
Address Post Office Box 70
Mount Airy, NC 27030
Telephone Number 336-786-3526
Authorized
Agent NA
Address
Telephone Number
Size and Location of Property (waterbody, Highway name/number, town, etc.): The property is
located southeast of City view Drive, approximately, 1000 feet east of East Pine Street, in Mount Airy,
Surry County, North Carolina.
Basis for Determination: The site contains no wetlands or stream channels except the Ararat River,
which is located along the properties western boundary. The Ararat River is in the Yadkin River Basin.
Indicate Which of the Followina Apply:
There are waters of the U.S., to include wetlands, on the above described property which we strongly suggest
should be delineated and surveyed. The surveyed wetland lines must be verified by our staff before the Corps will
make a final jurisdictional determination on your property.
Because of the size of your property and our present workload, our identification and delineation of your wetlands
cannot be accomplished in a timely manner. You may wish to obtain a consultant to obtain a more timely
delineation of the wetlands. Once the consultant has flagged a wetland line on the property, Corps staff will
review it, and, if it is accurate, we strongly recommend that you have the line surveyed for final approval by the
Corps. The Corps will not make a final jurisdictional determination on your property without an approved survey.
The waters of the U.S., to include wetlands, on your lot have been delineated, and the limits of the Corps
jurisdiction have been explained to you. 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 There are no waters of the U.S., to include wetlands, present on the above described property, except the Ararat
River adjacent to the western edge of the site, 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.
Placement of dredged or fill material in wetlands on this property without a Department of the
Army Permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A
permit is not required for work on the property restricted entirely to existing high ground. If you
have any questions regarding the Corps of Engineers regulatory program, please contact
Todd Tugwell ^ at telephone number (919) 876 - 8441 extension 26
Project Manager Signature \I oz
Date December 20, 2002
tion Date December 20, 2007
SURVEY PLAT OR FIELD SKETCH OF THE DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORD][ MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: City of Mount Air File Number: 200320281 Date: 12/20/2002
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
X 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://usace.army.mil/inet/functions/cw/cecwo/reg 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 Pen-nit, 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 Pen-nit 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.
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.
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DF.,M ID ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 4091 certification
Q O
o WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
?-- o W DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIRONMENT, HEALTH
Go © ?S ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES
Q REGULATORY FIELD OFFICE 4401 Reedy Creek Road
?Z 3 6508 Falls of The Neuse Road Raleigh, North Carolina 27607
Raleigh, NC 27615-5846 ATTN: MR. JOHN DORNEY
ur W Telephone [phone]
t E (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
.kVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT'.
PEASE PRINT:
I - Owners Name: C ITY O1= MOUWT Al KY
Owners Address POST Ol-'1=1Ct?-' WX -10. MOLL Q r 14 RY t?G Z-7030 Owners Phone Number (Horne). & 78(0 - 3501
4. If Applicable. Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP) County: Sl awr
Nearest Town or City: MDUtitr AIRY
Specific Location (include road numbers, landmarks, etc.): SR 11(00 CITY VIEW Dg%Vt?
6. Name of Closest Stream/River: AIZAleAT RIVER
7. River Basin : YA to ?.1 P eXE---
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS 1, or WS II? YES [ ] NO [?I
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [.f ]
If yes, explain
10. Estimated total number of acres of waters of the U.S., Including wetlands, located on project site: __O.
11. Number of acres of waters of the U.S., Including wetlands, impacted by the proposed project:
Filled:.
Drained: _
Flooded-
Excavated: 0.55 ACRe S
Total Impacte : 6. s s
12. Description of proposed work (Attach PLANS-8 112" X i 1 " drawings only): IHJIS pE2P-I ?r Fo(2
A 1?-%yeR G2oSSIQ4, OKIL-Y. COKE OF ]ROG1NEG STAFF HAS nF1?12MINEn wrn
??t T o.i?S 01.1 THE PRQIEC+ 1r__._
13. Purpose of proposed work: exr e LA n Sew EIZ SERv1 G$ TO PROJE C-r SIT(M .
14. State reasons why the applicant believes that this activity must be carried out In wetlands. Also, note measures taken to
minimize wetland Impacts. THE pt.1tX WP't To SEIZvt. 1-HF- P2L-?-JECT VV IT H SEWExz
v16 _l_S 1-0 CiZOS5 T- = 121 iE(_ _
I S. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES[ ] NO [ ?j
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties In the pen-nit area which may be affected by the proposed project? Have you done so? YES [ j NO [
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 - Additional Information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B • If available, representative photograph of wetlands to be Impacted by project
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a storm water management plan Is required for this project, attach copy.
E. What Is land use of surrounding property? lZ? t T? ?1Ti,e i. / Gtr (I ?J ST-1 LAD a"4a,..)
F. If applicable, what Is proposed method of sewage disposa ? uu N ICI PAS. SYS
Owner's Signature Date
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200320281 County: Sorry
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property
Owner City of Mount Airy
Attn: Ms. Tammy Johnson
Address Post Office Box 70
Mount Airy, NC 27030
Telephone Number 336-786-3526
Authorized
Agent NA
Address
Telephone Number
Size and Location of Property (waterbody, Highway name/number, town, etc.): The property is
located southeast of City view Drive, approximately, 1000 feet east of East Pine Street, in Mount Airy,
Surry County, North Carolina.
Basis for Determination: The site contains no wetlands or stream channels except the Ararat River,
which is located along the properties western boundary. The Ararat River is in the Yadkin River Basin.
Indicate Which of the Followine Apply:
There are waters of the U.S., to include wetlands, on the above described property which we strongly suggest
should be delineated and surveyed. The surveyed wetland lines must be verified by our staff before the Corps will
make a final jurisdictional determination on your property.
Because of the size of your property and our present workload, our identification and delineation of your wetlands
cannot be accomplished in a timely manner. You may wish to obtain a consultant to obtain a more timely
delineation of the wetlands. Once the consultant has flagged a wetland line on the property, Corps staff will
review it, and, if it is accurate, we strongly recommend that you have the line surveyed for final approval by the
Corps. The Corps will not make a final jurisdictional determination on your property without an approved survey.
The waters of the U.S., to include wetlands, on your lot have been delineated, and the limits of the Corps
jurisdiction have been explained to you. 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 There are no waters of the U.S., to include wetlands, present on the above described property, except the Ararat
River adjacent to the western edge of the site, 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.
Placement of dredged or fill material in wetlands on this property without a Department of the
Army Permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A
permit is not required for work on the property restricted entirely to existing high ground. If you
have any questions regarding the Corps of Engineers regulatory program, please contact
Todd Tugwell at telephone number (919) 876 - 8441 extension 26
Project Manager Signature \? oz
Date December 20, 2002
tion Date December 20, 2007
SURVEY PLAT OR FIELD SKETCH OF THE DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORM[ MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: City of Mount Airy File Number: 200320281 Date: 12/20/2002
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
X 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://usace.anny.mil/inet/fiinctions/cw/cecwo/reg 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 Pen-nit, 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 11 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.
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.
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I)EM ID ACTION ID:
Nationwide Permit Requested (}Provide Nationwide Permit A):
JOINT FORM FOR
a z Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
c"3 °o N
c., WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MANAGEMENT
c Q NC DEPARTMENT OF ENVIRONMENT, HEALTH
Z a =3 US ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES
-< REGULATORY FIELD OFFICE 4401 Reedy Creek Road
w 6508 Falls of The Neuse Road Raleigh, North Carolina 27607
ria Q Raleigh, NC 27615-6846 ATTN. MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (?) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
.PLEASE PRINT:
I -Owners Name: C ITY O1= MOLAKIT AI KY
2. Owners Address POST C4--F(CC Wx -to MOU Q T N RY KJG Z70 C>
3. Owners Phone Number (Horne): 33& 78(0 - 3501
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP) County: SLiFzK-'
Nearest Town or City: MOUWr AIRY'
Specift Location (include road numbers, landmarks, etc..): SR 1"1(00 CITY VIeW -DgIVe
6. Name of Closest Stream/River: AIZAleA. 1?%Vr=R
7. River Basin : YA1'-,ICi,.1 PEE-ME
8. Is this project located In a watershed classified as Trout, SA, HQW, ORW, WS 1, or WS If? YES [ ] NO [?]
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [?/ ]
If yes, explain
10. Estimated total number of acres of waters of die U.S., including wetlands, located on project site: _-0.
11. Number of acres of waters of the U.S., including wetlands, Impacted by the proposed project:
Pilled:.
Drained: _
Flooded:
Excavated: 0.5-ACRF S
Total Impacte . 0.5 ,S
12. Description of proposed work (Attach PLANS-8 1/2" X 1 1 " drawings only): -1-115 PE2M IT Fo
A tetve to C ZCSS I LCa 014L-Y- CDR 0 E?JG 1 KIeG25 STAFF HAS l-')EreJZM 1N _ L0
_WE?I °hl?S 00 THE Auk ci Slr?_
13. Purpose of proposed work: F_1(-re "n SmwEIZ SEfZvrc:E To PRc---,,Jt- CT SITE-
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures taken to
minimize wetland Impacts. THE c>it-Y W,d`I To SErzvta THE Piegiec-r w ITH Se-,vEg
SaRVI Is Tv C420SS T'Ht= i??yEV-
I S. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES[ ] NO[,/]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties In the permit area which may be affected by the proposed project? Have you done so? YES [ NO [ ?}
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 - Additional informatlon required by DEM:
A. Wetland delineation map showing ail wetlands, streams, and lakes on the property.
B • if available, representative photograph of wetlands to be Impacted by project
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a storm water management plan is required for this project, attach copy.
E. What Is land use of surrounding property? gE5t1 / SL- ( I rJ ST-1 TLin 0"4..)
F. If applicable, what Is proposed method of sewage disposa _M U N ICI pt yr, SYS TL?M
Owner's Signature Date
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200320281 County: S
NOTIFICATION OF JURISDICTIONAL, DETERMINATION
Property
Owner City of Mount Airy
Attn: Ms. Tammy Johnson
Address Post Office Box 70
Mount Airy, NC 27030
Telephone Number 336-786-3526
Authorized
Agent NA
Address
Telephone Number
Size and Location of Property (waterbody, Highway name/number, town, etc.): The property is
located southeast of City view Drive, approximately-1000 feet east of East Pine Street, in Mount Airy,
Surry County, North Carolina.
Basis for Determination: The site contains no wetlands or stream channels except the Ararat River,
which is located along the properties western boundary. The Ararat River is in the Yadkin River Basin.
Indicate Which of the Following Apply:
There are waters of the U.S., to include wetlands, on the above described property which we strongly suggest
should be delineated and surveyed. The surveyed wetland lines must be verified by our staff before the Corps will
make a final jurisdictional determination on your property.
Because of the size of your property and our present workload, our identification and delineation of your wetlands
cannot be accomplished in a timely manner. You may wish to obtain a consultant to obtain a more timely
delineation of the wetlands. Once the consultant has flagged a wetland line on the property, Corps staff will
review it, and, if it is accurate, we strongly recommend that you have the line surveyed for final approval by the
Corps. The Corps will not make a final jurisdictional determination on your property without an approved survey.
The waters of the U.S., to include wetlands, on your lot have been delineated, and the limits of the Corps
jurisdiction have been explained to you. 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 There are no waters of the U.S., to include wetlands, present on the above described property, except the Ararat
River adjacent to the western edge of the site, 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.
Placement of dredged or fill material in wetlands on this property without a Department of the
Army Permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A
permit is not required for work on the property restricted entirely to existing high ground. If you
have any questions regarding the Corps of Engineers regulatory program, please contact
Todd Tugwell ^ at telephone number- (919) 876 - 8441 extension 26
Project Manager Signature \1 cr
Date December 20, 2002
n Date December 20, 2007
SURVEY )PLAT OR FIELD SKETCH OF THE DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORM[ MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: City of Mount Airy File Number: 200320281 Date: 12/20/2002
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
X 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://usace.army.mil/inet/functions/cw/cecwo/reg 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 11 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 pen-nit 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. -Ck!-
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.
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DEM ID ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit 4):
JOINT FORM FOR
Z Nationwide permits that require notification to the Corps of Engineers
o Nationwide permits that require application for Section 401 certification
M o w
CO
WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
c? DIVISION OF ENVIRONMENTAL MANAGEMENT
c Q NC DEPARTMENT OF ENVIRONMENT, HEALTH
n = US ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES
Z Q REGULATORY FIELD OFFICE 4401 Reedy Creek Road
W 6508 Falls of The Neuse Road Raleigh, North Carolina 27607
Q Raleigh, NC 27615-6846 ATTN. MR. JOHN DORNEY
Telephone [phone]
ONE (I) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SRVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MA:NAOEMENT.
PLEASE PRINT:
I - Owners Name: C I Tl' 01= MOU&IT Al KY
2. Owners Address POST OI--FIGI? WX _-10MouWr AJ RY t?G Z?O p
3. Owners Phone Number (Horne): 33(0 78(o - 3501
4. IF Applicable: Agent's name or responsible corporate official, address, phone number:
va6
Ana- A'S
5. Location of work (MUST ATTACH MAP) County: SuRtzY
Nearest Town or City-, MOUWr AI rZY_?
Specific Location (include road numbers, landmarks, etc..): SR I-IGO CITY VIEW DR%VE
b. Name of Closest Stream/River: AKA2AT W%VE2
7. River Basin ;- YAT--,?--i,,
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS 1, or WS II? YES [ ] NO [?3
9. Have any Section 404 permits been previously requested for use on this property? YES [ NO [s/ )
If yes, explain
10. Estimated total number of acres of waters of the U.S., Including wetlands, located on project site: __0
11. Number of acres of waters of the U.S., including wetlands, Impacted by the proposed project:
Filled:.-
Dralned:
Flooded:? .? _
Excavated:' 0.5 ACRES Total Impacted; 0.5 . rges
12. Description of proposed work (Attach PLANS-8 112" X 1 1" drawings only): This PeKr-i L15 F0
t2
_ wsQ GZQ5SiL-1& 0ntt_Y. CORP OF ELlGrc.lEG2S STAFF HAS ??E1t2MtNED ND
°`? S OnJ THE Prz.Q IECf SITE _
13. Purpose of proposed work: EXTe KIn sevvElZ S6Rvic-a To PRc?E r?1' SITt_.-
14. State reasons why the applicant believes that this activity must be carried out In wetlands. Also, note measures taken to
minimize wetland Impacts. THE o"Lir WAI To SErevL=. THe Plecr)JcCT w lTH se.:WEK
viG IS TO Cleoss TN = i??ye r- _
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES [ 1 NO [ ?1
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties In the permit area which may be affected by the proposed project? Have you done so? YES [ 1 NO j
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 - Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B - If available, representative photograph of wetlands to be Impacted by project
C. If delineation was performed by a consultant, include all data sheets relevant to the placernenr of the
delineation line.
D. If a storm water management plan is required for this project, attach copy.
E. What Is land use of surrounding property? R? i1 ?iTrAr.. / ?? INS I 0"'OQ?
F. If applicable, what Is proposed method of sewage drsposal - °----
M u 1J !ct_ per,., SYs r??
Owner's Signature paw
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200320281 County: Surry
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property
Owner City of Mount Airy
Attn: Ms. Tammy Johnson
Address Post Office Box 70
Mount Airy, NC 27030
Telephone Number 336-786-3526
Authorized
Agent NA
Address
Telephone Number,
Size and Location of Property (waterbody, Hitzhway name/number, town, etc.): The property is
located southeast of City view Drive, approximately. 1000 feet east of East Pine Street, in Mount Airy,
Surry County, North Carolina.
Basis for Determination: The site contains no wetlands or stream channels except the Ararat River,
which is located along the properties western boundary. The Ararat River is in the Yadkin River Basin.
Indicate Which of the Following Apply:
There are waters of the U.S., to include wetlands, on the above described property which we strongly suggest
should be delineated and surveyed. The surveyed wetland lines must be verified by our staff before the Corps will
make a final jurisdictional determination on your property.
Because of the size of your property and our present workload, our identification and delineation of your wetlands
cannot be accomplished in a timely manner. You may wish to obtain a consultant to obtain a more timely
delineation of the wetlands. Once the consultant has flagged a wetland line on the property, Corps staff will
review it, and, if it is accurate, we strongly recommend that you have the line surveyed for final approval by the
Corps. The Corps will not make a final jurisdictional determination on your property without an approved survey.
The waters of the U.S., to include wetlands, on your lot have been delineated, and the limits of the Corps
jurisdiction have been explained to you. 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 There are no waters of the U.S., to include wetlands, present on the above described property, except the Ararat
River adjacent to the western edge of the site, 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.
Placement of dredged or ifll material in wetlands on this property without a Department of the
Army Permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A
permit is not required for work on the property restricted entirely to existing high ground. If you
have any questions regarding the Corps of Engineers regulatory program, please contact
Todd Tugwell at telephone number (919) 876 - 8441 extension 26
Project Manager Signature
Date December 20. 2002
Date December 20, 2007
SURVEY PLAT OR FIELD SKETCH OF THE DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORM MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: City of Mount Airy File Number: 200320281 Date: 12/20/2002
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
X 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://usace.army.mil/inet/ftinctions/cw/cecwo/reg 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 acid 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.
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.
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DEM ID' ACTION ID:
NationNvide Permit Requested (Provide Nationwide Permit fl:
JOINT FORM. FOR
Nationwide permits that require notification to the Corps of Engineers
z
a o Nationwide permits that require application for Section 401 certification

CC'3 M
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WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
T- C-i DIVISION OF ENVIRONMENTAL MANAGEMENT
-? NC DEPARTMENT OF ENVIRONMENT, HEALTH
Q US ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES
Z Q REGULATORY FIELD OFFICE 4401 Reedy Creek Road
aC
LU 6508 Falls of The Neuse Road Raleigh, North Carolina 27607

t
Z Raleigh, NC 27615-8846 ATTIC, MR. JOHN DORNEY
tt _ Telephone [phone]
?Fi E (I) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PL EASE PRINT:
I - Owners Name: C I T ( O MOL &IT Al KY
2. Owners Address POST CF-FICt? WX 10 HouQr /4 RY W- Z'70 p
78(0 - 3501
3. Owners Phone Number (Horne).--(L3-3_&_)
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP) County: SUggr
Nearest Town or City: MOUWr AIRY
Specific Location (include road numbers, landmarks, etc..): SR I IGO CITY VIEW DIetVE
6. Name of Closest Stream/River: ARAIieAT Rt V E R-____?___?
7. River Basin ; , YADIa wl PFD-DFZ?
8. Is this project located in a watershed classified as Trout, SA, FIQW, ORW, WS 1, or WS II? YES[ ] NO [?]
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [.V/ ]
If yes, explain
10. Estimated total number of acres. of waters of the U.S., including wetlands, located on project site: -0----
11. Number of acres of waters of the U.S., Including wetlands, Impacted by the proposed project:
Filled:-
Drained:
Flooded:
Excavated: 0.5 ACRES
Total Impacted: 0.5 Acweg - _-?_ --`?
12. Description of proposed work (Attach PLANS-8 112" X 1 1" drawings only): "THis Peter-i IT 15 PC&
RtveR G2Q551r.LCa OtJ1_Y. CARP O E?IGIt.I6G25 5TAPF HAS UErejRM?rvED WC)
W S khj s 00 THE 0Ka IEC1' Sir .
13. Purpose of proposed work: tXrE ?,jn sewElZ ScRvrGE TO Pr?t,)Jtrc-t' SITE.
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures taken to
minlmlze wetland Impacts. THE pI jLt r WP't To SEIZV C THE P2c21EC1- VV IT-H SF-vvEez
vrGE 119 Ty Cleoss TNT r?tyEr _
I S. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES j ] NO [ ?I
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties In the permit area which may be affected by the proposed project? Have you done so? YES [ j NO[ RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 - Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B • If available, representative photograph of wetlands to be Impacted by project
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation tine.
D. If a storm water management plan Is required for this project, attach copy.
E. What Is land use of surrounding property? &?? r WJ Sr1 Tt to
F. If applicable, what Is proposed method of sewage disposal? M U M ICI p 5
Owner's Signature Date
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200320281 County: Surry
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property
Owner City of Mount Airy
Attn: Ms. Tammy Johnson
Address Post Office Box 70
Mount Airy, NC 27030
Telephone Number 336-786-3526
Authorized
Agent NA
Address
Telephone Number.
Size and Location of Property (waterbody, Highway name/number, town, etc.): The property is
located southeast of City view Drive, approximately-1000 feet east of East Pine Street, in Mount Airy,
Surry County, North Carolina.
Basis for Determination: The site contains no wetlands or stream channels except the Ararat River,
which is located along the properties western boundary. The Ararat River is in the Yadkin River Basin.
Indicate Which of the Following Apply:
There are waters of the U.S., to include wetlands, on the above described property which we strongly suggest
should be delineated and surveyed. The surveyed wetland lines must be verified by our staff before the Corps will
make a final jurisdictional determination on your property.
Because of the size of your property and our present workload, our identification and delineation of your wetlands
cannot be accomplished in a timely manner. You may wish to obtain a consultant to obtain a more timely
delineation of the wetlands. Once the consultant has flagged a wetland line on the property, Corps staff will
review it, and, if it is accurate, we strongly recommend that you have the line surveyed for final approval by the
Corps. The Corps will not make a final jurisdictional determination on your property without an approved survey.
The waters of the U.S., to include wetlands, on your lot have been delineated, and the limits of the Corps
jurisdiction have been explained to you. 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 property, except the Ararat
River adjacent to the western edge of the site, 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.
Placement of dredged or fill material in wetlands on this property without a Department of the
Army Permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A
permit is not required for work on the property restricted entirely to existing high ground. If you
have any questions regarding the Corps of Engineers regulatory program, please contact
Todd Tugwell at telephone number (919) 876 - 8441 extension 26
Project Manager Signature I c¢
Date December 20, 2002
n Date December 20, 2007
SURVEY PLAT OR FIELD SKETCH OF THE DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORM MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORD.
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: City of Mount Airy File Number: 200320281 Date: 12/20/2002
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
X 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://usace.army.mil/inet/ftmctions/cw/cecwo/reg 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 fhe 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 tinder 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. -a!,
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.
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Nationwide Permit Requested (Provide Nationwide Permit ft):
JOIN'T' FORM FOR
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Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
175
(W uu.1
WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIRONMENT, HEALTH
US ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES
REGULATORY FIELD OFFICE 4401 Reedy Creek Road
6608 Falls of The Neuse Road Raleigh, North Carolina 27607
Raleigh, NC 27515-8846 ATTN. MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICA TION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT:
I - Owners Name: C ITT' 01= MOUNT Al KY
2. Owners Address POST 01--FICe- L3oX -(D, Mou"r N RY t?G Z'703p
3. Owners Phone Number (Home)- 330 -78& - 3501
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP) County: SuKg-r
Nearest Town or City: MoLtor AIRY _
SpeclfIc Location (Include road numbers, landmarks, etc.): SR 1"1(00 CITY VIeW DR?vE
6. Name of Closest Stream/River: Ale,&T %VEI
gZ
7. River Basin : YAI?,Ki cal Per-DEE
8, Is this project located In a watershed classified as Trout, SA, HQW, ORW, WS 1, or WS II? YES [ ] NO [?]
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [v/ ]
If yes, explain
10. Estimated total number of acres. of waters of tie U.S., Including wetlands, located on project site: _0
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:.-
Drained: _
Flooded:
Excavated: _._._.0.5?AGZES
Total Impacted-. C). 5 6C_?S _? - ?`
12. Description of proposed work (Attach PLANS-8 112" X I I " drawings only): ?Hts pErz,? it i5 Fo12
__ tZwEie CzcssikI.Ca OML-Y CDKF' OF EOG114ge S 5TAFF HAS n?1?r2MtNED t?0
WE. Ah s o?.l TNF PFZa fEG? SIr?__?
13. Purpose of proposed work. EXre "D sewElZ ScRviG6 TO PR(aJEU' SITE.
14. State reasons why the applicant believes that this activity must be carried out In wetlands. Also, note measures taken to
minimize wetland Impacts. THE C>JOr wA4 To SErzvt- THE PeLaj cT w tTti Se?vi=tz
seg'%/Lce. TO neoss T-N- WI iEe _
1 S. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES [ ] NO [ ,i]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Offlcer (SHPO) regarding the presence of historic
properties In the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 - Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B - If available, representative photograph of wetlands to be Impacted by project
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a storm water management plan is required for this project, attach copy.
E. What is land use of surrounding property? JZEStDE?1Tt,ot. Ik1ST-iTun
F. If applicable, what Is proposed method of sewage disposal?. M U N IC, p SYS ?M "-
Owner's Signatur? Date
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200320281 County: Sum
NOTIFICATION OF JURISDICTIONAL. DETERMINATION
Property
Owner City of Mount Airy
Attn: Ms. Tammy Johnson
Address Post Office Box 70
Mount Airy, NC 27030
Telephone Number 336-786-3526
Authorized
Agent NA
Address
Telephone Number.
Size and Location of Property (waterbody, Hishway name/number, town, etc.): The property is
located southeast of City view Drive, approximately-1000 feet east of East Pine Street, in Mount Airy,
Surry County, North Carolina.
Basis for Determination: The site contains no wetlands or stream channels except the Ararat River,
which is located along the properties western boundary. The Ararat River is in the Yadkin River Basin.
Indicate Which of the Following Apply:
There are waters of the U.S., to include wetlands, on the above described property which we strongly suggest
should be delineated and surveyed. The surveyed wetland lines must be verified by our staff before the Corps will
make a final jurisdictional determination on your property.
Because of the size of your property and our present workload, our identification and delineation of your wetlands
cannot be accomplished in a timely manner. You may wish to obtain a consultant to obtain a more timely
delineation of the wetlands. Once the consultant has flagged a wetland line on the property, Corps staff will
review it, and, if it is accurate, we strongly recommend that you have the line surveyed for final approval by the
Corps. The Corps will not make a final jurisdictional determination on your property without an approved survey.
The waters of the U.S., to include wetlands, on your lot have been delineated, and the limits of the Corps
jurisdiction have been explained to you. 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 There are no waters of the U.S., to include wetlands, present on the above described property, except the Ararat
River adjacent to the western edge of the site, 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.
Placement of dredged or fill material in wetlands on this property without a Department of the
Army Permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A
permit is not required for work on the property restricted entirely to existing high ground. If you
have any questions regarding the Corps of Engineers regulatory program, please contact
Todd Tugwell ^ at telephone number (919) 876 - 8441 extension 26
Propect Manager Signature
Date December 20. 20
ion Date December 20, 2007
SURVEY PLAT OR FIELD SKETCH OF THE DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORM MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: City of Mount Airy File Number: 200320281 Date: 12/20/2002
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
X 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://usace.army.mil/inet/functions/cw/eecwo/reg 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.
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.
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