20210161 Ver 1_USACE Permit_20210212

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2020-01221 County: Forsyth County U.S.G.S. Quad: Walkertown
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Courtney Driver
City of Winston-Salem
Address: 101 N. Main Street
Winston-Salem, North Carolina 27101
Telephone Number: [phone]
Size (acres) 11.1 (approximately) Nearest Town Walkertown
Nearest Waterway West Belews Creek River Basin Roanoke
USGS HUC 03010103 Coordinates Latitude: 36.173645
Longitude:-80.147081
Location description: The project site is located immediately east of the Church Street, NC Highway 311 (Main Street)
intersection and continues approximately 4750 feet eastward along West Belews Creek, in Walkertown, Forsyth County,
North Carolina and is identified as the Avalee Force Main Proiect.
Description of projects area and activity: This authorization is for temporary and permanent impacts to tributaries and
wetlands associated with the replacement/improvements of an existing sewer line as follows: Crossing #1: Site S1 (SA) 52
linear feet of temporary impacts. Crossing #2: Site S2 (West Belews Creek) 34 linear feet of temporary impacts. Crossing #3:
Site S3 (SC) 31 linear feet of temporary impacts, Site S4 (SD) 29 linear feet of temporary impacts, Site Wl (WB) 0.011 acre
permanent impact and Site W2 (WB) 0.026 acre of temporary impact. Crossing #4: Site S5 (SE) 31 linear feet of temporary
impacts, Site W3 (WC) 0.002 acre permanent impact and Site W4 (WC) 0.012 acre of temporary impact. Crossing #5: Site S6
(SF) 33 linear feet of temporary impacts, Site S7 (SG) 44 linear feet of temporary impacts. Crossing #6: Site S8 (West Belews
Creek) 31 linear feet of temporary impacts, Site S9 (SH) 31 linear feet of temporary impacts and Site W5 (WG) 0.002 acre of
temporary impact and 0.002 acre of permanent impact (associated with maintained ROW; will not result in permanent loss.
Wetland WG is herbaceous). All Temporary impacts are associated with existing line replacement/installation and/or
construction access.All Permanent impacts are associated with the permanent conversion of forested wetlands to herbaceous
wetlands (unless otherwise noted in the description above) (See attached plans).
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number and/or Nationwide Permit Number: NWP 12 Utility Line Activities
SEE ATTACHED RGP or NWP GENERAL, REGIONAL AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application and attached information received on January 25, 2021. Any violation of the
attached conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration
order, a Class I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide and/or regional general permit
authorization is modified, suspended or revoked. If, prior to the expiration date identified below, the nationwide and/or regional
general permit authorization is reissued and/or modified, this verification will remain valid until the expiration date identified below,
provided it complies with all requirements of the modified nationwide permit. If the nationwide and/or regional general permit
authorization expires or is suspended, revoked, or is modified, such that the activity would no longer comply with the terms and
conditions of the nationwide permit, activities which have commenced (i.e., are under construction) or are under contract to
commence in reliance upon the nationwide and/or regional general permit, will remain authorized provided the activity is completed
within twelve months of the date of the nationwide and/or regional general permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management in Morehead City, NC, at [phone].

This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact Andrew Williams at [phone] or Andrew.E.Williams2(&usace.armv.mil.
Date: 2021.02.12
Corps Regulatory Official: �yLl 16:32:59-05'00' Date: February 12, 2021
Expiration Date of Verification: March 18, 2022
A. Determination of Jurisdiction:
1. ❑ There are waters, including wetlands, on the above described project area that may be subject to Section 404 of the Clean
Water Act (CWA) (33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). This preliminary
determination is not an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part
331). However, you may request an approved JD, which is an appealable action, by contacting the Corps district for further
instruction. Please note, if work is authorized by either a general or nationwide permit, and you wish to request an appeal of an
approved JD, the appeal must be received by the Corps and the appeal process concluded prior to the commencement of any
work in waters of the United States and prior to any work that could alter the hydrology of waters of the United States.
2. ❑ There are Navigable Waters of the United States within the above described project area subject to the permit requirements
of Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act (CWA) (33 USC §
1344). Unless there is a change in the law or our published regulations, this determination may be relied upon for a period not to
exceed five years from the date of this notification.
3. ❑ There are waters, including wetlands, within the above described project area that are subject to the permit requirements of
Section 404 of the Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published regulations,
this determination may be relied upon for a period not to exceed five years from the date of this notification.
4. ❑ A jurisdiction determination was not completed with this request. Therefore, this is not an appealable action. However, you
may request an approved JD, which is an appealable action, by contacting the Corps for further instruction.
5. ® The aquatic resources within the above described project area have been identified under a previous action. Please reference
the preliminary jurisdictional determination issued 9/10/2020. Action ID: SAW-2020-01221.
B. Basis For Jurisdictional Determination: N/A. An Approved JD has not been completed.
C. Remarks: None
D. 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.
E. Appeals Information for Approved Jurisdiction Determinations (as indicated in A2 and A3 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

PHONE: [phone]; FAX [phone]
EMAIL: [e-mail]
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: Not Applicable.
It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence. Date: 2021.02.12 16:33:35
Corps Regulatory Official:
...._, _% i is
Andrew Williams
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
hgp:Hcorpsmou.usace.army.mil/cm_Uex/Vp=136 * 0.
Copy furnished (via email):
Phil May
Carolina Ecosystems, Inc.
P.O. Box 41
Lewisville, North Carolina 27023
Phil.m av(&carolin aeco.co m

NOW OR FORMERLY
PIN 6858-94-5155
NOW OR FORMERLY
PIN fi858-94-8133
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NOW OR FORMERLY
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NOW OR FORMERLY
NOW OR FORMERLY
I
HENRY M. READ, JR. PIN fi868-04-2157 PIN 6868-04-4167 PIN fi868-04-6127
NANCY CREWS MORETZ AND SALLIE C. WILLIAM T. TEDDER RHOEDONA G. HESTER
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DEED BOOK MORE, PAGE 2316
JOHNSON
NOW OR FORMERLY
CODY R. ATKINS AND WIFE NOW OR FORMERLY
HALEY R. ATKINS PIN 6868-04-3147
DEED BOOK PAGE
320 DEED BOOK 1153, PAGE 1534
POSSIBLE E%. SSMH
DEED BOOK 2CRE PAGE 4046
THE i. A. CREWS HEIRS
NOW OR FORMERLY
PIN 68fi8-04-0186
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DEED BOOK 3483, PAGE 3971 HAROLD G. SHULL AND WIFE
THE T. A. CREWS HEIRS E%. SLAB -TOP YARD
CREWS
INLET BENCH MARK
NOT ACCESSIBLE
PLAT BOOK 16, PAGE 90
PIN 6858-94-9187
OBERT LEE PRESNELL AND WIFE
AVERY GALE PRESNELL w
THE T. A. CREWS HEIRS ANN I. SHULL
PLAT BOOK 16. PAGE
90
TOP OF SLAB 963.2't EX. HYDRANT
u
w
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UNDER PAVEMENT
NANCY CREWS MORETZ AND
DEEDyB00K 2445, PAGE 2680
PLAT BOOK 16, PAGE 90 DEED BOOK 2438, PAGE 267fi
EX. DROP INLET
INLET WEIR 962.64' TOP OPERATING
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RECEMNG PIT
SALLIE C. JOHNSON
DEED BOOK 2964, PAGE 2849
T T. A. CREWS HEIRS u, m
THE T. A. CREWS HEIRS
INV. 971.45' PLAT BOOK 16, PAGE 90
GRATE 980.07'
INV. IN 961.22' BOLT 955.51'
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INV. IN 978.79'
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TOP OF CURB 996.00'
GRATE 995.39'
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BENCH MARK I
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INV. 950.49'
INV. IN (E 992.7'
INV. IN (S) 991.9'
INV. OUT 991.8'
45' RJ BEND 45' RJ BEND
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0 INV. IN S 980.38'
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LF WINSTON-SALEM/FORSYTH COUNTY
BOARD OF EDUCATION
ASPHALT ROAD BETWEEN STATION 15+50 AND 16+00 IS
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• SHELF 910.99
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PIN 6868-13-5883
WINSTON-SALEM/FORSYTH COUNTY
BOARD OF EDUCATION
DEED BOOK 2997, PAGE 993
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PLAT BOOK 52, PAGE 184
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PROJECT NO.
WIN 1803
FM-1 .3

Action ID Number: SAW-2020-01221 County: Forsyth County
Permittee:
Project Name:
Courtney Driver
City of Winston-Salem
Avalee Force Main
Date Verification Issued: February 12, 2021
Project Manager: Andrew Williams
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: Andrew Williams
3331 Heritiage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee Date

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Courtney Driver City of Winston-Salem
File Number: SAW-2020-01221
Date: February 12,
2021
Attached is:
See Section below
INITIAL PROFFERED PERMIT Standard Permit or Letter ofpermission)
A
PROFFERED PERMIT Standard Permit or Letter ofpermission)
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 hLtp://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPenuits.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.

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: Andrew Williams
CESAD-PDO
3331 Heritage Trade Drive, Suite 105
U.S. Army Corps of Engineers, South Atlantic Division
Wake Forest, North Carolina 27587
60 Forsyth Street, Room 1OM15
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 opportunit to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant or agent.
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 10M15, Atlanta, Georgia 30303-8801
PHONE: [phone]; FAX [phone]
EMAIL: [e-mail]