20210465 Ver 1_2019-01242 NWP 14 Tearsheet_20210601

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id.SAW-2019-01242 County:Rockingham U.S.G.S. Quad:NC-Ruffin
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: NCDOT Division 7
Attn:Wright Archer III,PE
Address: PO Box 14996
Greensboro,NC 27415
Size(acres) —4 Nearest Town Ruffin
Nearest Waterway Wolf Island Creek River Basin Roanoke
USGS HUC 03010103 Coordinates 36.498441,-79.541754
Location description: The project area is located at NCDOT Bridge 106 over Wolf Island Creek on SR 1902(Dibrell Road),
near Ruffin,in Rockingham County,North Carolina.
Description of projects area and activity:This verification authorizes the discharge of clean fill material associated with
replacing an existing bridge(Bridge 106 on SR 1902)in place.The project includes permanent impacts to 0.046 acre(280
linear feet)of stream channel(bank stabilization—no permanent loss)and 0.003 acre of riparian non-riverine wetlands
(mechanized clearing),and temporary impacts to 0.030 acre(83 linear feet)of stream channel for construction access and
dewatering including a temporary work causeway.
Applicable Law(s): ©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 14 Linear Transportation Projects
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 enclosed
Conditions, your application signed and dated 4/30/2021, and the enclosed plans, Surface Water Impacts Permit, Permit
Drawing Sheets 1 through 6, received via email on 4/30/2021.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.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,State
or local approvals/permits.
If there are any questions regarding this verification,any of the conditions of the Permit,or the Corps of Engineers regulatory program,
please contact David E.Bailey at(919)554-4884 X 30 or [e-mail].
Date:2021.06.01 11:35:00
Corps Regulatory Official: 04'00' Date: 6/1/2021
Expiration Date of Verification: 03/18/2022

SAW-2019-01242
SPECIAL CONDITIONS
1. The U.S. Fish and Wildlife Service's (USFWS's) Programmatic Biological Opinion (PBO) titled,
"NCDOT Program Effects on the Northern Long-eared Bat in Divisions 1-8", dated November 6,
2020, contains agreed upon conservation measures for the NLEB. As noted in the PBO,
applicability of these conservation measures varies depending on the location of the project. Your
authorization under this Department of the Army permit is conditional upon your compliance
with all applicable agreed upon conservation measures in the PBO,which are incorporated by
reference in this permit. Failure to comply with the applicable these conservation measures would
constitute non-compliance with your Department of the Army permit. The USFWS is the
appropriate authority to determine compliance with the terms and conditions of its PBO, and with
the ESA.
Date: 40 -04 00'
Corps Regulatory Official: 1 1:34: 0 041.06.01
' Date: 6/1/2021
Expiration Date of Verification: 03/18/2022
The Wilmington District is committed to providing the highest level of support to the public.To help us ensure we continue to do so,
please complete the Customer Satisfaction Survey located at https://regulatory.ops.usace.army.mil/customer-service-survey/.
Copy furnished:
Jerry Parker,NCDOT,P.O.Box 14996,Greensboro,NC.27415-4996
Ryan Conchilla,NCDEQ-DWR, 1617 Mail Service Center,Raleigh,NC 27699-1617

I lighwdy North Carolina Department of Transportation /
Storzil Vater-
Highway Stormwater Program ^, ;
STORMWATER MANAGEMENT PLAN \\
(Version 2.07;Released October 2016) FOR NCDOT PROJECTS
WBS Element: 17BP.7.R.126 TIP No.: B-5355 County(ies): ROCKINGHAM Page 1 of 1
General Project Information
WBS Element: 17BP.7.R.126 TIP Number: B-5355 Project Type: Bridge Replacement Date: 3/1/2021
NCDOT Contact: Galen Cail Contractor/Designer: David Holmes
Address: 1020 Birch Ridge Address: 1020 Birch Ridge
Raleigh,NC 27610 Raleigh,NC 27610
Phone: [phone] Phone: [phone]
Email: [e-mail] Email: dkholmes ncdot. ov
City/Town: County(ies): ROCKINGHAM
River Basin(s): Roanoke CAMA County? No
Wetlands within Project Limits? Yes
Project Description
Project Length(lin.miles or feet): 612' Surrounding Land Use: RURAL
Proposed Project Existing Site
Project Built-Upon Area(ac.) 0.5 ac. 0.5 ac.
Typical Cross Section Description: 0.02 Normal Crown 0.02 Normal Crown
Annual Avg Daily Traffic(veh/hr/day): Design/Future: 300 Year:2025 Existing: 150 Year: 2012
General Project Narrative: Bridge 780106 is located on SR 1902 in Rockingham County.The existing crossing over Wolf Island Creek on SR 1902(Dibrell Rd.)is a six span bridge(6 @ 30',total length
(Description of Minimization of Water 180')with reinforced concrete caps on timber piles(#1-5 crutches:ppc cap&steel piles),and sits at a 90 degree skew. The proposed structure is a four span,4 @ 60'24"
Quality Impacts) Cored slab,with a 240'total length.This new bridge will sit at a 90 degree skew on 4.0'high end bent caps,with 42"high concrete bridge barrier rail.The bridge opening will
increase from 1406 sq.ft.to 2262 sq.ft.Stream banks will be armored with class II rip rap for bank stabilization.The existing stable ditches will be maintained.Proposed cut
ditch south east of the bridge carries 1 cfs of roadside drainage allong the fill slope parallel to an adjacent wetland.Construction of the ditch will cause a minimal amout of
mechanized clearing in the wetland.Maximum 2:1 side slopes will be utalized. The proposed project drainage systems include 1 outlet pipe northwest of the bridge.The system
outlet discharges 0.9 cfs into the overbank. Deck drains will be utalized in overbanks only,including proposed rip rap swale under deck drains.
Waterbody Information
Surface Water Body(1): Wolf Island Creek NCDWR Stream Index No.: 22-48
NCDWR Surface Water Classification for Water Body Primary Classification: Class C
Supplemental Classification:
Other Stream Classification: None
Impairments: None
Aquatic T&E Species? No Comments:
NRTR Stream ID: Buffer Rules in Effect: N/A
Project Includes Bridge Spanning Water Body? Yes Deck Drains Discharge Over Buffer? No Dissipator Pads Provided in Buffer? No
Deck Drains Discharge Over Water Body? No (If yes,provide justification in the General Project Narrative) (If yes,describe in the General Project Narrative;if no,justify in the
(If yes,provide justification in the General Project Narrative) General Project Narrative)

r 1
STATE STATE PROJECT REFERENCE NO. SHEET TOTAL
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\' I LOCATION: BRIDGE NO. 106 OVER WOLF ISLAND CREEK ON SR 1902 (DIBRELL ROAD)
e1�• / !. TYPE OF WORK: GRADING, PAVING, DRAINAGE AND STRUCTURE
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LETTING DATE: LICENSE NO. F-0669
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PROGRAM MANAGER P.E.
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PROJECT REFERENCE SHEET NO.
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CNI -0 vi

PROJECT REFERENCE SHEET NO.
PE RM I T D RAWI N G 17BP.7.R.126 - ROCKINGHAM 106
ROADWAY DESIGN HYDRAULICS
j DENOTES IMPACTS IN S H E ET 4 0 F 6 ENGINEER ENGINEER
ii /// SURFACE WATER
//i�! \ 0, P��IELI1�'1[INA 1'Y PLANS
DENOTES TEMPORARY
IMPACTS IN SURFACE WATER DO NOT USE >i�� CONSTRUCTIONDETAIL D ^ � DETAIL B INCOMPLETE PLANS
BANK STABILIZATION N "V� DETAIL A DETAIL C DO NOT USE FOR R/W ACQUISITION
* * * DENOTES MECHANIZED (Not to Sale) m O STANDARD 'V' DITCH SPECIAL CUT DITCH DECK DRAIN DISSIPATER SWALE
* * * I- (Not to Scale)
* * * *
CLEARING Excavation (TYP)
Front
2'(TYP) 1/ Ditch W MOTT MACDONALD I& E,LLC
NWS Natural Natural Natural 0t Slope LICENSE NO. F-0669
1.5:1 Slope p \...r)
D/ Ground ?. 1Ground Ground ?.X 1,'1ec NATURAL NATURAL
or flatter mD v!, GROUND A GROUND DOCUMENT NOT CONSIDERED FINAL
Geotextile (TYP) , Min. D=1Ft. UNLESS ALL SIGNATURES COMPLETED
Min. D= 1Ft.\-1
Type of Liner= Class II Rip Rap co' d
-L- STA. 16+60 TO 16+97 RT -L- STA. 16+97 TO 17+20 RT GEOTEXTILE & RIP RAP Prepared in the
-L- STA. 14+37 TO 15+96 \ \ -I M
-L- STA. 16+46 TO 16+63 m v> ! Type of Liner= CLASS B Rip-Rap PO Box 700
t- " MOTT M Fuquay-Varina,NC 27526
cow-4 FT MACDONALD www.mottmac.comramericas
d=0.2 FT
0 1 NOTE: SWALE TO BE CENTERED UNDER DECK DRAINS VERTICAL SCALE HORIZONTAL SCALE
-L- STA. 14+65 TO 15+70 LT & RT
m\ \ 7.01.2.LiggIO'
1i11 'r 25'UM
co
41' r:::).-1.-
li
DECK DRAINS REQUIRED •
8" X 6" SLOTS ON 5' CENTERS ',m ''' UPCLATO SS IIELEVRIP .5
BEGIN
P
PROJECT l7BP.7.R.126 BEGIN BRIDGE 500.2' (TYP.) N
-L- STA. 14+62 TO 15+50 LT 1
-L- POT Ste. /2+50.00 -L- Ste. /4+55.69 -L- STA. 14+62 TO 15+50 RT (STRUCTURE PAY ITEM)
l DECK DRAIN END PROJECT 17BP.7.RJ26
mDISSIPATOR PAD r END BRIDGE -L- POT Ste.2/+00.00
EST CLASS3 TONS RAP SEE DETAIL C ` -L- Ste. 16+98.31
I EST. 10 SY GEOTEXTILE EST. TONS RIP RAP ` `.
k EST. 140 SY GEOTEXTILE EXCAVATION END APPROACH SLAB
EST. 35 CY DDE LIMITS TEMP.
cAUSv -L- Ste. 17+09.19
Y / 15" CSP � 4
/ W/ELBOWS SI a -L- PC Ste. 22+39.77
WOODS ta W60C'
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BANK STABILIZATION 1 o`� - - /
SEE DETAIL D �s Z STANDARD V DITCH / \ �-
-L- PC Sta. 10+00.00 EST. 445 TONS RIP RAP It <% SEE DETAIL A
EST. 590 SY GEOTEXTILE \ , 0 EST. 25 CY DDE
EST. 565 CY DDE c. ✓s
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_ SI T 1 5:1 (2 FT THICK) 1 i ill�ipa . a
O (NORMAL TO CAP) (TYP.) or `, ' i■ASE Dl CH I GE = 9,1/40 CFS
(STRUCTURE PAY ITEM)
IIIIII
e ; ►:ASE FR QU,�ntCY = /01I YRS
480 �, %ASE W E! , VAT ON = 4:'9.? FT
EXCAVATE TO u' ERT�P PING /ISCHARGE = 15 000 CFS
c ELEV=494.0 I
o.
z iPVERTOP"/NG REQUENCY = 5110 YRS
.E A
'� I1 RTOP"/NG LEVATI•N = 5o .6 FT
s� , 470 WIW
BANK STABILI T 0
►SATE OF SU I EY = • /10/19
W-'CLASS II RIP •P . +•.
(SI OPE 1S 1) o : • K •TAB LIZATI S.E�EV 'tTIQ
I. •
5.rIV, 'S II IPB RA �T DATE OF ► RVEY = 4%5.7 FT
:L 4:S.r' . < (►' PIPE 1.5: )
D ' 1 t, 01-10 2U19 N ' EX NATION = 1710 CY
460 kxX (STIUCTURE !AY ITEM
10 11 12 13 14 15 16 17 18 19 20 21 22 23

PROJECT REFERENCE SHEET NO.
PE RM I T D RAWI N G 17BP.7.R.126 - ROCKINGHAM 106
S
ROADWAY DESIGN HYDRAULICS
j! \\ DENOTES IMPACTS IN H E ET 5 0 F 61 ENGINEER ENGINEER
/ SURFACE WATER
PM ELIMINA 1'Y PLANS
//i�!
DENOTES TEMPORARY
IMPACTS IN SURFACE WATER \ ., \ \
DO NOT USE FOR CONSTRUCTION
DETAIL D 0 ^ � DETAIL B INCOMPLETE PLANS
BANK STABILIZATION N "V� DETAIL A DETAIL C DO NOT USE FOR R/W ACQUISITION
* * * * DENOTES MECHANIZED (Not ta sale) m O STANDARD 'V' DITCH SPEC(ALatCaUs Scale)
DECK DRAIN DISSIPATER SWALE
(Not to Scale) (Not to Scale)
CLEARING Excavation (TYP) \� Front
2'(TYP) x\� Ditch w MOTT MACDONALD I& E,LLC
NWS ta Natural Natural Natural \°t Slope LICENSE NO. F-0669
1.5:1 Slope p / , \ Ground �.1 Ground Ground ?./ D 1'• \,yet NATURAL NATURAL
eo flatter m \??‘-)
, D \Min. D=1Ft. GROUND GROUND DOCUMENT NOT CONSIDERED FINAL
UNLESS ALL SIGNATURES COMPLETED
Geotextile (TYP) F-
Min. D= 1Ft.
Type of Liner Class II Rip Rap co' d
GEOTEXTILE & RIP RAP Prepared in the
N -L- STA. 16+60 TO 16+97 RT -L- STA. 16+97 TO 17+20 RT Office of: M
-L- STA. 14+37 TO 15+96 '' M INSET INTO NATURAL GROUND
-L- STA. 16+46 TO 16+63 m v> ! Type of Liner= CLASS B Rip-Rap PO Box 700
t- "r MOTT M Fuquay-Varina,NC 27526
w w-4 FT MACDONALD www.mottmac.comVamericas
4 d=0.2 FT
O 1 NOTE: SWALE TO BE CENTERED UNDER DECK DRAINS VERTICAL SCALE HORIZONTAL SCALE
s' ! -L- STA. 14+65 TO 15+70 LT & RT �' " 1 2i:i1111■11...!.. i'' " 2 S0'
0
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\\\, L / BEGIN BRIDGE $ -X b SLOTS ON 5 CENTERS IlilI / I CLASS II RIP RAP
L TA. 14+ 2 T 1 + L,
/ BEGIN PROJECT l7BP.7.R.126 ->` �/ S b O 5 50 T col III 'll���"° ( :\\
\ UP TO ELEV. 500.2' (TYP.)
/ /°/ /� �� \ _b/// I I Il l 1 (STRUCTURE PAY ITEM)
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l -L7/i ¢- \ I I � r END PROJECT l7BP. b v
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y
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5 'Ps- II / \ �� DISSIPATOR PADb� \
lII l�l \ - - - EST. 3 TONS �1l �j 1 = -L- Sit, l6+98.3/ \
� I
C - _ _ --
EST. 40 TONS RIP RAP1�
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z 14
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z ` re-- 9" Bt BEAM
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490 r
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0
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ai 1PESIGN W ELEVATION = 497.9 FT
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° (NORMAL TO CAP) (TYP.) kI y' ` r �■
(STRUCTURE PAY ITEM) I
,:ASE FREQUEn�cY = loo YRS
480 /1 �, 1:ASE HW E!EVATION = 499.? FT
EXCAVATE TO c� T
e ELEV=494.0' + u ER OFFING DISCHARGE = 15,000 CFS
I�VRTOPPING FREQUENCY = 500 YRS
o t
4 II RT OPP/NG FLEV AT/ N = 501.6 FT
sty 470 - WBANK STABILIZAT ON 5� w ��ATE OF SURVEY = Ol/10,�19
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(q OPE 1S 1) NORMAL WS N•r W,rLA SBANK II IPLI RA S.ELEVATION
ELEV.-485.7' 71- (SLOPE 1.5:") p AT DATE OF SURVEY = 485.7 FT
DAIt 01-10-2019 `n ' EX VATION = 1710 CY
460 m J �� (STF4UCTURE !AY ITEM)
10 11 12 13 14 15 16 17 18 19 20 21 22 23

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WETLAND AND SURACE WATER IMPACTS SUMMARY
WETLAND IMPACTS SURFACE WATER IMPACTS
—
Hand Existing Existing
Permanent Temp. Excavation Mechanized Clearing Permanent Temp. Channel Channel Natural
Site Station Structure Fill In Fill In in Clearing in SW SW Impacts Impacts Stream
No. (From/To) Size/Type Wetlands Wetlands Wetlands in Wetlands Wetlands impacts impacts Permanent Temp. Design
(ac) (ac) (ac) (ac) (ac) (ac) (ac) (ft) (ft) (ft)
1 15+80-16+43-L- Bank Stabalization 0.016 0.005 100 20
1 15+97-16+43-L- Temporary Causeway 0.023 53
2 16+60-17+20-L-RT Cut Ditch/Standard V Ditch 0.003
3 14+32-16+04-L-RT Bank Stabilization 0.030 0.002 180 10
TOTALS: 0.000 0.003 0.046 0.030 280 83
NOTES:
i
Site 1 -->Wolf Island Creek NC DEPARTMENT OF TRANSPORTATION
Site 3-->Tributary to Wolf Island Creek DIVISION OF HIGHWAYS
3/1/2021
Length of temp causeway impacts are within length of permanent impacts along Wolf Island Creek. Rockingham County
Brg#106
17BP.7.R.126
Revised 2016 09 09 SHEET 1 OF 1

Action ID Number: SAW-2019-01242 County: Rockingham
Permittee: NCDOT Division 7 (Attn: Wright Archer III, PE)
Project Name: NCDOT/ Bridge 106 / SR 1902 /Dibrell Road/Rockingham County
Date Verification Issued: 6/1/2021
Project Manager: David E. Bailey
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: David E. Bailey
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee Date

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). The
waters,including wetlands,have been delineated,and the delineation has been verified by the Corps to be sufficiently
accurate and reliable. Therefore,this preliminary jurisdiction determination may be used in the permit evaluation
process,including determining compensatory mitigation. For purposes of computation of impacts,compensatory
mitigation requirements,and other resource protection measures,a permit decision made on the basis of a preliminary
JD will treat all waters and wetlands that would be affected in any way by the permitted activity on the site as if they are
jurisdictional waters of the U.S. This preliminary determination is not an appealable action under the Regulatory
Program Administrative Appeal Process(Reference 33 CFR Part 331). However,you may request an approved JD,
which is an appealable action,by contacting the Corps district for further instruction.
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 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 approved jurisdictional determination issued . Action ID: SAW-
B.Basis For Jurisdictional Determination: See attached Preliminary Jurisdictional Determination Form.
C.Remarks:
D. Attention USDA Program Participants
The delineation included herein has been conducted to identify the location and extent of the aquatic resource boundaries and/or the
jurisdictional status of aquatic resources for purposes of the Clean Water Act for the particular site identified in this request. This
delineation and/or jurisdictional determination may not be valid for the Wetland Conservation Provisions of the Food Security Act of
1985,as amended.If you or your tenant are USDA program participants,or anticipate participation in USDA programs,you should
discuss the applicability of a certified wetland determination with the local USDA service center,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: Mr.Philip A. Shannin
Administrative Appeal Review Officer
60 Forsyth Street SW,Floor M9
Atlanta,Georgia 30303-8803
AND
PHILIP.A.SHANNINc2 USACE.ARMY.MIL
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 N/A.
It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence. _ /4 Date:2021.06.01 11:33:41
Corps Regulatory Official: .'�� -04'00'
David E.Bailey
Date of JD: June 1,2021 Expiration Date of JD: N/A

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: NCDOT Division 7 File Number: SAW-2019-01242 Date: 6/1/2021
Attached is: See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission) A
P PROFFERED PERMIT (Standard Permit or Letter of permission) B
PERMIT DENIAL C
L APPROVED JURISDICTIONAL DETERMINATION D
17 PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx or
Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit,you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission(LOP),you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety,and waive all rights to appeal the
permit,including its terms and conditions,and approved jurisdictional determinations associated with the permit.
• OBJECT: If you object to the permit(Standard or LOP)because of certain terms and conditions therein,you may request that the
permit be modified accordingly.You must complete Section II of this form and return the form to the district engineer. Your
objections must be received by the district engineer within 60 days of the date of this notice,or you will forfeit your right to appeal
the permit in the future. Upon receipt of your letter,the district engineer will evaluate your objections and may: (a)modify the
permit to address all of your concerns,(b)modify the permit to address some of your objections,or(c)not modify the permit
having determined that the permit should be issued as previously written. After evaluating your objections,the district engineer
will send you a proffered permit for your reconsideration,as indicated in Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit,you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission(LOP),you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety,and waive all rights to appeal the
permit,including its terms and conditions,and approved jurisdictional determinations associated with the permit.
• APPEAL: If you choose to decline the proffered permit(Standard or LOP)because of certain terms and conditions therein,you
may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this form
and sending the form to the division engineer. This form must be received by the division engineer within 60 days of the date of
this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative
Appeal Process by completing Section II of this form and sending the form to the division engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or
provide new information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the date of
this notice means that you accept the approved JD in its entirety,and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD,you may appeal the approved JD under the Corps of Engineers Administrative
Appeal Process by completing Section II of this form and sending the form to the division engineer. This form must be received by
the division engineer within 60 days of the date of this notice.

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 A. SHANNIN
Attn:David E.Bailey ADMINISTRATIVE APPEAL REVIEW OFFICER
69 Darlington Avenue CESAD-PDS-O
Wilmington,North Carolina 28403 60 FORSYTH STREET SOUTHWEST,FLOOR M9
ATLANTA,GEORGIA 30303-8803
PHONE:[phone];FAX[phone]
EMAIL:[e-mail]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel,and any government
consultants,to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation,and will have the opportunity to participate in all site investigations.
Date: Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer,Wilmington Regulatory Division,Attn:David E.Bailey,69 Darlington Avenue,Wilmington,North
Carolina 28403
For Permit denials,Proffered Permits and approved Jurisdictional Determinations send this form to:
Division Engineer,Commander,U.S.Army Engineer Division,South Atlantic,Attn:Mr.Phillip Shannin,
Administrative Appeal Officer,CESAD-PDO,60 Forsyth Street,Room 10M15,Atlanta,Georgia 30303-8801
Phone: [phone]