20210451_2019-01251 NWP 3 Tearsheet_20210617

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2019-01251 County: Caswell U.S.G.S.Quad:NC-Greensboro
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 Yanceyville
Nearest Waterway Country Line Creek River Basin Roanoke
USGS HUC 03010104 Coordinates 36.403330,-79.299200
Location description: The site is located along SR 1780(South Gatewood Road)over Country Line Creek at NCDOT Bridge
117 in Caswell County,North Carolina.
Description of projects area and activity: This verification authorizes the discharge of clean fill material associated with removal
of an existing bridge(Bridge 117 on SR 1780).The project includes permanent impacts to<0.01 acre(10 linear feet)of stream
channel(bank stabilization)and 0.049 acre of riparian non-riverine wetlands(excavation),and temporary impacts to 0.03 acre
(33 linear feet)of stream channel and 0.01 acre of riparian non-riverine wetlands(construction access and bridge bent
removal).The project would also require hand clearing in an additional 0.02 acre of riparian non-riverine wetlands.
Applicable Law(s): N 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 3 Maintenance
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 3/26/2021 and additional information submitted 6/7/2021,and the enclosed plans
"Wetland and Surface Water Impacts Permit",Permit Drawing Sheets 1 through 7.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 David.E.Bailev2(&,,usace.armv.mil.
Date:2021.06.17 09:08:26
Corps Regulatory Official: 04'00' Date: 6/17/2021
Expiration Date of Verification: 03/18/2022

SAW-2019-01251
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.
2. The USFWS's Programmatic Biological/Conference Opinion (PBO/PCO) titled "Bridge and
Culvert Replacements/Repairs/Rehabilitations in Eastern North Carolina,NCDOT Divisions 1-
8)," dated September 11, 2019, contains mandatory terms and conditions to implement the
reasonable and prudent measures that are associated with "incidental take" that are specified in
the PBO/PCO. Your authorization under this Corps permit is conditional upon your compliance
with all the mandatory terms and conditions associated with incidental take of the PBO/PCO,
which terms and conditions are incorporated by reference in this permit. Failure to comply with
the terms and conditions associated with incidental take of the PBO/PCO,where a take of the
listed species occurs,would constitute an unauthorized take, and it would also constitute non-
compliance with your Corps permit. The USFWS is the appropriate authority to determine
compliance with the terms and conditions of its PBO/PCO, and with the ESA.
3. For areas authorized for temporary fill in wetlands, temporary fill material must be completely
removed and restored to pre-project conditions upon completion of the construction activity. For
areas authorized for excavation in wetlands associated with bridge demolition, the affected areas
must be restored such that they match the immediately adjacent natural wetland grades upon
completion of the construction activity.Within 30 days of the above the above,these wetland areas
must be planted with regionally appropriate plant species.
Date: 2021 .06.17
09:08:08 -04'00'
Corps Regulatory Official: _ Date: 6/17/2021
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

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DETAIL OF CAUSEWAY
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NCDOT
DIVISION OF HIGHWAYS
OASWELL COUNTY
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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 -L- 14+39 TO 16+35 BRIDGE REMOVAL 0.01 0.049 0.02 < 0.01 0.03 10 33
TOTALS*: 0.01 0.049 0.02 < 0.01 0.03 10 33 0
*Rounded totals are sum of actual impacts
NOTES:
NC DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
JANUARY 14, 2021
CASWELL COUNTY
17BP.7.R.130
Revised 2018 Feb SHEET 7 OF 7

Action ID Number: SAW-2019-01251 County: Caswell
Permittee: NCDOT Division 7 (Attn: Wright Archer III, PE)
Project Name: NCDOT/U5841 /West Friendly Avenue widening and improvements /Greensboro/
Guilford County/transportation
Date Verification Issued: 6/17/2021
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
[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 iv/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. i! 0. Date:2021.06.17 09:07:12
Corps Regulatory Official: 04'00'
David Bailey
Date of JD: 6/17/2021 Expiration Date of JD: N/A

NOTIFICATION OF ADMINISTRATIVE
QUESTFOR APPEALAPPEAL OPTIONS AND PROCESS AND
RE
Applicant: NCDOT Division 7 File Number: SAW-2019-01251 Date: 6/17/2021
Attached is: See Section below
E INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission) A
PROFFERED PERMIT (Standard Permit or Letter of permission) B
[ PERMIT DENIAL C
L APPROVED JURISDICTIONAL DETERMINATION D
II 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: ii s 1
If you have questions regarding this decision and/or the If you only have questions regarding the appeal process you may I
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 I
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 investi ations.
Date: Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer,Wilmington Regulatory Division,Attn: David E.Bailey,69 Darlington Avenue,Wilmington,North
Carolina 28403
For Permit denials,Proffered Permits and approved Jurisdictional Determinations send this form to:
Division Engineer,Commander,U.S.Army Engineer Division,South Atlantic,Attn: Mr.Phillip Shannin,
Administrative Appeal Officer,CESAD-PDO,60 Forsyth Street,Room 10M15,Atlanta,Georgia 30303-8801
Phone: [phone]