20210554 Ver 1_2022-00263 RGP 50 Tearsheet_20220217

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2022-00263 County: Guilford U.S.G.S. Quad:NC-McLeansville
GENERAL PERMIT (REGIONAL AND NATIONWIDE)VERIFICATION
Permittee: NC Department of Transportation
Attn:William Barrett
Address: 1598 Mail Service Center
Raleigh,NC 27699-1598
Size(acres) =8 Nearest Town Greensboro
Nearest Waterway South Buffalo Creek River Basin Cape Fear
USGS HUC 03030002 Coordinates 36.053210,-79.739230
Location description: The project area is located at Bridges 109 and 121 on SR 4240(East Gate City Boulevard/East Lee Street)
over South Buffalo Creek in Greensboro,Guilford County,North Carolina.
Description of projects area and activity: This verification authorizes the discharge of clean fill material associated with
replacing two existing bridges in place,known as B-5717.The project requires the permanent discharge of fill material into
0.03 acre of wetlands,the discharge of dredged material via mechanized clearing and excavation within 0.14 acre of wetlands,
and the temporary discharge of fill material into 0.07 acre of stream channel for work causeways.These impacts are necessary
to construct the replacement bridges and approaches and remove existing bridge columns/pilings.
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 50-NCDOT-Bridges,Road Widenings,and Interchanges
SEE ATTACHED 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,your application signed and dated 1/28/2022, and the enclosed plans Wetland and Surface Water Impacts Permit
October 2021,Permit Drawing Sheets 01 through 17.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 Depaitiiient 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(a,usace.army.mil.
Date:2022.02.17 15:39:43
Corps Regulatory Official: -05'00' Date: 02/17/2022
Expiration Date of Verification: 5/25/2025

SAW-2022-00263
SPECIAL CONDITIONS
1. In order to compensate for wetland impacts associated with B-5717, mitigation shall be provided
from the NCDOT South Buffalo Creek Mitigation Site (I-2402, U-2525A, and I-2201F/E). The
NCDOT will debit 0.34 acre of Riparian Wetland Restoration credits from the site. NCDOT will
provide an updated copy of the ledger to the Corps of Engineers, Raleigh Regulatory Field Office,
prior to initiation of permitted wetland impacts.
2. 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: 2022.02.17
15:39:25 -05'00'
Corps Regulatory Official: Date: 02/17/2022
Expiration Date of Verification: 5/25/2025
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 i1M.
North Carolina Department of Transportation °F—�°�
Highway Stormwater Program
STORMWATER MANAGEMENT PLAN
(Version 2.08;Released April 2018) FOR NCDOT PROJECTS
WBS Element: 45673.1.2 TIP No.: B-5717 County(ies): Guilford Page 1 of 1
General Project Information Mr
WBS Element: 45673.1.2 ITIP Number: B-5717 Project Type: Bridge Replacement Date: 10/21/2021
NCDOT Contact: Kristy Alford,PE Contractor/Designer: AECOM/Matt Kemp,PE
Address: NCDOT Century Center Address: 5438 Wade Park Boulevard
1000 Birch Ridge Dr Raleigh NC 27607
Raleigh NC 27610 Suite 200
Phone: [phone] Phone: [phone]
Email: [e-mail] Email: [e-mail]
City/Town: Greensboro County(ies): Guilford
River Basin(s): Cape Fear CAMA County? No
Wetlands within Project Limits? Yes
Project Description r _
Project Length(lin.miles or feet): 0.32 Surrounding Land Use: Wooded/Low Density Commerical
i i Proposed Project ixistirg Site
Project Built-Upon Area(ac.) 3.9 ac. 3.3 ac.
Typical Cross Section Description: 4 lane 12'wide lanes divided arterial with median ditches,curb and gutter,and storm 4 lane 12'wide lanes divded arterial with median ditches and storm sewer systems.
sewer systems and sidewalks. West of South Buffalo Creek contains curb and gutter,east contains paved shoulder
Annual Avg Daily Traffic(veh/hr/day): Design/Future: 20100 Year:2040 18184 Year: 2020
General Project Narrative: Existing parallel bridges 0121/0109 consist of 5 spans of 40 ft,for total bridge lengths of 200 ft over South Buffalo Creek.Both bridges consist of reinforced concrete cap and
(Description of Minimization of Water column on spread footings,end bents consist of reinforced concrete cap and piles.Bridge 0120(WB)deck is a reinforced concrete deck with concrete I beams.Bridge 0109 is a
Quality Impacts) reinforced concrete deck with steel I beams.
The replacement bridges are 3 span bridges(1@55,1@100,and 1@60)with 54"prestressed concrete girders and 4 ft end bent caps.The proposed bridges will not contain
deck drains.Roadway drainage on the east and west side of the bridge are collected by catch basins along concrete medians and shoulders,outletting at the bottom of the
roadway fill slope.Velocities are disspated by rip rap aprons.Temporary causeways will be utilized to provide the contractor with working area for demolition of existing bridges.
Existing bridge columns will be cut down 1 ft below the current ground elevation.No more than 1 temporary rock causeway will be in place at any given time and will cover no
more than half the stream width.
In an effort to reduce wetland impacts,roadway fill slopes in regions near wetlands will be contructed at a 1.5:1 fill slope,reinforced with rock plating.Permanent impacts to the
wetlands mostly occur on the northern westbound fill slope,west of the proposed bridges
Waterbody Information
Surface Water Body(1): South Buffalo Creek NCDWR Stream Index No.: 16-11_14-2
NCDWR Surface Water Classification for Water Body Primary Classification: Water Supply V(WS-V)
Supplemental Classification: Nutrient Sensitive Waters(NSW)
Other Stream Classification:
Impairments: fecal coliform
Aquatic T&E Species? No Comments:
NRTR Stream ID: South Buffalo Creek Buffer Rules in Effect: Jordan Lake
Project Includes Bridge Spanning Water Body? Yes Deck Drains Discharge Over Buffer? No Dissipator Pads Provided in Buffer? N/A
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)

STATE STATE PROTECT REFERENCE N
W STATE OF NORTH CAROLINA NO. SHEETS
N.C. B-5717
DIVISION OF HIGHWAYS fTATRPEW-NO S. T F. N
b ` Aks 45673.1.2 PE
a
.' •• 3000 ' -
\...
it-, ,. 0 ENDTECT DZ 7 GUILFORD COUNTY
Pauly ,60.7':
O ,. ii
— -
carp
whr
le) �, \ 3r4o LOCATION: BRIDGES 109 AND 121 ON SR 4240 (E. GATE CITY BLVD)
p�'l BEGIN y PROJECT 3 N OVER SOUTH BUFFALO CREEK
F�� °,,th Buffalo - N n
3037 3123 Q
I
L! 4� ,�y � �ebR6 3036 ' o V TYPE OF WORK: GRADING,DRAINAGE,PAVING,AND STRUCTURES
�_I 3171Lt` 3033
V
, e
3160 N
L 3156 1+1 � WETLAND AND SURFACE WATER IMPACTS PERMIT ��
'-!i ,64 31.7 ` J N
Fg VICINITY MAP OCTOBER 2021 �zz
See Sheet 1A For Index of Sheets NOT 2n SCALE
See Sheet 1 B For Conventional Symbols PERMIT D RAW I N G
SITE 5 SHEET 01 OF 17
visi BEGIN TIP PROJECT B-5717 4 SITE 7 5
-L- STA 11+00.00 SITE 2 SITE E 4 END CONSTRUCT10
BEGIN BRIDGE 's -Yl- STAI31-00.00 ND TIP P .ROJECT 8- 717
q L +AGQ� -L f 1 t cE PARK Ito
s$0RO V SR 3140
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SITE 4w END BRIDGE
-L- STA.22+29 #/-
I
THERE IS NO CONTROL OF ACCESS ON THIS PROJECT. '- ..IT E _
CLEARING ON THE PROJECT SHALL BE TO THE LIMITS
ESTABLISHED USING METHOD II. _
- L________ INCOMPLETE PLANS
DO NOT USE FOR R/W ACQUISITION
4, THIS PROJECT IS WITHIN THE MUNICIPAL BOUNDARIES
DOCUMENT NOT CONSIDERED FINAL
* OF THE CITY OF GREENSBORO. UNLESS ALL SIGNATURES COMPLETED
F» 1
EA69 61
V f GRAPHIC SCALES DESIGN DATA PROJECT LENGTH Prepared In the Office or: HYDRAULICS ENGINEER
NC FIRM LICENSE No:F-0342
ADT 2020 = 18,184 A=COM 701CorporaRe Ce to 207607,Suite 475
50 25 0 50 100 ADT 2040 = 20,100 [phone] - [phone](FAX) r
NOR g
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��» LL ROADWAY DESIGN e
w*w l I I I I-� V = 50 MPH MAY 26,2021 TIMOTHY KLOTZ,P.E. A.
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(f)Az O PROFILE (HORIZONTAL) * UST =1% DUAL 4% c� tit fie
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PERMIT DRAWING I HEREBY CERTIFY THESE PLANS
ARE THE AS-BUILT PLANS
SHEET 15 OF 17
(+)0.50287. O (-)0.7000%
SPAN A SPAN B SPAN C
GRADE DATA —L-
INT. EXP. EXP. EXP. EXP. INT.
PI = 23+10.00
LOW CHORD EL = 721.20'
VC = 150'
FILL FACE (0 END BENT 1 EL.714.36 FILL FACE CO END BENT 2 K = 125
LIMITS OF UNCLASSIFIED NORMAL WATER
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EL.TBD FREQUENCY OF DESIGN FLOOD = 50 YRS.
INTEGRAL INTEGRAL DESIGN HIGH WATER ELEVATION = 710.0 FT.
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BENT 1 BENT 2 BASE HIGH WATER ELEVATION ............. = 710.3 FT.
OVERTOPPING FLOOD DATA
SECTION ALONG RIGHT WORKLINE OVERTOPPING DISCHARGE = 17,500 CFS
a FREQUENCY OF OVERTOPPING FLOOD = 500± YRS.
o_ (SECTIONS AT END BENTS AND BENTS ARE AT RIGHT ANGLES) OVERTOPPING FLOOD ELEVATION
AT SAG 530'WEST OF END BENT 1
pSTA.14+85 +/- -L- ....................... = 718.2 FT.
0
BENT 1 CONTROL LINE BENT 2 CONTROL LINE W.P.14 END BENT 2
W.P.13 CO BENT 2
FILL FACE
m
STA.21+60.84 -L- STA.22+20.84 -L-
8 W.P.11 (0 END BENT 1 W.P.12 (0 BENT 1 BRIDGE ID
g STA.21+22.00 -L-
P. FILL FACE \ STA.20+60.84 -L- t BRIDGE END APPROACH SLAB
STA.20+05.84 -L-
°
§ L STA.21+13.34 -L- STA.22+44.88 -L-
20+i0.00
oil ! iS72°35'47.8"E, �"
I BEGIN APPROACH SLAB ` ,
STA.19+81.80 -L- /a RIGHT LANE
s n120°00'00" WORKLINE
_'y .. Gj . /' (TYP.) 6., /> d
/'f
/ •
/`C w // / �
x BEGIN FRONT SLOPE / /// /� i /// // /
STA.19+91.60 -L- / V
// // 7 // ///
BEGIN FRONT SLOPE
// / // �� / / /// /� STA.22+35.35 L
// / /
FILL FACE a �/ o~�Q 4 120°00'00" �// // ILL FACE
° END BENT 1 h ` (TYPO 09`�e / (- END BENT 2
PTO E.FLORIDA ST �� `� TO SR 3140
p
�`, �� PROJECT NO. B-5717
F t.. TEMPORARY o SUISTIUC ' GUILFORD
I L F O R D SUBSTRUCTURE
COUNTY
��� ACCESS (TYPO Q (TYP.)
[If/Ill,H /N/� , WWI RIPSRAPI +
N 1-,� 1-,0 (TYP.EA.END) STATION: 21 22.00 —L-
8 FQRTy MTN, /„. F�RTy MTN
/���8o,�y/ (4F�F9eP/T'41 — MEET 1 OF REPLACES BRIDGE NO. 109
A_COM
52'-6" 47'-6" STATE OF NORTH CAROLWA
ti 1 DEPARTMENT OF TRANSPORTATION
55' 0" + 100'-0" 60' 0" °M,E RALEIGH
a.
SPAN A SPAN B SPAN C s;sE """°wum°rtEmPom PRELIMINARY
215'-0°(FILL FACE TO FILL FACE) GENERAL D R A W I N G
w
.54 FOR BRIDGE ON SR 4240 OVER
S. BUFFALO CREEK BETWEEN
E. FLORIDA ST. AND SR 3140
(RIGHT LANE)
E PLAN
REVISIONS SHEET NO.
2" DRAWN BY : M.L.CATER DATE : 03/2021 (DRILLED PIERS AND PILES NOT SHOWN FOR CLARITY) No. Br: DATE: NO. BY: DATE: S1-01
' CHECKED BY : D.R.DRUM/G.R.COLS DATE : 03/2021 DOCUMENT NOT CONSIDERED TOTAL
wi DESIGNED BY : G.L.HAMILTON DATE 03/2021
FINAL UNLESS ALL c91 / SHEETSL
`j. DESIGN CHECKED BY : D.R.DRUM DATE : 03/2021 SIGNATURES COMPLETED Lc

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
19+00 19+50 20+00 20+50 21+00 21+50 22+00 22+50 23+50
PERMIT DRAWING (+)0.5o28i (-)0.7000z
SHEET 16 OF 17
GRADE DATA —L—
SPAN A SPAN B SPAN C PI = 23+10.00
EL = 721.20'
VC = 150'
INT. EXP. EXP. EXP. EXP. INT. K = 125
FILL FACE 2 END BENT 1 LIMITS OF UNCLASSIFIED NORMAL WATER
STA.20+23.16 -L- 1'-6" STRUCTURE EXCAVATION (TYPO SURFACE EL.698.0± FILL FACE (9 END BENT 2
_ 750 WORKLINE EL.719.76 (TYPO BASE HIGH WATER
— TOP OF TEMPORARY STA.22+38.16 L
ACCESS EL.700.0 (100-YR)EL.710.3 WORKLINE EL.720.84
0"MIN. TYPO
740 EARTH BERM EXISTING BEGIN FRONT SLOPE
BEGIN FRONT SLOPE TYPO SUBSTRUCTURE
730 STA.20+09.27 -L LOW CHORD [(TYP.) STA.22+52.35 LWOL.719.69EL.713.59LOW CHORD I WORKLINE EL.720.90
720 CC °),° ci EL.714.63 6
�'� 10 EL, <�° - - EL.714-
710 11.\-\\\
I II ------- APPROXIMATE EXISTING
De_ = 1' 0"MIN. . 1 1 I I F( / GROUND LINE
— 700 (TYPO II \\ m - I - �OJ / II 2'-0"THICK
EXCAVATE TO_ EL.707.60 _, I = - 4 v Al CLASS II
Ww — 690 HP 12 X 53 1 1 o RIP RAP
Q,6STEEL PILES F F EXCAVATE TO (TYP.)
UNCLASSIFIE EL.709.70
°� - TYPO STRUCTURE G9 Gp 6 w 11/2:1 SLOPE
— 680 EXCAVATION Gx o* NORMAL TO CAP
(TYPO (TYPO
TOP OF DRILLED PIER HYDROGRAPHIC DATA
TOP OF DRILLED PIER
EL.TBD EL.TBD DESIGN DISCHARGE = 4,400 CFS
FREQUECY
INTEGRAL 3'-6"DIA.DRILLED PIER INTEGRAL DESIGN HI OF DESIGN FLOOD = 50 YRS.
(TYPO HI WATER ELEVATION = 710.0 FT.
DRAINAGE AREA ........................ = 31.7 SO.MI.
END BENT 1 BENT 1 BENT 2 END BENT 2 BASE DISCHARGE (6100).................. = 4,700 CFS
BASE HIGH WATER ELEVATION ............. = 710.3 FT.
OVERTOPPING FLOOD DATA
SECTION ALONG LEFT WORKLINE OVERTOPPING DISCHARGE = 17,500 CFS
FREQUENCY OF OVERTOPPING FLOOD = 500± YRS.
(SECTIONS AT END BENTS AND BENTS ARE AT RIGHT ANGLES) OVERTOPPING FLOOD ELEVATION
AT SAG 530'WEST OF END BENT 1
P STA.14+85+/- -L- 718.2 FT.
N
h
O
j
e
Ci
9 EXISTING
SUBSTRUCTURE /
YPO (7 CLASS II RIP RAP
g (TYP.EA.END)
§ ILL FACE W.P.22 BENT 1 :1 4 W.P.23 2BENT W.P.24 Ca EN BENT 2 AV
END BENT 1 STA.20+78.16 -L- ' .21+78.16 FILL FACE
// STA STA.22+38. -L-
TEMPORARY /
W.P.21 2 END BENT 1 ; ACCESS (TYPO
s •STAFILL 20A 23.16 -L- 5 g �CE �� , FILL FACE 2
p , END BENTFRONT
/ ,/ // /
BEGIN FRONT SLOPE // / /// /// // // // // BEGIN FRONT SLOPE
STA.20+09.27 -L- / / / // J;/,-/ / / / STA.22+52.35 L
/ o / // m 00// // / END APPROACH SLAB
BEGIN APPROACH SLAB / / tiQ / / / �� // // / STA.22+62.20 L
STA.19+99.12 L / nP` o n� 09 e / // LEFT LANE WORKLINE
,TO E.FLORIDA ST �. b /� TO SR 3140�
zo+ o.00 �� BRIDGE 120°00'00" PROJECT NO. B-5717
m /m --� / STA.21+30.66 -L- (TYPO ' S72°35'47.8"E
�� l ,� ' ► GUILFORD COUNTY
8 -L_ 20"OO'QQ" BRIDGE ID 0 STATION: 21+22.00 -L-
I. (TYPO STA.21+22.00 -L- /
hBENT 1
N Fq,5,T MT CONTROL LINE F4,9, 4
d F/° y F4° y IICCT 1 OC REPLACES BRIDGE NO. 121
2FfrFC,B6RM (4F F<9eoRM
BENT 2 A-COM STATE OF NORTH CAROLINA
CONTROL LINE N DEPARTMENT OF TRANSPORTATION
ry
52'-6" 47'-6" aecomiec ccEwEaomEsunens RALEIGH
MeCoVN
tvum m.�ml-91 PRELIMINARY
55' °" ��
100 °° 60' ° GENERAL DRAWING
SPAN A SPAN B ,-1... SPAN C _
w
FOR BRIDGE ON SR 4240 OVER
21s' o"(FILL FACE TO FILL FACE) S. BUFFALO CREEK BETWEEN
E. FLORIDA ST. AND SR 3140
(LEFT LANE)
E PLAN
REVISIONS SHEET NO.
DRAWN BY : M.L.CATER DATE : 03/2021 (DRILLED PIERS AND PILES NOT SHOWN FOR CLARITY) No. DO, DATE: No. DY: DATE: S2-01
', CHECKED BY : D.R.DRUM / G.R.COLS DATE : 03/2021 DOCUMENT NOT CONSIDERED TOTAL
wi DESIGNED BY : G.L.HAMILTON DATE 03/2021 11
FINAL UNLESS ALL / SHEETS
''. DESIGN CHECKED BY : D.R.DRUM DATE : 03/2021 SIGNATURES COMPLETED Lc

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** 12+77-12+88-L-RT Utility Reloc.*** <0.01 <0.01
2 13+62-19+94-L-LT Roadway Fill 0.02 0.07
3** 19+40-19+80-L-RT Roadway Fill/Util Reloc. <0.01 0.01 0.04
4** 20+56-20+75 -L-LT Bridge <0.01
5** 20+88-21+05-L-LT Bridge <0.01
6 20+67-21+81 -L-R/L Temp.Causeways 0.07 145
7 22+13-22+73-L-LT Bridge 0.02
TOTALS*: 0.03 0.01 0.13 0.07 0 145 0
*Rounded totals are sum of actual impacts
NOTES:
** Isolated Wetlands NC DEPARTMENT OF TRANSPORTATION
***Guy wire removal DIVISION OF HIGHWAYS
Roadway Fill includes Dissipator Pad quantities where applicable 10/20/2021
Guilford County
B-5717
45673.1.2
Revised 2018 Feb SHEET 17 OF 17

Action ID Number: SAW-2022-00263 County: Guilford
Permittee: NC Department of Transportation (Attn: William Barrett)
Project Name: NCDOT/B-5717/Bridges 109 and 121 / SR 4240/ South Buffalo Creek/Guilford
County/Division 7
Date Verification Issued: 02/17/2022
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

SAW-2022-00263
A. Determination of Jurisdiction:
1. /Z1 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). This determination may be relied upon for a period not to exceed five years from the date of this notification,provided
there is no change in law or our published regulations or new information that warrants revision of this determination.
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). This determination may be relied upon for a period not to exceed
five years from the date of this notification,provided there is no change in law or our published regulations or new information
that warrants revision of this determination.
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 jurisdictional areas within the above-described project area have been identified under a previous action.Please reference
jurisdictional determination issued_. Action ID:_.
B. Basis For Determination: See the Preliminary Jurisdictional Determination form dated 02/17/2022.
C. Remarks:
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]
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 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: 2022.02.17
Corps Regulatory Official: 15:37:57 -05'00'
David E.Bailey
Date of JD:02/17/2022 Expiration Date of JD:Not applicable

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant:NC Department of Transportation(Attn: William Barrett) File Number: SAW-2022-00263 Date: 02/17/2022
Attached is: See Section below
▪ INITIAL PROFFERED PERMIT(Standard Permit or Letter of permission) A
▪ PROFFERED PERMIT(Standard Permit or Letter of permission) B
• PERMIT DENIAL C
▪ APPROVED JURISDICTIONAL DETERMINATION D
Z 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 or http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx
or the 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 district 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
Raleigh Regulatory Office CESAD-PDS-O
U.S Army Corps of Engineers 60 FORSYTH STREET SOUTHWEST,FLOOR M9
3331 Heritage Trade Drive,Suite 105 ATLANTA,GEORGIA 30303-8803
Wake Forest,North Carolina 27587
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.Philip Shannin,Administrative
Appeal Officer,CESAD-PDO,60 Forsyth Street,Room 10M15,Atlanta,Georgia 30303-8801
Phone: [phone]