20210816 Ver 1_2014-02098 NWP 39 Tearsheet_20220727

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2014-02098 County: Guilford U.S.G.S. Quad: NC-Guilford/Kernersville
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: PNK Holdings, LLC
Attn: Park Mon Scout!
Address: 1100 Peachtree Street NE, Suite 800
Atlanta, GA 30309
Size (acres) 118 Nearest Town High Point
Nearest Waterway UT to West Fork Deep River River Basin Cape Fear
USGS HUC 03030003 Coordinates 36.079388,-80.004132
Location description: The project area is located within the High Point North Industrial Center, east of Sandy Ridge Road,
north of Joe Drive, and west and south of Adkins Road in High Point, Guilford County, North Carolina.
Description of projects area and activity: This verification authorizes the permanent discharge of fill material into 0.0197 acre
(158 linear feet) of stream channel and 0.027 acre of riparian non-riverine wetlands and the temporary discharge of fill
material into 0.0026 acre (26 linear feet) of stream channel for construction of the PNK High Point industrial development.
This activitv is considered nart of the High Point North Industrial Center single and comnlete nroiect.
"Reference also the NWP 14 verification issued under separate cover on 7/27/2022, using the same Action ID (SAW-2014-
02098) for another portion of the High Point North Industrial Center single and complete proiect: the access road to the PNK
High Point industrial develonment (also known as nhase 1 of the Gallimore Dairy Road extension).
Applicable Law(s): ❑X Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Nationwide Permit 39. Commercial and Institutional Developments
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 5/24/2022, additional and revised information submitted via email on 6/27 and
7/7/2022, and the enclosed plans "High Point North Industrial Center" "Overall Impacts Mad' (Sheet No. EX1.10) dated
2/2/2022, "Utility Plan" (Sheet No. C5.0), "Impact Plan, PNK- High Point" dated 5/19/2022, and "French Drain, PNK- High
Point" dated 5/18/2022. 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 (LAMA), 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 [phone] X 30 or David.E.Bailev2(&usace.armv.mil.
Corps Regulatory Official: Date: 2022.07.27 13:47:33-04'00'
Date: 07/27/2022
Expiration Date of Verification: 3/14/2026

SAW-2014-02098
SPECIAL CONDITIONS
1. In order to compensate for impacts associated with this permit, mitigation shall be provided in
accordance with the provisions outlined on the most recent version of the attached Compensatory
Mitigation Responsibility Transfer Forms (2). The requirements of these forms, including any
special conditions listed on these forms, are hereby incorporated as special conditions of this
permit authorization.
2. Groundwater base flow to Stream MSB down -drainage of the authorized impact limits for the
PNK-High Point project component must be maintained per the French drain detail as shown on
the plan sheet labeled "French Drain, PNK- High Point" of the enclosed plans.
3. Stream and wetland impacts authorized herein are considered part of the High Point North
Industrial Center single and complete project. Please note that future impacts and/or phases of the
PNK-High Point and Gallimore Dairy Road extension project components, as well as future
impacts and/or phases of the High Point North Industrial Center and related activities associated
with Corps Action ID: SAW-2014-02098, may be considered part of a single and complete project.
These impacts may be considered cumulative with impacts authorized during earlier phases with
respect to compensatory mitigation and Nationwide Permit thresholds. Current cumulative
impacts to waters of the US for the High Point North Industrial Center single and complete
project include a total loss of 0.0197 acre (158 linear feet) of streams and 0.027 acre of wetlands, or
a total of 0.0467 acre of waters of the US.
Date: 2022.07.27
13:47:02-04'00'
Corps Regulatory Official:
Expiration Date of Verification: 3/14/2026
Date: 07/27/2022
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 hgps://regulatory.ops.usace.army.mil/customer-service-survey.
Copy furnished electronically:
Brad Luckey, Pilot Environmental, Inc.
Sue Homewood, NCDEQ-DWR

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: PNK Holdings, LLC Action ID: SAW-2014-02098
Project Name: High Point North Industrial Center - PNK-High Point project component County: Guilford
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that Wilmington District Project Manager identified on page two is in receipt of a signed copy of this form before conducting
authorized impacts, unless otherwise specified below. If more than one Mitigation Sponsor will be used to provide the
mitigation associated with the permit, or if the impacts and/or the mitigation will occur in more than one 8-digit Hydrologic
Unit Code (HUC), multiple forms will be attached to the permit, and the separate forms for each Sponsor and/or HUC must
be provided to the appropriate Mitigation Sponsors.
Instructions to Sponsor: The Sponsor verifies that the mitigation requirements (credits) shown below have been released
and are available at the identified site. By signing below, the Sponsor is accepting full responsibility for the identified
mitigation, regardless of whether they have received payment from the Permittee. Once the form is signed, the Sponsor
must update the bank ledger and provide a copy of the signed form and the updated ledger to the Permittee, the Project
Manager who issued the permit, the Bank Project Manager, and the District Mitigation Office (see contact information on
page 2). The Sponsor must also comply with all reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements
Permitted Impacts Requiring Mitigation*: 8-digit HUC and Basin: 03030003, Cape Fear River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
54
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements: 8-digit HUC and Basin: 03030003, Cape Fear River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
108
Mitigation Site Debited: EBX sponsored RES Cape Fear 03 Umbrella Mitigation Bank - Feed and Seed Site
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCDMS, list NCDMS. If the NCDMS
acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsibility for
providing the mitigation identified in this document (see the table above), associated with the USACE Permittee and Action
ID number shown. I also verify that released credits (and/or advance credits for NCDMS), as approved by the Wilmington
District, are currently available at the mitigation site identified above. Further, I understand that if the Sponsor fails to provide
the required compensatory mitigation, the USACE Wilmington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the mitigation requirements.
Mitigation Sponsor Name:
Name of Sponsor's Authorized Representative:
Signature of Sponsor's Authorized Representative Date of Signature
Page 1 of 2 Form Date July 7, 2020

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the District is in receipt of the signed form, the
Permittee is no longer responsible for providing the mitigation identified in this form, though the Permittee remains
responsible for any other mitigation requirements stated in the permit conditions.
• Construction within jurisdictional areas authorized by the permit identified on page one of this form can begin only after
the District is in receipt of a copy of this document signed by the Sponsor, confirming that the Sponsor has accepted
responsibility for providing the mitigation requirements listed herein. When NCDMS provides mitigation for authorized
impacts conducted by the North Carolina Department of Transportation (NCDOT), construction within jurisdictional areas
may proceed upon permit issuance; however, a copy of this form signed by NCDMS must be provided to the District
within 30 days of permit issuance. NCDOT remains fully responsible for the mitigation until the District has received this
form, confirming that the Sponsor has accepted responsibility for providing the mitigation requirements listed herein.
• Signed copies of this document must be retained by the Permittee, Mitigation Sponsor, and in the USACE administrative
records for both the permit and the Bank/ILF Instrument. It is the Permittee's responsibility to ensure that the District
Project Manager (address below) is provided with a signed copy of this form.
• If changes are proposed to the type, amount, or location of mitigation after this form has been signed and returned to
the District, the Sponsor must obtain case -by -case approval from the District Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios maybe applied, as per current District guidance
and a new version of this form must be completed and included in the District administrative records for both the permit
and the Bank/ILF Instrument.
Comments/Additional Conditions:
• A letter from RES, confirming they are willing and able to accept the applicant's compensatory mitigation
responsibility was provided.
• The stream credits required correspond to 54 linear feet of impacts at 2:1,.
This form is not valid unless signed below by the District Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor should provide copies of this form along with an updated bank ledger to: 1) the Permittee, 2) the
District Project Manager at the address below, 3) the Bank Manager listed in RIBITS, and 4) the Wilmington District
Mitigation Office, 3331 Heritage Trade Drive, Suite 105, Wake Forest, NC27587 (or by email to [e-mail]).
Questions regarding this form or any of the permit conditions may be directed to the District Mitigation Office.
USACE Project Manager: David E. Bailey
USACE Field Office: Raleigh Regulatory Office
US Army Corps of Engineers
3331 Heirtage Tade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: [e-mail]
Date: 2022.07.27
13:46:44-04'00'
Wilmington District Project Manager Signature
July 27, 2022
Date of Signature
Current Wilmington District mitigation guidance, including information on mitigation ratios, functional assessments, and
mitigation bank location and availability, and credit classifications (including stream temperature and wetland groupings) is
available at http://ribits.usace.army.mi1.
Page 1 of 2 Form Date July 7, 2020

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: PNK Holdings, LLC Action ID: SAW-2014-02098
Project Name: High Point North Industrial Center - PNK-High Point project component County: Guilford
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that Wilmington District Project Manager identified on page two is in receipt of a signed copy of this form before conducting
authorized impacts, unless otherwise specified below. If more than one Mitigation Sponsor will be used to provide the
mitigation associated with the permit, or if the impacts and/or the mitigation will occur in more than one 8-digit Hydrologic
Unit Code (HUC), multiple forms will be attached to the permit, and the separate forms for each Sponsor and/or HUC must
be provided to the appropriate Mitigation Sponsors.
Instructions to Sponsor: The Sponsor verifies that the mitigation requirements (credits) shown below have been released
and are available at the identified site. By signing below, the Sponsor is accepting full responsibility for the identified
mitigation, regardless of whether they have received payment from the Permittee. Once the form is signed, the Sponsor
must update the bank ledger and provide a copy of the signed form and the updated ledger to the Permittee, the Project
Manager who issued the permit, the Bank Project Manager, and the District Mitigation Office (see contact information on
page 2). The Sponsor must also comply with all reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements
Permitted Impacts Requiring Mitigation*: 8-digit HUC and Basin: 03030003, Cape Fear River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
104
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements: 8-digit HUC and Basin: 03030003, Cape Fear River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
208
Mitigation Site Debited: NCDMS
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCDMS, list NCDMS. If the NCDMS
acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsibility for
providing the mitigation identified in this document (see the table above), associated with the USACE Permittee and Action
ID number shown. I also verify that released credits (and/or advance credits for NCDMS), as approved by the Wilmington
District, are currently available at the mitigation site identified above. Further, I understand that if the Sponsor fails to provide
the required compensatory mitigation, the USACE Wilmington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the mitigation requirements.
Mitigation Sponsor Name:
Name of Sponsor's Authorized Representative:
Signature of Sponsor's Authorized Representative Date of Signature
Page 1 of 2 Form Date July 7, 2020

USACE Wilmington District
Compensatory Mitigation Responsibility Transfer Form, Page 2
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the District is in receipt of the signed form, the Permittee is
no longer responsible for providing the mitigation identified in this form, though the Permittee remains responsible for any other
mitigation requirements stated in the permit conditions.
• Construction within jurisdictional areas authorized by the permit identified on page one of this form can begin only after the
District is in receipt of a copy of this document signed by the Sponsor, confirming that the Sponsor has accepted responsibility for
providing the mitigation requirements listed herein. When NCDMS provides mitigation for authorized impacts conducted by the
North Carolina Department of Transportation (NCDOT), construction within jurisdictional areas may proceed upon permit
issuance; however, a copy of this form signed by NCDMS must be provided to the District within 30 days of permit issuance.
NCDOT remains fully responsible for the mitigation until the District has received this form, confirming that the Sponsor has
accepted responsibility for providing the mitigation requirements listed herein.
• Signed copies of this document must be retained by the Permittee, Mitigation Sponsor, and in the USACE administrative records
for both the permit and the Bank/ILF Instrument. It is the Permittee's responsibility to ensure that the District Project Manager
(address below) is provided with a signed copy of this form.
• If changes are proposed to the type, amount, or location of mitigation after this form has been signed and returned to the District,
the Sponsor must obtain case -by -case approval from the District Project Manager and/or North Carolina Interagency Review Team
(NCIRT). If approved, higher mitigation ratios maybe applied, as per current District guidance and anew version of this form must
be completed and included in the District administrative records for both the permit and the Bank/ILF Instrument.
Comments/Additional Conditions:
• A letter from NCDMS, confirming they are willing and able to accept the applicant's compensatory mitigation responsibility
was provided.
• The stream credits required correspond to 104 linear feet of impacts at 2:1,.
This form is not valid unless signed below by the District Project Manager and by the Mitigation Sponsor on Page 1. Once signed, the
Sponsor should provide copies of this form along with an updated bank ledger to: 1) the Permittee, 2) the District Project Manager
at the address below, 3) the Bank Manager listed in RIBITS, and 4) the Wilmington District Mitigation Office, 3331 Heritage Trade
Drive, Suite 105, Wake Forest, NC 27587 (or by email to [e-mail]. mil). Questions regarding this form or any of the
permit conditions may be directed to the District Mitigation Office.
USACE Project Manager: David E. Bailey
USACE Field Office: Raleigh Regulatory Office
US Army Corps of Engineers
3331 Heirtage Tade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: [e-mail]
Date: 2022.07.27
13:46:28-04'00'
Wilmington District Project Manager Signature
July 27, 2022
Date of Signature
Current Wilmington District mitigation guidance, including information on mitigation ratios, functional assessments, and mitigation
bank location and availability, and credit classifications (including stream temperature and wetland groupings) is available at
http://ribits.usace.armV.mil.
Page 2 of 2

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Action ID Number: SAW-2014-02098 County: Guilford
Permittee: PNK Holdings, LLC (Attn: Park Mun Seon2)
Project Name: High Point North Industrial Center — PNK-High Point proiect component
Date Verification Issued: 07/27/2022
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-2014-02098
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). 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 07/27/2022.
C. Remarks: Note that the Approved Jurisdictional Determination issued for portions of this property expired on 11/19/2019.
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
PHILIP.A. SHANNINgUSACE.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 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: 2022.07.27
Corps Regulatory Official:
13:46:10-04'00'
David E. Bailey
Date of JD: 07/27/2022 Expiration Date of JD: Not applicable

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Pilot Environmental, Inc. File Number: SAW-2014-02098
Date: 07/27/2022
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
❑X
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.miUMissions/CivilWorks/ReaulatoryProgramandPenuits.asi)
OZI& 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: PHILIP.A.SHANNIN(aUSACE.ARMY.MIL
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 opportum to participate in all site invest] 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. Philip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]