20210923 Ver 2_Wentworth NW 3 Permit_20221006

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2019-00831 County: Rockingham U.S.G.S. Quad: NC -Reidsville
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Pennittee: NCDOT Division 7
Attn: Wright Archer III, PE
Address: PO Box 14996
Greensboro, NC 27415-4996
Size (acres) —18 Nearest Town Reidsville
Nearest Waterway Wolf Island Creek River Basin Roanoke
USGS HUC 03010103 Coordinates 36.37237,-79.685748
Location description: The project area is located at Bridte No. 239 on SR 1998 (Wentworth Street) over Wolf Island Creek in
Reidsville, Rockinuham County, North Carolina.
Description of projects area and activity: This verification authorizes the discharge of clean fill material associated with removal
of an existing bridue (Bridue 117 on SR 1780). The proiect includes permanent impacts to <0.01 acre (54 linear feet) of stream
channel (bank stabilization) and temuorary impacts to 0.01 acre (65 linear feet) of stream channel. The proiect also reauires
hand clearing in 0.01 acre of riparian non-riverine wetlands.
Applicable Law(s): © Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: NWP 3. Maintenance
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 6/23/2021, and the enclosed plans "Wetland and Surface Water Impacts Permit",
Permit Drawing Sheets 1 throuuh 5. 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 pennit. 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 terns 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 pennit'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/pennits. 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.Bailev2nusace.armv.mil.
Jp Date: 2021.07.28 15:08:29 -04'00'
Corps Regulatory Official: ��° Date: 07/28/2021
Expiration Date of Verification: 03/18/2022

SAW-2019-00831
SPECIAL CONDITIONS
1. Historic Properties (MOA): The Permittee shall fully implement the Memorandum of Agreement
between the Permittee, the North Carolina State Historic Preservation Officer and the U.S. Army
Corps of Engineers, Wilmington District, dated October 2, 2019, which is incorporated herein by
reference.
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.
3. 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.
Date: 2021.07.28
-M- 15:08:08-04'00'
Corps Regulatory Official:
Expiration Date of Verification: 03/18/2022
Date: 07/28/2021
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 htt rLa/Lrc_gulq1t:2LJ�QLrs�L tq 'inln�gl dust-O�ci s€,1_v_ic�,_suI- eLC
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

10.1.813.101 MIMI
,AMONG THE U.S. ARMY CORPS OF ENGINEERS,
THE NORTH CAROLINA DEPARTMENT OF TRNNSISO RTATION,
AND
T] IE NORTH CAROLINA STATE FIIS'l I ORIC PRESERVATION OFFICER
FOR
REPLACEMENT OF'BRIDGE NUMBER 239 ON SR 1998 (WENTWORT H STREET
OVER WOLF ISLAND CREEK
ROCKINGHAM COUNTY, NORTH CAROLINA
WTI S No. 1713P.7.R.140
PA No. 1-1-0025
AID# SAW-2,019-00831
WHEREAS, the (I.S. Army ps OfF,11,16racers 7'sl'\(J ") is considcsil l-1119 isl.111cc Ofa permit under
Section 404 of ilic C.1can V7,mcr Act tar the Nortli ("'arobina Dcl-mrtincrit ofTransportation (N('-'1)0'1)
for Replacement o f Bridge N unitm- 239 on SR 1998 (Went -woo au Strect) over Wol f lsla ild (seek,
Rockingh,am (..'ounty, North, (:arofima (ttic t Indertaking,'); and
WHEREAS, the has cletermilled dint the 1- I ndertaking will have anadversc effecr upoll
Rockinghan'i (','(')umy Bridge Nuinber 239,a property determined cligible for listing In the Nntional
Register of I fist(',)mcf)laccs (NR111") (historic property); ancl
WHEREAS, the IJSACJ"��" ]US corlsulted with the North (",atc)lina State 1-11storic Preservation Officer
(`ail 1)(J) pursuant to 36 CFR, llart 800, rcgulations iniplemcnang Section 106 of the National
llistoric 1'reserv:ation Act (16 1).S.C. 47001- and
WHEREAS, (-j")"%cll"
I has sic:;atificd the /\dvisory ("'ouncil on 1--listotic Prescrvation (COLincl,l) of dic
'ah; andadvmc effects and the ("ouncihas dcclLned to coniment or patcntcconsutaton
WHEREAS, N('I)(,)'"I'has parilcipatcd in the consultation and has been invited b), the
sfill() lo'o lac as signatory to dill N4ernorandurn ofAgrect-nent (:Nl()A);aad
NOW, THEREFORE, N(A)(")]"' arld the SI-11k), agree that any authorization Issued for
J_'
Lllg,.Il, iclude tJlC I'01,10\611g $tipLlklt'S't0 intoaccourit the effect of the
the t-Isidet,IkI 'ffl It I I()Tl
,Ikillg oll thC hL."
I , toric property.
for \umber 239
Rc,)ckinghmn
P911

STIPULATIONS
The L)SACE" will require corripliance with the following rneasurcs by including a spccl.-.11 conditic'm ill
any authorization that is issued tuw NC: DC)"I'for the U)iidertaking.
I. Photo recordation
Prior to the InItiatiori of construction, will record the existing condition of Bridge No.
239 and its surroundings in accordance with the attached I listoric Structures and I andscape
1iecordaticni Plan (Appendix A). (."OPICS Of the (.10CLITTIClitation will Ile deposited In the files of
the State Historic prcservati()n Office, and the Historic Architecture Section.
11. Unanticip-med Discovery
In accordance with 36 ("Flk 800.11 (a), if NCDOTidentifies additional CUltUral resotirCe(s)
durflig Construction, all work will be halted withiii the Lin-InS Of the Mac: Urce(s) and the USACF'
will be contacted. The USACF will initiate the apl-.noptiate, agency and/or Tribal coo')rdinati(',)n
required f(..)i- a detern'Wilation of eligibility or recovery effort, If after consultation I)etwccri. the
Signatories and concurritig parties, additional initigatioi-t is detcrtnined necessary, the N(A)OT,
in consultation with dic Sigmatories and concurring p-arties, will dcvclopand irlipicnictit
appropriate protection/mitigation nieaSUres for the resource(s). Inadvertent czar accidental.
discovery of human remains will be handled in accordance with North ("arolina General
Statutes 65 and 70.
HL Amendments
Should any of the Signatory Party(les) to this MOA 1"Ielieve that its terms cannot be carried out
or that an aniendnient to the terrns must be tirade, that party(ies) shall, in-imcdiately consult
with the other party(ics) tr.) de\,clop aniendinents in accordance with 36 CFIZ 800,6(c)(7), 'I'lils
NJOA nay be arriended wheit such an amendment is agreed to in writing by all sigliatories. The
amendment will be effecti%,e on the date a c( py, signed by all of the signatories, is filed with
the ACFIR If an ainendnient cannot be agreed Up -On, the (hSJ)Ute resolution process set forth
in StipUlation 1\1 will be followed.
IV. Dispute Resolution
Should any of the parties to this MOA object within (30) days to any plans, or dOCUIT-lentation
pruvided for reN�I-C%V pUtSUe'Int to this 1,\10A, the USM-1," shall Colisult with the ob)ccting
party(tes) to resolve the objection. If the USACT" or the objecting party(ics) dercrinisies that
the Objection cannot be resolved, the USACF, will f()r,,Nard all dOCUMC114,16011 rCICVallt tO the
dispute to the Council. Within thirty (30) days after receipt of all pertinent documeritatUin, the
Council will either:
1, I)rovide the L'SACE` with rcconiniendations, xvbich the Lf'SACIF, will take into accouilt, ill
reaching as final decision regarding the dispute, or
1 Notif ' y the USACF, that it will C011-inlCilt pursuant to 36 CTR Section 800.7(c) and proceed to
M COInent. �\I-INTC(..)LIllCil,C(-)I'YIIIIClltprovided in response to, such a request will be taken into
account by the USACU, in accordance with 36 ("I'lk Scalon 800.7(c')(4) with reference t(") the
Sub,lect of the dispute,
MOA for Bridge Number 239
Rockinghmn C(.)untV
P9, 2

Any recon-imendations or comments Provided by the COLITICA Will Ile'understood to pertain
only to dic all of the dispute; the si�n, ) , atorics' respo nsibili ties tbat, are not the subject of thL
d,I%PL,ItC 'Will r0-11.11i.11 unchanged.
,.I
V. Termination
Any of the Signaic)ry Party(ics)t(-,) this NIOA rnay terminate the agreernent by I)r(widing notice
to the otber parties, provided that the signatories and concurring parties will c()nsult duting the
period prior to tertnimajon to seek agreernent, on an-wndments or rather actiro that would
aVOid tertninarion, 'rermination of this NIOA vvill, require conipliance with 36 CIFR 84lll. "This
MOIN may be tertninated by the execution of a subsequent MOA fli-at explIcitly terminates, or
supersedes its terms,
VI. Duration
(.1inless tertlairiated pLarsuant to Stipulation XII above, this MON will be in effect uritil thc
LTSAC'E, in cotisultation with the other Signatory Parties, determines that all of its ternis have
[caeca, fulfilled or if Ncmar is unable or decides not to construct the Undertaking
F"xecution of this MOA by USACE, NCDOT, arld the North ('arolinn Sl"IPO, its subsocluent, filing
with tile Council, and irnplernentation of its terms evidence that the I 1S,ACT'�" bas afforded tile
Council an opportunity tra comment on the Undertaking, and that US,t\('E has taken into acccitint
the effect of the Undertaking on tile, historic property.
MOA f(,)r Briclge NLIIIIIXT239
Rockingham COUIlry
pg3

AGREE:
United States Army Corps of Engineers:
FOR THE COMMANI�ER
Scott McLendon
Chief, Regulatory Division
Wilmington District
State Historic Preservation Officer:
Zo
Date
r Date:
Kevin herry, Ph. D.
Deputy Secretary North Carolina Department of Natural and Cultural Resources
North Carolina Department of Transportation;
r�.
Date:
tPhilipS. Hai III, P.E., CPM
Environmental Analysis Unit Head
MO A for Bridge Number 239
Rockingham County
pg. 4

MEMORANDUM OF AGREEMENT
AMONG THE U.S. ARMY CORPS OF ENGINEERS,
THE NORTH CAROLINA DEPARTMEiNT'OF'T;RANS�P'ORTATION,
AND
THE NORTH CAROLINA STATE HISTORIC PRESERVATION OFFICER
FOR
OVER WOLF ISLAND CREEK
ROCKINGHAM COUNTY, NORTH CAROLINA
1,"',XCCLAH0n, Ofthis N4(.)A by USACF',, NCD0'1-', and the Nordi its, subsequent filing
with the (."ouncil, and i,niplementation of its terms evidence that the l,-'SAC1 ',1 has afforded the
Clouncil ar, opporturnty to conitnent on the Undertakirig, and that USACE has taken into account
the effect of the Undertaking on the historic property.
Date:
Advisory ("'ouncil on tfistoric Preservation
MOA for Bridge Number 239
Roc�Mpbmn Count)`
pg.

APPENDIX A
Histotic Structures and Landscaped c orcdation Plan
For
The Replacement of Bridge Number 239
on SR 1998 (Wentworth Street) over Wolf Island Creek
Rocklihigham County, North Carolina
Pl,],O'I'OGRAP� lilc'RIFQ(�IRENI"F,�N"I'S
I$ F'Ilc°vatiotvs and obhquo: views of firldge Numbcr 239 and its setting,
61 Representative structuraland, ortiatnental details of the bridge.
Photographic Format
• (-,(.)]or digital ini.,,iges (al.] views). linages are to be shot on as SLA digital camera with as mininium
resolution o)f 6 tnegabyte pixels, at as high quality (ptefcrably RAW), setting, to be saved in 'I'll,
fortnat as the archival masters and labeled according to dic State Historic Preservation Office
standards,
• All pr(:,)cesstlig (o be done to archival standards.
• 'I'he accompanying prilitcd inventory (­,f the images — includIng SUbjCCt, h-wation, date, and
photographer information for catch image --- is to be completed according to the State Ulistonc
Preservafion Office standar&
Copies, and Curation
(..)IAc (1) set of all:above I'l-lentioned P1,10tograpIlic docurnetitation, includ-inga cornpact disc of
Labeled images, wall be deposited Avith theNoilliCarolina Office ofArcNvesand 111story/1-11storic
Prcsen,ation Officc tobe made as perruanent j.-iart of the statewide su.nTey and iconographic
coflection.
One (1) contact sheet shall be deposited in the Files of the Historic Arcl-ii,tecturc ""'ection of
NCDOT
\10A f rr Bridpe Number 239
Rockingluim County
lag, 6

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1998 1987 O� 34
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1713P. R.140
PROJ C 3
LIMIT
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20 6/
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VICINITY MAP
(NOT TO SCALE)
OFF -SITE DETOUR
STATE OF NORTH CAROLINA
DIVISION OF HdG1NIWAY5
ROCI<INGHAM
COUNTY
LOCATION: BRIDGE 1110.239 OVER WOLF ISLAND CREEK
ON SR 1998 (WENTWORTH STREET)
TYPE OF WORD: GRADING, PAVING, DRAINAGE AND STRUCTURE
WETLAND AND SURFACE WATER IMPACTS PERMIT
BEGIN PROJECT I7BP.7.R.140
-L- POT Sta. 11+50.00
WENT bb`f�Tf/--------- SR 1998
(WENTW®fT-H� STR ET)
,
0 /
BEGIN APPROACH B
—L Sta. I3+23.00
BEGIN BRIDGE
—L— Sta. I3+35
-L-
SITE 2
STATE
STATE PROJECT REFERENCE NO.
SHEET
NO.
TOTAL
SHEETS
N.C.
17BP.7.R.140
1
STATE PROD. NO.
F.A. PROD. NO.
DESCRIPTION
Z
�o
SITE / 2
END BRIDGE END PROJECT /78P.7RJ40
-L- Sto.14+00.00 -L- POT Sta. 15t 0.00
--------- TO
-------- NT OW N REI DSV I LLE
FND APPROACH SLAB
—L— Sta. I4+I2.00
PERMIT DRAWING
SHEET 1 OF 5
DOCUMENT NOT CONSIDERED FINAL
UNLESS ALL SIGNATURES COMPLETED
GRAPHIC SCALES
50 25 0 50 100
DESIGN DATA
ADT (2 014) = 1,400
ADT (2025)= 2 800
V = 40 MPH
FUNC CLASS =
MINOR COLLECTOR
SUB REGIONAL TIER
PROJECT LENGTH
LENGTH ROADWAY TIP PROJECT = 0.062 MILES
LENGTH STRUCTURE TIP PROJECT = 0.014 MILES
—
TOTAL LENGTH TIP PROJECT - 0.076 MILES
Prepared In the Office of Simpson Engineers & Assoclates for
DIVISION 7
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
ROADWAY DESIGN ENGINEER
P.E.www.simpsonengr.com
PLANS PREPARED BY:
IMPSON 5640 Dillard Drive
Suite 200
E N SSOCATES 919Cary,52-0468NC 8
[phone] (Fax)
LICENSE NO. C-2521
2018 STANDARD SPECIFICATIONS
DAVID SIMPSON, PE
PLANS
50 25 0 50 100
RIGHT OF WAY DATE:
PROJECT ENGINEER
REID B. ROBOL, PE
SIGNATURE:
HYDRAULICS ENGINEER
PE
LETTING DATE:
v1,1�
VHB Engineering NC, P.C. (C-3705)
940 Main Campus Drive, Suite 500
Raleigh, NC 27606
PROFILE (HORIZONTAL)
10 5 0 10 2I
HYDRAULIC ENGINEER
TIM POWERS, PE
NCDOT CONTACT: DIVISION BRIDGE
PROGRAM MANAGER
11
PROFILE (VERTICAL)
SIGNATURE:

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------------------------------------- ---
DETAIL 1
TOE PROTECTION
( Not to Scale)
1 'qt� FILL
NATURAL pC� SLOPE
GROUND d
GEOTEXTILE
d= 1.4 FT
ZO
Type of Liner= CLASS A RIP -RAP
FROM 14+20 TO 15+30 L RT
DETAIL 2
BANK STABILIZATION
( Not to Scale)
3.0'min.
2.0'
NWS
Q
GEOTEXTILE
Type of Liner= CLASS II RIPRAP
STA 115 + 92 L LT
STA 261 +40 L LT
TO WENTWORTH o
0
01
BL-Q
-- POT Sta. /0+00.6
I�7���J�T17tr��7
—L— JIU. IJTCJ.VV
QCr'IA/ 00f) lCr'T I7007 0 Idn
—L— rVl 13ly. lIT0V.VV
GULUNIAL F'IFLLINL GUMYAN
IRIGHT OF WAY EASEMENT
DB 591 PG 686
BLANKET IN NATURE
CLAIMED EASEMENT 25' FROM
pr.ITCDI WE AC WC 7.1 1 En 1 MCC
JERRY HARDEN
MARGERETTE FOUNTAIN
DB IIII PG 2005
3
I
�o
CP
0
1
BANK STABILIZATI
FESSTT 124 TONS
DD�'lAI DDZT_1LTF_SY
—L— JIU. I4t*V0.I0
PAIGE HARDY HICKS
DB 676 PG 810
WB 14E PG 833
CAROLINA
FOUND
For
FAlll PRn_ lFr'T l7PP 7 P lAn
I- f-V/ J/Uo /.JT:JV.VV
J W MOCARGO
ELKANA C McCARGP
DB 706 PG 675
JS STREAM NOT SURVEYED.
DO NOT IMPACT WITH WORK IN DUE AREA.
GPS LOCTION PROVIDED FOR REFERENCE ONLY
DENOTES IMPACTS IN
SURFACE WATER
DENOTES TEMPORARY
IMPACTS IN SURFACE WATER
DENOTES HAND
CLEARING
TO DOWNTOWN REIDSVIUE
WILLIAM ERNEST SMITH, JR
DB 1498 PG 775
10 11 12 13 14 15 16 17
PROJECT REFERENCE SHEET NO.
17BP.7.R.140 - ROCKINGHAM 239 4
ROADWAY DESIGN HYDRAULICS
ENGINEER I ENGINEER
MOTT MACDONALD I & E, LLC VHB ENGINEERING
LICENSE NO. F-0669 LICENSE NO. C-3705
DOCUMENT NOT CONSIDERED FINAL
UNLESS ALL SIGNATURES COMPLETED
Prepared in the �/�
Office of: M
M1Y1 PO Box 700
MOTT Fuquay-Varina, NC 27526
MACDONALD www.mottmac.com/americas
Via'; I�� VHB Engineering NC, P.C. (C-3705)
`Y, 940 Main Campus Drive, Suite 500
Raleigh, NC 27606
5 VERTICAL SCALE HORIZONTAL SCALE
T 1Q 2P 1 Q 2> ' 5f
PERMIT DRAWING
SHEET 2 OF 5

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'i10111`2 111 F i:: otled
ON 1
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i111■■1■1A■I KWA
'Ill 11■■IMEN I■■I5 WA,
1i1111■■I�■■I■■1►' �i,�►�
"711■oil ■■Ic'i;!'II

TEMPORARY
SW IMPACT
i
w
SW IMPACT
� X
Y TS
---------------- ----- -------
---
---------------------- ---
---------------------
-PROP 0/H
iJ
OW
rE 2�'
Rim
'00
PROP '0 / F
IM 0 0 Q,,S-/
i
DENOTES IMPACTS IN
SURFACE WATER
DENOTES TEMPORARY
IMPACTS IN SURFACE WATER
DENOTES HAND
CLEARING
SITE 1
SSW IMPACT
F
T S
S-ER V I C E
DUE
i
------------------
PROJECT REFERENCE SHEET NO.
1713P.7.R.140 — ROCKINGHAM 239 4
ROADWAY DESIGN HYDRAULICS
ENGINEER ENGINEER
MOTT MACDONALD I & E, LLC VHB ENGINEERING
LICENSE NO. F-0669 LICENSE NO. C-3705
DOCUMENT NOT CONSIDERED FINAL
UNLESS ALL SIGNATURES COMPLETED
Prepared in the �/�
Office of: M
M PO Box 700
MOTT Fuquay-Varina, INC 27526
MACDONALU www.mottmac.corr✓americas
�'o' VHB Engineering I P.C. (C-3705)
�`/I�� 940 Main Campus Drive, Suite 500
Y Raleigh, NC 27606
HORIZONTAL SCALE
6.25' 0 6.25' 12.50'
PERMIT DRAWING
SHEET 4 OF 5
JS STREAM NOT SURVEYED.
DO NOT IMPACT WITH WORK IN DUE AREA.
GPS LOCATION PROVIDED FOR REFERENCE ONLY

WETLAND AND SURACE WATER IMPACTS SUMMARY
WETLAND IMPACTS SURFACE WATER IMPACTS
Site
No.
Station
(From/To)
Structure
Size/Type
Permanent
Fill In
Wetlands
(ac)
Temp.
Fill In
Wetlands
(ac)
Excavation
in
Wetlands
(ac)
Mechanized
Clearing
in Wetlands
(ac)
Hand
Clearing
in
Wetlands
(ac)
Permanent
SW
impacts
(ac)
Temp.
SW
impacts
(ac)
—Existing
Channel
Impacts
Permanent
(ft)
—Existing
Channel
Impacts
Temp.
(ft)
Natural
Stream
Design
(ft)
1
13+53 to 13+86 -L-
Bank Stabilization
< 0.01
0.01
54
65
2
12+27 to 13+19 -L-
1 @70' 24" CORED SLAB W/ 4'-0" CAPS
0.01
TOTALS`:
0.01
< 0.01
0.01
54
65
0
`Rounded totals are sum of actual impacts
NOTES: —Existing Channel Impacts Permanent and Existing Channel Impacts Temp. are coincident

Action ID Number: SAW-2019-00831 County: Rockingham
Permittee: NCDOT Division 7 (Attn: Wright Archer III, PE)
Project Name: NCDOT / Bridge 239 / SR 1998 / Wolf Island Creek / Rockingham County
Date Verification Issued: 07/28/2021
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

SAW-2019-00831
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 pennit 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 deternination may be relied upon for aperiod 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 deternination.
3. ❑ There are waters, including wetlands within the above described project area that are subject to the pennit requirements of
Section 404 of the Clean Water Act (CWA) (33 USC § 1344). This determination may be relied upon for aperiod 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 07/28/2021.
C. Remarks:
D. Attention USDA Program Participants
This delineation/detennination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/detennination 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 deternination 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) forn. If you request to appeal this
detennination you must submit a completed RFA forn to the following address:
US Anny 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.SHANNINCg USACE.ARMY.MIL
In order for an RFA to be accepted by the Corps, the Corps must detennine 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 forn, it must be received at the above address by Not applicable .

SAW-2019-00831
It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence.
Corps Regulatory Official:
Date:2021.07.28
14:56:21-04'00'
David E. Bailev
Date of JD: 07/28/2021 Expiration Date of JD: Not applicable

Wll 5
gC r/
If
Applicant: NCDOT Division 7 (Attn: Wri ht Archer III PE File Number: SAW-2019-00831 I Date: 07/28/2021
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
©
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 1�9t :flviww.usiuce.�u�m� .inn/1iss�onsfCivnn°orks%P.eala%r faro xa�nandPenits,as x
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 I1- 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: P111 IP.A SFIANNIN rr>U�Ac ..ARMY.Mll,
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 opportuni 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. Philip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]