WQ0045274_Project_Lodestar_FTSSE_App_2nd_Submission_20240403

° �6 0- v of 4
State of North Carolina
P1vision
.;,A i f ',4 $"/6 h,'ssecr-t rccaiv*ad Department of Environmental Quality
�
nzy ap. e0 ittaT : n a/tn oFo Afr Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dof Water Resources �� —Z 3 Wu? YLC�"� Vae� p� FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: LWd4S ;1% T (m be completed by DWR)
All items must be completed or the aoolication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Colonial Pipeline Company (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual Z Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Douglas Castleberry per 15A NCAC 02T .0106(b)
Title: Pmject Manager
4. Applicant's mailing address: 1000 Lake Street
City: Alpharetta State: GA Zip: 30009-41. 55
5. Applicant's contact information:
Phone number: (ZJ) 2,'if-44,_1i Email Address: dcas@eberryftolpiye com
II. PROJECT INFORMATION:
1. Project nano: krpjoq Lodestar
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: W000 and issued date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000
3. County where project is located: Guilfo
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0657' Longitude:-79.9474°
5. Parcel ID (if applicable): 99785 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Hubert Saam License Number_ 049308
Finn: Pond & Company
Mailing address: 3500 Parkway Lane, Suite 500
City: Peachtree Comers State: GA Zip: 30092
Phone number: 40 ) 748-4854 Email Address: saamh ondco.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside Wastewater Treament Plant Permit Number: NCPD24M
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. Permit Number(s): WQ^.
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s):
FORM: FTA 10-23 Page I of 5

VLm GC1VL+"itAIMMQIARUIY ENTV
1„
etiachea?,
-a''Yes Uo 9"s'4x,
2;, It lretApplicant is aDeveippero£lots to'besold,$Yis?a'1):eye oi'uer s Ooe tiDn'al A`gmeme UO M_een;attached7i
Yes ❑�?a t�N/A
3;
[[�'olx o- ®N%A,
4� 0'r44il wastewater,~tliat &&--
❑ il'esidenUal (lndw�duall f;(?waed) [� Retad (stot'es, eenferfi>!ma117i
❑Res�dent�al (Leased) � Retad wtt)i food preparat�on/servlcq:
❑ $ cliool /preschool / day, cacti. (] Medlcul / dontall yptgnnary facilities
,�Foadand�lr�nkfac�6hes; ❑Churclu
9Rolne5ffi0Nut sfngN*Ce
5. NCittire of:�va`s"teWate`i �_,I Aoinesho
6 Has:aflotvfedudhonbeefi.approvedundei•=l''.
➢ lf'vds provide a coovo£flow redu'efim
7, Summarize wasfewater;generAied by projects
❑ Car Wash,
E]Halel andlotl4lotels
Sw�minigg PooVCIu1}housv�
Sw��injngPooUFjite?Backtvasji
:0 Othels(EX�IIam in;A(tachmept)
C�sfa67ishmenE.Type (see b21' U114(f))�
p�ily Design Flowv�6
No, of LJmte
Flog'
Busiuesses.wMrsliowers
3S gaVemployee/shlR
T -
245 GPIs
gaf/
GPD
.gall
xGpb
ToraJ,
245 OPD
r
8:
b;
A ;Do nof'incliide fiititaCe flowssat previously-pC
If p"ei mitfed`'floiv.ls' zeroi �4ease.inilic`ate �vliy
[]El'owaiasalreadybeen;aifoctifed•inSPermitNumler€ 'dssaancolYater_
'ltelieiiilitafionocreplaceinenfofezisting;sewerswiilrnanew,flow:expce d
`O`tberOxplaih) _
tgi-connect to tlris!linci.
EORM.TTA,10-23., :Paget2 o£S.

'VU. GRkV1TY'SEINER-,DESIGNCRMRIA(I[ApplicabTef=_'6LTii565'&=MDC7Gra"vltvSewersl':
1-< Smmnarizegravity.sewerto`tie,pennift d:
`Siie(Inetiesj �L;edgth (feeet) Mnferial � �
i
l
}
A Seeiiori li & 11I oEtfie'1v1DC'for P.em
Section'11I'contafns`infonnationretal
> 'OverslAnwIluesfo_meel,mrrilmum
'Villa,
in of theR4DG
T Pump;sth6mnumbcrorname:
1, Approximate;Coordinates.(Dec�maEl)ggrees), Latitade;_. Longdude=
3- Totelnpmherofplmspsatthepamp�tation.,_, -
3 Dgsign flow-o thg pump stab n; mQltons gal,(otts.peK day (fim cupaci yj!
A " flits should'feflecl tfig;tvtat GPM for t$e pump stAhgnwiQ(t6e large(j3gm(to`utgf seMce,
4. ApeTaUona[po�iit(s)perpui`n'p(s) _gallons,pe.E,`ininuti (GPNOaf feetfotiil;dyMnii0i&d(MH),
5. Siim`mariz`e fhe faits �naiii to.be�e"rmitted (for#liis;Eam�Sta&on) -
*kuunches* ength(f, , Miiterlals
6;;1'o�tierrehabilitySmaccordancewitfi-ISANCACO2T:0305(hliilc�
[], Standbypowersourcepr,tEj ;Standiypump
15,000-�gallons per d f
Orifthe.pumpAafion;hasanaveragedzi yllowaessillia-r1SqWgallonsper,dgyISA'NCACO2T:0303(h)()(C);,
P.or(abtopotversourcelvithsmanual activation, qufckwnnectionseceptacle and telemetry-
`.n[
Poriabfepumpinguniti4fthplugged•emergencypmnpconnechoaandaelemetryr
Ss
FORNid-TTA;;1013t pegO o0i

IX: SETSACX8''&.SEPARATIO1H5=(02B'.0204 &e M-NCAU021T:0305(Q)
'1. Ddes.tlieprojecf_camplytwiliall'separationslaltemadves,foun3mZ1Ces ❑;No
tSd Ti('dC62T313f1i7F1 rnnfnin¢minimum cenarnfinne thnt-dull--;henmvitadh`xxnwersvcfnmc•. '
SeparationRegdlred'
5toim severs -and other utilifiesnot.li'sted belovt(ver iealj-
18 Inc ies -
�Waser mains (vertical-:water'over seWe_r prefemd; noltulmg in benched tr�Itiches}
18 moues _
Reclaimed igafe%Cues verEica_I declaimed aver sewea
18 ineties
Iteclaim ed'.water tines'(horizonlal ';rechdatedover-sewer);
2 teen
x'�Any prrvate�oc pabhc wafer supply'source, meludingany wol'15; WS I waters df Class I or.
Tlass*, anpounded reservofrsused as source ofdrinlang tvater;'and associated teed no.
*=Wafers classitie� W$ (ei`cep# WS Yon,WS-j?) B; SA, ORV�,,HQW; or,SB!frottm normal
�tigh=tyafer (or tide elevation: and Iyetlan�s assoaiSted'wdh ihcs@;watecs.(see;item IX2)� _
E
SO feet?
**Any other stream, lake i npoundmenl,-or ground water lowcring and -stir acilrainap.
4tch6, ii Vetl as wetlands associated.with.these-waters onclassified as WL.
10-feet.
Anybuildingfnyiidaifon(horizontal)
S^feet R
Anybasement_t7orizontalj
Top slope of
emliankmeitor,euts of2;fept ormore veittca#iieigliE,_. _ _ _ __
_ _ lOTeeh'_ _ ,_,_
Drainagesysfems;and7ntircaptordiaios - - " - - -�
-
— S fee[
- - - - -
:Any swimming -pools
1 Q.feeG
--
III
❑ No IEIX
t Nq.
®•Yes: ❑No
Yes: ENO
D If yes, �nclyde an attachinentivuli deta(Is fo4,each lme, mctudmg type(iierlal h-ne; size, materi it apd-loca#iog);
ra
FORlvfi'F'rA IOr23 1'age4 of 5

iX? CERFIFICATIONSg;
h Doesithe-submitted syst<
11
2 Professioual Efigine`erS:Celtific`atiolit
has been reviewed by me and, is
NOTE — In ticcordatice.
is.appIication'for P_foidet Lodestar
-- (Prii)ect Name from AppliFan�tem Irl)
and consistent with the information supplied in the
my_signature; and seal signifies -that j have;
i fine notto.exceed.$10,000,-as.well.as civil, penalties up.to $25;000 per.
ion, mcluding'fatlure to disclose any.design non-comphancewith the;at
`Carolina-licensed.Professional Eif9ine'er'to`referial to the I censing'bt
J _1 v
North_Carolina; Professional Engineer,'s seal, signaiure,_and'date;'
wmcwmay__—
�+application
maysubject
3. Applicaijsi ej tification;per lSA NCAC 02T..0106(b):;
h_ Douglas Castleperry:��_ attest thit.thi's application for,. Pr5je8fLodes'tar
(Signatum Authonly Nmne.@om"Application Item li3:) (Project Name from: Application Rem ll:l)`
attest that this application has been reviewed by, me and is _accurate and complete to; the) best of my knowledge:
t understand that if. all required parts of -this -application; are not completed' and than if all required sapporting.documenta[ on
and attachments are notmcluded, this application package.is subjee[ to�.bemg.retumed as incoinpleteiI Irund tand tfiat;any
discharge of wastewater from this:non-discharge system to suiface.waters odic- landwill result in an'immediat enforcement
action, that may,inefude civil penalties, injunctive relief, and/or criminal prosecution. I'will make:no claim against thebivision
of Water Resources should a condition of tkts permilbe vtolaled I alsoiunderstandthat ifill.required parts oftliis:applicatlon
package are no[ completed andi thatif all xeijoired,supporting,inf rifiation and attachmeits aie;not`included, this applie'anon
package_will be returned: to'me.as mcomplete.,
NOTE — In accordance with General_Statutes'143-215.6A and 143-215.6B, any, person whoknowingly makes anyi false
statement,.representation or certification in any application package shall`be.guilty'of a Class2 misdemeanor,Xhich may
mclude�a fine not to czcced$10,000'as well _as civil. penalties up.to;$25;000 per violation:
I MUM
Date:,--.?4.=2aZ�f_ _
Page 51 of 5:

NC Department of
Environmental Cluality
State of North Carolina Received
DIN&O'
Department of Environmental Quality
Division of Water Resources APR 2 2024
FlowTracldngfor SeruerExtension Applications Winston-Salem
[Division of Water Restrttrre.s OSE10-23) Regional Office
BaityRequesting Allocation: HighPointNC
Project Name forwhichflow6beingrequmted:ProjectLodestar
More than one ME may be required for a single project rf the owner of the W WPP is not responsible for allpump stations along the
route of the proposed wastewaterflow
I. Complete this section only ffyou are the owner of the wastewater treatment plant
a. W WIP Facility nano: Eastside W WIP
b. W WTP Facility Penrit M NCO024210
All flaws are in MGD
c. W WTP facility's Permitted flow
26
d. Estimated obligated Now not yet trbutary to the W WTP
4.4118
e. WWTP facrl'¢}rs actml average flow
14.92
£ Total flow for this specific request
0.0002
g. Total actual and obligated flows to flz facility
19.332
h Percent ofpermdted flow used
74.35%
II. Conplete this section for eachpump station your are responsible for along the route oftba proposed wastewater Now
Llstpurrp station located between the project correction point and the W WTP.
(A) (B) (C) (DMB+C) (E}=(A-D)
Pump Pump Design Approx Obligated Total Current
Station Station Firm Average Daily Current Not Yet Flow Plus Available
(Name or Pennit Capacity, * Flow** Avg Daily Tributary Obligated Capacity***
Number) No. MGD (Fimtpf) Flow Daily Flow Flow MGD
MGD MGD MGD MGD
Eastfork WQ0015751 A.0 t.728 0.8611 0.2727 1.1338 0.5942
Rverdae W00008572 30,0887 11,4842 8.3901 1.2567 9.6468 1.8374
*The Fhm Capacity of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
"Design Average Daily Flowis the firm capacity of the pump station divided by a pealing factor (pt)
not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
***A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTPwhere the Available Capacity is < 0.
DowustreamFaciltyName(Sewer): EastsideWWfP
DowmtreamPemrtNumber (Seiner): NCO024210
Page 1 of
FTSE 10-23

M. Certification Statement
I, Denick Boone, certify to the best ofmy knowledge that the addition ofthe volune of
wastewater to be peiwitted in this project has been evaluated along due route to the receiving wastewater
treahrenf facility and that the flow from this project is not anticipated to cause any capacity related sanitary
sewer overflows or overburden any downsheampunp station en mule to the receiving treatr emplant
under normal circunatances, given the inpleneutation ofthe planned inprover eats identified in the
planning assessmnt where applicable. This analysis has beenperfonred in accordance with local
established policies and procedures using the best available data. This certification applies to those itens
listed above in Sections I and U plus all attached planning assessuent addenduas for which I am the
responsible party. Signature ofthis form indicates acceptance offt wastewater flow.
Signing Official Signature
Job
Tdle of Signing Official
Assistant Public Services Director
3/13/2024
Date
Page 2 of 8
FTSE10-23

NC Department of
Environmental Quality
Received
APR 2 2024
To: Division of Water Resources, Attn: Ron Boone
North Carolina Department of Environmental Quality (NCDEQ) Winston-Salem
450 W Hanes Mill Road, Suite 300 Regional Office
Winston-Salem, North Carolina 27105
Colonial Pipeline Company— Project Lodestar
Fast Track Sewer Extension Application (FTA 10-23)
Mr. Ron Boone,
Colonial Pipeline Company is proposing the installation of a new gravity sanitary sewer line from a new
building to an existing public sewer main along Federal Dr. New 6-inch DIP from the new building will
cross under S Chimney Rock Rd to a new sanitary sewer manhole. From the new manhole, 8-inch DIP
will connect to the existing manhole along Federal Dr. The project site is located on 732 S Chimney
Rock Rd and is within Greensboro City Limits. Due to the location of the closest sanitary sewer
manhole, approximately 200 feet south from the intersection of S Chimney Rock Rd (SR 1554) &
Federal Dr, the sanitary sewer will cross city limits from the City of Greensboro to the City of High Point
for wastewater treatment. The as -built documents from the City of High Point show that the existing
pipe connecting to the manhole, where the new pipe will connect, has a minimum cover of 1.8 ft. Since
the minimum cover requirement of 36" for nonferrous pipe is not met, ductile iron pipe (DIP) was
utilized for the new 8-inch pipe connection to the manhole to comply with the specifications outlined
in section 02T.0305(g).
The application package includes:
• One original set of stamped full-sized (30"x42") plans
• One copy set of stamped full-sized plans
• The Flow Tracking for Sewer Extension (FTSE)
• A check of $600 payable to the NCDEQ
• Colonial Pipeline Company's business registration within North Carolina
• An 8.5 x 11-inch USGS Topographic Map
• Authorization of 404 Nationwide Permit 12. Oil or Gas Pipeline Activities No. SAW-2023-00711
• Approval of 401 Water Quality Certification No. WQC005992
Engineering I Architecture I Planning I Construction Management
pondco.com

Thank you,
Vu Nguyen
[e-mail]
678-459-2541
Engineering I Architecture I Planning I Construction Management
pondco.com

4 State of North Carol►na
fl � 'Depar�ient ofEnyironmeritel Quality
''D ,R�_ 'Dtvlston'of Wate�Resoutces
T FASMACKSEVVERSYSIMI&EXt'ENSTONAPP=XMN
Dlvislon;o"f, Water. Resources: INSTRUCTIONSIOR,FORM: I?TA40IS &'SUPPORTING DOCUt4IEHTATIOIV
,
While. n6,upfront engineering design,documents are -required for. submittal, is accordance with. ISAT NCAkC 02T 03U5(b), design
doctmtents.6st be.prepare&prior'-to;sr bniittal.of a fast track permit'applfcationlnt0ie Di'vision, This;}yould mclude;plans; design
calculations,; and .projechspecifications referenced un 15A-NCAC+02Tt A305 and the. applicable-miniinnmt acsikn eriteria;'Thcces
projectsfhakare;deemed;permitied;'(danotrequirespermitfrom;thellivisiot ,:are:e:iplamedin`tSANC`ACO2T0303j
A i?cojecfs.'thafurtvolvemorethan:onevaetancefrom.gie
=Piessuresewer sysfems.uiiliiing;simplex,sepiicfarik-a
fSknplexSTEP..orsimplex_g hderpumps:connectinga
A 'Vacuumsewersystems.
A 'One Orlglnat:and:OneCopy{second.capymaybedigitalj7ofApplicationandSuppo_Ytingb6- -inswig
Requued tmless.othenv�se note�t Signatures of orig:pal'musfBe "wet ink="orsect digital signatures;
•PJease do niif`s ibprit engineermg desigiipleaswitTi fbe applicafion ufirds speeificilly requested..-
M
G:,
'O iS6bmifacheckormoneyorderih-flie
Yablii to-i jma cifiiuiiii D'e'DartttiR
dated no:morp flian 96 days pnot to applieatlon submittal:
Mp),:
q IEnecessary',forclarity'ardu_elospacerestrigTicuis ettachn is, theapplicationmuy'licmade
If;tlie Apphcarif_Type tn'Itein I;2 is ii:corporation.or company,provide documentation.it i`s.registereiifor:'business=with the:
m
� "I'Ge Projec[Nama m'Iiem Ihl shall6e cons�st'enlw'ith tliepro�etit name on the flosy aecepfanceilette[s; egeee
ls� "Tfie;Professiodal Engineer's, erfificatibn_on Page:3_ofthe application,sliall be -signed, sealed and datedby,.
INSTRUCTIOms,voR EORa.v m l:o 2n.& SUPP.oid NG DOCUM- ENTATIDII Page 1'<of 3

p T7ie,Applicant`s'Cerii$cation:onPager5;'ofihe_applicaGonshallbestgn6d:inaccordence.with€fSANCtCC�2T OT06(6}SiPer-
;15A NCAC'02T 0, :0166, an ilternate:person mag''be:designalted lie as signing 6mdial if a delegaGonlettecis prosidedlmm.
Ei
®- Stl6rott the co>jipieted-and ¢Xcented FTSE form frtim Iht OwnetS of the downstream sewers and treatment facdity '
9 'Mifliiple forms maybe.reyuiied wlierelhe;downstream sewer., owner, andwastewater treatment facility- are. differeriti,
7h6,fl6w aceeptance tndtcated-m.fot n: FrSE mu`O)a6f expire.p—ior to pettttit issuance and mds(' da eEd`Ies`s than oaeyear'
prioif•-to the application date
➢' i%bn tttai ofthts apphcation and formFTSE mdicatesthat olvnerhas adequate capactty'an dmllWiA4 I 2153in1.,
D , flntergovermnentai'agreemetits or oil>ceccaniracts wilPnofbe accleil`.ia-1'ieu ofa project spec�fic`PT$E..
r.,
,Go 'E%
.Q'
1.
score to identify the cntie pm�ect area;,
❑ The-par�ative;'should clearly identify the i�quested perittitting actiottuud uccoeutelydesci itiefhosawers:tatie`listeil'tic
the final permit. `
k
ff
Jt Operational Ageeaments (Applieatron; ftyin HOA/I'QA ngdDegeloper� fok_Igfgto be"'soul):;
❑' Abjne/Propertybwners' Associations
p Per 15A NCAC 02T o l IS(eli, submit the ;prepeilyexecuted Openational ARmement (FORM 'HOAR
-:.. _
❑ Per-ISA'NCAC,02T'.Oh15(c);svbmtta"copyofthe_Ai icles:ofipcorpoiation;D.eclamhonsandEy-1a
C15 Develooers of lots to be sold _
❑ Terl sd NCAC 02T 0115{bl submii the.properly-execvted Operatfonal Agreement
For more.injmrnatfoal; vlsilafie:Divisfai's:co11ec1ioasysteius7reAslle i
INSTRUCTIONS FOR ROW FTA'IO 23 &SUPPORTING DOCUMENTATION' Page 2'nP1!

REGIt)19A1'OFPICE .
�1I�U�ES3'•
' C'OUNTIE9 $E�VED ;
AsFev7tle"FFenfonalON(cat
�091)US1itghway70
Ayery,Bunrpmbe,Burka;CaldweU,`Chemkea.
Mater Duality Section
pywanhagoa, Noph,CotQlma 287i8 8211
�Iay,,Graham tiaywoQd tenderson, Jacksan,
(828)29i 500
lVtacon,Madison,M6b&reU Mitchelf;,Potfi;,.NN
[phone] Fail
RSI(herfdrd, Swaln,'Tresivaai$jYancey
Favetteyllte ReglonaFOffice,
225 Gieeh StreAt 5t(te 714
A�ns n, Biadefi, CUmbe�l8�td, HarnettpHoke
i Water Quality Section — , -
_
-Fayetteville, North:Carolina 28901'5095
Montgomery N re; RObeSOr1,,RlCtnrlond,
(916y43333gQ_..
SampSOA:;ScoUanal-.- `
!(810) 48fi-0707,,Faii
l)Hice� ..
610E -Center Avegne
'Atexander,,Cabarrus, Catawba, Cleveland,
WaferOvaliWSelcttori,
iAogresvile,NorthGarnliiia281t5'
Gaafonjredell inWn,,MkRlenburg,Rowap+,.
—�
j(704) 663-,1699
Stan(y Union' 4
QY04)�d63-6046 Fax
Raleigh Redlonal Office]
3M0 Barreit Drive
_ _ ,
Cha[ham, Durham, Edgeeomhe, FrarikUh
Water.Ouality Seclio_ri
Izaarot[27 torth Ciia,603'.
�ranvilie'Halifax John�[aq, Lee�Nash;
.
t orBrampton Orange Person; Lance,�iNaica
J(94D).7a'1elgh';,N4200
(919).571-4718 F$it
_
SNarreir Wilson
'MAhlnaton Regional OHicei ,
t943 Washmgfon Sptfaca Mal(
B'saufori Berle Camdeet Chowen Graven
Water Quality Section--' '
Wasliktglon; North Caroilna278_B9'
Curntuck Dare, Oates ,Greene Heri(ord, Hyds4
[phone]
eAnes 1_ehatr Marbrp paiil9co Pasquolank,
(252} 975 3716 Fak;
;Perqutrctarss; PtU„Tyrit;ll Washington; Wayne;
--_
,.WIImina—tonReglonal Officej
127 Card nel Drive! ietenston
:Btunswtck, Carteret Columbus; Oupltn New"
Water•QaalltvSectioii — ,'Wilrrlfn§totY
Nodl'fCaFbltna,28¢p5
kladpy�7 Oristow Peride
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Winston-salaInRediooai Off 6d. i
g50 W:Iianes MUIRO's0
Alamahbe glleghany; Asha Caswell; Damdsort -
VaiterQualitV Section--�� �
Suile 300 -
�Davte,,Forsyth Gmiforti,,RockmgtreM Randalp5„
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Winstoh-Salere, Nortb CaroUria27=T05'
{(336)
rStokes; Sarrys lNataaga,.�Jilkes,.11a`dktn
77E 9800'
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(336� 77H 979T Fax:
INSTRUCTIONSFORFORM::F,TA.(f23&S,UJ?PORT[Nf3,D0,CiMEN1'ATION' PagC +Qf3vi

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ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
June 14, 2023
NC Department of
Environmental Quality
Received
APR 2 2024
Winston-Salem
Regional Office
D W R # 20230487
Guilford County
Colonial Pipeline Company
Attn: Kyle Boyan
411 Gallimore Dairy Rd
Greensboro, NC 27409
Delivered via email to: [e-mail]
Subject: Approval of Individual 401 Water Quality Certification
Colonial Pipeline Company Greensboro Junction Butane Truck Offload
USACE Action ID. No. SAW-2023-00711
Dear Mr. Boyan:
Attached hereto is a copy of Certification No. WQC005992 issued to Kyle Boyan and Colonial Pipeline
Company, dated June 13, 2023. This approval is for the purpose and design described in your application.
The plans and specifications for this project are incorporated by reference as part of this Water Quality
Certification. If you change your project, you must notify the Division and you may be required to submit
a new application package with the appropriate fee. If the property is sold, the new owner must be given
a copy of this Certification and is responsible for complying with all conditions. [15A NCAC 02H
.0507(d)(2)].
This Water Quality Certification does not relieve the permittee of the responsibility to obtain all other
required Federal, State, or Local approvals before proceeding with the project, including those required
by, but not limited to, Sediment and Erosion Control, Non -Discharge, Water Supply Watershed, and
Trout Buffer regulations.
This Water Quality Certification neither grants nor affirms any property right, license, or privilege in any
lands or waters, or any right of use in any waters. This Water Quality Certification does not authorize
any person to interfere with the riparian rights, littoral rights, or water use rights of any other person
and does not create any prescriptive right or any right of priority regarding any usage of water. This
Water Quality Certification shall not be interposed as a defense in any action respecting the
determination of riparian or littoral rights or other rights to water use. No consumptive user is deemed
by virtue of this Water Quality Certification to possess any prescriptive or other right of priority with
respect to any other consumptive user.
North Carolina Department of Environmemal Quality I Division of Water Resources
D
Winston-Salem Regional Office 1450 W. Hanes Mill Rd, Suite 3001 Winston-Salem, North Carolina 27105
\ �./
336.776.9800

Colonial Pipeline Greensboro Junction Butane Offload
DWR# 20230487
Individual Certification #WQC005992
Page 2 of 11
Upon the presentation of proper credentials, the Division may inspect the property.
This Water Quality Certification shall expire on the same day as the expiration date of the corresponding
Section 404 Permit. The conditions shall remain in effect for the life of the project, regardless of the
expiration date of this Water Quality Certification.
Non-compliance with or violation of the conditions herein set forth may result in revocation of this
Water Quality Certification for the project and may also result in criminal and/or civil penalties.
If you are unable to comply with any of the conditions of this Water Quality Certification you must notify
the Winston-Salem Regional Office within 24 hours (or the next business day if a weekend or holiday)
from the time the permittee becomes aware of the circumstances.
The permittee shall report to the Winston-Salem Regional Office any noncompliance with, and/or any
violation of, stream or wetland standards [15A NCAC 02B .02001 including but not limited to sediment
impacts to streams or wetlands. Information shall be provided orally within 24 hours (or the next
business day if a weekend or holiday) from the time the permittee became aware of the non-compliance
circumstances.
This approval and its conditions are final and binding unless contested [G.S. 143-215.51.
This Certification can be contested as provided in Chapter 150E of the North Carolina General Statutes by
filing a Petition for a Contested Case Hearing (Petition) with the North Carolina Office of Administrative
Hearings (OAH) within sixty (60) calendar days. Requirements for filing a Petition are set forth in Chapter
150B of the North Carolina General Statutes and Title 26 of the North Carolina Administrative Code.
Additional information regarding requirements for filing a Petition and Petition forms may be accessed at
http://www.ncoah.COM/ or by calling the OAH Clerk's Office at [phone].
A party filing a Petition must serve a copy of the Petition on:
William F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, NC 27699-1601
If the party filing the Petition is not the permittee, then the party must also serve the recipient of the
Certification in accordance with N.C.G.S 150B-23(a).
r/ _ Noah Carolina Department of Environmental Quality I Division of Water Resourees
GGG/ D Winston-Salem Regional Office 1450 W. Hanes Mill Rd, Suite 3001 Winston-Salem, North Carolina 27105
'b"TM�iOr^+s 336.776.9800

Colonial Pipeline Greensboro Junction Butane Offload
DWR# 20230487
Individual Certification #WQCG05992
Page 3 of 11
This letter completes the Division's review under section 401 of the Clean Water Act and 15A NCAC 02H
.0500. Please contact Rebecca Chandler at 336-776-9705 or [e-mail] if you have
any questions or concerns.
Sincerely,
DocuSlpmE by:
CLOD.
1/584SEY25C84EA..
Lon T. Snider
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ— WSRO
Electronic cc: Michael Barfield, Corblu Ecology Group
David Bailey, USACE Raleigh Regulatory Field Office
Olivia Munzer, NCWRC
Todd Bowers, EPA
DWR 401 & Buffer Permitting Branch Electronic file
North Carolina Department of Environmental Quality I Division of Water Resources
QJ Winston-Salem Regional Office 1450 W. Hanes Mill Rd, suite 3001 Winston-Salem, North Carolina 27105
1i0fTM D 336.776.9900
aery

Colonial Pipeline Greensboro Junction Butane Offload
DWR# 20230487
Individual Certification #lWQC005992
Page 4 of 11
NORTH CAROLINA 401 WATER QUALITY CERTIFICATION
CERTIFICATION ##WQC005992 is issued in conformity with the requirements of Section 401, Public Laws
92-500 and 95-217 of the United States and subject to North Carolina's Regulations in 15 NCAC 02H .0500
and 15A NCAC 026 .0200, to Kyle Boyan and Colonial Pipeline Company, who have authorization for the
impacts listed below, as described within your application received by the N.C. Division of Water
Resources (Division) on March 30, 2023 and subsequent information on May 24, 2023, and by Public
Notice issued by the Division on April 4, 2023.
The State of North Carolina certifies that this activity will comply with water quality requirements and
the applicable portions of Sections 301, 302, 303, 306, 307 of the Public Laws 92-500 and PL 95-217 if
conducted in accordance with the application, the supporting documentation, and conditions
hereinafter set forth.
The following impacts are hereby approved. No other impacts are approved, including incidental
impacts. [15A NCAC 02H .0506(b)]
Type of Impact
Amount Approved
Permanent
Amount Approved
Temporary
Riparian Wetlands
W1— Mechanized Clearing
0.018 acres
N/A
W2—Grading
N/A
0.045 acres
W3 - Fill
0.243 acres
N/A
This approval requires you to follow the conditions listed in the certification below.
CONDITIONS OF CERTIFICATION [15A NCAC 02H .0507(c)]:
1. The permittee shall report to the DWR Winston-Salem Regional Office any noncompliance with,
and/or any violation of, stream or wetland standards [15A NCAC 02B .0200], including but not
limited to sediment impacts to streams or wetlands. Information shall be provided orally within
24 hours (or the next business day if a weekend or holiday) from the time the permittee became
aware of the non-compliance circumstances.
Citation: 15A NCAC 02H .05O6(b), 15A NCAC 02H .0507(c)
Justification: Timely reporting of non-compliance is important in identifying and minimizing
detrimental impacts to water quality and avoiding impacts due to water pollution that precludes
any best use on a short-term or long-term basis.
2. No waste, spoil, solids, or fill of any kind shall occur in wetlands or waters beyond the footprint
of the approved impacts (including temporary impacts).
Citation: 15A NCAC 02H .0506,• 15A NCAC 02H .0507(c)
D North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional once 1450 W. Hanes Mill Rd, Suite 300 1 Winston-Salem, North Carolina 27105
a..wOrOZO336.716.9800

Colonial Pipeline Greensboro Junction Butane Offload
DW R# 20230487
Individual Certification #WQC005992
Page 5 of 11
Justification: Surface water quality standards require that conditions of waters be suitable for all
best uses provided for in state rule (including, at minimum: aquatic life propagation, survival,
and maintenance of biological integrity,• wildlife; secondary contact recreation; agriculture); and
that activities must not cause water pollution that precludes any best use on a short-term or
long-term basis.
3. All activities shall be in compliance with any applicable State Regulated Riparian Buffer Rules in
Chapter 26 of Title 15A in the North Carolina Administrative Code.
Citation: 15A NCAC 02H .0506(b), 15A NCAC 02H .0507(c)
Justification: The referenced Riparian Buffer rules were adopted to address water quality
impairments and further protect existing uses.
4. When applicable, all construction activities shall be performed and maintained in full
compliance with G.S. Chapter 113A Article 4 (Sediment and Pollution Control Act of 1973).
Regardless of applicability of the Sediment and Pollution Control Act, all projects shall
incorporate appropriate Best Management Practices for the control of sediment and erosion so
that no violations of state water quality standards, statutes, or rules occur.
Design, installation, operation, and maintenance of all sediment and erosion control measures
shall be equal to or exceed the requirements specified in the most recent version of the North
Carolina Sediment and Erosion Control Manual, or for linear transportation projects, the North
Caroline Department of Transportation Sediment and Erosion Control Manual.
All devices shall be maintained on all construction sites, borrow sites, and waste pile (spoil) sites,
including contractor -owned or leased borrow pits associated with the project. Sufficient
materials required for stabilization and/or repair of erosion control measures and stormwater
routing and treatment shall be on site at all times.
For borrow pit sites, the erosion and sediment control measures shall be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual. Reclamation measures and implementation shall comply with the
reclamation in accordance with the requirements of the Sedimentation Pollution Control Act
and the Mining Act of 1971.
Citation: 15A NCAC 02H .0506(b), 15A NCAC 02H .0507(c); 15A NCACO2B .0200, I5A NCAC 02B
.0231
Justification: A project that affects waters shall not be permitted unless the existing uses, and the
water quality to protect such uses, are protected. Activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. As cited in Stream Standards: (12)
Oils, deleterious substances, or colored or other wastes: only such amounts as shall not render
the waters injurious to public health, secondary recreation, or to aquatic life and wildlife, or
adversely affect the palatability offish, aesthetic quality, or impair the waters for any designated
uses; and (21) turbidity in the receiving water shall not exceed 50 Nephelometric Turbidity Units
(NTU) in streams not designated as trout waters and 10 NTU in streams, lakes, or reservoirs
designated as trout waters; for lakes and reservoirs not designated as trout waters, the turbidity
shall not exceed 25 NTU; if turbidity exceeds these levels due to natural background conditions,
V&
North Carolina Department of Environmental Quality I Division of Water Resources
.D QM
Winston-Salem Regional Office 1450 W. Hanes Mill Rd, Suite 3001 Winston-Salem, North Carolina 27105
336.776.9800

Colonial Pipeline Greensboro Junction Butane Offload
DWR# 20230487
Individual Certification #WQC005992
Page 6 of 31
the existing turbidity level shall not be increased. As cited in Wetland Standards: (c)(1) Liquids,
fill or other solids, or dissolved gases shall not be present in amounts that may cause adverse
impacts on existing wetland uses; and (3) Materials producing color or odor shall not be present
in amounts that may cause adverse impacts on existing wetland uses.
5. Sediment and erosion control measures shall not be installed in wetland or waters except within
the footprint of temporary or permanent impacts otherwise authorized by this Certification. If
placed within authorized impact areas, then placement of such measures shall not be conducted
in a manner that results in dis-equilibrium of any wetlands, streambeds, or streambanks. Any
silt fence installed within wetlands shall be removed from wetlands and the natural grade
restored within two (2) months of the date that DEMLR or locally delegated program has
released the specific area within the project to ensure wetland standards are maintained upon
completion of the project.
Citation: 15A NCAC 02H .0506(b); 15A NCAC 02H .0507(c); 15A NCAC 028.0200; 15A NCAC 02B
.0231
Justification: A project that affects waters shall not be permitted unless the existing uses, and the
water quality to protect such uses, are protected. Activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. As cited in Stream Standards: (12)
Oils, deleterious substances, or colored or other wastes: only such amounts as shall not render
the waters injurious to public health, secondary recreation, or to aquatic life and wildlife, or
adversely affect the palatability offish, aesthetic quality, or impair the waters for any designated
uses, and (21) turbidity in the receiving water shall not exceed 50 Nephelometric Turbidity Units
(NTU) in streams not designated as trout waters and 10 NTU in streams, lakes, or reservoirs
designated as trout waters; for lakes and reservoirs not designated as trout waters, the turbidity
shall not exceed 25 NTU; if turbidity exceeds these levels due to natural background conditions,
the existing turbidity level shall not be increased. As cited in Wetland Standards: (c)(1) Liquids,
fill or other solids, or dissolved gases shall not be present in amounts that may cause adverse
impacts on existing wetland uses; and (3) Materials producing color or odor shall not be present
in amounts that may cause adverse impacts on existing wetland uses.
6. Erosion control matting that incorporates plastic mesh and/or plastic twine shall not be used
along streambanks or within wetlands.
Citation: 15A NCAC 02H .0506(b); 15A NCAC 02H .0507(c)
Justification: A project that affects waters shall not be permitted unless the existing uses
(including aquatic life propagation and biological integrity), and the water quality to protect
such uses, are protected. Protections are necessary to ensure any remaining surface waters or
wetlands, and any surface waters or wetlands downstream, continue to support existing uses
during and after project completion. The Division must evaluate if the activity has avoided and
minimized impacts to waters, would cause or contribute to a violation of standards, or would
result in secondary or cumulative impacts.
If the project is covered by NPDES Construction Stormwater Permit Number NCGO10000 or
NPDES Construction Stormwater Permit Number NCG250000, full compliance with permit
conditions including the erosion & sedimentation control plan, inspections and maintenance,
self -monitoring, record keeping and reporting requirements is required.
Carolina Department of Quality Division Resources
NorthWinston-Salem
00 1 Winater
a 1450 W. Hal
Winston-Salem Regional Office 450 W. Hanes Mill Rd, Suite 300 Win+ron-Salem. North Carolina 27105
336.776.9800

Colonial Pipeline Greensboro Junction Butane Offload
D W R# 20230487
Individual Certification #WQC005992
Page 7 of 11
Citation: 15A NCAC 02H .0506(b); 15A NCAC 021-1.0507(c); 15A NCAC 02B .0200, I5A NCAC 02B
.0231
Justification: A project that affects waters shall not be permitted unless the existing uses, and the
water quality to protect such uses, are protected. Activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. As cited in Stream Standards: (12)
Oils, deleterious substances, or colored or other wastes: only such amounts as shall not render
the waters injurious to public health, secondary recreation, or to aquatic life and wildlife, or
adversely affect the palatability offish, aesthetic quality, or impair the waters for any designated
uses, and (21) turbidity in the receiving water shall not exceed 50 Nephelometric Turbidity Units
(NTU) in streams not designated as trout waters and 10 NTU in streams, lakes, or reservoirs
designated as trout waters; for lakes and reservoirs not designated as trout waters, the turbidity
shall not exceed 25 NTU; if turbidity exceeds these levels due to natural background conditions,
the existing turbidity level shall not be increased. As cited in Wetland Standards: (c)(1) Liquids,
fill or other solids, or dissolved gases shall not be present in amounts that may cause adverse
impacts on existing wetland uses; and (3) Materials producing color or odor shall not be present
in amounts that may cause adverse impacts on existing wetland uses.
8. All work in or adjacent to streams shall be conducted so that the flowing stream does not come
in contact with the disturbed area. Approved best management practices from the most current
version of the NC Sediment and Erosion Control Manual, or the NC Department of
Transportation Construction and Maintenance Activities Manual, such as sandbags, rock berms,
cofferdams, and other diversion structures shall be used to minimize excavation in flowing
water.
Citation: 15A NCAC 02H .0506(b), 15A NCAC 02H .0507(c), 15A NCAC 02B .0200
Justification: Surface water quality standards require that conditions of waters be suitable for all
best uses provided for in state rule, and that activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. As cited in Stream Standards: (12)
Oils, deleterious substances, or colored or other wastes: only such amounts as shall not render
the waters injurious to public health, secondary recreation, or to aquatic life and wildlife, or
adversely affect the palatability offish, aesthetic quality, or impair the waters for any designated
uses; and (21) turbidity in the receiving water shall not exceed 50 Nephelometric Turbidity Units
(NTU) in streams not designated as trout waters and 10 NTU in streams, lakes, or reservoirs
designated as trout waters; for lakes and reservoirs not designated as trout waters, the turbidity
shall not exceed 25 NTU, • if turbidity exceeds these levels due to natural background conditions,
the existing turbidity level shall not be increased.
9. Application of fertilizer to establish planted/seeded vegetation within disturbed riparian areas
and/or wetlands shall be conducted at agronomic rates and shall comply with all other Federal,
State and Local regulations. Fertilizer application shall be accomplished in a manner that
minimizes the risk of contact between the fertilizer and surface waters.
Citation: 15A 02H .0506(b); 15A NCAC 02H .0507(c); 15A NCAC 02B .0200, 15A NCAC 02B .0231
Justification: A project that affects waters shall not be permitted unless the existing uses, and the
water quality to protect such uses, are protected. Activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. As cited in Stream Standards: (12)
D Na h Carolina Department or Environmental Quality I Division or Wafer Resouroes
./' Wimton-Salem Regional Office 1450 W. Hanes Mill Rd, Sufm 3001 Wimwn-Saleny North Carolina 27105
336.776.9800

Colonial Pipeline Greensboro Junction Butane Offload
DWR#Y 20230487
Individual Certification #lWQC005992
Page 8 of 11
Oils, deleterious substances, or colored or other wastes: only such amounts as shall not render
the waters injurious to public health, secondary recreation, or to aquatic life and wildlife, or
adversely affect the palatability offish, aesthetic quality, or impair the waters for any designated
uses. As cited in Weiland Standards: (c)(1) Liquids, fill or other solids, or dissolved gases shall not
be present in amounts that may cause adverse impacts on existing wetland uses; and (3)
Materials producing color or odor shall not be present in amounts that may cause adverse
impacts on existing wetland uses.
10. If concrete is used during construction, then all necessary measures shall be taken to prevent
direct contact between uncured or curing concrete and waters of the state. Water that
inadvertently contacts uncured concrete shall not be discharged to waters of the state.
Citation: 15A 02H .0506(b), 15A NCAC 02H .0507(c), 15A NCAC 028.0200,• 15A NCAC 02B .0231
Justification: A project that affects waters shall not be permitted unless the existing uses, and the
water quality to protect such uses, are protected. Activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. As cited in Stream Standards: (12)
Oils, deleterious substances, or colored or other wastes: only such amounts as shall not render
the waters injurious to public health, secondary recreation, or to aquatic life and wildlife, or
adversely affect the palatability offish, aesthetic quality, or impair the waters for any designated
uses. As cited in Wetland Standards: (c)(1) Liquids, fill or other solids, or dissolved gases shall not
be present in amounts that may cause adverse impacts on existing wetland uses; and (3)
Materials producing color or odor shall not be present in amounts that may cause adverse
impacts on existing wetland uses.
11. All proposed and approved temporary fill and culverts shall be removed and the impacted area
shall be returned to natural conditions within 60 calendar days after the temporary impact is no
longer necessary. The impacted areas shall be restored to original grade, including each
stream's original cross -sectional dimensions, planform pattern, and longitudinal bed profile. All
temporarily impacted sites shall be restored and stabilized with native vegetation.
Citation: 15A NCAC 02H.0506(b); 15A NCAC 02H .0507(c)
Justification: A project that affects waters shall not be permitted unless the existing uses, and the
water quality to protect such uses, are protected. Protections are necessary to ensure any
remaining surface waters or wetlands, and any surface waters or wetlands downstream,
continue to support existing uses after project completion.
12. All proposed and approved temporary pipes/culverts/rip-rap pads etc. in streams or wetlands
shall be installed as outlined in the most recent edition of the North Carolina Sediment and
Erosion Control Planning and Design Manual or the North Carolina Surface Mining Manual or
the North Carolina Department of Transportation Best Management Practices for Construction
and Maintenance Activities so as not to restrict stream flow or cause dis-equilibrium during use
of this Certification.
Citation: 15A NCAC 02H .0506(b); 15A NCAC 02H .0507(c)
Justification: Surface water quality standards require that conditions of waters be suitable for all
best uses provided for in state rule, and that activities must not cause water pollution that
North Carolina Department of Environmental Quality I Division of Water Resources
D_E Q Winston-Salem Regional Office 1450 W. Hanes Mill Rd Suite 3001 Winston-Salem, Noah Carolina 27105
O336,776.9800

Colonial Pipeline Greensboro Junction Butane Offload
DWRfi 20230487
Individual Certification #WQC005992
Page 9 of it
precludes any best use on a short-term or long-term basis. Ensuring that structures are installed
properly in waters will ensure that surface water quality standards are met and conditions of
waters are suitable for all best uses.
13. Any rip -rap required for proper culvert placement, stream stabilization, or restoration of
temporarily disturbed areas shall be restricted to the area directly impacted by the approved
construction activity. All rip -rap shall be placed such that the original streambed elevation and
streambank contours are restored and maintained and shall consist of clean rock or masonry
material free of debris or toxic pollutants. Placement of rip -rap or other approved materials
shall not result in de -stabilization of the stream bed or banks upstream or downstream of the
area or be installed in a manner that precludes aquatic life passage.
Citation: 15A NCAC 02H .0506(b); 15A NCAC 02H .0507(c)
Justification: Surface water quality standards require that conditions of waters be suitable for all
best uses provided for in state rule, and that activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. The Division must evaluate if the
activity has avoided and minimized impacts to waters, would cause or contribute to a violation
of standards, or would result in secondary or cumulative impacts.
14. All mechanized equipment operated near surface waters shall be inspected and maintained
regularly to prevent contamination of surface waters from fuels, lubricants, hydraulic fluids, or
other toxic materials. Construction shall be staged in order to minimize the exposure of
equipment to surface waters to the maximum extent practicable. Fueling, lubrication, and
general equipment maintenance shall be performed in a manner to prevent, to the maximum
extent practicable, contamination of surface waters by fuels and oils.
Citation: 15A NCAC 02H .0506(b); 15A NCAC 02H .0507(c); 15A NCAC 02B .0200, 15A NCAC 02B
.0231
Justification: A project that affects waters shall not be permitted unless the existing uses, and the
water quality to protect such uses, are protected. Activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. As cited in Stream Standards: (12)
Oils, deleterious substances, or colored or other wastes: only such amounts as shall not render
the waters injurious to public health, secondary recreation, or to aquatic life and wildlife, or
adversely affect the palatability offish, aesthetic quality, or impair the waters for any designated
uses. As cited in Wetland Standards: (c)(1) Liquids, fill or other solids, or dissolved gases shall not
be present in amounts that may cause adverse impacts on existing wetland uses; and (3)
Materials producing color or odor shall not be present in amounts that may cause adverse
impacts on existing wetland uses.
15. Heavy equipment working in wetlands shall be placed on mats or other measures shall be taken
to minimize soil disturbance and compaction.
Citation: 15A NCAC 02H .0506(b); 15A NCAC 02H .0507(c); 15A NCAC 02B .0231
Justification: Wetland standards require maintenance or enhancement of existing uses of
wetlands such that hydrologic conditions necessary to support natural biological and physical
characteristics are protected, • populations of wetland flora and fauna are maintained to protect
D E
NorthClina Department ofEnviromevtnl Quality Division of WatrResources ///r`_`v—_/— ✓✓v Winston-Salem Regional Once 1450 W. Hanes Mill Rd, Suite 300 1 Winston-Salem, North Carolina 27105
�7:
�� 336.776.9800

Colonial Pipeline Greensboro Junction Butane Offload
DWR# 20230487
Individual Certification #WQC005992
Page 10 of 11
biological integrity of the wetland, • and materials or substances are not present in amounts that
may cause adverse impact on existing wetland uses.
16. In accordance with 143-215.85(b), the permittee shall report any petroleum spill of 25 gallons or
more; any spill regardless of amount that causes a sheen on surface waters; any petroleum spill
regardless of amount occurring within 100 feet of surface waters; and any petroleum spill less
than 25 gallons that cannot be cleaned up within 24 hours.
Citation: 15A NCAC 02H .0507(c); N.C.G.S 143-215.85(b)
Justification: Person(s) owning or having control over oil or other substances upon notice of
discharge must immediately notify the Department, or any of its agents or employees, of the
nature, location, and time of the discharge and of the measures which are being taken or are
proposed to be taken to contain and remove the discharge. This action is required in order to
contain or divert the substances to prevent entry into the surface waters. Surface water quality
standards require that conditions of waters be suitable for all best uses provided for in state rule
(including, at minimum: aquatic life propagation, survival, and maintenance of biological
integrity; wildlife; secondary contact recreation; agriculture), and that activities must not cause
water pollution that precludes any best use on a short-term or long-term basis.
17. The permittee and their authorized agents shall conduct all activities in a manner consistent
with State water quality standards (including any requirements resulting from compliance with
§303(d) of the Clean Water Act), and any other appropriate requirements of State and Federal
Law.
Citation: 15A NCAC 02H .0506(b); 15A NCAC 02H .0507(c)
Justification: Surface water quality standards require that conditions of waters be suitable for all
best uses provided for in state rule, and that activities must not cause water pollution that
precludes any best use on a short-term or long-term basis. The Division must evaluate if the
activity has avoided and minimized impacts to waters, would cause or contribute to a violation
of standards, or would result in secondary or cumulative impacts.
18. The permittee shall require its contractors and/or agents to comply with the terms and
conditions of this certification in the construction and maintenance of this project, and shall
provide each of its contractors and/or agents associated with the construction or maintenance
of this project with a copy of this Water Quality Certification. A copy of this Water Quality
Certification shall be available at the project site during the construction and maintenance of
this project.
Citation: 15A NCAC 02H .0506(b), 15A NCAC 02H .0507(c)
Justification: Those actually performing the work should be aware of the requirements of this
401 Water Quality Certification to minimize water quality impacts.
D North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 W. Hanes Mill Rd, Suite 300 1 Winston-Salem, North Carolina 27105
!7a��M �/ 336.776.9800

Colonial Pipeline Greensboro Junction Butane Offload
DWR# 20230487
Individual Certification #WQC005992
Page 11 of 11
This approval to proceed with your proposed impacts or to conduct impacts to waters as depicted in
your application shall expire upon expiration of the 404 Permit. The conditions in effect on the date of
issuance shall remain in effect for the life of the project, regardless of the expiration date of this
Certification. [15A NCAC 02H .0507(c)]
This, the 14th day of June 2023
E
DncuSlyrwE by:
,E>.JW
1451i49E225C94EA...
Lon T. Snider
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ— WSRO
yR North Carolina Department of Environmental Qonlity I Division of Water Resources
D :® Winston-Salem Regional Office 1450 W. Hanes Mill Rd, Suite 300 1 W inston-Salem, North Carolina 27105
336.776.9800

(ODepartment
..
STATE OF
NORTH of The
C ROLINA Secretary of State
I, THAD EURE, Secretary of state of the State of North
Carolina, do hereby certify that
COLONIAL PIPELINE COMPANY
a corporation organized
'under the laws of Delaware was duly domesticated
in the State of North Carolina by .issuance of a Certificate
of Authority on the 5th of June, 1962'
AND I FURTHER certify that said COLONIAL PIPELINE COMPANY
is authorized to transact
such business in this State'as is permitted by its certificate
of incorporation and Chapter 55, General Statutes of North
Carolina, entitled "Business Corporation Act" and is in good
standing so far as is shown by the records of my office..
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my official seal.
DONE IN OFFICE at Raleigh, this the 14th of January, 1987,
THAD SURE t
Secret y o State
c et y o tat

NC Department of
Environmental Quality
Received
U.S. ARMY CORPS OF ENGINEERS APR 2 M4
WILMINGTON DISTRICT
Action Id. SAW-2023-00711 County: Guilford U.S G. uuilford
Regional cOffice
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Colonial Pipeline Comvanv
Attn: Kyle Bovan
Address: 411 Gallimore Dairy Road
Greensboro, NC 27409
E-mail: KDBovan(dcolpiye.com
Size (acres) --48 Nearest Town Greensboro
Nearest Waterway UT East Fork Deep River River Basin Cane Fear
USGS HUC 03030003 Coordinates 36.0664031,-79.9469589
Location description: The project area is located on the north side of Chimney Rock Road, approximately 0.3 mile east of its
intersection with Gallimore Dairy Road, at the Colonial Pipeline Company Greensboro Junction Facility in Greensboro,
Guilford County, North Carolina.
Description of projects area and activity: This verification authorizes the permanent discharee of fill material into 0.243 acre of
riparian non-riverine wetlands, and the temporary discharee of dredged material into 0.063 acre of riparian non-riverine
wetlands (resultine in the permanent conversion of 0.018 acre of forested to herbaceous wetlands). These impacts are
necessary for the construction of access and infrastructure for a butane truck offload terminal and associated pipeline at the
Colonial Pipeline Company Greensboro Junction Facili
Applicable Law(s): ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Nationwide Permit 12. Oil or Gas Pipeline Activities
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 4/3/2023, additional information received via email on 5/24/2023, and the enclosed
plans "Greensboro Junction Butane Truck Offload Pr000sed Site Plan' (Sheet 7-GBJ-C102), "Typical Prefabricated Mat
Crossing for Wetlands", "Typical Trench Box Installation', and "Wetland Re -vegetation List." Any violation of the attached
conditions or deviation from your submitted pans may subject the permittee to a stop work order, a restoration order, a Class
I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide and/or regional general permit
authorization is modified, suspended or revoked. If, prior to the expiration date identified below, the nationwide and/or regional general
permit authorization is reissued and/or modified, this verification will remain valid until the expiration date identified below, provided
it complies with all requirements of the modified nationwide permit. If the nationwide and/or regional general permit authorization
expires or is suspended, revoked, or is modified, such that the activity would no longer comply with the terms and conditions of the
nationwide permit, activities which have commenced (i.e., are under construction) or are under contract to commence in reliance upon
the nationwide and/or regional general permit, will remain authorized provided the activity is completed within twelve months of the
date of the nationwide and/or regional general permit's expiration, modification or revocation, unless discretionary authority has been
exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA), prior
to beginning work you must contact the N.C. Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits. If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of
Engineers regulatory program, please contact David E. Bailey at 919 817-2436 or David.E.Bailev2na usace.armv.mil.
Corps Regulatory Official: 7 � Date: 06/2912023
Expiration Date of Verification: 3/14/2026

SAW-2023-00711
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 Form. The requirements of this form, including any special
conditions listed on this form, are hereby incorporated as special conditions of this permit
authorization.
2. Temporary discharges of excavated or fill material into wetlands must be for the absolute
minimum period of time necessary to accomplish the work, and such authorized crossings must be
constructed, restored, and seeded per the project description in the PCN and details provided on
the enclosed "Typical Prefabricated Mat Crossing for Wetlands", "Typical Trench Box
Installation", and "Wetland Re -vegetation List" detail sheets.
3. Please note that future impacts and/or phases of the Colonial Pipeline Company (CPC)
Greensboro Junction Facility, and related activities associated with Corps Action IDs: SAW-2023-
00711, 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 CPC Greensboro Junction Facility single and complete project include a total loss of 0.243
acre of wetlands/potential waters of the US.
Corps Regulatory Official: r Date: 06/29/2023
Expiration Date of Verification: 3/14/2026
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 httns://re ug latory.ons.usace.army.mil/customer-service-survey.
Copy furnished electronically:
Michael Barfield, Corblu Ecology Group, LLC, mbarfreldna corblu.com
Seren Homer, NCDEQ-DWR, seren.homer(a-ncdencgov
Rebecca Chandler, NCDEQ-DWR, rebecca.chandler a,ncdenr.gov

Compensatory Mitigation Responsibility Transfer Form
Permittee: Colonial Pipeline Company, Attn: Kyle Boyan Action ID: SAW-2023-00711
Project Name: Colonial Pipeline Company / Greensboro Junction Facility / Butane Truck Offload Terminal and pipeline County: Guilford
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved Mitigation
Bank orthe 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:
PermittedImpactsRequiring 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
0,261
*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
0.504
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 of Sponsor's Authorized
Signature of Sponsor's Authorized Representative Date of Signature
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.
dated 5/18/2023 was included with the preconstruction notification.
• The wetland credits required correspond to 0.243 acre of direct impacts at 2:1 and 0.018 acre of reduction of wetland
function at 1:1.
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 SAWMITMusoce.ormv.mill. Questions regarding this form or any of the
permit conditions may be directed to the District Mitigation Office.
USAGE Project Manager: David E. Bailey
USACE Field Office: Raleigh Regulatory Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: David. [e-mail]
USACE Project Manager Signature
06/29/2023
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.mil.

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Notes:
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1. The excavated area between the outside of the trench box and the face
of the trench should be as small as possible.
2. The space between the trench box and the excavation sides shall be
backfilled to prevent lateral movement of the box.
3. Shields may not be subject to loads exceeding those which the system
was design to withstand. Contractor is responsible for verification and
compliance with manufacturer specifications.
4. Trench Box installation shall conform to OSHA Standards.
En neering Temporary Shoring - Shielding
3 3 Typical Trench Box
Stream Installation
Restoration
Civil Engineering and Land Surveying www.Engineering303.com Phone:[phone] Page 1
01 N
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Welland Re -vegetation List
Colonial Pipeline Company — Greensboro Junction Butane Truck Offload Corblu Project No. 02-041901-839 — Guilford Co. NC
CPC proposes to re -vegetate the portion of forested wetland proposed for conversion to emergent and
the temporarily disturbed emergent portion of W2 with Roundstone Seed Southern Wetland Meadow
Mix No. 129. This seed mix is comprised of nine native grass and sedge species and sixteen wildflower
species as outlined in the table below and does not contain any species listed on the North Carolina
Invasive Plant List. The seed will be applied at the recommended rate of 4.2-6.0 PLS pounds/acre.
Roundstone Southem Wetland Meadow Mix (Mix 129)
Common Name
Botanical Name
PLS Oz.
Virginia Wild Rye
Elymus virginicus
3.75
Broomsedge
Andropogon virginicus
0.313
Deer Tongue Grass
Ponicum clandestinum
3
Upland Bentgrass
Agrostis perennans
0.25
Red Top Panicum
Panicum rigidulum
0.625
Nodding Sedge
Carex crinita
0.375
Hop Sedge
Carex lupulino
0.375
Shallow Sedge
Carex lurido
0.875
Path Rush
Juncustenuis
0.188
Wool Grass
Scirpus cyperinus
0.25
Virginia Mountain Mint
Pycnanthemum virginionum
0.075
Smooth Beardtongue
Penstemon digitalis
0.197
Ohio Spiderwort
Tradescantio ohiensis
0.403
Spiked Blazing Star
Liatris spicato
0.932
Cup Plant
Silphium perfoliatum
0.169
Seed Box
Ludwigia olternifolia
0.158
Blue Vervain
Verbena hastato
0.371
Swamp Milkweed
Asclepias incarnate
0.38
Showy Tickseed
Bidens oristosa
1.157
Joe-Pye Weed
Eupatorium fistulosum
0.177
Sneezeweed
Helenium autumnale
0.177
Monkey Flower
Mimulus ringens
0.032
Iron Weed
Vernonia altissima
0.554
Yellow Wingstem
Verbesina alternifolia
0.846
httas://roundstoneseed.com/wetland-mixes/1034-wetland-meadow-m ix.htm I

Action ID Number: SAW-2023-00711
Permittee: Colonial Pipeline Company, Attn: Kyle Boyan
County: Guilford
Project Name: Colonial Pipeline Company / Greensboro Junction Facility / Butane Truck Offload
Terminal and pipeline
Date Verification Issued: 06/29/2023
Project Manager: David E. Bailey
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: David E. Bailey
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of.Permittee Date

A. Determination of Jurisdiction:
1. ® There are waters, including wetlands on the above -described project area that may be subject to Section 404 of the
Clean Water Act (CWA) (33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). 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 iurisdictional determination form dated 06/29/2023.
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 Par 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 M9
Atlanta, Georgia 30303-8801
Phone: [phone]
AND
philip.a. shannin(a).usace. army. mil
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by 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.
Corps Regulatory Official:
David E. Bailey
Date of JD: 06/29/2023 Expiration Date of JD: Not applicable

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Colonial Pipeline Company (Attn: Kyle
File Number: SAW-2023-00111
Date: 06/29/2023
Bovan
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 WITHOUT PREJUDICE
C
❑
PERMIT DENIAL WITH PREJUDICE
D
❑
APPROVED JURISDICTIONAL DETERMINATION
E
®
PRELIMINARY JURISDICTIONAL DETERMINATION
F
SECTION 1
The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at https://www.usace.army.mil/Missions/Civil-Works/Reoulatorv-
Prooram-and-Permits/appeals/ or Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the
district engineer for final authorization. If you received a Letter of Permission (LOP), you may accept
the LOP and your work is authorized. Your signature on the Standard Permit or acceptance of the
LOP means that you accept the permit in its entirety, and waive all rights to appeal the permit,
including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions
therein, you may request that the permit be modified accordingly. You must complete Section I I of this
form and return the form to the district engineer. 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 WITHOUT PREJUDICE: Not appealable
You received a permit denial without prejudice because a required Federal, state, and/or local
authorization and/or certification has been denied for activities which also require a Department of the
Army permit before final action has been taken on the Army permit application. The permit denial without
prejudice is not appealable. There is no prejudice to the right of the applicant to reinstate processing of
the Army permit application if subsequent approval is received from the appropriate Federal, state, and/or
local agency on a previously denied authorization and/or certification.
D: PERMIT DENIAL WITH PREJUDICE: You may appeal the 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.
E: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or
provide new information for reconsideration
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps
within 60 days of the date of this notice means that you accept the approved JD in its entirety and
waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of
Engineers Administrative Appeal Process by completing Section II of this form and sending the form to
the division engineer. This form must be received by the division engineer within 60 days of the date of
this notice.
• RECONSIDERATION: You may request that the district engineer reconsider the approved JD by
submitting new information or data to the district engineer within 60 days of the date of this notice. The
district will determine whether the information submitted qualifies as new information or data that
justifies reconsideration of the approved JD. A reconsideration request does not initiate the appeal
process. You may submit a request for appeal to the division engineer to preserve your appeal rights
while the district is determining whether the submitted information qualifies for a reconsideration.
F: PRELIMINARY JURISDICTIONAL DETERMINATION: Not appealable
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.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision you
If you have questions regarding the appeal process,
may contact:
or to submit your request for appeal, you may
District Engineer, Wilmington Regulatory Division
contact:
Attn: David E. Bailey
Philip Shannin
Raleigh Regulatory Office
Regulatory Appeals Review Officer
U.S Army Corps of Engineers
South Atlantic Division
3331 Heritage Trade Drive, Suite 105
60 Forsyth St SW, Floor M9
Wake Forest, North Carolina 27587
Atlanta, Georgia 30303-8803
Philia.A.Shannin20usace.army.miI
404-562-5136

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. Use additional pages as necessary.
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.
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:
Signature of appellant or agent.
Email address of appellant and/or agent:
Telephone number: