20180852 Ver 1 - McKnight Mill Road USACE JD_1.11.18_Pilot 2547 - 6/19/2018 1:52 PM

6$:
86$50<&25362)(1*,1((56
:,/0,1*721',675,&7

$FWLRQ,G6$:&RXQW\*XLOIRUG86*64XDG1&%URZQV6XPPLW

127,),&$7,212)-85,6',&7,21$/'(7(50,1$7,21

5HTXHVWRU3LORW(QYLURQPHQWDO,QF
$WWQ0LFKDHO%UDPH
$GGUHVV32%R[
.HUQHUVYLOOH1&

6L]HDFUHVa1HDUHVW7RZQ*UHHQVERUR
1HDUHVW:DWHUZD\87WR1RUWK%XIIDOR&UHHN 5LYHU%DVLQ&DSH)HDU
86*6+8&&RRUGLQDWHV1:
/RFDWLRQGHVFULSWLRQ7KHSURMHFWDUHDLVORFDWHGRQWKHHDVWVLGHRI0F.QLJKW0LOO5RDGDSSUR[LPDWHO\PLOHVRXWKRILWV
LQWHUVHFWLRQZLWK+LFRQH5RDGDW0F.QLJKW0LOO5RDGLQ*UHHQVERUR*XLOIRUG&RXQW\1RUWK&DUROLQD7KH3URMHFW
$UHDLVVKRZQDVWKH³6LWH%RXQGDU\´RQWKHDWWDFKHGPDSHQWLWOHG³:HWODQG0DS´

,QGLFDWH:KLFKRIWKH)ROORZLQJ$SSO\
$.PreliminaryDetermination
7KHUHDSSHDUWREHZDWHUVLQFOXGLQJZHWODQGVRQWKHDERYHGHVFULEHGSURMHFWDUHDSURSHUW\WKDWPD\EHVXEMHFWWR
6HFWLRQRIWKH&OHDQ:DWHU$FW&:$86&†DQGRU6HFWLRQRIWKH5LYHUVDQG+DUERUV$FW5+$
86&†7KHZDWHUVLQFOXGLQJZHWODQGVKDYHEHHQGHOLQHDWHGDQGWKHGHOLQHDWLRQKDVEHHQYHULILHGE\WKH&RUSVWREH
VXIILFLHQWO\DFFXUDWHDQGUHOLDEOH7KHDSSUR[LPDWHERXQGDULHVRIWKHVHZDWHUVDUHVKRZQRQWKHHQFORVHGGHOLQHDWLRQPDS
GDWHG7KHUHIRUHWKLVSUHOLPLQDU\MXULVGLFWLRQGHWHUPLQDWLRQPD\EHXVHGLQWKHSHUPLWHYDOXDWLRQSURFHVV
LQFOXGLQJGHWHUPLQLQJFRPSHQVDWRU\PLWLJDWLRQ)RUSXUSRVHVRIFRPSXWDWLRQRILPSDFWVFRPSHQVDWRU\PLWLJDWLRQ
UHTXLUHPHQWVDQGRWKHUUHVRXUFHSURWHFWLRQPHDVXUHVDSHUPLWGHFLVLRQPDGHRQWKHEDVLVRIDSUHOLPLQDU\-'ZLOOWUHDW
DOOZDWHUVDQGZHWODQGVWKDWZRXOGEHDIIHFWHGLQDQ\ZD\E\WKHSHUPLWWHGDFWLYLW\RQWKHVLWHDVLIWKH\DUHMXULVGLFWLRQDO
ZDWHUVRIWKH867KLVSUHOLPLQDU\GHWHUPLQDWLRQLVQRWDQDSSHDODEOHDFWLRQXQGHUWKH5HJXODWRU\3URJUDP
$GPLQLVWUDWLYH$SSHDO3URFHVV5HIHUHQFH&)53DUW+RZHYHU\RXPD\UHTXHVWDQDSSURYHG-'ZKLFKLVDQ
DSSHDODEOHDFWLRQE\FRQWDFWLQJWKH&RUSVGLVWULFWIRUIXUWKHULQVWUXFWLRQ

7KHUHDSSHDUWREHZDWHUVLQFOXGLQJZHWODQGVRQWKHDERYHGHVFULEHGSURMHFWDUHDSURSHUW\WKDWPD\EHVXEMHFWWR6HFWLRQRI
WKH&OHDQ:DWHU$FW&:$86&†DQGRU6HFWLRQRIWKH5LYHUVDQG+DUERUV$FW5+$86&†+RZHYHU
VLQFHWKHZDWHUVLQFOXGLQJZHWODQGVKDYHQRWEHHQSURSHUO\GHOLQHDWHGWKLVSUHOLPLQDU\MXULVGLFWLRQGHWHUPLQDWLRQPD\QRWEH
XVHGLQWKHSHUPLWHYDOXDWLRQSURFHVV:LWKRXWDYHULILHGZHWODQGGHOLQHDWLRQWKLVSUHOLPLQDU\GHWHUPLQDWLRQLVPHUHO\DQ
HIIHFWLYHSUHVXPSWLRQRI&:$5+$MXULVGLFWLRQRYHUDOORIWKHZDWHUVLQFOXGLQJZHWODQGVDWWKHSURMHFWDUHDZKLFKLVQRW
VXIILFLHQWO\DFFXUDWHDQGUHOLDEOHWRVXSSRUWDQHQIRUFHDEOHSHUPLWGHFLVLRQ:HUHFRPPHQGWKDW\RXKDYHWKHZDWHUVLQFOXGLQJ
ZHWODQGVRQ\RXUSURMHFWDUHDSURSHUW\GHOLQHDWHG$VWKH&RUSVPD\QRWEHDEOHWRDFFRPSOLVKWKLVZHWODQGGHOLQHDWLRQLQD
WLPHO\PDQQHU\RXPD\ZLVKWRREWDLQDFRQVXOWDQWWRFRQGXFWDGHOLQHDWLRQWKDWFDQEHYHULILHGE\WKH&RUSV
%$SSURYHG'HWHUPLQDWLRQ

7KHUHDUH1DYLJDEOH:DWHUVRIWKH8QLWHG6WDWHVZLWKLQWKHDERYHGHVFULEHGSURMHFWDUHDSURSHUW\VXEMHFWWRWKHSHUPLW
UHTXLUHPHQWVRI6HFWLRQRIWKH5LYHUVDQG+DUERUV$FW5+$86&†DQG6HFWLRQRIWKH&OHDQ:DWHU$FW
&:$86&†8QOHVVWKHUHLVDFKDQJHLQODZRURXUSXEOLVKHGUHJXODWLRQVWKLVGHWHUPLQDWLRQPD\EHUHOLHGXSRQIRU
DSHULRGQRWWRH[FHHGILYH\HDUVIURPWKHGDWHRIWKLVQRWLILFDWLRQ

7KHUHDUHZDWHUVLQFOXGLQJZHWODQGVRQWKHDERYHGHVFULEHGSURMHFWDUHDSURSHUW\VXEMHFWWRWKHSHUPLWUHTXLUHPHQWVRI6HFWLRQ
RIWKH&OHDQ:DWHU$FW&:$86&†8QOHVVWKHUHLVDFKDQJHLQWKHODZRURXUSXEOLVKHGUHJXODWLRQVWKLV
GHWHUPLQDWLRQPD\EHUHOLHGXSRQIRUDSHULRGQRWWRH[FHHGILYH\HDUVIURPWKHGDWHRIWKLVQRWLILFDWLRQ

:HUHFRPPHQG\RXKDYHWKHZDWHUVLQFOXGLQJZHWODQGVRQ\RXUSURMHFWDUHDSURSHUW\GHOLQHDWHG$VWKH&RUSVPD\QRWEH
DEOHWRDFFRPSOLVKWKLVZHWODQGGHOLQHDWLRQLQDWLPHO\PDQQHU\RXPD\ZLVKWRREWDLQDFRQVXOWDQWWRFRQGXFWDGHOLQHDWLRQWKDW
FDQEHYHULILHGE\WKH&RUSV

7KHZDWHUVLQFOXGLQJZHWODQGVRQ\RXUSURMHFWDUHDSURSHUW\KDYHEHHQGHOLQHDWHGDQGWKHGHOLQHDWLRQKDVEHHQYHULILHGE\WKH
&RUSV7KHDSSUR[LPDWHERXQGDULHVRIWKHVHZDWHUVDUHVKRZQRQWKHHQFORVHGGHOLQHDWLRQPDSGDWHG0$3'$7(,I\RXZLVKWR
KDYHWKHGHOLQHDWLRQVXUYH\HGWKH&RUSVFDQUHYLHZDQGYHULI\WKHVXUYH\XSRQFRPSOHWLRQ2QFHYHULILHGWKLVVXUYH\ZLOO
SURYLGHDQDFFXUDWHGHSLFWLRQRIDOODUHDVVXEMHFWWR&:$DQGRU5+$MXULVGLFWLRQRQ\RXUSURSHUW\ZKLFKSURYLGHGWKHUHLVQR
FKDQJHLQWKHODZRURXUSXEOLVKHGUHJXODWLRQVPD\EHUHOLHGXSRQIRUDSHULRGQRWWRH[FHHGILYH\HDUV
6$:

7KHZDWHUVLQFOXGLQJZHWODQGVKDYHEHHQGHOLQHDWHGDQGVXUYH\HGDQGDUHDFFXUDWHO\GHSLFWHGRQWKHSODWVLJQHGE\WKH&RUSV
5HJXODWRU\2IILFLDOLGHQWLILHGEHORZRQ6859(<6,*1(''$7(8QOHVVWKHUHLVDFKDQJHLQWKHODZRURXUSXEOLVKHG
UHJXODWLRQVWKLVGHWHUPLQDWLRQPD\EHUHOLHGXSRQIRUDSHULRGQRWWRH[FHHGILYH\HDUVIURPWKHGDWHRIWKLVQRWLILFDWLRQ

7KHUHDUHQRZDWHUVRIWKH86WRLQFOXGHZHWODQGVSUHVHQWRQWKHDERYHGHVFULEHGSURMHFWDUHDSURSHUW\ZKLFKDUHVXEMHFWWRWKH
SHUPLWUHTXLUHPHQWVRI6HFWLRQRIWKH&OHDQ:DWHU$FW86&8QOHVVWKHUHLVDFKDQJHLQWKHODZRURXUSXEOLVKHG
UHJXODWLRQVWKLVGHWHUPLQDWLRQPD\EHUHOLHGXSRQIRUDSHULRGQRWWRH[FHHGILYH\HDUVIURPWKHGDWHRIWKLVQRWLILFDWLRQ

7KHSURSHUW\LVORFDWHGLQRQHRIWKH&RDVWDO&RXQWLHVVXEMHFWWRUHJXODWLRQXQGHUWKH&RDVWDO$UHD0DQDJHPHQW$FW&$0$
<RXVKRXOGFRQWDFWWKH'LYLVLRQRI&RDVWDO0DQDJHPHQWLQ0RUHKHDG&LW\1&DWWRGHWHUPLQHWKHLU
UHTXLUHPHQWV

3ODFHPHQWRIGUHGJHGRUILOOPDWHULDOZLWKLQZDWHUVRIWKH86LQFOXGLQJZHWODQGVZLWKRXWD'HSDUWPHQWRIWKH$UP\SHUPLWPD\
FRQVWLWXWHDYLRODWLRQRI6HFWLRQRIWKH&OHDQ:DWHU$FW86&†3ODFHPHQWRIGUHGJHGRUILOOPDWHULDOFRQVWUXFWLRQRU
SODFHPHQWRIVWUXFWXUHVRUZRUNZLWKLQQDYLJDEOHZDWHUVRIWKH8QLWHG6WDWHVZLWKRXWD'HSDUWPHQWRIWKH$UP\SHUPLWPD\
FRQVWLWXWHDYLRODWLRQRI6HFWLRQVDQGRURIWKH5LYHUVDQG+DUERUV$FW86&†DQGRU,I\RXKDYHDQ\TXHVWLRQV
UHJDUGLQJWKLVGHWHUPLQDWLRQDQGRUWKH&RUSVUHJXODWRU\SURJUDPSOHDVHFRQWDFW'DYLG%DLOH\DW;RU
'DYLG(%DLOH\#XVDFHDUP\PLO

&%DVLV)RU'HWHUPLQDWLRQ6HHWKHDWWDFKHG3UHOLPLQDU\-XULVGLFWLRQDO'HWHUPLQDWLRQ)RUPGDWHG

'5HPDUNV1RQH

($WWHQWLRQ86'$3URJUDP3DUWLFLSDQWV

7KLVGHOLQHDWLRQGHWHUPLQDWLRQKDVEHHQFRQGXFWHGWRLGHQWLI\WKHOLPLWVRI&RUSV¶&OHDQ:DWHU$FWMXULVGLFWLRQIRUWKHSDUWLFXODUVLWH
LGHQWLILHGLQWKLVUHTXHVW7KHGHOLQHDWLRQGHWHUPLQDWLRQPD\QRWEHYDOLGIRUWKHZHWODQGFRQVHUYDWLRQSURYLVLRQVRIWKH)RRG6HFXULW\
$FWRI,I\RXRU\RXUWHQDQWDUH86'$3URJUDPSDUWLFLSDQWVRUDQWLFLSDWHSDUWLFLSDWLRQLQ86'$SURJUDPV\RXVKRXOGUHTXHVW
DFHUWLILHGZHWODQGGHWHUPLQDWLRQIURPWKHORFDORIILFHRIWKH1DWXUDO5HVRXUFHV&RQVHUYDWLRQ6HUYLFHSULRUWRVWDUWLQJZRUN

)$SSHDOV,QIRUPDWLRQ7KLVLQIRUPDWLRQDSSOLHVRQO\WRDSSURYHGMXULVGLFWLRQDOGHWHUPLQDWLRQVDVLQGLFDWHGLQ%
DERYH

7KLVFRUUHVSRQGHQFHFRQVWLWXWHVDQDSSURYHGMXULVGLFWLRQDOGHWHUPLQDWLRQIRUWKHDERYHGHVFULEHGVLWH,I\RXREMHFWWRWKLV
GHWHUPLQDWLRQ\RXPD\UHTXHVWDQDGPLQLVWUDWLYHDSSHDOXQGHU&RUSVUHJXODWLRQVDW&)53DUW(QFORVHG\RXZLOOILQGD
1RWLILFDWLRQRI$SSHDO3URFHVV1$3IDFWVKHHWDQGUHTXHVWIRUDSSHDO5)$IRUP,I\RXUHTXHVWWRDSSHDOWKLVGHWHUPLQDWLRQ\RX
PXVWVXEPLWDFRPSOHWHG5)$IRUPWRWKHIROORZLQJDGGUHVV

 86$UP\&RUSVRI(QJLQHHUV
 6RXWK$WODQWLF'LYLVLRQ
 $WWQ-DVRQ6WHHOH5HYLHZ2IILFHU
 )RUV\WK6WUHHW6:5RRP0
 $WODQWD*HRUJLD

,QRUGHUIRUDQ5)$WREHDFFHSWHGE\WKH&RUSVWKH&RUSVPXVWGHWHUPLQHWKDWLWLVFRPSOHWHWKDWLWPHHWVWKHFULWHULDIRUDSSHDO
XQGHU&)5SDUWDQGWKDWLWKDVEHHQUHFHLYHGE\WKH'LYLVLRQ2IILFHZLWKLQGD\VRIWKHGDWHRIWKH1$36KRXOG\RX
GHFLGHWRVXEPLWDQ5)$IRUPLWPXVWEHUHFHLYHGDWWKHDERYHDGGUHVVE\1RW$SSOLFDEOH

,WLVQRWQHFHVVDU\WRVXEPLWDQ5)$IRUPWRWKH'LYLVLRQ2IILFHLI\RXGRQRWREMHFWWRWKHGHWHUPLQDWLRQLQWKLVFRUUHVSRQGHQFH




&RUSV5HJXODWRU\2IILFLDOBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

'DWHRI-'([SLUDWLRQ'DWHRI3UHOLPLQDU\-'1RW$SSOLFDEOH

7KH:LOPLQJWRQ'LVWULFWLVFRPPLWWHGWRSURYLGLQJWKHKLJKHVWOHYHORIVXSSRUWWRWKHSXEOLF7RKHOSXVHQVXUHZHFRQWLQXHWRGRVR
SOHDVHFRPSOHWHWKH&XVWRPHU6DWLVIDFWLRQ6XUYH\ORFDWHGDWKWWSFRUSVPDSXXVDFHDUP\PLOFPBDSH[I"S 

&RS\IXUQLVKHG
6XH+RPHZRRG1&'(4':5:+DQHV0LOO5G6XLWH:LQVWRQ6DOHP1&
Digitally signed by BAILEY.DAVID.E.1379283736
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI,
ou=USA, cn=BAILEY.DAVID.E.1379283736
Date: 2018.01.11 16:08:57 -05'00'
6$:
127,),&$7,212)$'0,1,675$7,9($33($/237,216$1'352&(66$1'
5(48(67)25$33($/
$SSOLFDQW3LORW(QYLURQPHQWDO,QF$WWQ0LFKDHO%UDPH)LOH1XPEHU6$:'DWH
$WWDFKHGLV6HH6HFWLRQEHORZ
 ,1,7,$/352))(5('3(50,76WDQGDUG3HUPLWRU/HWWHURISHUPLVVLRQ $
 352))(5('3(50,76WDQGDUG3HUPLWRU/HWWHURISHUPLVVLRQ%
 3(50,7'(1,$/&
 $33529('-85,6',&7,21$/'(7(50,1$7,21'
 35(/,0,1$5<-85,6',&7,21$/'(7(50,1$7,21(
6(&7,21,7KHIROORZLQJLGHQWLILHV\RXUULJKWVDQGRSWLRQVUHJDUGLQJDQDGPLQLVWUDWLYHDSSHDORIWKHDERYHGHFLVLRQ$GGLWLRQDO
LQIRUPDWLRQPD\EHIRXQGDWRUKWWSZZZXVDFHDUP\PLO0LVVLRQV&LYLO:RUNV5HJXODWRU\3URJUDPDQG3HUPLWVDVS[RUWKH&RUSV
UHJXODWLRQVDW&)53DUW
$,1,7,$/352))(5('3(50,7<RXPD\DFFHSWRUREMHFWWRWKHSHUPLW
x$&&(37,I\RXUHFHLYHGD6WDQGDUG3HUPLW\RXPD\VLJQWKHSHUPLWGRFXPHQWDQGUHWXUQLWWRWKHGLVWULFWHQJLQHHUIRUILQDO
DXWKRUL]DWLRQ,I\RXUHFHLYHGD/HWWHURI3HUPLVVLRQ/23\RXPD\DFFHSWWKH/23DQG\RXUZRUNLVDXWKRUL]HG<RXU
VLJQDWXUHRQWKH6WDQGDUG3HUPLWRUDFFHSWDQFHRIWKH/23PHDQVWKDW\RXDFFHSWWKHSHUPLWLQLWVHQWLUHW\DQGZDLYHDOOULJKWV
WRDSSHDOWKHSHUPLWLQFOXGLQJLWVWHUPVDQGFRQGLWLRQVDQGDSSURYHGMXULVGLFWLRQDOGHWHUPLQDWLRQVDVVRFLDWHGZLWKWKHSHUPLW
x2%-(&7,I\RXREMHFWWRWKHSHUPLW6WDQGDUGRU/23EHFDXVHRIFHUWDLQWHUPVDQGFRQGLWLRQVWKHUHLQ\RXPD\UHTXHVWWKDW
WKHSHUPLWEHPRGLILHGDFFRUGLQJO\<RXPXVWFRPSOHWH6HFWLRQ,,RIWKLVIRUPDQGUHWXUQWKHIRUPWRWKHGLVWULFWHQJLQHHU
<RXUREMHFWLRQVPXVWEHUHFHLYHGE\WKHGLVWULFWHQJLQHHUZLWKLQGD\VRIWKHGDWHRIWKLVQRWLFHRU\RXZLOOIRUIHLW\RXUULJKW
WRDSSHDOWKHSHUPLWLQWKHIXWXUH8SRQUHFHLSWRI\RXUOHWWHUWKHGLVWULFWHQJLQHHUZLOOHYDOXDWH\RXUREMHFWLRQVDQGPD\D
PRGLI\WKHSHUPLWWRDGGUHVVDOORI\RXUFRQFHUQVEPRGLI\WKHSHUPLWWRDGGUHVVVRPHRI\RXUREMHFWLRQVRUFQRWPRGLI\
WKHSHUPLWKDYLQJGHWHUPLQHGWKDWWKHSHUPLWVKRXOGEHLVVXHGDVSUHYLRXVO\ZULWWHQ$IWHUHYDOXDWLQJ\RXUREMHFWLRQVWKH
GLVWULFWHQJLQHHUZLOOVHQG\RXDSURIIHUHGSHUPLWIRU\RXUUHFRQVLGHUDWLRQDVLQGLFDWHGLQ6HFWLRQ%EHORZ
%352))(5('3(50,7<RXPD\DFFHSWRUDSSHDOWKHSHUPLW
x$&&(37,I\RXUHFHLYHGD6WDQGDUG3HUPLW\RXPD\VLJQWKHSHUPLWGRFXPHQWDQGUHWXUQLWWRWKHGLVWULFWHQJLQHHUIRUILQDO
DXWKRUL]DWLRQ,I\RXUHFHLYHGD/HWWHURI3HUPLVVLRQ/23\RXPD\DFFHSWWKH/23DQG\RXUZRUNLVDXWKRUL]HG<RXU
VLJQDWXUHRQWKH6WDQGDUG3HUPLWRUDFFHSWDQFHRIWKH/23PHDQVWKDW\RXDFFHSWWKHSHUPLWLQLWVHQWLUHW\DQGZDLYHDOOULJKWV
WRDSSHDOWKHSHUPLWLQFOXGLQJLWVWHUPVDQGFRQGLWLRQVDQGDSSURYHGMXULVGLFWLRQDOGHWHUPLQDWLRQVDVVRFLDWHGZLWKWKHSHUPLW
x$33($/,I\RXFKRRVHWRGHFOLQHWKHSURIIHUHGSHUPLW6WDQGDUGRU/23EHFDXVHRIFHUWDLQWHUPVDQGFRQGLWLRQVWKHUHLQ\RX
PD\DSSHDOWKHGHFOLQHGSHUPLWXQGHUWKH&RUSVRI(QJLQHHUV$GPLQLVWUDWLYH$SSHDO3URFHVVE\FRPSOHWLQJ6HFWLRQ,,RIWKLV
IRUPDQGVHQGLQJWKHIRUPWRWKHGLYLVLRQHQJLQHHU7KLVIRUPPXVWEHUHFHLYHGE\WKHGLYLVLRQHQJLQHHUZLWKLQGD\VRIWKH
GDWHRIWKLVQRWLFH
&3(50,7'(1,$/<RXPD\DSSHDOWKHGHQLDORIDSHUPLWXQGHUWKH&RUSVRI(QJLQHHUV$GPLQLVWUDWLYH$SSHDO3URFHVVE\
FRPSOHWLQJ6HFWLRQ,,RIWKLVIRUPDQGVHQGLQJWKHIRUPWRWKHGLYLVLRQHQJLQHHU7KLVIRUPPXVWEHUHFHLYHGE\WKHGLYLVLRQ
HQJLQHHUZLWKLQGD\VRIWKHGDWHRIWKLVQRWLFH
'$33529('-85,6',&7,21$/'(7(50,1$7,21<RXPD\DFFHSWRUDSSHDOWKHDSSURYHG-'RUSURYLGHQHZ
LQIRUPDWLRQ
x$&&(37<RXGRQRWQHHGWRQRWLI\WKH&RUSVWRDFFHSWDQDSSURYHG-')DLOXUHWRQRWLI\WKH&RUSVZLWKLQGD\VRIWKH
GDWHRIWKLVQRWLFHPHDQVWKDW\RXDFFHSWWKHDSSURYHG-'LQLWVHQWLUHW\DQGZDLYHDOOULJKWVWRDSSHDOWKHDSSURYHG-'
x$33($/,I\RXGLVDJUHHZLWKWKHDSSURYHG-'\RXPD\DSSHDOWKHDSSURYHG-'XQGHUWKH&RUSVRI(QJLQHHUV$GPLQLVWUDWLYH
$SSHDO3URFHVVE\FRPSOHWLQJ6HFWLRQ,,RIWKLVIRUPDQGVHQGLQJWKHIRUPWRWKHGLVWULFWHQJLQHHU7KLVIRUPPXVWEHUHFHLYHG
E\WKHGLYLVLRQHQJLQHHUZLWKLQGD\VRIWKHGDWHRIWKLVQRWLFH
(35(/,0,1$5<-85,6',&7,21$/'(7(50,1$7,21<RXGRQRWQHHGWRUHVSRQGWRWKH&RUSVUHJDUGLQJWKH
SUHOLPLQDU\-'7KH3UHOLPLQDU\-'LVQRWDSSHDODEOH,I\RXZLVK\RXPD\UHTXHVWDQDSSURYHG-'ZKLFKPD\EHDSSHDOHGE\
FRQWDFWLQJWKH&RUSVGLVWULFWIRUIXUWKHULQVWUXFWLRQ$OVR\RXPD\SURYLGHQHZLQIRUPDWLRQIRUIXUWKHUFRQVLGHUDWLRQE\WKH&RUSV
WRUHHYDOXDWHWKH-'

6(&7,21,,5(48(67)25$33($/RU2%-(&7,21672$1,1,7,$/352))(5('3(50,7
6$:
5($6216)25$33($/252%-(&7,216'HVFULEH\RXUUHDVRQVIRUDSSHDOLQJWKHGHFLVLRQRU\RXUREMHFWLRQVWRDQLQLWLDO
SURIIHUHGSHUPLWLQFOHDUFRQFLVHVWDWHPHQWV<RXPD\DWWDFKDGGLWLRQDOLQIRUPDWLRQWRWKLVIRUPWRFODULI\ZKHUH\RXUUHDVRQVRU
REMHFWLRQVDUHDGGUHVVHGLQWKHDGPLQLVWUDWLYHUHFRUG





$'',7,21$/,1)250$7,217KHDSSHDOLVOLPLWHGWRDUHYLHZRIWKHDGPLQLVWUDWLYHUHFRUGWKH&RUSVPHPRUDQGXPIRUWKH
UHFRUGRIWKHDSSHDOFRQIHUHQFHRUPHHWLQJDQGDQ\VXSSOHPHQWDOLQIRUPDWLRQWKDWWKHUHYLHZRIILFHUKDVGHWHUPLQHGLVQHHGHGWR
FODULI\WKHDGPLQLVWUDWLYHUHFRUG1HLWKHUWKHDSSHOODQWQRUWKH&RUSVPD\DGGQHZLQIRUPDWLRQRUDQDO\VHVWRWKHUHFRUG+RZHYHU
\RXPD\SURYLGHDGGLWLRQDOLQIRUPDWLRQWRFODULI\WKHORFDWLRQRILQIRUPDWLRQWKDWLVDOUHDG\LQWKHDGPLQLVWUDWLYHUHFRUG
32,172)&217$&7)2548(67,21625,1)250$7,21
,I\RXKDYHTXHVWLRQVUHJDUGLQJWKLVGHFLVLRQDQGRUWKH
DSSHDOSURFHVV\RXPD\FRQWDFW
'LVWULFW(QJLQHHU:LOPLQJWRQ5HJXODWRU\'LYLVLRQ
DWWQ'DYLG(%DLOH\
5DOHLJK5HJXODWRU\)LHOG2IILFH
+HULWDJH7UDGH'ULYH6XLWH
:DNH)RUHVW1RUWK&DUROLQD
,I\RXRQO\KDYHTXHVWLRQVUHJDUGLQJWKHDSSHDOSURFHVV\RXPD\
DOVRFRQWDFW
0U-DVRQ6WHHOH$GPLQLVWUDWLYH$SSHDO5HYLHZ2IILFHU
&(6$'3'2
86$UP\&RUSVRI(QJLQHHUV6RXWK$WODQWLF'LYLVLRQ
)RUV\WK6WUHHW5RRP0
$WODQWD*HRUJLD
3KRQH
5,*+72)(175<<RXUVLJQDWXUHEHORZJUDQWVWKHULJKWRIHQWU\WR&RUSVRI(QJLQHHUVSHUVRQQHODQGDQ\JRYHUQPHQW
FRQVXOWDQWVWRFRQGXFWLQYHVWLJDWLRQVRIWKHSURMHFWVLWHGXULQJWKHFRXUVHRIWKHDSSHDOSURFHVV<RXZLOOEHSURYLGHGDGD\
QRWLFHRIDQ\VLWHLQYHVWLJDWLRQDQGZLOOKDYHWKHRSSRUWXQLW\WRSDUWLFLSDWHLQDOOVLWHLQYHVWLJDWLRQV

BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
6LJQDWXUHRIDSSHOODQWRUDJHQW
'DWH 7HOHSKRQHQXPEHU

For appeals on Initial Proffered Permits send this form to:

'LVWULFW(QJLQHHU:LOPLQJWRQ5HJXODWRU\'LYLVLRQ'DYLG%DLOH\'DUOLQJWRQ$YHQXH:LOPLQJWRQ1RUWK&DUROLQD


For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:

'LYLVLRQ(QJLQHHU&RPPDQGHU86$UP\(QJLQHHU'LYLVLRQ6RXWK$WODQWLF$WWQ0U-DVRQ6WHHOH$GPLQLVWUDWLYH$SSHDO
2IILFHU&(6$'3'2)RUV\WK6WUHHW5RRP0$WODQWD*HRUJLD
3KRQH

35(/,0,1$5< -85,6',&7,21$/ '(7(50,1$7,213-' )250
%$&.*5281',1)250$7,21
$5(3257 &203/(7,21'$7( )253-'
%1$0($1'$''5(662)3(56215(48(67,1*3-'0LFKDHO%UDPH3LORW(QYLURQPHQWDO,QF
3RVW2IILFH%R[.HUQHUVYLOOH1RUWK&DUROLQD
& ',675,&7 2)),&( ),/( 1$0( $1' 180%(56$:%\URQ'HYHORSPHQW0F.QLJKW
0LOO5RDG*UHHQVERUR*XLOIRUG&RXQW\UHVLGHQWLDO
' 352-(&7/2&$7,216$1'%$&.*5281',1)250$7,21
7KHSURMHFWLVORFDWHGDW0F.QLJKW0LOO5RDGLQ*UHHQVERUR*XLOIRUG&RXQW\1&7KHVLWHFRQWDLQVZRRGHGODQGDQG
ILHOGV7KHVLWHLVSURSRVHGIRUGHYHORSPHQW
86(7+(7$%/(%(/2:72'2&80(17 08/7,3/($48$7,&5(6285&(6$1'25
$48$7,&5(6285&(6$7',))(5(176,7(6
6WDWH1RUWK&DUROLQD &RXQW\SDULVKERURXJK*XLOIRUG &LW\*UHHQVERUR
&HQWHUFRRUGLQDWHVRIVLWHODWORQJLQGHJUHHGHFLPDOIRUPDW/DWƒ/RQJƒ
8QLYHUVDO7UDQVYHUVH0HUFDWRU:*6
1DPHRIQHDUHVWZDWHUERG\ 6RXWK%XIIDOR&UHHN
(5(9,(:3(5)250(')256,7((9$/8$7,21&+(&.$//7+$7$33/<
2IILFH'HVN'HWHUPLQDWLRQ'DWH
)LHOG'HWHUPLQDWLRQ'DWHV
7$%/(2)$48$7,&5(6285&(6,15(9,(:$5($:+,&+0$<%(68%-(&7725(*8/$725<
-85,6',&7,21
6LWH
1XPEHU
/DWLWXGHGHFLPDO
GHJUHHV
/RQJLWXGH
GHFLPDOGHJUHHV
(VWLPDWHGDPRXQWRI
DTXDWLFUHVRXUFHVLQ
UHYLHZDUHDDFUHDJH
DQGOLQHDUIHHWLI
DSSOLFDEOH
7\SHRIDTXDWLF
UHVRXUFHVLH
ZHWODQGYVQRQ
ZHWODQGZDWHUV
*HRJUDSKLFDXWKRULW\WR
ZKLFKWKHDTXDWLFUHVRXUFH
³PD\EH´VXEMHFWLH
6HFWLRQRU6HFWLRQ

6$ ƒ ƒ OLQHDUIHHW 6WUHDP
3HUHQQLDO

6% ƒ ƒ OLQHDUIHHW 6WUHDP
3HUHQQLDO

6%$ ƒ ƒ OLQHDUIHHW 6WUHDP
3HUHQQLDO

6& ƒ ƒ OLQHDUIHHW 6WUHDP
,QWHUPLWWHQW

,6% ƒ ƒ OLQHDUIHHW 6WUHDP
,QWHUPLWWHQW

,6%$ ƒ ƒ OLQHDUIHHW 6WUHDP
,QWHUPLWWHQW

,6%9 ƒ ƒ OLQHDUIHHW 6WUHDP
,QWHUPLWWHQW

:$:$$ ƒ ƒ $FUHV:HWODQG
)RUHVWHG

:% ƒ ƒ $FUHV :HWODQG
(PHUJHQW

:& ƒ ƒ $FUHV :HWODQG
)RUHVWHG

:'$ ƒ ƒ $FUHV :HWODQG
)RUHVWHG

7KH&RUSVRI(QJLQHHUVEHOLHYHVWKDWWKHUHPD\EHMXULVGLFWLRQDO DTXDWLFUHVRXUFHVLQ WKH
UHYLHZDUHDDQGWKHUHTXHVWRURIWKLV3-'LVKHUHE\DGYLVHGRIKLVRUKHURSWLRQ WR UHTXHVW
DQGREWDLQDQDSSURYHG-'$-'IRUWKDWUHYLHZDUHDEDVHGRQDQ LQIRUPHGGHFLVLRQDIWHU
KDYLQJGLVFXVVHGWKHYDULRXVW\SHVRI-'VDQGWKHLU FKDUDFWHULVWLFVDQGFLUFXPVWDQFHVZKHQ
WKH\PD\EHDSSURSULDWH
,QDQ\FLUFXPVWDQFHZKHUHDSHUPLWDSSOLFDQWREWDLQVDQLQGLYLGXDOSHUPLWRUD 1DWLRQZLGH
*HQHUDO3HUPLW1:3RURWKHUJHQHUDOSHUPLWYHULILFDWLRQUHTXLULQJ SUHFRQVWUXFWLRQ
QRWLILFDWLRQ3&1RUUHTXHVWVYHULILFDWLRQIRUDQRQUHSRUWLQJ 1:3RU RWKHUJHQHUDOSHUPLW
DQGWKHSHUPLWDSSOLFDQWKDVQRWUHTXHVWHGDQ$-'IRUWKH DFWLYLW\WKHSHUPLWDSSOLFDQWLV
KHUHE\PDGHDZDUHWKDWWKHSHUPLWDSSOLFDQWKDV HOHFWHGWRVHHNDSHUPLWDXWKRUL]DWLRQ
EDVHGRQD3-'ZKLFKGRHVQRWPDNHDQRIILFLDOGHWHUPLQDWLRQRIMXULVGLFWLRQDODTXDWLF
UHVRXUFHVWKHDSSOLFDQWKDVWKHRSWLRQWRUHTXHVWDQ$-'EHIRUHDFFHSWLQJWKHWHUPVDQG
FRQGLWLRQVRIWKHSHUPLW DXWKRUL]DWLRQDQGWKDW EDVLQJDSHUPLWDXWKRUL]DWLRQRQDQ$-'FRXOG
SRVVLEO\UHVXOWLQOHVV FRPSHQVDWRU\PLWLJDWLRQEHLQJUHTXLUHGRUGLIIHUHQWVSHFLDOFRQGLWLRQV
WKHDSSOLFDQWKDVWKHULJKWWRUHTXHVWDQLQGLYLGXDOSHUPLWUDWKHUWKDQDFFHSWLQJWKHWHUPV
DQGFRQGLWLRQVRIWKH1:3RURWKHUJHQHUDOSHUPLWDXWKRUL]DWLRQWKHDSSOLFDQWFDQ DFFHSW
DSHUPLWDXWKRUL]DWLRQDQGWKHUHE\DJUHHWRFRPSO\ZLWKDOOWKHWHUPVDQG FRQGLWLRQVRIWKDW
SHUPLWLQFOXGLQJZKDWHYHUPLWLJDWLRQUHTXLUHPHQWVWKH&RUSVKDV GHWHUPLQHGWREHQHFHVVDU\
XQGHUWDNLQJDQ\DFWLYLW\LQUHOLDQFHXSRQWKHVXEMHFW SHUPLWDXWKRUL]DWLRQZLWKRXW
UHTXHVWLQJDQ$-'FRQVWLWXWHVWKHDSSOLFDQW
VDFFHSWDQFHRIWKHXVHRIWKH3-'DFFHSWLQJD
SHUPLWDXWKRUL]DWLRQHJVLJQLQJDSURIIHUHG LQGLYLGXDOSHUPLWRUXQGHUWDNLQJDQ\DFWLYLW\LQ
UHOLDQFHRQDQ\IRUPRI&RUSVSHUPLW DXWKRUL]DWLRQEDVHGRQD3-'FRQVWLWXWHVDJUHHPHQWWKDW
DOODTXDWLFUHVRXUFHVLQWKH UHYLHZDUHDDIIHFWHGLQDQ\ZD\E\WKDWDFWLYLW\ZLOOEHWUHDWHGDV
MXULVGLFWLRQDO DQG ZDLYHVDQ\FKDOOHQJHWRVXFKMXULVGLFWLRQ LQDQ\DGPLQLVWUDWLYHRUMXGLFLDO
FRPSOLDQFH RUHQIRUFHPHQWDFWLRQRULQDQ\DGPLQLVWUDWLYHDSSHDORULQDQ\)HGHUDOFRXUW
DQGZKHWKHU WKHDSSOLFDQWHOHFWVWRXVHHLWKHUDQ$-'RUD3-'WKH-'ZLOOEHSURFHVVHG
DVVRRQDVSUDFWLFDEOH)XUWKHUDQ$-'DSURIIHUHGLQGLYLGXDOSHUPLWDQGDOOWHUPV DQG
FRQGLWLRQVFRQWDLQHGWKHUHLQRULQGLYLGXDO SHUPLWGHQLDOFDQEHDGPLQLVWUDWLYHO\DSSHDOHG
SXUVXDQWWR&)53DUW,IGXULQJDQDGPLQLVWUDWLYHDSSHDOLW EHFRPHVDSSURSULDWH WR
PDNHDQRIILFLDOGHWHUPLQDWLRQZKHWKHUJHRJUDSKLFMXULVGLFWLRQH[LVWVRYHUDTXDWLFUHVRXUFHV
LQWKHUHYLHZDUHDRUWRSURYLGHDQRIILFLDO GHOLQHDWLRQRIMXULVGLFWLRQDO DTXDWLFUHVRXUFHVLQ
WKHUHYLHZDUHDWKH&RUSVZLOO SURYLGHDQ$-'WRDFFRPSOLVKWKDWUHVXOWDVVRRQDVLV
SUDFWLFDEOH7KLV3-'ILQGV WKDWWKHUH"may be" ZDWHUVRIWKH86DQGRUWKDWWKHUH"may be"
QDYLJDEOHZDWHUVRI WKH86RQWKHVXEMHFWUHYLHZDUHDDQGLGHQWLILHVDOODTXDWLFIHDWXUHVLQ
WKHUHYLHZ DUHDWKDWFRXOGEHDIIHFWHGE\WKHSURSRVHGDFWLYLW\EDVHGRQWKHIROORZLQJ
LQIRUPDWLRQ
6833257,1*'$7$'DWDUHYLHZHGIRU3-'FKHFNDOOWKDWDSSO\
&KHFNHGLWHPVVKRXOGEHLQFOXGHGLQVXEMHFWILOH$SSURSULDWHO\UHIHUHQFHVRXUFHV EHORZZKHUH
LQGLFDWHGIRUDOOFKHFNHGLWHPV
0DSVSODQV SORWV RU SODW VXEPLWWHG E\RURQ EHKDOI RI WKH 3-'UHTXHVWRU
$HULDOVRLOVDQGWRSRPDSV3LORW(QY
'DWDVKHHWVSUHSDUHGVXEPLWWHGE\RURQEHKDOIRIWKH3-'UHTXHVWRU
2IILFHFRQFXUVZLWKGDWDVKHHWVGHOLQHDWLRQ UHSRUW
2IILFHGRHVQRWFRQFXUZLWKGDWDVKHHWVGHOLQHDWLRQUHSRUW5DWLRQDOH
'DWDVKHHWVSUHSDUHGE\WKH&RUSV
&RUSVQDYLJDEOHZDWHUV
VWXG\
86*HRORJLFDO6XUYH\+\GURORJLF$WODV
86*61+'GDWD
86*6DQGGLJLW+8&PDSV
86*HRORJLFDO6XUYH\PDSV&LWHVFDOH TXDGQDPH9LHZ'UDZLQJ
1DWXUDO5HVRXUFHV&RQVHUYDWLRQ6HUYLFH6RLO6XUYH\&LWDWLRQ9LHZ'UDZLQJV $
1DWLRQDOZHWODQGVLQYHQWRU\PDSV&LWHQDPH9LHZ'UDZLQJ
6WDWHORFDOZHWODQGLQYHQWRU\PDSVB
)(0$),50PDSV9LHZ'UDZLQJ
\HDU)ORRGSODLQ(OHYDWLRQLV 1DWLRQDO*HRGHWLF9HUWLFDO'DWXPRI
3KRWRJUDSKV$HULDO1DPH 'DWH9LHZ'UDZLQJ
RU 2WKHU1DPH 'DWH
3UHYLRXV GHWHUPLQDWLRQV )LOH QRDQG GDWHRI UHVSRQVH OHWWHU
2WKHULQIRUPDWLRQSOHDVHVSHFLI\/L'$51&)ORRGPDSV
,03257$17127(7KHLQIRUPDWLRQUHFRUGHGRQWKLVIRUPKDVQRWQHFHVVDULO\EHHQ
YHULILHGE\WKH&RUSVDQGVKRXOGQRWEHUHOLHGXSRQIRUODWHU MXULVGLFWLRQDO
GHWHUPLQDWLRQV
6LJQDWXUHDQGGDWHRI 5HJXODWRU\
VWDIIPHPEHU FRPSOHWLQJ3-'
6LJQDWXUHDQGGDWHRI SHUVRQ
UHTXHVWLQJ3-'5(48,5('
XQOHVVREWDLQLQJ WKHVLJQDWXUH
LVLPSUDFWLFDEOH
'LVWULFWVPD\HVWDEOLVKWLPHIUDPHVIRUUHTXHVWHUWRUHWXUQVLJQHG3-'IRUPV ,IWKHUHTXHVWHUGRHVQRWUHVSRQG ZLWKLQWKH
HVWDEOLVKHGWLPHIUDPHWKHGLVWULFWPD\SUHVXPHFRQFXUUHQFH DQGQRDGGLWLRQDOIROORZ XSLV QHFHVVDU\SULRUWRILQDOL]LQJ
DQDFWLRQ
03.22.2017
Y
Y
Y
Digitally signed by
BAILEY.DAVID.E.1379283736
DN: c=US, o=U.S. Government,
ou=DoD, ou=PKI, ou=USA,
cn=BAILEY.DAVID.E.1379283736
Date: 2018.01.11 15:54:06 -05'00'
&>'EhDZ^ͬ/E&K
td>E&>'^с
^dZD&>'^с
^ƚƌĞĂŵ&ůĂŐƐсϭϵ
tĞƚůĂŶĚ&ůĂŐƐсϳϰ
dŽƚĂů&ůĂŐƐсϵϯ
ƌĂǁŝŶŐϱ
ϮϬϭϱĞƌŝĂůWŚŽƚŽŐƌĂƉŚĨƌŽŵ'ŽŽŐůĞ
ĂƌƚŚĂŶĚW/&ŝĞůĚEŽƚĞƐ
^ĐĂůĞ͗ϭ͟сϰϬϬ͛
ĂƚĞ͗Ϭϯ͘Ϯϭ͘ϭϳ
tĞƚůĂŶĚDĂƉ
ƉƉƌŽdžŝŵĂƚĞϲϱ͘ϮĐƌĞ^ŝƚĞ
ϰϲϮϮDĐ<ŶŝŐŚƚDŝůůZŽĂĚ
'ƌĞĞŶƐďŽƌŽ͕'ƵŝůĨŽƌĚŽƵŶƚLJ͕E
W/WƌŽũĞĐƚϮϱϰϳ
d, >Kd/KE^ K& &dhZ^ ^,KtE KE d,/^ DW Z WZ>/D/EZz E WWZKy/Dd͘ d,z tZ sZ/&/ z DZ͘ s/
/>z t/d, d, h^ E D^͘ ^h ,KDtKK t/d, d, EYͲtZ KE DZ, ϮϮ͕ ϮϬϭϳ͘ d,z ,s EKd E
^hZsz KZ 'K>Kd͘ >/Ed/KE KDW>d z DZ͘ D/,> ZD E DZ͘Z>h<zt/d,W/KE&ZhZz
ϭϳ͕ ϮϬϭϳ͘
>'E
^ŝƚĞŽƵŶĚĂƌLJ
WĞƌĞŶŶŝĂů^ƚƌĞĂŵ
/ŶƚĞƌŵŝƚƚĞŶƚ^ƚƌĞĂŵ
tĞƚůĂŶĚƐ
&ůĂŐEƵŵďĞƌ
ĂƚĂWŽŝŶƚ
ƵůǀĞƌƚ
ŚĂŶŐĞĚƵƌŝŶŐsĞƌŝĨŝĐĂƚŝŽŶ
tϭͲϭϬ
WͲϭ
tϭͲϭϬtϭͲϯϳ
^ƚƌĞĂŵ^͖
^ƵƌǀĞLJŽƌ>ŽĐĂƚĞ
^ƚƌĞĂŵ/^͖
^ƵƌǀĞLJŽƌ>ŽĐĂƚĞ
^ƚƌĞĂŵ/^͖
^ƵƌǀĞLJŽƌ>ŽĐĂƚĞ
^ƚƌĞĂŵ^͖
^ƵƌǀĞLJŽƌ>ŽĐĂƚĞ
^ƚƌĞĂŵ^͖
^ƵƌǀĞLJŽƌ>ŽĐĂƚĞ
tϭͲϵ
WͲϭ
WͲϮ
WͲϯ^ϭͲϱ
tϭͲϭϱ
^ƚƌĞĂŵ/^s͗
^ƵƌǀĞLJŽƌ>ŽĐĂƚĞ
tϭͲϯ
tϭͲϭϬ