20140957 Ver 2_20180215 USACE SAW Mitigation Documentation_20180215

Dominion Energy Services, Ine.
5000 Dominion Boulevard,
Glen Allen, VA 23060
February 16, 2018
BY EMAIL
Ms. Jean Gibby
U.S. Army Corps of Engineers — Wilmington District
Regulatory Division.
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Jean.B.Gibby`i?usace,army.
��
Ir
• •
��
Enerqy-
Re: Atlantic Coast Pipeline
Submittal of Compensatory Mitigation Responsibility Transfer Forms for the Proposed
Atlantic Coast Pipeline Project in North Carolina
SAW -2014-01568
Dear Ms. Gibby:
Atlantic Coast Pipeline, LLC, (Atlantic) is pleased to provide Compensatory Mitigation Responsibility
Transfer Forms documenting that compensatory mitigation credits for unavoidable wetland and stream
impacts associated with the construction of the proposed Atlantic Coast Pipeline (ACP) in ten (10)
Hydrologic Unit Codes (HUCs) in North Carolina have been obtained. The goal of this submittal is to
fulfill Special Condition #24 of the Nationwide Permit (NAW) 12 verification for the ACP in the
Wilmington District (SAW -2014-01568).
As indicated in the revised Compensatory Mitigation Plan, Atlantic compensated for the unavoidable
wetland and stream impacts in the subject RUCs through a combination of mitigation bank credit
purchase, ILF credit purchase and permittee -responsible mitigation (PRM) in the Neuse River Basin.
Attached to this letter are completed Compensatory Mitigation Responsibility Transfer Forms for the
following sources of compensatory mitigation:
• Barra Farms Regional Mitigation Bank Phase R
• Cape Fear Umbrella Mitigation Bank
• NC Division of Mitigation Services (NCDMS)
Atlantic appreciates the coordination to date and looks forward to continuing to work with you on this
project. Please contact Spencer Trichell at [phone] or Spencer.Trichelltc`�,dominioggag[gys2in, if
there are questions regarding this submittal.

U.S Army Corps of Engineers — Wilmington District.
Atlantic Coast Pipeline — Compensatory Mitigation Responsibility Transfer Forms
February 16, 2018
Page 2 of 2
Please direct written responses to:
Richard B. Gangle
Dominion Energy Resources, Inc.
5000 Dominion Boulevard
Glen Allen, Virginia 23060
Sincerel
Richard B. Gangle
Environmental Manager, Atlantic Coast Pipeline
cc: Spencer Trichell, Dominion
Attachments

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee; Atlantic Coast Pipeline, LLC Action ID: SAW -2014-01558
Project Name: Atlantic Coast Pipeline
County: North Hampton, Halifax, Nash, Wilson, Johnston, Sampson, Cumberland, and Robeson
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that to the U.S. Army Corps of Engineers (USACE) 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 must verify that the mitigation requirements (credits) shown below are available at the
identified site. By signing below, the Sponsor is accepting full responsibility for the identified mitigation, regardless of
whether or not 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 bank ledger to the Permittee, the USACE Project Manager, and
the Wilmington District Mitigation Office (see contact information on page 2). The Sponsor must also comply with all
reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted Impacts Requiring Mitigation* 8 -digit HUC and Basin: 03030004, Cape Fear River Basin
Stream Impacts (linear feet) Wetland Impacts (acres)
Warm Cool
Cold Riparian Riverine
Riparian Non-Riverine
Non -Riparian
I Coastal
Coastal
2.51
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements: S -digit HUC and Basin: 03030004, Cape Fear River Basin
Stream Mitigation (credits) Wetland Mitigation (credits)
Warm
Cool
Cold Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
2.51
Mitigation Site Debited: Barra Farms II Mitigation Bank
(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 1 am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and 1 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 USACE, 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: Southern Produce Distributors, Inc.
Name of Snnnsnr's Authnri7ed Representative:John Preyer - Restoration Systems, LLC
2-13-2018
Signature of Sponsor's Authorized Representative Date of Signature
Page I of 2 Form Updated 23 November, 2015

USAGE Wilmington District
Compensatory Mitigation Responsibility Transfer Form, Page 3
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the USACE 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 USACE 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. 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 the Sponsor must be provided to the USACE within 30 days of permit
issuance. NCDOT remains fully responsible for the mitigation until the USACE 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 USACE
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 USACE, the Sponsor must obtain case-by-case approval from the USACE Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios may be applied, as per current District guidance
and a new version of this form must be completed and included in the USACE administrative records for both the permit
and the Bank/ILF Instrument.
Comments/Additional Conditions:
This form is not valid unless signed below by the USACE 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 USACE
Project Manager at the address below, and 3) the Wilmington District Mitigation Office, Attn: Todd Tugwell, 3331 Heritage
Trade Drive, Suite 105, Wake Forest, NC27587 (email., [e-mail]). Questions regarding this form or
any of the permit conditions may be directed to the USACE Project Manager below.
USACE Project Manager: Samantha Dailey
USACE Field Office: Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: Samantha.![e-mail]
USACE Project ManaiRer Signature
February 7, 2018
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.mii,
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 our website at http://regulatory.usacesurvey.com/to complete the survey online.

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation ResponsibilitV Transfer Form
Permittee., Atlantic Coast Pipeline, LLC Action ID: SAW -2014-01558
Project Name-, Atlantic Coast Pipeline
County: North Hampton, Halifax, Nash, Wilson, Johnston, Sampson, Cumberland, and Robeson
Instructions to Permittee, The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it ls'the Permittee's responsibility to ens i ure
that to the U.S. Army Corps of Engineers (USACE) 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 must verify that the mitigation requirements (credits) shown below are available at the
Identified site. By signing below, the Sponsor Is accepting full responsibility for the identified mitigation, regardless of
whether or not 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 bank ledger to the Permittee, the USACE Project Manager, and
the Wilmington District Mitigation Office (see contact information on page 3). The Sponsor must also comply with all
reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted Impacts Requiring Mitigation* 9 -digit HUC and Basin: 03030005, Cape Fear River Basin
I Stream Impacts (linear feet) Wetland Impacts (acres)
Warm
cool Cold Riparian Riverine
Riparian Non-Riverine
I Non -Riparian
Coastal
30
1.55
1.7
10.59
10.6
*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. 03030005, Cape Fear River Basin
Stream Mitigation (credits) Wetland Mitigation (credits)
Warm Cool
Cold Riparian Riverine
Riparian Non-Riverine
Non -Riparian
coastal
60
1.7
1224
10.6
1
Permitted Impacts Requiring Mitigation* 8 -digit HUC and Basin: 03030006, Cape Fear River Basin
Stream Impacts (linear feet) Wetland Impacts (acres)
Warm
cool Cold Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
612
I Non -Riparian Coastal
1224
1
*If more than one mitigation sponsorwill be used forthe permit, only include impacts to be mitigated bythis sponsor,
Compensatory Mitigation Requirements: 8 -digit HUC and Basin: 03030008; Cape Fear River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
/arm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
I Non -Riparian Coastal
1224
1
1
Mitigation Site Debited, Lower Cape Fear Umbrella Mitigation Bank (Sneeden and White Sioring Tracts)
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCDIVIS, list NCDMS. lftheNCDMS
acceptance letter identifies a specific site, also list the specific site to be debited).
Page 1 of 3 Form Updated 23 November, 2015

U.S. ARMY CORPS OF ENGINEERS
Wilrnington District
section to be completed by the Mitigation Sponsor
sfatLment of Mitigation Liability Acceptance: 1, the undersigned, verify that I am authorized to approve 1111HP11011
If the Mitigation Sponsor,
, r i r �� `�i f: t; n n s , c )r I shown below, and I certify that the Sponsor agrees to accept ru!'I r sponslbllity fol
�)fclvidirig the witigation identified, in this docurnent (see the table above), associated witty the USACE Pc-rj-nittee and Action
J) number shown, 1 also verify 'hat rifleased credits (and/or advance credits for NCDMS), as appi-oved by the USACE, are
carr nnfly 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 ineasures against the Sponsor tD
ensure compliance associated with the mitigation requirements.
Mitigation Sponsor Nam
Name of Sobilsor's Aulhl
!W-M—orized Representative Date of Signature
"

USACE Wilmington District
Compensatory Mitigation Responsibility Transfer Form, Page 3
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the USACE 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 USACE 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. 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 the Sponsor must be provided to the USACE within 30 days of permit
issuance. NCDOT remains fully responsible for the mitigation until the USACE 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 USACE
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 USACE, the Sponsor must obtain case-by-case approval from the USACE Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios may be applied, as per current District guidance
and a new version of this form must be completed and included in the USACE administrative records for both the permit
and the Bank/ILF Instrument.
Comments/Additional Conditions:
This form is not valid unless signed below by the USACE Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor shouldprovide copies of this form along with an updated bank ledger tar 1) the Permittee, 2) the USACE
Project Manager at the address below, and3) the Wilmington District Mitigation Office, Attn: Todd Tugwell, 3331 Heritage
Trade Drive, Suite 105, Wake Forest, NC 27587 (email. todd. tuywell@usace. army. mil). Questions regarding this form or
any of the permit conditions may he directed to the USACE Project Manager below.
USACE Project Manager: Samantha Dailey
USACE Field Office: Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: Samantha.J.Da€leypusace.army.tni1
A
USACE Project Manager Signature
February 7, 2018
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,
"rite 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 our website at htto:[/regulatory.usacesgNeycom
Ito complete the survey online.

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Permittee: Atlantic Coast Pipeline, LLC Action ID: SAW -201401558
Project Name: Atlantic Coast Pipeline
County: North Hampton, Halifax, Nash, Wilson, Johnston, Sampson, Cumberland, and Robeson
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that to the U.S. Army Corps of Engineers (USACE) 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 must verify that the mitigation requirements (credits) shown below are available at the
identified site. By signing below, the Sponsor is accepting full responsibility for the identified mitigation, regardless of
whether or not 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 bank ledger to the Permittee, the USACE Project Manager, and
the Wilmington District Mitigation Office (see contact information on page 5). The Sponsor must also comply with all
reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted impacts Requiring M
Stream Impacts (linear
HUC and Basin: 03010107, Roanoke River Basin
�l
- ares)
Warm J Cool Cold ' Riparian Riverine Riparian N n-RiverineI Non-Riparlan Coastal
�.M . ^ 1.76 1.15
If more than one mitigation sponsor will be used e
ed for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements:
8 -digit HUC and Basin_ 03010107, Roanoke River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Coof Cold
Riparian Riverine
I Riparian Non-Riverine Non Riparian Coastal
a.dn� -
_.0
1.76
1.15
Permitted Impacts Requiring Mitigation's
.... 8 -digit HUC and Basin: 03010204, Chowan River Basin
Stream Impacts (linear feet)
Wetland impacts (acres)
Warm Cooi
Coid
Riparian Riverine
_.
Riparlan Nan-Riverine
Non-Riparlan Coastal
__
6 56
m... .
1.49
If more than one mitigation sponsor will be used for the permit, only include Impacts to be mitigated by this sponsor
ipensatory mitigation Requirements: 8 -digit HUC and Basin: 03010204, Chowan River Basin
Stream Mitigation (credits) Wetland Mitigation (credits) _
Warm
Cool Cold Riparian RivennewRiparia�-n. Non-Riverine Non -Riparian Coastal h
_
6.57 w.m......_
Compensatory Mitigation Requirements: 8 -digit HUC and Basin: 03010205, Chowan River Basin
Stream Mitigation (credits) and Mitigation (credits)
Warm Cool Cold Riparian Riverme Riparlan Non-Riverine Non -Riparian Coastal
a . 1.49
Page 1 of S Form Updated 23 November, 2015

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Permitted Impacts Requiring Mitigation* 8 -digit HUC and Basin: 03020102_ , Tar -Pamlico River Basin
pp Wetland Impacts (acres)
Stream impacts (linear feet) l p
Warm Cool Cold Riparian Riverine Ri arian Non-Riverme Non -Riparian Coastal
9.43 5.07
... . ...... *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 03020102, Tar Pamlico River Basin
p p Wetland Mitigation credits
Stream Mitigation (credits) g (credits) LL.v. .
g
Warm Cool Cold Riparian Riverine Riparian Nan Riverme Non -Riparian Coastal
- .._
9.56 1 5.2
Permitted Impacts Requiring Mitigation* 8 -digit HUC and Basin: 03020101, Tar -Pamlico River Basin
Stream Impacts (linear feet) Wetland Impacts (acres)
-. �.
---
Warm Cool Cold Riparian Riverine Riparian Non-Riverine Non Riparian Coastal
_ _ _ R .__ —
V 10.14 6.21
*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: 03020101, Tar -Pamlico River Basin
M... —. - - - w
Stream Mitigation (credits) Wetland Mitigation (credits)
verine i Riparian Non-Riverine Non -Riparian Coastal
Warm Cool Cold Ri arian Ri -
p
6.21
Compensatory Mitlgation_Requlrements: 8 -digit HUC and Basin: 03020102, Tar -Pamlico River Basin
Stream Mitigation redits)------7 Wetland Mitigation (credits)
Warm Coal Cold Riparian Riverine Riparian Non-Riverine Non Riparian Coastal
*If more than one mitigation sponsor will be used for the permit, only Include impacts to be mitigated by this sponsor,
Permitted Impacts Requiring Mitigation* 8 -digit HUC and Basin: 03020203, Neuse River Basin
Stream Impacts (linear feet) Wetland Impacts (acres)
Wa �T-F Cool Cold Riparian Riverine Riparian Non-Riverine Non -Riparian Coastal
6.7 _ 10.53
*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: 03020203, Neuse River Basin
nw e... _ a ._ — -
Stream Mitigation (credits) Wetland Mitigation (credits) m
Warm C 00 Cold Rlparian Riverine Riparian Non-Riverine Non -Riparian Coastal
6.7 10.53
Permitted Impacts Requiring Mitigation* 8 -digit HUC and Basin: 03020201, Neuse River Basin
Stream Impacts (linear feet) Wetland impacts (acres)
Warm Coal Cold Riparian Rivarine� Riparian Non-Riverine Non -Riparian Coastal
63 .......
.:
*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: 03020201, Neuse River Basin
Stream Mitigation (credits) Wetland Mitigation (credits)
Warm Cool Cold Riparian Riverine Riparian Non Riverine Non -Riparian Coastal
126 . � �..,.
Page 2 of 5 Farm Updated 23 November, 2015

[VINOWAS."T
Wilmington District
Permitted Impacts Requiring Mitigation*
8-dfgit HUC and Basin: 03030006, Cape Fear River Basin
Stream Impacts linear feet
P { )
_ Wetland Impacts (acres)
Warm Cool ColdRiparian
Riverine Riparian Nan-Riverine Non Riparian
—..
Coastal
... _
16.6.3
*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: 03030006, Cape Fear River Basin
Stream Mitigation (credits)
... —.
Wetland Mitigation (credits)
Warm
Coof
Cold
Riparian Riverine Riparian Non-Riverine Non -Riparian Coastal_
16 63
Compensatory Mitigation Requirements:
8 -digit HUC and Basin: 03030005, Cape Fear River Basin
Stream impacts (credits) _
Wetland Mitigation (credits)
Warm Cool Cold
Riparian Riverine Riparian Non-Riverine
Non-RipariaN�oa,tal,
---;If more than one mitigation sponsor will be
9.88
used for the permit, only include impacts to be mitigated by this sponsor.
Permitted Impacts Requiring Mitigation*
8-digft HUC and Basin: 03030004, Cape Fear River Basin
Stream Impacts (linear feet) -
Wetland Impacts (acres)
Warm Cool Cold
61 _
Riparian Riverine
Rjparian Non-Riverine Non -Riparian Coastal
_. -
*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: 03030004, Cape Fear River Basin
Stream Mitigation (credits)_
-�
Wetland Mitigation (credits)
Warm Coof Cold -.
122
Riparian Riverine
� ...�
Riparian Non-Riverine
- _
Non -Riparian Coastal
Permitted Impacts Requiring Mitigation*
8 -digit HUC and Basin: 03040203,_. Lumber River Basin
Stream Impacts (linear feet)
Warm Cool Cold
Wetland impacts (acres)
— . _
Riparian Riverine
_._. _
Riparian Non-Riverine Non -Riparian Coastal
__. .m_
10.37
—
13.32
If Imore than one mitigation sponsor will be used for the permit, on � �r—.__�.....
* only include impacts to be mitigated..by this sponsor.
Compensatory Mitigation _Requirements:
8 -digit HUC and Basin: 03040203, Lumber River Basin
Stream Mitigation (credits)
___J�.
Wetland Mitigation (credits)
Warm
Cool Cold
Riparian Riverine Riparian Non-Riverine
__
Non -Riparian Coastal
. ..... .
10.37
13.32
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).
Page 3 of 5 Form Updated 23 November, 2015

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: 1, 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 USACE, 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.
s
Mitigation Sponsor Name:.® � • ....... - --- -
Name of
Page 4 of 5
Authorized Representative Date of Signature
Form Updated 23 November, 2015

USACE Wilmington District
Compensatory Mitigation Responsibility Transfer Form, Page 2
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the USACE 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 USACE 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. 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 the Sponsor must be provided to the USACE within 30 days of permit
issuance. NCDOT remains fully responsible for the mitigation until the USACE 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 USACE
Project Manager (address below) is provided with a signed copy of this form.
a If changes are proposed to the type, amount, or location of mitigation after this form has been signed and returned to
the USACE, the Sponsor must obtain case-by-case approval from the USACE Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios may be applied, as per current District guidance
and a new version of this form must be completed and included in the USACE administrative records for both the permit
and the Bank/ILF Instrument,
Comments/Additional Conditions:
This form is not valid unless signed below by the USACE Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor shouldprovide copies of this form along with an updated bank ledger to:11 the Permittee, 2) the USACE
Project Manager at the address below, and 3) the Wilmington District Mitigation Office, Attn: Todd Tugwell, 3331 Heritage
Trade Drive, Suite 105, Wake Forest, NC 27587 {emall: [e-mail]. Questions regarding this form or
any of the permit conditions may be directed to the USACE Project Manager below.
USACE Project Manager: Samantha Dailey
USACE Field Office: Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: Samantha.J.Dailey usace.armmii
,_.. February 7, 2018..., _.....
USACE Project er
Man Signature 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:/Iribits.usace.armv.mil.
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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 our website at http:Z/regulatory.usacesurvey.com/ to complete the survey online.