20150301 Ver 1_USACE Permit_20150413

Permittee:
Address:
Size (acres)
Nearest Waterway
USGS HUC
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2015-00585 County: Cumberland U.S.G.S. Quad: NC-HOPE MILLS
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
NC DOT, Division 6
Mr. Greg Bw•ns, DE
Post Office Box 1150
Fayetteville, NC 28302
4.43 miles
Little Rocici►sh Creelc
3030004
Nearest Town Favetteville
River Basin Uaper Cape Fear. North Carolina.
Coordinates Latitude:34.9604
Longitude: -78.909
Location description: The nroiect site is located alon� Tom Starling Road (SR 2220), for approximatelv 4.43 miles, located in
southwest Favetteville, in between Business US 301 and NC H�vv 87, in Cumberland Countv, Noi•th Carolina.
Description of projects area and activity: This veri�cation authorizes impacts to waters of the U.S. in association with an NC
DOT road widenin� proiect on Tom Starlin� Road (SR 22201, known as W-5512. Permanent impacts to st►�eams involve
culvert replacement/lengthening and banlc stabilization. Temporary impacts are necessary for dewatei•ins dui•ine the structure
replacements at the stream crossings.
Summa of Authorized Im acts and Re uired Miti ation
Impact ID # NWP � Open Water (ac) Wetland (ac) Stream (i fl
GP # Temporary Permanent Temporary Permanent Temporary Permanent
0.001 (pipe
0.003 installation/
Site lx 14 bank -- -
(dewatering�
stabilization�
Site 2* �4 -- -- -- -- 20 20 (pipe installation)
de�vatering}
Site 3 14 -- -- -- -- 20 31(pipe installation)
dewatcring)
Site 4 14 -- -- -- -- �� 12(pipe installation)
dewatet•ing}
Site 5''�* iQ -- -- -- -- 2a 0(pipe installation)
dc�vatering)
Impact Totals 0.003 0.001 0 0 80 63
Total Loss of Waters of the U.S. (ac) 0.001 Total Loss of Waters of the U.S. (1 fl 43
Required Wetland Mitigation
(ac) � Required Stream Mitigation (lf) 86 In-Lieu/EEP
*lntermittent tributaiy ** No permanent impact as the pipe replacement is same length as existing pipe
Applicable Law:
Authorization:
� Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Regional General Permit Number or Nationwide Permit Number: NWP 14
SEE ATTACHED RGP or NWP GENERAL, REGIONAL AND SPECIAL CON�3ITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application and attached information dated March 20, 2015 and i•evised March 27, 2015. Any
violation of the attached conditions oi• deviation fi�om your submitted plans may subject the pei•mittee to a stop worlc order, a
restoi•ation order, a Class I administrative penalty, and/or appropriate legal action.

This verification wi11 remain valid until the expiration date identified below unless the nationwide authorizatioil is modified,
suspended or revolced. If, prior to the expiration date identified below, the nationwide pei�tnit autl2ot•ization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it compIies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revolced, or is modified, such that the
activity would no longer cornply with the tet•ms 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 permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide 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 Quality (telephone [phone]) to detet•mine Section 401 requiretnents.
For activities occturing 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 in Morehead City, NC, at [phone].
This Depal�tment 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 Peimit, or the Corps of Engineers regulatory
program, please contact Sarah Hair at 910-251-4049 or Sarah.E.Hair(u�usace.army.mil.
HAIR.SARAH.E `��r°�����s�"�`�'�693512
Cor s Re ulatoi OfficiaL• �"°.°"-°S0.
P g �' A 1 nSdtiA�512 ��:�°�935�� Date: April 13, 2015
Expiration Date of Verification: March 18, 2U17
Determination of Jurisdiction:
A. � Based on preliminary information, there appear to be waters of the US including wetlands within the above described
project area. This pi•eliminary determination is not an appealable action under the Regulatoiy Program Administrative
Appeal Process (Refei•ence 33 CFR Pai�t 331).
B. ❑ There are Navigable Waters ofthe United States within the above described project area subject to the peimit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five yeais from the date of this
notif cation.
C. ❑ There are waters of the US and/or wetlands within the above described project area subject to the petmit requirements of
Section 404 of the Ciean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or oui• published regulations,
this determination may be relied upon for a period not to exceed five years from the date of this notification.
D. ❑ The jurisdictional areas within the above described project area ha�e been identified under a previous action. Please reference
jm•isdictional deteimination issued . Action ID: SAW- .
Basis For Determination: The site exhibits �vetland criteria as described in the Corps of Engineers 1987 Wetland
Delineation Manual anci appi•opriate Regional Supplement. This site contains stream channels �vhich exhibi� indicators of an
Ordinat•y High Watet• Mark (OIIWM).
Remarks:
E. Attention USDA Program Participants
This delineation/detei��ination 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 Seivice, pi•ior to stai�ting work.
F. Appeals InfOrtttation (This information applies only to approved jurisdictional dete�•minations as indicated in B
and C above).
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclased 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: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1OM15
Atlanta, Georgia 30303-8801
Phone: (404} 562-5137
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 N/A.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this correspondence.**
HAIR,SARAH,EA.�OS`FV7JS DN'rlUSio=U.56GovelnmAen[HoEu--DoD6ou=PKl,
COPpS R0gU11tOly �ff1C1`dl: � 2 /..��ou=USA,rn=HAIR.SARAH.EA.1054693572�
Sarah Hair
Date of JD: April 13, 2015
Expiration Date of JD: N/A
The Wilmington District is comnlitted to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete our customer Satisfaction Suivey online at http:/fre ug Iatory.usacesuE•vev.com/.
Copy furnished:
NIr. Jim Rerko, Division 6 DEO (e-copy)
Mr. Mason Herndon, NC DENR-DWR (e-copy)

SAW-2015-00585
SPECIAL CONDITIONS
1. In order to compensate for impacts associated with this perinit, 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. All work must be performed in strict compliance with the plans received by this office on 3-24-2015 and 3-27-2015, which
are a part of this permit. Any modification to the permit plans must be approved by the USACE prior to implementation
3. Failure to institute and cai7y out the details of these special conditions will result in a directive to cease all ongoing and
permitted work within waters and/or wetlands associated with the permitted project, or such other remedies and/or ftnes as
the District Engineer or his authorized representatives may seek.
4. The permittee shalI requu•e its contractors and/or agents to comply with the terms and conditions of this permit in the
consh•uction and maintenance of this project, and shall provide each of its contractors and/ar agents associated with the
construction or maintenance of this project with a copy of this permit, and any autliorized modifications. A copy of this
pennit, and any authorized modifications, including all conditions, shall be available at the project site during construction
and maintenance ofthis project.
5. This permit does not authorize tetnporary placement or double handling of excavated or fill material within waters or
wetlands outside the permitted area.
6. The peimittee will report any violation of these conditions ar violations of Section 404 of the Clean Water Act or Section 10
of the Rivers and Harbors Act in writing to the Wilmington District, U. S Army Corps of Enginears, within 24 hours of the
permittee's discovery of the violation.

Action ID Number: SAW-2015-00585 County: Cumberland
Permittee: NC DOT, Division 6 Mr. Gre� Burns, Division Engineer
Project Name: NC DOT/SR2220 Tom Starlin� Road/W-5512/Division 6
Date Verification Issued: Api•i113, 2015
Project Manager: Sarah Hair
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certi�cation and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: Sarah Hair
69 Darlington Avenue
Wilmington, North Carolina 28403
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engiueers representative. Failure to comply with any terms or conditions of this autharization 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 ihe 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

NOTIFICATION OF A�MIN�STT�A'TI'4�I� AP�'EAL OY'�'IONS AND PROCESS AND
" K�QIJEST I'C}R AF'P�:AL`
Applicant: �NC DOT, Mr< Greg Burns, Division � File Number: SAW-2015-00585 Date: April 13, 2015 ��
Engiueer
Attached is:
INITIAL PROFF`ERED PERMIT (Standard Permit ar• Letter of
PROFFERED PERMIT (Standard Permit or Letter of permissio
PERMIT DEr]IAL
APPROVED JURISDICTIONAL DETERMINATION
PRELIMINARY JIJRISDICTIONAL DETERIVIIlVATION
See Sectian below
0
:
0
0
�
[ON'I - The following identifies yot�r rights and aptians regzrdin� an adtninistrative appeal ofthe above decision.
onal inforrnation inay be found at or I��� j,''�s��r�•.a��ace.��•�n� ani�%i��issic�iis}Civii�3�ai•�s;'Reguiatt�r�°Pra�ra�n�ndPe�snits:ast��
Corps r•egulations at 3� CFR Part 331.
A: Il\TITIAL PROFFERI;ll PERIVIIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the peimit document and retui�n it to the distt•ict engineer for fmal
authorization. If you received a Letter of Pei7nission (LOP), you may aecept 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 entu•efy, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
pel7nit.
OBJECT: If yau abject to the perinit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the dish•ict
engineer, Your objections rnust be received by the dish�ict engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of yom� letter, the district engineer will evaluate your
objections and lnay: (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 pei7nit having deteimined that the permit should be issued as previously written. Aftei•
evahiating your objections, the dish�ict engineet• will send you a proffered pei•mit 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 Peirnit, you lnay sign the peimit document and retuin it to the dish•ict engineer for final
authorization. If you received a Letter of Pei7nission (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 entu�ety, and waive all
rights to appeal the pei7nit, including its teirns and conditions, and approved jw•isdictional determinations associated with the
pei7nit.
APPEAL: If you choose to decline the proffered peimit (Standard or LOP) because of certain tel7ns and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administr•ative Appeal Process by completing Section II of
this fo17n and sending the foi7n to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Adininish•ative Appeal Process by
completing Section II of this foim and sending the foi7n to the division engineer. This form inust be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JiJRISDICTIONAL DETERMINATION: You may accept or appeal the approved 7D or provide new
infoz7nation.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. F'ailure to notify the Coips within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all �•ights to appeal tlle approved JD.
• APPEAL: If you disagree with the approved JD, you inay appeal the approved JD under the Corps of Engineers
Adininistrative Appeal Process by completing Section II of this foi7n and sending the foi�tn to the dish•ict engineer. This form
must be received by the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JITRISDICTIONAL DETERMINATION: You do not need to i•espond to the Corps regarding the
preliminary JD. The Preliminaiy JD is not appealable. If you wish, you may request an approved JD (which tnay be appealed),
by contacting the Corps district for fui�ther instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SEGTI()N II- REQiJEST FOR APPEAL or OBJECTIONS TO AN IM'TIAL PROF�:RED PERMIT
REASONS FOR AI'PLAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise staternerrts. You may attach additional information to this form to clai7fy where your reasons or
objections are addressed in the administ�•ative record.)
ADDITIONAL INFORM�TION: 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 infar•mation that the review officer has determined is needed to
clal�ify the adminisn�ative 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 infoimation that is ah•eady in the adininistrative
record,
PO1NT OF CONTACT FOR QUESTIONS OR INFORMATION:
> - .,. � . _�
If you have questions regarding this decision and/or the If you only have questions regarding the appeal process you may
appeal process you tnay contact: also contact:
District Engineer, Wilmington Regulatoi•y Division, Attn: Mr. Jason Steele, Administrative Appeal Review Officer
Sarah Hair CESAD-PDO
69 Darlington Avenue U.S. Aimy Corps of Engineers, South Atlantic Division
Wilmington, North Carolina 28403 60 Foisyth Street, Room l OM15
Atlanta, Geoigia 30303-8801
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of enh�y to Corps of Engineeis personnel, and any government
consultants, to conduct investigations of the project site dm�ing the couise of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportunity to pat�ticipate in all site investigations.
Date: Telephone numbei°
Signature of appellant or agent.
Fo�� appeals on IrtitiaC Proffererl Pef•mils ser7d this fornr to:
Dist►•ict Engineer, Wilmington Regulatory Division, Attn: Sarah Hair, 69 Darlington Avenue, Wilmington, North Carolina
28403
For• Pe��mit detrials, Proffererl Permits and �rpproved Jrrrisdictio�ttrl Deterntiftatiojts send tlris form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele, Adminfstrative Appeal
Of�cer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

TIP R-5512
Cumberland County
PREL1MtNARY JURISDICTIONAL DETERMINATION FORM
BACKGR�UND 1NFOt�MATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURiSDiCTIQNAL
DETERMtNATIaN (JD�: �arC� a`"'�, aDI�
B, NAME AND ADDRESS t)F PERSUN REQUESTING PRELIMINARY JD:
James J. Rerko, PWS RIGDOT Box 1105 Fayefteviil�, NC 28302
C. DISTRICT OFFICE, �ILE NAME, AND NUMBER: i��,� �-,����
�lGDt3t' �SF� �.Z2o 1 orv� $�ar � i r� l�C.� W- 55I2�� V(o ��y�W' c�0 - O
D. PR�JECT LOCATION S AND BA�GR �UND INF�RMATION: Br' e�S ��S
( _ ) idg
is 0,5 mile south of the intersection of SR 1006 and SR 1� 18.
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERB4DIES
AT QIFFERENT SITES) -
State:NC Counfiy/parish/boroughGumberland City: Fayetteville
Center coordinates of site (lat/long in degree decimal format): Lai. 34.9473°
Pick List, Long. -78.8824° Pick List.
Universal Transverse Mercator:
Name ofi nearesf wafierbody: Rockfish Creek
Identify (estimate) amount of waters in the review area:
Non-wetland waters: 63 linear feefi: ft.width (ft) andJar
Cowardin Class: Riverine
Stream Flow: Perennial / Intermittenf
Wetlands:
Cowardin C(ass: Scrub-shrub
Name of any water bodies on the sife that have been identified as Section 10
waters:
Tidal:
Non-Tictal:
E. REVIEW PERFORMED FOR SITE EVAL.UATION (CHECK ALL THAT
NPPLY):
Office (Desk) Determination. Date: Q�r� 1 13i 2�IS
❑ Field Determination. ❑ate(s):
9. The Corps of Engineers believes that there may be jurisdictional waters of fihe
United S#ates an the subject sifie, and the permit applicant or other affected party
who requested this preliminary JD is hereby advis�d of his or her option to

request and obtain an approved jurisdictiona! det�rmination (JD) for fhat site.
Nevertheless, the permit applicant Qr other person who requested this
preliminary JD has declined to exercise the optian to obtain an approved JD in
�his instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide Gen�ral Permit (NWP) or ofiher general permit verification requiring
"pre-construction notification" (PCN), or requests verification for a nan-reporting
NWP ar other genera[ permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereb_y made aware of the
following: (1 } the permit applicant has elected to seek a permit autharization
based on a preliminary JD, which does not make an official determina#ion of
jurisdiciional waters; (2) that the applicant has fihe option to request an approved
JD befare accepting th� terms and conditians of the permit authorizatian, arid
tha# basirtg a permit authorization on an approved JD could possibly resu(t in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP ar other general permit authorizaiion; (4)
that the app{icant can accept a permit authorization and thereby agree to comply
with all ihe terms and condifions of that permit; including whatever mitigafiion
requirements #he Corps has determined to be necessary; (5) that undertaking
any activity in refiance upan the subject permit authorization without requesting
an approved JD constifiutes fihe applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Gorps
permit authorization based on a pre(iminary JD constifiutes agreement that all
wetlands and .other water bodies on fihe site affected in any way by fhafi activity
are jurisdictionai waters of the United States, and precludes any challenge to
such jurisdiction in any administra#ive or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applican# efects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Fur�her, an approved JD, a proffered
individual permif (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in ar�y administrative appeal, jurisdictional issues can be raised {see 33
C.F.R. 331.5(a)(2)}, ff, during that administrafiive appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a sit�, or
to provide an official delineation of jurisdictional waters on the si#e, the Corps will
provide an approved JD to accomplish that result, as sooh as is practicabfe.
This preliminary JD finds that there "may be" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the praposed activity, based on the following information:
SUPPORTING DATA. Data reviewed for preliminary JD (check all that apply
- checked items shauld be included in case file and, where checked and
requested, appropriately reference sources below):
2

� Maps, plans, piots or plat submitfied by ar on behalf of the
applicanticonsultant: .
� Data sheets prepared/submitted by or on behalfi of the
applicant/consultant.
❑ OfFice concurs with data sheetsldelineafifon repar�.
❑ Qffice does nat concur with data sheets/delineation report.
❑ Data sheets prepared b,y the Corps: .
❑ Carps navigable waters' study:
� U.S. Geological Survey Hydrologic AtI��: .
❑ USGS NHD data.
❑ USGS 8 and 12 digifi HUC maps.
� U.S. Geological Survey map(s). Cite scale & quad name: Lillington, NC.
❑ USDA Natural Resources Conservation Service Sail Survey. Citation:
❑ National wetlands inventory map(s). Cite name:
❑ StatelLocaf wetland inventory map(s): .
❑ F.EMAIFIRM maps: .
❑ 100-year Floodplain Elevation is: (National Geodectic Vertical Datum
of 1929)
❑ Photographs: ❑ Aerial (Name & Date): . -��
or ❑ Other (Name & Date):
❑ Previous determination(s). File no, and date of response ietter:
❑ �ther information (please specify): .
IMPORTANT NOTE: The information recorded on this form has not
necessarilv been verified bv the Corps and shauld not be relied upon for
later 'urisdictional determinations.
-- '� (
�` i� � ' � � L� �I�3�
3 �. d 1 S rr�,� � � ' .� , /�iv.S
Signaiu �,n e af S�gnature arid da�e of '
Regulatory Proje�t Manager p9erson req�esting preliminary JD
(REQUIRED) (F2EQUIRED, unless obtaining
the signature is impracticab(e)
3

R-5512 Gumberland County
- Esfimated
Site Cawardin amount of Class of
number �-atitude Longitude Class aqua#ic aquatic
resource in resource
review area
1 34.9604 -78.9080 Riverine 0.004 acre Non-section �10
-tributary
2 34.9479 -78.8$45 Riverine 20LF Non-section 10
non— wetland
3 34.9473 -78.8824 Riverine �i�31 1� Non-section 'I0
k ` —nan-wet{and
4 34.9468 -78.8720 Riverine 12 LF Non-section 10
�non-wetland
5 34.950� -78.8553 Riverine 0 LF Non-saetion 10
—non-wetiand

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatorv Miti�ation Responsibilitv Transfer Form
Permittee: NC DOT, Mr. Greg Burns, Division 6 Engineer
Project Name: W-2215/Tom Starling Road/ SR 2220
Action ID: SAW-2015-00585
County: Cumberland
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 Ecosystem Enhancement Program (NCEEP), 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 Hydroiogic 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 Imoacts ilinearfeetl Wetland Impacts (acres)
Warm � Cool � Cold � Riparian Riverine � Riparian Non-Riverine � Non-Riparian � Coastal
43
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mit
Stream M
Warm
86
ion Requirements: 8-digit HUC and Basin: 03030004, Cape Fear River Basin
�tion (credits) Wetland Mitigation (credits}
Cool Cold Riparian Riverine Riparian Non-Riverine Non-Riparian Coastal
Mitigation Site Debited: NC DMS
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCEEP, list NCEEP. If the NCEEP
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 NCEEP), 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 Nam
Name of Sponsor's Authorized Representative
Signature of Sponsor's Authorized Representative
Date of Signature
Page 1 of 2 Form Updated 12 September, 2014

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.
• 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 reeords 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: 1j the Permittee, 2J the
USACE Project Manager at the address below, and 3J the Wilmington District Mitigation Office, Attn: Todd Tugwell,
11405 Falls of Neuse Raad, Woke Fores% NC 27587 (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: Liz Hair
USACE Field Office: Wilmington Regulatory Field Office
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, NC 28403
Email: sarah.e.hairC�usace.armv.mil
; i Digitallysigned by
HAIR.SARAH.E DN'RSUSAo=U.S.G vemm �t,
A. � O5`t�93S � 2 cn=HA R;SARAH!EA.1 54693572
Date: 2015.04.13 14:09:7 8 -04'00'
USACE Praject Manager Signature
April 13, 2015
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:/lribits.usace.armv.mil.
Page 2 of 2
The Wilmington District is committed to providing the highest Ievel 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./Iregulatorv.usacesurvey.coml to complete the survey online.