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Home My WebLink About20150819 Ver 1_Mitigation Transfer Form_20150923U.S. ARMY CORPS OF ENGINEERS Wilmington District Compensatorv Miti�ation Responsibilitv Transfer Form Permittee: NCDOT Action ID: SAW-2015-01791 Project Name: NCDOT / Replace Bridge 85 on SR 2158 / Alamance County County: Alamance 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 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: 03030002, Cape Fear River Basin Stream Impacts Warm Cool 102 Wetland Im 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. ipensatory Mitigation I Stream Mitigation Warm Cool 102 HUC and Basin: Wetland Cape Fear River Basin ion (credits) Cold � Riparian Riverine � Riparian Non-Riverine � Non-Riparian � Coastal Mitigation Site Debited: NCDMS (formerlv NCEEP) (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 6y the Mitigation Sponsor Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation transactions for the Mitigation 5ponsor 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 Name: rU,( > �i�� ' Name of onsor's Authorized Representative:��A' /,t�/1�(f� � � I � �I� Sig ature of Sponsor's Authorized Representative Date Signa re 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 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, 2J the USACE Project Manager at the address below, and 3) the Wilmington District Mitigotion Office, Attn: Todd Tugwe/l, 11405 Falls of Neuse Road, Wake Forest, NC27587 (email: todd.tugwel!@usace.army.mil). Questions regarding this form or any of the permit conditions may be directed to the USACE Project Manager below. USACE Project Manager: David Bailey USACE Field Office: Email: Raleigh Regulatory Field Office US Army Corps of Engineers 3331 Heritage Trade Drive, Suite 105 Wake Forest, North Carolina 27587 David.E.Bailev2@usace.armv.mil Digitally signed by BAILEY.DAVID.E.7379283736 ' DN: c=US, o=U.S. Government, ou=DoD, ou=PKl, �- ou=USA, cn=6AILEY.DAVID.E.1379283736 Date: 207 5.09.141320:05 -04'00' USACE Project Manager Signature September 14. 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://ribits.usace.armv.mil. Page 2 of 2 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://reaulatorv.usacesurvev.com/ to complete the survey online.