20190432 Ver 2_Mitigation Receipt_20200428

Compensatory Mitigation Responsibility Transfer Form
Permittee: Piedmont Natural Gas, Attn: David Vena, PE, PMP Action ID: SAW-2018-02075
Project Name: Piedmont Natural Gas / Line 450 / Flare Site Access Road County: Guilford
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* S-digit iaur and Racin• n!zn:2nnn) r- -- c,....- o
- - -
Stream Impacts (linear feet)
- -- -- - - - - �-, _ara I cal .'I Z, uaJll l
Wetland Impacts (acres)
Warm+_
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
1 0.066
aL..
IIIUI < ulai, one miltJ8duun sponsor wui De uses Tor the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements: 8-digit HUr and Rnain- nznznnr» r-I,- c . o:
- -
Stream Mitigation (credits)
- - -- --- - v J � Va I O01 InIVU, udJlll
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
I Non -Riparian
Coastal
0.132
Mitigation Site Debited: Wildlands - Cane Creek Umbrella Mitigation Bank Bethel Branch Site
(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
►D 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: U%>ld/G,7i/ y/JId, � i
I
Name of Sponsor's Authorized Representative: ��-� 6C,
t7
`/ 20,20
Signature of Sponso onzed Representative Date of Signature