20070173 Ver 5_Final 404_Novo permit Review_20200819

DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
69 DARLINGTON AVENUE
WILMINGTON, NORTH CAROLINA 28403-1343
23 May 2016
Regulatory Division/1200A
Action ID: SAW-2015-02127
Mr. Gary Lohr
Novo Nordisk Pharmaceutical Industries, Inc.
3612 Powhatan Road
Clayton, North Carolina 27527
Mr. Timothy M. Little, P.E.
North Carolina Department of Transportation — Division 4
509 Ward Boulevard
Wilson, North Carolina 27895-1670
Dear Mr. Lohr and Mr. Little:
In accordance with the written request of December 22, 2015, and the ensuing administrative
record, enclosed is a Department of the Army (DA) Permit to authorize permanent discharge of
fill impacts to 2.45 acres of jurisdictional wetlands associated with the propose construction of
the Novo Nordisk Active Pharmaceutical Ingredient production facility and discharge of fill
impacts to 3.01 acres of jurisdictional wetlands and 188 linear feet of jurisdictional stream
channel associated with the proposed Gordon Road Access located approximately 0.5 mile east
of the intersection of US 70 business and Powhatan Road, in Clayton, Johnston County, North
Carolina.
Any deviation in the authorized work will likely require modification of this permit. If a
change in the authorized work is necessary, you should promptly submit revised plans to the
Corps showing the proposed changes. You may not undertake the proposed changes until the
Corps notified you that your permit has been modified.
Carefully read your permit. The general and special conditions are important. Your failure
to comply with these conditions could result in a violation of Federal law. Certain significant
general conditions require that:
a. You must complete construction before December 31, 2021.
b. You must notify this office in advance as to when you intend to commence and
complete work.

- 2 -
c. You must allow representatives from this office to make periodic visits to your worksite
as deemed necessary to assure compliance with permit plans and conditions.
You should address all questions regarding this authorization to Mr. John Thomas, in the
Raleigh Regulatory Field Office, telephone number [phone], extension 25.
Thank you in advance for completing our Customer Survey Form. This can be
accomplished by visiting our web -site at http://corpsmapu.usace.arinv.mil/cm apex/f?p=136.4.0
+and completing the survey on-line. We value your comments and appreciate your taking the
time to complete a survey each time you interact with our office.
Sincerely,
Kevin P. Landers Sr.
Colonel, U.S. Army
District Commander
Enclosures
Copy Furnished (with enclosures):
Chief, Source Data Unit
NOAA/National Ocean Service
Attn: Sharon Tear N/CS261
1315 East-West Hwy., Rm 7316
Silver Spring, Maryland 20910-3282
Copies Furnished (with special conditions and plans):
Mr. Pete Benjamin
U.S. Fish and Wildlife Service
Raleigh Ecological Service Field Office
Post Office Box 33726
Raleigh, North Carolina 27636-3726

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Mr. Fritz Rohde
Habitat Conservation Division - Atlantic Branch
101 Pivers Island Road
Beaufort, North Carolina 28516
Mr. Todd Bowers
Wetlands and Streams Regulatory Section
NC Regulatory and Surface Coal Mining
U.S. Environmental Protection Agency - Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, SW
Atlanta, Georgia 30303-8931
Mr. Doug Huggett
Division Coastal Management
N.C. Department of Environment and Natural Resources
400Commerce Avenue
Morehead City, North Carolina 28557
Dr. Pace Wilber
Habitat Conservation Division - Atlantic Branch
NOAA Fisheries Service
219 Fort Johnston Road
Charleston, South Carolina 29412

Permittee: Novo Nordisk Pharmaceutical Industries Inc. — ATTN: Mr. Gary Lohr / North Carolina Department of
Transportation Division 4 — ATTN: Mr. Timothy M. Little P.E.
Permit No: SAW-2015-02127
Issuing Office: USAED, WILMINGTON
Project Description: The project, Novo Nordisk Active Pharmaceutical Ingredient production facility (API) & Gordon Road
Access, consists of the construction of a new API facility and supporting Gordon Road Access resulting in unavoidable
discharge of fill impacts to 2.45 acres of jurisdictional wetlands associated with the API facility and 3.01 acres of jurisdictional
wetlands and 188 linear feet of jurisdictional stream channel impacts associated with the supporting Gordon Road Access.
In order to compensate for impacts associated with this permit, Novo Nordisk Pharmaceutical Industries, Inc. will provide
payment to Resource Environmental Solutions, LLC (RES) for 4.90 riparian wetland mitigation units within the Neuse River
Bashi (Cataloging Unit 03020201) for 2.45 acres of riparian wetlands associated with the API facility construction. The North
Carolina Department of Transportation will provide payment to the North Carolina Department of Mitigation Service (DMS)
for 376 warm water stream channel mitigation units and 6.02 riparian wetland mitigation units within the Neuse River Basin
(Cataloging Unit 03020201) for permanent loss impacts to 188 linear of feet of warm water stream channel and 3.01 acres of
riparian wetlands associated with the Gordon Road Access construction.
Project Location: The proposed project is located on a 269-acre tract located approximately 0.5 mile east of the intersection of
US 70 Business and Powhatan Road, in Clayton, Johnston County, North Carolina.
Project Area (acres): 269 Nearest Town: Clayton River Basin: Neuse River
Nearest Waterways: Little Poplar Creek
LATITUDE & LONGITUDE: Latitude North: 35.616392; Longitude West:-78.402377.
Pen -nit Conditions:
General Conditions:
1. The tine limit for completing the work authorized ends on December 31, 2021. If you find that you need more time to
complete the authorized activity, submit your request for a time extension to this office for consideration at least one month
before the above date is reached.
2. You must maintain the activity authorized by this permit in good condition and in conformance with the terms and
conditions of this permit. You are not relieved of this requirement if you abandon the pennitted activity, although you may
make a good faith transfer to a third party in compliance with General Condition 4 below. Should you wish to cease to
maintain the authorized activity or should you desire to abandon it without a good faith transfer, you must obtain a modification
of this permit from this office, which may require restoration of the area.
3. If you discover any previously unknown historic or archeological remains while accomplishing the activity authorized by
this pen -nit, you must immediately notify this office of what you have found. We will initiate the Federal and state coordination
required to determine if the remains warrant a recovery effort or if the site is eligible for listing in the National Register of
Historic Places.
ENG FORM 1721, Nov 86 EDITION OF SEP 82 IS OBSOLETE. (33 CFR 325 (Appendix A))

4. If you sell the property associated with this permit, you must obtain the signature of the new owner in the space provided
and forward a copy of the permit to this office to validate the transfer of this authorization.
5. If a conditioned water quality certification has been issued for your project, you must comply with the conditions specified
in the certification as special conditions to this permit. For your convenience, a copy of the certification is attached if it
contains such conditions.
6. You must allow representatives from this office to inspect the authorized activity at any time deemed necessary to ensure
that it is being or has been accomplished in accordance with the terms and conditions of your permit,
Special Conditions:
SEE ATTACHED SPECIAL CONDITIONS
Further Information:
1. Congressional Authorities: You have been authorized to undertake the activity described above pursuant to:
( ) Section 10 of the Rivers and Harbors Act of 1899 (33 U.S.C. 403).
( X) Section 404 of the Clean Water Act (33 U.S.C. 1344).
( ) Section 103 of the Marine Protection, Research and Sanctuaries Act of 1972 (33 U.S.C. 1413).
2. Limits of this authorization.
a. This permit does not obviate the need to obtain other Federal, state, or local authorizations required by law.
b. This permit does not grant any property rights or exclusive privileges.
c. This permit does not authorize any injury to the property or rights of others.
d. This pen -nit does not authorize interference with any existing or proposed Federal project.
3. Limits of Federal Liability. In issuing this permit, the Federal Government does not assume any liability for the following:
a. Damages to the permitted project or uses thereof as a result of other permitted or unpermitted activities or from natural
causes.
b. Damages to the permitted project or uses thereof as a result of current or future activities undertaken by or on behalf
of the United States in the public interest.
c. Damages to persons, property, or to other permitted or unpermitted activities or structures caused by the activity
authorized by this permit.
d. Design or construction deficiencies associated with the permitted work.
e. Damage claims associated with any future modification, suspension, or revocation of this permit.
*U.S. GOVERNMENT PRINTING OFFICE: 1986 - 717-425

4. Reliance on Applicant's Data: The determination of this office that issuance of this permit is not contrary to the public
interest was made in reliance on the information you provided.
5. Reevaluation of Permit Decision. This office may reevaluate its decision on this permit at any time the circumstances
warrant. Circumstances that could require a reevaluation include, but are not limited to, the following:
a. You fail to comply with the terns and conditions of this permit.
b. The information provided by you in support of your permit application proves to have been false, incomplete, or
inaccurate (See 4 above).
c. Significant new information surfaces which this office did not consider in reaching the original public interest decision.
Such a reevaluation may result in a determination that it is appropriate to use the suspension, modification, and revocation
procedures contained in 33 CFR 325.7 or enforcement procedures such as those contained in 33 CFR 326.4 and 326.5. The
referenced enforcement procedures provide for the issuance of an administrative order requiring you to comply with the terms
and conditions of your permit and for the initiation of legal action where appropriate. You will be required to pay for any
corrective measures ordered by this office, and if you fail to comply with such directive, this office may in certain situations
(such as those specified in 33 CFR 209.170) accomplish the corrective measures by contract or otherwise and bill you for the
cost.
6. Extensions. General condition 1 establishes a time limit for the completion of the activity authorized by this permit. Unless
there are circumstances requiring either a prompt completion of the authorized activity or a reevaluation of the public interest
decision, the Corps will normally give favorable consideration to a request for an extension of this time limit.
Your signature below, as permittee, indicates that you accept and agree to comply with the terms and conditions of this permit.
(PERMITTEE) NOVO NOFDISK PHARMACEU'ICAL INDUSTRIES, INC.
ATTN: MR. GARY LOHR
. )009 U
(PERMIfTEE%TN:
RTH COLINA DEPARTMENT OF TRANSPORTATION — DIV 9
MR. TIMOTHY M. LITTLE, P.E.
(DATE)
(DATE)
This permit becomes effective when the Federal official, designated to act for the Secretary of the Army, has signed below.
(DIS CT COMMANDER) KEVIN P. LANDERS SR., COLONEL (DAIS)
When the structures or work authorized by this permit are still in existence at the time the property is transferred, the terms and
conditions of this permit will continue to be binding on the new owner(s) of the property. To validate the transfer of this permit
and the associated liabilities associated with compliance with its terms and conditions, have the transferee sign and date below.
(TRANSFEREE) (DATE)
*U.S. GOVERNMENT PRINTING OFFICE: 1986 - 717-425

SPECIALOD
ACTION ID SAW-2015-02127
(,, O NORDISKINDUSTRIAL,
1. CONSTRUCTION PLANS: All work authorized by this permit must be performed in strict
compliance with the attached plans dated December 22, 2015, which are a part of this permit.
Any modification to the plans must be approved by the US Army Corps of Engineers (USAGE)
prior to implementation.
2.UNAUTHORIZED DREDGE OR FILL: Except as authorized by this permit or any USACE
approved modification to this permit, no excavation, fill or mechanized land -clearing activities
shall take place at any time in the construction or maintenance of this project, within waters or
wetlands. This permit does not authorize temporary placement or double handling of excavated
or fill material within waters or wetlands outside the permitted area. This prohibition applies to
all borrow and fill activities connected with this project.
3. MAINTAIN CIRCULATION AND FLOW OF WATERS: Except as specified in the plans
attached to this permit, no excavation, fill or mechanized land -clearing activities shall take place
at any time in the construction or maintenance of this project, in such a manner as to impair
normal flows and circulation patterns within waters or wetlands or to reduce the reach of waters
or wetlands.
4. DEVIATION FROM PERMITTED PLANS: The permittee shall ensure that the construction
design plans for this project do not deviate from the permit plans attached to this authorization.
Written verification shall be provided that the final construction drawings comply with the
attached permit drawings prior to any active construction in waters of the United States,
including wetlands. Any deviation in the construction design plans will be brought to the
attention of the Corps of Engineers, Mr. John Thomas, Raleigh Regulatory Field Office, prior to
any active construction in waters or wetlands.
5. PRECONSTRUCTION MEETING: The permittee shall schedule and attend a
preconstruction meeting between its representatives, the contractors representatives, and the
Corps of Engineers, Raleigh Field Office, Regulatory Project Manager, prior to any work within
jurisdictional waters and wetlands to ensure that there is a mutual understanding of all the terms
and conditions contained with this Department of Army Permit. The permittee shall provide the
USACE, Raleigh Field Office, Project Manager, with a copy of the final permit plans at least two
weeks prior to the preconstruction meeting along with a description of any changes that have
been made to the project's design, construction methodology or construction timeframe. The
permittee shall schedule the preconstruction meeting for a timeframe when the USACE and
NCDWR Project Managers can attend. The permittee shall invite the Corps and NCDWR Project
Managers a minimum of thirty (30) days in advance of the scheduled meeting in order to provide
those individuals with ample opportunity to schedule and participate in the required meeting.

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ACTION1SAW-2015-02127
6. WATER QUALITY CERTIFICATION: The North Carolina Division of Water Resources
(NCDWR) permit/certification number WQC004051 was issued for this project on April 26,
2016. Special conditions were issued associated with this water quality permit/certification and a
copy of these conditions is attached as Exhibit A. These referenced conditions are hereby
incorporated as special conditions of this permit.
7. WATER CONTAMINATION: All mechanized equipment will be regularly inspected and
maintained to prevent contamination of waters and wetlands from fuels, lubricants, hydraulic
fluids, or other toxic materials. In the event of a spill of petroleum products or any other
hazardous waste, the permittee shall immediately report it to the N.C. Division of Water
Resources at [phone] or [phone] and provisions of the North Carolina Oil
Pollution and Hazardous Substances Control Act will be followed.
S. NOTIFICATION OF CONSTRUCTION COMMENCEMENT AND COMPLETION: The
permittee shall advise the Corps in writing prior to beginning the work authorized by this permit
and again upon completion of the work authorized by this permit.
9. CLEAN FILL: Unless otherwise authorized by this permit, all fill material placed in waters or
wetlands shall be generated from an upland source and will be clean and free of any pollutants
except in trace quantities. Metal products, organic materials (including debris from land clearing
activities), or unsightly debris will not be used. Soils used for fill shall not be contaminated with
any toxic substance in concentrations governed by Section 307 of the Clean Water Act.
10. PERMIT DISTRIBUTION: The permittee shall require its contractors and/or agents to
comply with the terms and conditions of this permit in the construction and maintenance of this
project, and shall provide each of its contractors and/or agents associated with the construction or
maintenance of this project with a copy of this permit. A copy of this permit, including all
conditions, shall be available at the project Site during construction and maintenance of this
project.
11. SILT -FENCING: The permittee shall employ all sedimentation and erosion control
measures necessary to prevent an increase in sedimentation or turbidity within waters and
wetlands outside the permit area. This shall include, but is not limited to, the immediate
installation of silt fencing or similar appropriate devices around all areas subject to soil
disturbance or the movement of earthen fill, and the immediate stabilization of all disturbed
areas. Additionally, the project must remain in full compliance with all aspects of the
Sedimentation Pollution Control Act of 1973 (North Carolina General Statutes Chapter 113A
Article 4).

SPECIAL CONDITIONS
ACTION ID SAW-2015-02127
12. PERMIT REVOCATION: The permittee, upon receipt of a notice of revocation of this
permit or upon its expiration before completion of the work will, without expense to the United
States and in such time and manner as the Secretary of the Army or his authorized representative
may direct, restore the water or wetland to its pre -project condition.
13. EROSION CONTROL MEASURES IN WETLANDS: The permittee shall remove all
sediment and erosion control measures placed in wetlands or waters, and shall restore natural
grades in those areas, prior to project completion.
14. REPORTING ADDRESS: All reports, documentation and correspondence required by the
conditions of this permit shall be submitted to the following address: U.S. Army Corps of
Engineers, Regulatory Division, Raleigh Regulatory Field Office, c/o Mr. John Thomas, 3331
Heritage Trade Drive, Suite 105, Wake Forest, NC 27587, and by telephone at: 919 554-4884,
ext. 25. The Permittee shall reference the following permit number, SAW-2015-002127, on all
submittals.
15. REPORTING VIOLATIONS OF THE CLEAN WATER ACT AND RIVERS AND
HARBORS ACT: Violation of these conditions or violation of Section 404 of the Clean Water
Act or Section 10 of the Rivers and Harbors Act must be reported in writing to the Wilmington
District, U.S. Army Corps of Engineers, within 24 hours of the permitee's discovery of the
violation.
16. COMPLIANCE INSPECTION: A representative of the Corps of Engineers will periodically
and randomly inspect the work for compliance with these conditions. Deviations from these
procedures may result in an administrative financial penalty and/or directive to cease work until
the problem is resolved to the satisfaction of the Corps.
17. COMPENSATORY MITIGATION: In Lieu Fee: In order to compensate for impacts
associated with this permit, 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.
18. PROHIBITIONS ON CONCRETE: The permittee shall take measures to prevent live or
fresh concrete, including bags of uncured concrete, from coming into contact with any water in
or entering into waters of the United States. Water inside coffer dams or casings that has been in
contact with concrete shall only be returned to waters of the United States when it no longer
poses a threat to aquatic organisms (concrete is set and cured).
20. TEMPORARY FILLS: Temporary fills must be removed in their entirety and the affected
areas returned to pre -construction elevations. The affected areas must be revegetated, as
appropriate.

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N��T„ICI'IaCATIOSN�OFDMIIYISTRA'TIyE APPEAL OPTTONNS ��iND PROCESS ANDS � � { � `�'�
Applicant: Novo Nordisk Pharmaceutical Industries,
File Number SAW-2015-02127
Date: May 9, 2016
Inc. , Gary Lohr / NC DOT Division 4,
Timothy M. Little
Attached is:
See Section below
®
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission)
A
❑
PROFFERED PERMIT (Standard Permit or Letter of permission)
B
❑
PERMIT DENIAL
C
❑
APPROVED JURISDICTIONAL DETERMINATION
D
❑ PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at http://www.usace'.anny.mil/inet/functions/cw/cecwo/reg or
Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
® ACCEPT: If you received a Standard Pennit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (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 pen -nit in its entirety, and waive all
rights to appeal the permit, including its tenns and conditions, and approved jurisdictional determinations associated with the
permit.
® OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section 11 of this form and return the form to the district
engineer. Your objections must be received by the district 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 your letter, the district engineer will evaluate your
objections and may: (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 permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit 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 Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (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 entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
® APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form 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 Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
® ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
® APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.

SECTION 11 - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT I
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections toaninitial
proffered pen -nit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: 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 information that the review officer has determined is needed to
clarify the administrative 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 information that is already in the administrative
record.
POINT 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 may contact:
also contact:
District Engineer, Wilmington Regulatory Div.
Mr. Jason Steele, Administrative Appeal Review Officer
Attn: Mr. John Thomas
CESAD-PDO
3331 Heritage Trade Drive, Suite 105
U.S. Army Corps of Engineers, South Atlantic Division
Raleigh, North Carolina 27587
60 Forsyth Street, Room 10M15
Phone: [phone], extension 25
Atlanta, Georgia 30303-8801
Phone: 404 11" 1 9 3 "
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportunity to participate in all site investigations.
Date Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: John Thomas, 69 Darlington Avenue, Wilmington, North
Carolina 28403

Wilmington
Compensatory Mitigation Responsibility Transfer Form
Permittee: Novo Nordisk Pharmaceutical Industries, Inc. / Gary Lohr Action ID: SAW-2015-02127
Project Name: Novo Nordisk Pharmaceutical Active Ingredient Production Facility County: Johnston
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: 03020201, Neuse River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
4.90
*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: 0-1020201. Neuse River Ra-in
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
2.45
Mitigation Site Debited: 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 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 Name:
Name of Sponsor's Authorized Representative:
Signature of Sponsor's Authorized Representative
Date of Signature
Page 1 of 2 Form Updated 23 October, 2013

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.
D 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.
D 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,
11405 Falls of Neuse Road, Wake Forest, NC27587 (email: [e-mail]. mill. Questions regarding this form
or any of the permit conditions may be directed to the USACE Project Manager below.
USACE Project Manager: John Thomas
USACE Field Office: Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: [e-mail]
Project Manager Signatu
//VV 6 - ; � /) /' '-,
3 Date o/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.
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://regulatory.usacesurvey.com/ to complete the survey online.

Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: North Carolina Department of Transportation / Timothy M. Little, P.E. Action ID: SAW-2015-02127
Project Name: Gordon Road Access County: Johnston
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: 03020201. Neuse River Rasin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
376
6.02
It 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
188
3.01
Mitigation Site Debited: 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 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 Name:
Name of Sponsor's Authorized Representative:
Signature of Sponsor's Authorized Representative
Date of Signature
Page 1 of 2 Form Updated 23 October, 2013

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 flank ledger to: 1) the Permittee, 2) the
USACE Project Manager at the address below, and 3) the Wilmington District Mitigation Office, Attn: Todd Tugwell,
11405 Falls of Neuse Road, Wake Forest, NC27587 (email: todd. tugwell@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: John Thomas
USACE Field Office: Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Email: [e-mail]
Project Manager Signa
_& 1
ate of ignature
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.mi1.
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:lyregulatory.usacesuivey.com/ to complete the survey online.