20201663 Ver 1_ePCN Application_20201124

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
October 26, 2020 Ver 3.3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change only if needed.
BIMS # Assigned *
20201663
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Robb Mairs:eads\rlmairs2
Information for Initial Review
1a. Name of project:
COURTESY COPY - Sanctuary at Hanover Reserve; Phase 4-1
1a. Who is the Primary Contact?*
Kim Williams - Land Management Group
1b. Primary Contact Email:*
[e-mail]
Date Submitted
11/24/2020
Nearest Body of Water
Smith Creek
Basin
Cape Fear
Water Classification
C; Sw
Site Coordinates
Latitude:
34.297122
Pre -Filing Meeting Information
ID#
No meeting required
Pre -fling Meeting or Request Date*
11/5/2020
Longitude:
-77.829009
Attach documentation of Pre -Filing Meeting Request here:*
DWR Email No Written Auth Needed.pdf
Version#*
1
Reviewing Office*
Wilmington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Version
188.73KB
A. Processing Information C^U
County (or Counties) where the project is located:
New Hanover

Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
la. Type(s) of approval sought from the Corps:
* Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
29 - Residential Developments
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - E)press
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes (- No
2. Owner Information
2a. Name(s) on recorded deed:
Hanover Development Company, Inc.
2b. Deed book and page no.:
2c. Responsible party:
Will Bland
*
r Yes r No
r Yes r No

2d.Address
Street Address
P.O. Box 1625
Address tine 2
City
Wrightsville Beach
Postal / Zip Code
28480
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Kim Williams
4b. Business Name:
Land Management Group
4c.Address
Street Address
3805 Wrightsville Avenue; Suite 15
Address Line 2
city
Wilmington
Postal / Zip Code
28403
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
HDC - LMG Agent Form.pdf
State / Province / legion
NC
Country
USA
2f. Fax Number:
State / Province / I3gion
NC
Country
USA
4e. Fax Number:
[phone]
1.22MB
C. Project Information and Prior Project History C^U
1. Project Information
1b. Subdivision name:
(d appropriate)
Hanover Reserve
1c. Nearest municipality/ town:
Wilmington
2. Project Identification
2a. Property Identification Number:
Portion of R02800-004-104-000
2c. Project Address
Street Address
Off Murrayville Road
Address tine 2
city
Wilmington
Festal / Zip Code
28411
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Smith Creek
3b. Water Resources Classification of nearest receiving water:*
C; SW
2b. Property size:
6.6
State / Province / legion
NC
Country
USA

3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300070808
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The site is undeveloped and forested. Dirt roads are located in the northern and southern portions of the site and along its eastern boundary. Non -jurisdictional ditches are located
throughout the tract and one jurisdictional ditch is located along the western boundary. The site is part of a larger tract, which is partially developed. Adjacent land use is residential or
undeveloped and forested.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r- Unknown
4c. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
Developer obtained a NWP for impacts to 50 LF of stream and 0.028 acre of Waters of the US for Phase 1 of Hanover Reserve, which is located south of the tract (Action ID# SAW-
2012-01490). 50 LF of stream mitigation credits were purchased as required by the NWP.
Project History Upload
Hanover NWP 7-13.pdf
Hanover MTF Signed.pdf
314.7KB
925.07KB
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Fig2-Topo.pdf
1.8MB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
Fig4-Soils.pdf 902.99KB
4f. List the total estimated acreage of all existing wetlands on the property:
None
4g. List the total estimated linear feet of all existing streams on the property:
None
4h. Explain the purpose of the proposed project:*
The purpose of the project is to construct another phase of residential development to serve the housing needs of the community. A minor jurisdictional ditch impact is needed to
provide access into the site.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The project includes the construction of 11 multi -family buildings (each with either 3 or 4 units), a small stormwater pond that will tie into an eAsting pond in Phase 1, utilities, and access
roads. Site access will be provided from Murrayville Road to the north and also Springwater Drive to the south (Phase 1). The limits of disturbance will be cleared of vegetation.
Roadways and utilities will be installed. Then home construction will occur. Track hoe, loader, dump truck, bob cat, and other standard construction equipment will be used.
4j. Please upload project drawings for the proposed project.
Site Plan Drawings 11-13-20 rev.pdf
Overall Site Plan.pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r- Not Verified r- Unknown r N/A
Corps AID Number:
Action ID# 2011-01979
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Corey Novak
Agency/Consultant Company: Land Management Group
Other:
1.73MB
2.13MB
O Unknown
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made bythe Corps or DWR
Rachel Capito with the USACE issued the JD on 10/23/20.
5d1. Jurisdictional determination upload
Sanctuary AJD.pdf
2.01 MB
6. Future Project Plans

6a. Is this a phased project?*
r Yes f No
7b. If yes, explain.
The proposed project is a multi -family phase of Hanover Reserve.
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
Not at this time. The project area is part of a larger tract and it may be developed in the future. If impacts are required, they will be looked at cumulatively.
[D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands f Streams -tributaries ❑ Buffers
W Open Waters r Pond Construction
4.Open Water Impacts
4a. Site # 4a1. Impact Reason 4b. Impact type 4c. Name of waterbody 4d. Activity type :114e. Waterbody type 4f. Impact area
Road Crossing
P
NIA
Culverts
Ditch
0.02
Road Crossing
P
N/A
Culverts
_11
Ditch
0.01
4g. Total temporary open water Impacts: 4g. Total permanent open water impacts:
0.00 0.03
4g. Total open water impacts:
0.03
4h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
There is an wasting road at this location and this crossing will widen it. The crossing needs to be placed at this location to tie into Murrrayville Road. A
ditch runs the entire length of the western project boundary and impacts could not be avoided. Placing it at an epsting crossing reduces impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The developer will obtain stornmater and sedimentation and erosion control permits prior to development.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Only 0.03 acre of jurisdictional ditch are proposed.
F. Stormwater Management and Diffuse Flow Plan (required by DWR) C^U
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
Site is located in the Cape Fear River Basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater
program?
r Yes r No
r NIA - project disturbs < 1 acre

2d. Which of the following stormwater management program(s) apply:
W Local Government P State
Local Government Stormwater Programs
W Phase II r NSW r USMP r Water Supply
Please identifywhich local government stormwater program you are using.
New Hanover County
State Stormwater Programs
r Phase II fJ Coastal Counties
r HWQ or ORW r Other
Comments:
State SW was submitted 8-17-20. New Hanover County SW was submitted 8-17-20 and permitted 9-29-20.
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Although this is part of a phased subdivision, impacts are viewed cumulatively.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated
at a treatment plant, list the capacity available at that plant.
Project Will tie into local municipal wastewater treatment system.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
Se. Is this a DOT project located within Division's 1.8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?'
r Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?

The NC Natural Heritage Program database was used to determine the known presence of rare species. No federally listed species are known to
occur on the site. The northern long-eared bat and rough -leaved loosestrife are known to occur within a one mile radius of the site. However the bat
may be an historical occurrence. Forested areas within the site may support appropriate roosting habitat for the northern long-eared bat. However, no
roosting trees are known to occur near the site. Therefore, any adverse effect from tree clearing would be exempt per the 4(d) rule. The site does not
provide suitable habitat for the loosestrife or any other rare plants known to occur in the County. Additionally, the site does not contain any mature
pines and would not provide suitable habitat for the red -cockaded woodpecker.
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes
r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA EFH Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes
r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
The NC State Historic Preservation Office HPOWEB GIS mapping resource was used to determine the known presence of cultural or historic
resources. No resources are identified within or adjacent to the site.
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes
r No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map Service Center website
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Fig1-Vicinity.pdf 1.85MB
Fig6-Aerial.pdf 1.34MB
I
Signature
W By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Kimberlee C Williams
Signature
Date
11/24/2020
u

T G
LAND MANAGEMENT GROUP
a p�1i/EY. company
AGENT AUTHORIZATION FORM
TO WHOM IT MAY CONCERN:
I/we, the undersigned, hereby authorize Land Management Group to act as our agent in the
preparation and representation of information related to the Section 404/401 permit application
for Sanctuary at Hanover Reserve located in Wilmington, NC. All questions regarding this
project should be directed to Land Management Group.
Sincerely,
V
1W /
Applicant
w1kc4eut �10(n
J�v� b� tX AUA c--
Print ame
Date
www.lmgroup.net ® [e-mail] ® Phone: [phone] ® Fax: [phone]
3805 Wrightsville Avenue, Suite 15 ® Wilmington, NC 28403

Esri, HERE, Garmin, (c) OpenStreetMap contributors
0 1 20.5 Miles
Scale app lies to 11X17" print.
3805 Wrightsville AvenueWilmington, NC 28403(910) 452-0001
Figure 1Vicinity Map
Sanctuary at Hanover ReserveNew Hanover County, NC
Map Date: 03-09-2020LMG # 20.069
L:\WETLANDS\2020 WETLANDS FILES\LMG20.069 --- Sanctuary at Hanover Reserve, HDC Inc\MapsBoundaries are approximate and not meant to be absolute.Map Source: 2016 DeLorme Atlas & Gazetteer, pg. 85 ¯
ProjectArea
Esri, HERE, Garmin, (c) OpenStreetMap contributors
0 1,200 2,400600Feet
Scale app lies to 11X17" print.
3805 Wrightsville AvenueWilmington, NC 28403(910) 452-0001
Figure 2Topographic Map
Sanctuary at Hanover ReserveNew Hanover County, NC
Map Date: 03-09-2020LMG # 20.069
L:\WETLANDS\2020 WETLANDS FILES\LMG20.069 --- Sanctuary at Hanover Reserve, HDC Inc\MapsBoundaries are approximate and not meant to be absolute.Map Source: USGS Scotts Hill Topographic Quad ¯
ProjectArea
Mu
Le
Esri, HERE, Garmin, (c) OpenStreetMap contributors
0 80 16040Feet
Scale applies to 11X17" print.
3805 Wrightsville AvenueWilmington, NC 28403(910) 452-0001
Figure 4Soils Map
Sanctuary at Hanover ReserveNew Hanover County, NC
Map Date: 03-09-2020LMG # 20.069
L:\WETLANDS\2020 WETLANDS FILES\LMG20.069 --- Sanctuary at Hanover Reserve, HDC Inc\MapsBoundaries are approximate and not meant to be absolute.Map Source: GIS Soils Data ¯
ProjectArea
LegendLe: Leon sandMu: Murville fine sand
Esri, HERE, Garmin, (c) OpenStreetMap contributors
0 100 20050Feet
Scale app lies to 11X17" print.
3805 Wrightsville AvenueWilmington, NC 28403(910) 452-0001
Figure 62018 Aerial
Sanctuary at Hanover ReserveNew Hanover County, NC
Map Date: 03-09-2020LMG # 20.069
L:\WETLANDS\2020 WETLANDS FILES\LMG20.069 --- Sanctuary at Hanover Reserve, HDC Inc\MapsBoundaries are approximate and not meant to be absolute.Map Source: 2018 NearMap Aerial Photography ¯
ProjectArea
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2012-01490 County: New Hanover U.S.G.S. Quad: Murrayville
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Applicant: Hanover Land LLC
Attn: Robin Grathwol
Address: P.O. Box 1490
Wrightsville Beach, NC 28480
[phone]
Agent: Land Management Group, Inc.
Attn: Kim Williams
Address: 3805 Wrightsville Ave., Suite 15
Wilmington, NC 28403
[phone]
Size and location of property (water body, road name/number, town, etc.): Project area is approximately 36.7 acres known
as Hanover Reserve Phase I, located at the terminus of Murravville Road, adjacent to an unnamed tributary to Smith Creek,
Wilmington, North Carolina. Latitude: 34.293537 Longitude:-77.827167
Description of projects area and activity: This permit authorizes permanent impacts to 501f of stream and 0.028 acres of Waters
of the U.S. for the construction of four (4) road crossings to facilitate the development of a single family residential
community. PLEASE SEE SPECIAL CONDITIONS ON THE FOLLOWING PAGE.
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number or Nationwide Permit Number: 29
SEE ATTACHED NATIONWIDE AND SPECIAL CONDITIONS.
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 5/8/2013 & 7/l/2013. Any violation of the attached
conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration order and/or
appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms 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 determine Section 401 requirements.
For activities occurring 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.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/perm ts.
If there are any questi s re ding this verification, ny of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact hes at 910 251-46 5.
Corps Regulatory Official i f i Ll k11 Date: July 2, 2013
Expiration Date of Verification: 3/18/2017
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 attached customer Satisfaction Survey or visit http://per2.twvi?.iisace.arm—,` .iilii SL1r` C" , A'1tm1 to complete the survey
online.

Special conditions:
SAW-2012-01490
Hanover Reserve, Phase I
1) 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.
Use of stream credits from the Northeast Cape Fear Mitigation Bank have not been made available at
the time of permit issuance. Once credit release has been granted, the applicant will make payment in
full and forward a copy of receipt to the Corps. No authorized work may begin until proof of payment
is received.
Corps Regulatory Official: Date:
1 '

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_ Figure 5. Site Plan Showing Proposed Impacts
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RPW Impact 01 Stream Impact S1 00 RPW Impact 02 na RPW Impact 03
ENTRANCE ROAD OFF OU AIL RABBIT HOLLOW DRIVE CROSSING #3 CROSSING #1
WOODS RD. — CROSSING #1 EXTENSION — CROSSING #2

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: Hanover Land LLC, Robin Grathwol Action ID: SAW-2012-01490
Project Name: Hanover Reserve County: New Hanover
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 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
appropriate ledger and provide a copy of the signed form to the Permittee and to the USACE Bank/In-Lieu Fee Program
Manager. 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: 03030007, Cape Fear River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Riparian
Riparian
Warm
Cool
Cold
Non -Riparian
Coastal
Riverine
Non-riverine
50
*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: 03030007, Cape Fear River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Riparian
Riparian
Warm
Cool
Cold
Non -Riparian
Coastal
Riverine
Non-riverine
50
Mitigation Site Debited:_ Northeast Cape Fear Mitigation Bank
(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 of Sponsor's Authorized Representative:
Signature of Sponsor's Authorized Representative Date of Signature
Page 1 of 2 Form Updated 2 October, 2012

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 by the mitigation Sponsor and USACE Project Manager. For questions regarding this
form or any of the conditions of the permit authorization, contact the Project Manager at the address below.
USACE Project Manager: Emily Hughes
USACE Field Office: Wilmington Regulatory Field Office
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, NC 28403
Email:
HUGHES.EMILY.BURTON.128907 Digitally,ignedbyHUGHES.EMILY.BURTON.1289073660
DN: r-US, -Us, Government, ou=DoD, ou=PKI, —USA,
3660 cn=H UGHES.EMILY.BURTON.1289073660
Dale: 2013.07,0210:48:49-04'00'
USACE Project Manager 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://ribits.usace.arm\/.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.% 're ulatory.usacesurvey.comb to complete the survey online.

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