20130918 Ver 6_U-2525B-C - STR - RW nonriv - CF 02 - Guilford_20150803

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatorv Miti�ation Responsibilitv Transfer Form
Permittee: North Carolina Department of Transportation
Project Narne: NCDO'f/U-2525 B and C/Di�lsion 7
Action ID: SAW-Z005-21386
County: Guilford
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or #he North Carolina Ecosystem Enhancement Program (NCEEPj, who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, ft is the Permittee's responsi6ility 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 impac#s, unless otherwise specified below. If more than one mitigation
Sponsor w(II 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-dfgit Hydrologic Unit Code (MUC), 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 Spansors.
Instructfons to Sponsor: The Sponsor must verify that the mitigation requiremenfis (credits) shown belaw are available at
the identifled slte. By signing below, the Sponsor is accepting full responsibllity 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 prov(de 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
wlth all reporting requirements established in their authorizing instrument,
Permitted Impacts and Compensatory Mitigation Requlrements:
Permitted Impacts Requiring Mitigation* 8-digit HUC and Basin; 03030002, Cape Fear River Basin
Stream Impacts ([inear feet) Wetland Impacts (acres)
Warm Cool Cold Riparian Riverine Riparian Non-Riverine Non-Rfparian Coastal
24,784 9.95
*If more than one mitigation sponsor will be used for the permit, only fnclude impacts to be mitigated by this sponsor.
�pensatory Mitigation Requirements: 8-digit HUC and Basin: 03030002, Cape Fear River Basin
Stream Mitigation (credits) Wetlahd Mftigation (credltsj
Warm Cool Cold Riparian Riverine Riparian Non-Riverine Non-Riparian
19.88
Coastal
Mitigation Site Deb[ted: North Carolina Division of Mitisation Services {NCDMS)
(List the name of the bank to be debited. For umbrella banks, also list the speciflc site, For NCEEP, list NCEEP. If the NCEEP
acceptance letter identifies a specific site, also fist the specific site to be debited).
Section tv be completed hy the Mitigatlon Spnnsor
Statement of Mitigation Liabillty Acceptance; I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation 5ponsor shown below, and I certlfy 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 credlts (and/or advance credits for NCEEP), as approved by the USACE, are
currently avallable at the mitigation site identified above. Further, I understand that if the Sponsor fails to provide the
required compensatory mitigation, the USACE Wifmington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the mitigation requirements.
Page 1 of 2 Form Updated 23 October, 2013

USACE Wilmingtan District
Compensatory Mitigatian Responsibility Transfer Form, Page 2
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by ihe Mftigatlon Sponsor and the USACE is in receipt of the signed form, the
Permittee is no longer responsibie for providing the mitigation Identlfled 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
af#er the USACE is in receipt of a copy of this document sfgned by the Sponsor, confirming that the Sponsor has
accepted responsibility for providing the mitigation requfrements Iisted hereln. For authorized impacts conducted by
the North Carolina Department of Transportation (NCDOT), constructlon within Jurlsdictlonal areas may proceed upon
permit )ssuance; however, a copy of this form signed by the Sponsor must be provided to the USACE wfthin 30 days of
permit issuance. NCDO7 remains fully responsible for the mitigation until the USACE has recelved this form, confirming
that the Sponsor has accepted responsibilifiy 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/IiF Instrument. It is the Permittee's responsibility to ensure
that the USACE Project Manager (adciress below) is provlded wlth 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 andJor North Carolina
Interagency Review Team (NClRT}. If approved, higher mitigatlon ratlos may be applled, 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.
CommentsJAdditional Conditions:
� This Form supersedes the Compensa#ory Mitigation Responsibility Transfer Forms dated April 14,
2014, October 31, 2014, and December 4, 2014, that were included as part of the DA Permit dated
April 1S, 2014 and subsequent Permit Modifications.
This modification results in a net INCREASE in the number o# stream credits required relative to the
original DA Permit dated April 15, 2014 and subsequent Permit Modifications, consisting of additional
permanent loss of 314 linear feet of stream channe) at a 2:1 ra#io (628 additional credits requiredj.
Additional on-site mitigation was required by special permit conditian included in the original DA
Permit dated April 15, Z014. This requirement has not changed as a result of this modification.
This form is not valid unless stgned below by the USACE Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor should provJde copies of thls form along wTth an updated bank ledger to: 1J the Permittee, ZJ the
USACE ProJect Manager at the address below, and 3J the Wilmfngton Distrfct Mitlgation Offlce, Attn: Todd Tugwell,
11405 Fdlls of Neuse Road, Wake Forest, NC 27587 (emall: [e-mail]/J. Questions regarding this form
or any of the permlt conditions may be directed to the USACE Project Manager below.
USACE Project Manager: David Bailey
USACE Field Office: Raleigh Regulatory Field Office
' US Army Corps of Engineers
3331 Heritage Trade Dr3ve, Suite 105
Wake Forest, North Carolina 27587
Email: Da�[e-mail]
�� "�� Julv 24. 2015
USACE Project Manager Signature Date of Signature
Current Wilmington D1strEct mitigation guidance, inciuding information on mitigation ratios, functional assessments, and
mitigation bank location and availability, and credit classifications (including stream temperature and wetland groupings) fs
available at http://ribits.usace.armv.mil.
Page 2 of 2
The Wilmington District Is tommltted to providing the hlghest level af support to the public. To help us ensure we continue to do so, please compiete the
Customer5atisfaction Survey located at our website at http://resulatorv.usacesurvev com/to complete the survey onitne.