SAW-2016-01337 NCDOT U-5760 Permit Mod 1 Rev 1 Issued R

DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
69 DARLINGTON AVENUE
WILMINGTON, NORTH CAROLINA 28403-1343
June 12, 2023
Regulatory Division
Action ID. SAW-2016-01337, NCDOT U-5760 Kernersville Southern Loop, Big Mill Farm
Road Widening and Extension, Forsyth County, Modification #1, Revision 1
Ms. Amy Euliss, Division 9 Environmental Officer
North Carolina Department of Transportation
375 Silas Creek Parkway
Winston-Salem, North Carolina 27127
aeuliss ncdot.gov
Dear Ms. Euliss:
Reference the Department of the Army (DA) permit issued on August 10, 2020
for the discharge fill material with 0.11 acre permanent wetland impacts, 1,372 linear
feet of permanent stream impacts, and 266 linear feet of temporary stream impacts.
These impacts are associated with the construction of TIP U-5760, widening and
extension of Big Mill Farm Road, and widening of Hopkins Road, from the north end of
Harmon Creek Road, to north of West Mountain Street, west of downtown Kernersville,
in Forsyth County, North Carolina.
On March 17, 2023, NCDOT requested a modification (Modification #1) for the
authorization of an additional 123 linear feet (If) of permanent stream impacts at Sites
#1 B & # 4A. Specifically, an increase to proposed enclosure length via extension (88 If)
at Site #1 B, additional stream channel improvements (13 If) at Site #1 B and additional
stream channel improvements at Site #4A (22 If). Also, this modification includes an
extension of time to the existing Department of the Army (DA) permit issued for the
above referenced permit to include five additional years. On June 2, 2023, the Corps
issued you an authorization for this modification with modified permit special conditions.
Since that time, it was determined that the Corps needed to revise the language of
those special conditions. Please be advised that this letter of modification
authorization and special conditions will supersede the modification
authorization letter issued to you on June 2, 2023.
The Corps has determined that the proposed project modifications described
above are not contrary to the public interest and are consistent with the 404 (B) (1)
Guidelines and therefore, the DA permit is hereby modified. The authorized work shall
be completed in accordance with the enclosed revised drawings. Please be aware that
all other conditions of the original permit remain applicable, with the following
General/Special conditions from the original authorization which have been revised;

General Condition
The time limit for completing the work authorized ends on December 31, 2030.
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.
Modified Special Conditions: See enclosed Special Conditions Modification #1
dated June 12, 2023, as part of the Department of Army Authorization for this
project. This includes all special conditions from the existing permit dated
August 10, 2020, and revisions as required as part of Modification #1. In
addition to the original Special Condition language, the project's revised special
conditions include original language that has been either crossed out and/or the
includes additional language which is highlighted.
Please note that all other terms and conditions of your Department of the Army
permit dated August 10, 2020, shall remain in effect.
This approved modification should be attached to the original permit and will be
utilized for future compliance reviews of the project. If you have questions, please
contact Stephen Brumagin of the Charlotte Regulatory Field Office, at telephone (704)
798-6471 or via e-mail at Stephen.A.Brumagin(cDusace.army. mi1.
FOR THE DISTRICT ENGINEER
�001k_ 2023.06.12
A11% � 15:13:21-04'00'
Monte K. Matthews
Chief, WRDA/Transportation Branch
Wilmington District
Enclosures:
Special Conditions for Modification #1 revised June 2, 2023
401 WQC for modification #1 dated April 20, 2023
Modified Plans dated February 20, 2023
Mitigation Transfer Form
Copies Furnished with enclosures (electronic):
Matthew W. Jones, P.E NCDOT
mw0ones2(a-)_ncdot.gov
Amy Chapman, NC DEQ

amy.chapman(a)-ncdenr.gov
Ms. Lauren Wilson, USFWS
Lauren wilson(c)-fws.gov
Mr. David McHenry, NC WRC
david. mchenry(a-).ncwiIdIife.org

WILMINGTON DISTRICT REGULATORY DIVISION
PERMIT SPECIAL CONDITIONS
DA# SAW-2016-01337
U-5760 Big Mill Farm Road Widening/Extension,
Modification 91, Dated June 12, 2023
1. Work Limits: All work authorized by this permit shall be performed in strict
compliance with the attached permit plans (WETLAND AND STREAM DRAFT PERMIT
PACKAGE, dated MAY 4, 2020) and attached Modified Plans dated February 20, 2023,
which are a part of this permit. The Permittee shall ensure that the construction design
plans for this project do not deviate from the permit plans attached to this authorization.
Any modification to the attached permit plans must be approved by the US Army Corps
of Engineers prior to any active construction in waters or wetlands.
2. Unauthorized Dredge or Fill: Except as authorized by this permit or any U.S. Army
Corps of Engineers 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, or shall any activities take place
that cause the degradation of waters or wetlands. There shall be no excavation from,
waste disposal into, or degradation of, jurisdictional wetlands or waters associated with
this permit without appropriate modification of this permit, including appropriate
compensatory mitigation. This prohibition applies to all borrow and waste activities
connected with this project. In addition, 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, into, or out of waters or wetlands or to
reduce the reach of waters or wetlands.
3. 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, drawings and attachments shall be available at the
project site during the construction and maintenance of this project.
4. Pre -Construction Meeting: The Permittee shall schedule and attend a
preconstruction meeting between its representatives, the contractors representatives,
and the U.S. Army Corps of Engineers, NCDOT 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 Corps, NCDOT 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 time frame when the Corps 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. The thirty (30) day requirement can be waived with the concurrence
of the Corps.

WILMINGTON DISTRICT REGULATORY DIVISION
PERMIT SPECIAL CONDITIONS
DA# SAW-2016-01337
U-5760 Big Mill Farm Road Widening/Extension,
Modification #1, Dated June 12, 2023
5. Notification of Construction Commencement and Completion: The
Permittee shall notify the U.S. Army Corps of Engineers in writing prior to beginning
the work authorized by this permit and again upon completion of the work authorized
by this permit.
6. Reporting Address: All reports, documentation, and correspondence required by the
conditions of this permit shall be submitted to the following: U.S. Army Corps of
Engineers, Wilmington District Raleigh Regulatory Field Office, Attn: Eric Alsmeyer,
3331 Heritage Trade Drive, Suite 105, Wake Forest, NC 27587 or
[e-mail]. The Permittee shall reference the following permit
number, SAW-2016-01337, on all submittals.
7. 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.
8. Reporting Violations: Violation of these permit conditions or violation of Section 404
of the Clean Water Act or Section 10 of the Rivers and Harbors Act shall be reported to
the Corps in writing and by telephone at: 919-554-4844, ext. 23, within 24 hours of the
Permittee's discovery of the violation.
9. Clean Fill: The Permittee shall use only clean fill material for this project. The fill
material shall be free from items such as trash, construction debris, metal and plastic
products, and concrete block with exposed reinforcement bars. Soils used for fill shall
not be contaminated with any toxic substance in concentrations governed by Section
307 of the Clean Water Act. Unless otherwise authorized by this permit, all fill material
placed in waters or wetlands shall be generated from an upland source.
10. Culverts:
1) Unless otherwise requested in the application and depicted on the approved
permit plans, culverts greater than 48 inches in diameter shall be buried at least one
foot below the bed of the stream. Culverts 48 inches in diameter and less shall be
buried or placed on the stream bed as practicable and appropriate to maintain aquatic
passage, and every effort shall be made to maintain existing channel slope. The bottom
of the culvert shall be placed at a depth below the natural stream bottom to provide for
passage during drought or low flow conditions. Culverts shall be designed and
constructed in a manner that minimizes destabilization and head cutting.
2) Measures shall be included in the construction/installation that will promote the
safe passage of fish and other aquatic organisms. The dimension, pattern, and profile of
the stream above and below a pipe or culvert shall not be modified by widening the
stream channel or by reducing the depth of the stream in connection with the
construction activity. The width, height, and gradient of a proposed opening shall be
such as to pass the average historical low flow and spring flow without adversely

WILMINGTON DISTRICT REGULATORY DIVISION
PERMIT SPECIAL CONDITIONS
DA# SAW-2016-01337
U-5760 Big Mill Farm Road Widening/Extension,
Modification 91, Dated June 12, 2023
altering flow velocity. Spring flow should be determined from gauge data, if available. In
the absence of such data, bankfull flow can be used as a comparable level.
3) The Permittee shall implement all reasonable and practicable measures to
ensure that equipment, structures, fill pads, work, and operations associated with this
project do not adversely affect upstream and/or downstream reaches. Adverse effects
include, but are not limited to, channel instability, flooding, and/or stream bank erosion.
The Permittee shall routinely monitor for these effects, cease all work when detected,
take initial corrective measures to correct actively eroding areas, and notify this office
immediately. Permanent corrective measures may require additional authorization by
the U.S. Army Corps of Engineers.
4) Culverts placed within wetlands must be installed in a manner that does not
restrict the flows and circulation patterns of waters of the United States. Culverts placed
across wetland fills purely for the purposes of equalizing surface water shall not be
buried, but the culverts must be of adequate size and/or number to ensure unrestricted
transmission of water.
11. Sediment and Erosion Control:
1) During the clearing phase of the project, heavy equipment shall not be
operated in surface waters or stream channels. Temporary stream crossings will be
used to access the opposite sides of stream channels. All temporary diversion channels
and stream crossings will be constructed of non -erodible materials. Grubbing of riparian
vegetation will not occur until immediately before construction begins on a given
segment of stream channel.
2) No fill or excavation impacts for the purposes of sedimentation and erosion
control shall occur within jurisdictional waters, including wetlands, unless the impacts
are included on the plan drawings and specifically authorized by this permit. This
includes, but is not limited to, sediment control fences and other barriers intended to
catch sediment losses.
3) The Permittee shall remove all sediment and erosion control measures placed
in waters and/or wetlands, and shall restore natural grades on those areas, prior to
project completion.
4) The Permittee shall use appropriate sediment and erosion control practices
which
equal or exceed those outlined in the most recent version of the "North Carolina
Sediment and
Erosion Control Planning and Design Manual" to ensure compliance with the
appropriate turbidity water quality standard. Erosion and sediment control practices
shall be in full compliance with all specifications governing the proper design,
installation and operation and maintenance of such Best Management Practices in
order to ensure compliance with the appropriate turbidity water quality standards. This
shall include, but is not limited to, the immediate installation of silt fencing or similar

WILMINGTON DISTRICT REGULATORY DIVISION
PERMIT SPECIAL CONDITIONS
DA# SAW-2016-01337
U-5760 Big Mill Farm Road Widening/Extension,
Modification #1, Dated June 12, 2023
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 shall remain in full compliance with all aspects of the Sedimentation Pollution
Control Act of 1973 (North Carolina General Statutes Chapter 113A, Article 4).
Adequate sedimentation and erosion control measures shall be implemented prior to
any ground disturbing activities to minimize impacts to downstream aquatic resources.
These measures shall be inspected and maintained regularly, especially following
rainfall events. All fill material shall be adequately stabilized at the earliest practicable
date to prevent sediment from entering into adjacent waters or wetlands.
12. Borrow and Waste: To ensure that all borrow and waste activities occur on high
ground and do not result in the degradation of adjacent waters and wetlands, except
as authorized by this permit, the Permittee shall require its contractors and/or agents
to identify all areas to be used as borrow and/or waste sites associated with this
project. The Permittee shall provide the U.S. Army Corps of Engineers with
appropriate maps indicating the locations of proposed borrow and/or waste sites as
soon as such information is available. The Permittee shall submit to the Corps site -
specific information needed to ensure that borrow and/or waste sites comply with all
applicable Federal requirements, to include compliance with the Endangered Species
Act and the National Historic Preservation Act, such as surveys or correspondence
with agencies (e.g., the USFWS, the NC-HPO, etc.). The required information shall
also include the location of all aquatic features, if any, out to a distance of 400 feet
beyond the nearest boundary of the site. The Permittee shall not approve any borrow
and/or waste sites before receiving written confirmation from the Corps that the
proposed site meets all Federal requirements, whether or not waters of the U.S.,
including wetlands, are located in the proposed borrow and/or waste site. All
delineations of aquatic sites on borrow and/or waste sites shall be verified by the U.S.
Army Corps of Engineers and shown on the approved reclamation plans. The
Permittee shall ensure that all borrow and/or waste sites comply with Special
Condition 2. of this permit. Additionally, the Permittee s h a I I produce and maintain
documentation of all borrow and waste sites associated with this project. This
documentation will include data regarding soils, vegetation, hydrology, any
delineation(s) of aquatic sites, and any jurisdictional determinations made by the
Corps to clearly demonstrate compliance with Special Condition 2. All information will
be available to the U.S. Army Corps of Engineers upon request. The Permittee shall
require its contractors to complete and execute reclamation plans for each borrow
and/or waste site and provide written documentation that the reclamation plans have
been implemented and all work is completed. This documentation will be provided to
the U.S. Army Corps of Engineers within 30 days of the completion of the reclamation
work.
13. Compensatory Mitigation: 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.

WILMINGTON DISTRICT REGULATORY DIVISION
PERMIT SPECIAL CONDITIONS
DA# SAW-2016-01337
U-5760 Big Mill Farm Road Widening/Extension,
Modification #1, Dated June 12, 2023
14. Endangered Species Act: The Permittees shall implement all necessary
measures to ensure the authorized activity does not kill, injure, capture, harass, or
otherwise harm any federally -listed threatened or endangered species. While
accomplishing the authorized work, if the Permittees discover or observe an injured or
dead threatened or endangered species, the U.S. Army Corps of Engineers,
Wilmington District Raleigh Field Office, Attn: Stephen Brumagin at [phone] or
Stephen.A.BrumaginCc�usace.army.mil will be immediately notified to initiate the
required Federal coordination.
The permittee will implement the following conservation measures to ensure the
authorized activity does not kill, injure, capture, harass or otherwise harm the proposed
for listing Tricolored bat (Perimyotis sublavas):
1)Tree clearing will occur between October 16 and March 31.
2)Tree clearing will be minimized to the maximum extent practicable.
3)Clearing limits will be clearly marked for the contractors.
4)Project culverts equal to and greater than three feet in diameter and greater than
60 linear feet in length will be re -surveyed to confirm absence of bats and signs of
bat use in 2024.
5)Lighting for night work will be downward facing and contained to the work area [with
the exception of the Salem Parkway/US 421/NC150/Business 40 section of the
action area].
6)The replacement of existing streetlighting will be downcast.
7)Blast mats will be utilized for any blasting. No mass blasting will occur.
8)Blasting and pile driving will occur after tree clearing has occurred in the work areas
immediately around and adjacent to these activities.
15. Maintain Flows and Circulation Patterns 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 and/or wetlands.
16. Temporary Fills: Within thirty (30) days of the date of completing the authorized
work, the Permittee shall remove all temporary fills in waters of the United States and
restore the affected areas to pre -construction contours and elevations. The affected
areas shall be re -vegetated with native, non-invasive vegetation as necessary to
minimize erosion and ensure site stability.
17. Water Contamination: All mechanized equipment shall 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 Permittees 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 shall be followed.

WILMINGTON DISTRICT REGULATORY DIVISION
PERMIT SPECIAL CONDITIONS
DA# SAW-2016-01337
U-5760 Big Mill Farm Road Widening/Extension,
Modification 91, Dated June 12, 2023
18. Aquatic Life Movement: No activity may substantially disrupt the necessary life
cycle movements of those species of aquatic life indigenous to the waterbody, including
those species that normally migrate through the area. All discharges of dredged or fill
material within waters of the United States shall be designed and constructed, except as
authorized as indirect impacts, to maintain low flows to sustain the movement of aquatic
species.
19. Prohibitions on Concrete: The Permittees shall take measures necessary to
prevent live or fresh concrete, including bags of uncured concrete, from coming into
contact with any water in or entering 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).

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DocuSign Envelope ID: C76BC9B5-E862-44CC-8CO3-4416CB95879A
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Ms. Amy Euliss
NCDOT, Division 9 PDEA Engineer
375 Silas Creek Parkway
Winston Salem, NC 27127
NORTH CAROLINA
Environmental Quality
April 20, 2023
Subject: Modification to the 401 Water Quality Certification Pursuant to Section 401 of the Federal Clean Water
Act with ADDITIONAL CONDITIONS for Proposed widening and extension of Big Mill Farm Road and
widening of Hopkins Road from I-40 Business/US 421 to West Mountain Street with a new partial
cloverleaf interchange at I-40 Business/US 421 in Forsyth County; STIP No U-5760; WBS Element No.
46381.1.1. NCDWR Project No. 20200628v2; WQ Certification No. 0044231.
Dear Ms. Euliss:
Attached hereto is a modification of Certification No. 0044231 issued to The North Carolina Department of
Transportation (NCDOT) originally issued on July 13, 2020.
If we can be of further assistance, do not hesitate to contact us.
Sincerely,
DocuSigned by:
I KAQ
Ri IP6R6§694Jr., Director
Division of Water Resources
Electronic copy only distribution:
Matt Jones, NCDOT Division 9 ([e-mail])
Steve Brumagin, US Army Corps of Engineers, Charlotte Field Office
Amanetta Somerville, US Environmental Protection Agency
Rebekah Reid, US Fish and Wildlife Service
David McHenry, NC Wildlife Resources Commission
Beth Harmon, NC DMS
File Copy
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
e-�JD,E Q 919.707.9000

DocuSign Envelope ID: C76BC9B5-E862-44CC-8CO3-4416CB95879A
Modification to the 401 Water Quality Certification Pursuant to Section 401 of the Federal Clean Water Act
with ADDITIONAL CONDITIONS
THIS CERTIFICATION is issued in conformity with the requirements of Section 401 Public Laws 92-500 and
95-217 of the United States and subject to the North Carolina Division of Water Resources (NCDWR) Regulations
in 15 NCAC 2H .0500. This certification authorizes the NCDOT to permanently impact an additional 123 linear
feet of jurisdictional streams and reduce temporary impacts by 19 linear feet (for the two Sites) in Forsyth County.
The project shall be constructed pursuant to the modification received March 17, 2023. The authorized impacts are
as described below:
Stream Impacts in the Yadkin Pee Dee River Basin
Permanent Fill in Perennial
Temporary Fill in Perennial
Stream
Stream
Stream
Impacts
Site
(linear ft)
(linear ft)
Requiring
Additional
Culvert
Channel
Fill
Mitigation
Improvements
(linear ft)
Current impacts at 1B
522
20
20
-
New additional impacts at 1B
88
13
4
101
Current impacts at 4A
61
30
28
New additional impacts at 4A
No change
22
Reduction of 23
22
Relevant Totals
gg
35
4
123
(for this modification)
Total Stream Impact (for this modification): 127 linear feet (total includes new temporary impacts)
The application provides adequate assurance that the discharge of fill material into the waters of the Yadkin Pee Dee
River Basin in conjunction with the proposed development will not result in a violation of applicable Water Quality
Standards and discharge guidelines. Therefore, the State of North Carolina certifies that this activity will not violate
the applicable portions of Sections 301, 302, 303, 306, 307 of PL 92-500 and PL 95-217 if conducted in accordance
with the application and conditions hereinafter set forth.
This approval is only valid for the purpose and design that you submitted in your modification application dated
March 17, 2023. All the authorized activities and conditions associated with the original Water Quality Certification
originally dated July 13, 2020, still apply except where superseded by this Certification. Should your project
change, you are required to notify the NCDWR and submit a new application. If the property is sold, the new owner
must be given a copy of this Certification and approval letter and is thereby responsible for complying with all the
conditions. If any additional wetland impacts, or stream impacts, for this project (now or in the future) exceed one
acre or 300 linear feet, respectively, additional compensatory mitigation may be required as described in 15A NCAC
2H .0506 (h) (6) and (7). For this approval to remain valid, you are required to comply with all the conditions listed
below. In addition, you should obtain all other federal, state or local permits before proceeding with your project
including (but not limited to) Sediment and Erosion control, Coastal Stormwater, Non -discharge and Water Supply
watershed regulations. This Certification shall expire on the same day as the expiration date of the corresponding
Corps of Engineers Permit.
Condition(s) of Certification:
1. This modification is applicable only to the additional proposed activities and design that you submitted in
your request for modification received March 17, 2023. [15A NCAC 02H.0506(b) (1, 2)]
, North Carolina Department of Environmental Quality e Division o, Water Resources
j._�n E512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

DocuSign Envelope ID: C76BC9B5-E862-44CC-8CO3-4416CB95879A
2. All the authorized activities and conditions associated with the original Water Quality Certification dated
July 13, 2020, still apply except where superseded by this certification. [15A NCAC 02H.0506(b) (1, 2)]
Compensatory mitigation for 123 linear feet of impact to streams is required. We understand that you
have chosen to perform compensatory mitigation for impacts to streams through the North Carolina
Division of Mitigation Service (DMS) (formerly NCEEP), and that the DMS has agreed to implement the
mitigation for the project. The DMS has indicated in a letter dated February 23, 2023, that they will
assume responsibility for satisfying the federal Clean Water Act compensatory mitigation requirements
for the above -referenced project, in accordance with the DMS Mitigation Banking Instrument signed July
28, 2010.
Violations of any condition herein set forth may result in revocation of this Certification and may result in criminal
and/or civil penalties. This Certification shall become null and void unless the above conditions are made
conditions of the Federal 404 and/or Coastal Area Management Act Permit. This Certification shall expire upon the
expiration of the 404 or CAMA permit.
If you wish to contest any statement in the attached Certification you must file a petition for an administrative
hearing. You may obtain the petition form from the office of Administrative Hearings. You must file the petition
with the office of Administrative Hearings within sixty (60) days of receipt of this notice. A petition is considered
filed when it is received in the office of Administrative Hearings during normal office hours. The Office of
Administrative Hearings accepts filings Monday through Friday between the hours of 8:00am and 5:00pm, except
for official state holidays. The original and one (1) copy of the petition must be filed with the Office of
Administrative Hearings.
The petition may be faxed -provided the original and one copy of the document is received by the Office of
Administrative Hearings within five (5) business days following the faxed transmission.
The mailing address for the Office of Administrative Hearings is:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Telephone: [phone], Facsimile: [phone]
A copy of the petition must also be served on DEQ as follows:
Mr. Bill F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
This the 20th day of April 2023
DIVISION OF WATER RESOURCES
DocuSigned by:
ll••Yv1M.
Rich//��l�gl��*���:, Director
WQC No. 004231
North Carolina Department of Environmental Quality e Division oWater Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh,, North Carolina 27699-1617
919.707.9000
L�µ•�� d Ln��

DocuSign Envelope ID: C76BC9B5-E862-44CC-8CO3-4416CB95879A
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Qaality
NCDWR Project No.:
Applicant:
Project Name:
County:
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be returned to NCDWR by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Agent's Certification
Date:
I, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Engineer's Certification
Partial Final
Date:
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the 401
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
OPRIE Q���� 919.707.9000

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: North Carolina Department of Transportation, Division 9 Action ID: SAW-2016-01337
Project Name: U-5760 Kernersville Southern Loop, Big Mill Farm Road, Modification #1 County: Forsyth
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 Wilmington District 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 verifies that the mitigation requirements (credits) shown below have been released
and are available at the identified site. By signing below, the Sponsor is accepting full responsibility for the identified
mitigation, regardless of whether 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 ledger to the Permittee, the Project
Manager who issued the permit, the Bank Project Manager, and the 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: 03040101, Yadkin River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
123
*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: 03040101, Yadkin River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
246
Mitigation Site Debited:
(List the name of the bank to be debited. For umbrella banks, also list the specific site
acceptance letter identifies a specific site, also list the specific site to be debited).
For NCDMS, list NCDMS. If the NCDMS
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 NCDMS), as approved by the Wilmington
District, 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:
NCDEQ-DMS
Name of Sponsor's Authorized Representative:
Beth Harmon
06/07/2023
re of Sponsor's Authorized Representative Date of Signature
Page 1 of 2 Form Date July 7, 2020

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 District 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 District 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. When NCDMS provides mitigation 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 NCDMS must be provided to the District
within 30 days of permit issuance. NCDOT remains fully responsible for the mitigation until the District 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 District
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 District, the Sponsor must obtain case -by -case approval from the District 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 District administrative records for both the permit
and the Bank/ILF Instrument.
Comments/Additional Conditions: The permittee shall provide mitigation for the authorized Modification #1 to this
Project's Sites #1B and #4A. Specifically, to provide compensatory mitigation for the additional 123 If of permanent stream
impacts authorized by this modification. NCDMS confirmed in a February 23, 2023, letter to provide the additional
compensatory mitigation for this project. For the previous issued permit that authorized 1,372 If of warm stream impacts
and 0.11 acres of riparian non-riverine wetland impacts. NCDOT provided a total of 2,744 warm stream mitigation credits
and 0.22 riparian non-riverine wetland mitigation credits as signed by the mitigation sponsor (NCDMS) on August 20, 2020,
for the U-5760 Kernersville Southern Loop, Big Mill Farm Road Widening and Extension, Forsyth County.
This form is not valid unless signed below by the District 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
District Project Manager at the address below, 3) the Bank Manager listed in R/B/TS, and 4) the Wilmington District
Mitigation Office, 3331 Heritage Trade Drive, Suite 105, Wake Forest, NC27587 (or by email to [e-mail]. mi).
Questions regarding this form or any of the permit conditions may be directed to the District Mitigation Office.
USACE Project Manager: Stephen A, Brumagin
USACE Field Office: Charlotte Regulatory Field Office
US Army Corps of Engineers
8430 University Executive Park Drive, Suite 615
Charlotte, North Carolina 28262
Email: [e-mail]
Digitally signed by
BRUMAGIN.STEPHEN.A.12835207
37
Date: 2023.06.02 14:13:07-04'00'
Wilmington District Project Manager Signature
June 2, 2023
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.army.mi1.
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