FINAL R-2577ABC - SAW-2018-02113_Permit, SC, MrT & 401.pdf

DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
69 DARLINGTON AVENUE
WILMINGTON, NORTH CAROLINA 28403-1343
November 17, 2023
Regulatory Division
Action ID. SAW-2018-02113, NCDOT R-2577 ABC Forsyth & Guilford Counties
North Carolina Department of Transportation (NCDOT)
Attn: Matt Jones, P.E.
Division 9 Project Development Engineer
375 Silas Creek Parkway
Winston-Salem, NC 27127
Dear Mr. Jones:
In accordance with the written request of January 27, 2023, and the ensuing
administrative record, enclosed is a permit to place fill material elevate vertical grade
and widen existing US 158 (Reidsville Road) to a multi -lane, median divided facility.
This proposed three phase roadway widening project will include a total of 1.74 acres of
permanent wetland impacts and 8,022 linear feet of permanent stream impact.
Specifically, for Phase A, this phase of the project will include 0.06 acre of
permanent impacts to wetlands and 1,633 linear feet of permanent impacts to streams.
For Phase B (based upon preliminary design), this phase of the project will include
2,210 linear feet of stream impacts and 0.32-acre wetland impacts. For Phase C (based
upon preliminary design), this phase of the project will include 4,179 linear feet of
stream impacts and 1.36-acre wetland impacts.
Any deviation in the authorized work will likely require modification of this permit. If
any 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 notifies 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, 2028.
b. You must notify this office in advance as to when you intend to commence and
complete work.
c. You must allow representatives from this office to make periodic visits to your

-2-
worksite as deemed necessary to assure compliance with permit plans and conditions.
You should address all questions regarding this authorization to Stephen A.
Brumagin at the Charlotte Regulatory Field Office, telephone [phone], or via
email at stephen.a.brumaain(cDusace.army.mil .
FOR THE CHIEF, REGULATORY DIVISION
Ion. 2023.11.17
07:07:43-05'00'
Monte K. Matthews
WRDA/Transportation Permitting
Wilmington District Enclosures:
Enclosures
Electronic Copies Furnished (with enclosures):
Chief, Source Data Unit
NOAA/National Ocean Service
1315 East -west Highway, Room 7316
Silver Spring, Maryland 20910-3282
Electronic Copies Furnished with Special Conditions and Plans:
U. S. Fish and Wildlife Service
Asheville Ecological Services Field Office
160 Zillicoa Street
Asheville, North Carolina 28801
Mr. Todd Bowers
Wetlands and Marine Regulatory Section
Water Protection Division — Region IV
U. S. Environmental Protection Agency
61 Forsyth St. SW
Atlanta, Georgia 30303-8931
North Carolina, Division of Water Resources
Department of Environmental Quality
1617 Mail Service Center
Raleigh, North Carolina 27699

DEPARTMENT OF THE ARMY PERMIT
Permittee: North Carolina Department of Transportation, Division 9, Attn: Matt Jones, P.E.
Permit No. SAW-2018-02113, NCDOT STIP R-2577 ABC
Issuing Office CESAW-RG-D
NOTE: The term "you" and its derivatives, as used in this permit, means the permittee or any future transferee. The term "this
office" refers to the appropriate district or division office of the Corps of Engineers having jurisdiction over the permitted activity
or the appropriate official of that office acting under the authority of the commanding officer.
You are authorized to perform work in accordance with the terms and conditions specified below.
Project Description: To place fill material to elevate vertical grade and widen existing 18.8 mile long section of US 158
(Reidsville Road) in Forsyth and Guilford Counties to a multi -lane, median divided facility. This proposed three phase
roadway widening project will include a total of 1.74 acres of permanent wetland impacts and 8,022 linear feet of
permanent stream impact.
Specifically, for Phase A, this phase of the project will include 0.06 acre of permanent impacts to wetlands and 1,632
linear feet of permanent impacts to streams. For Phase B (based upon preliminary design), this phase of the project will
include 2,210 linear feet of stream impacts and 0.32-acre wetland impacts. For Phase C (based upon preliminary design),
this phase of the project will include 4,179 linear feet of stream impacts and 1.36-acre wetland impacts.
THIS IS A PHASED PERMIT AUTHORIZATION: This permit only authorizes work on Sections R-2577 A of the STIP
R-2577 project. The permittee is authorized to impact regulated waters along R-2577 A as follows: permanent discharge
of fill material into 1496 linear feet of streams and 0.06 acres of wetlands. The permittee is also authorized to temporarily
impact 136 linear feet of streams during construction. Construction on the remaining sections of STIP R-2577 (B & C)
shall not commence until final designs have been completed for these sections; the permittee has minimized impacts to
waters and wetlands to the maximum extent practicable, and; any modifications to the plans, and the compensatory
mitigation plans, have been approved by the US Army Corps of Engineers (the Corps).
Project Location: The NCDOT R-2577 ABC project is located along existing US 158 (Reidsville Road) for distance of
approximately 18.8 miles from a location starting near the US 158 intersection with Old Greensboro Road in Forsyth
County near Winston-Salem to a new proposed interchange of US 158 with US 220/I-73 in Guilford County near
Stokesdale, North Carolina.
Permit Conditions:
General Conditions:
1. The time limit for completing the work authorized ends on December 31, 2028. 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 permitted 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
ENG FORM 1721, Nov 86 EDITION OF SEP 82 IS OBSOLETE. (33 CFR 325 (Appendix A))

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
permit, 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.
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 permit 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.
ENG FORM 1721, Nov 86 EDITION OF SEP 82 IS OBSOLETE. (33 CFR 325 (Appendix A))

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.
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 terms 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.
DocuSigned by:
11/16/2023
E��OB45D6C71FOO459...
(PERMITTEE) NCDOT, ATTN: MR. MATT JONES, P.E.
(DATE)
This permit becomes effective when the Federal official, designated to act for the Secretary of the Army, has signed below.
2023.11.17 07:20:27
FOR/-05'00'
(DISTRICT COMMANDER) BRAD A. MORGAN, COLONEL (DATE)
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

SAW-2018-02113 NCDOT R-2577 ABC Forsyth &Guilford Counties, N.C.
OTIFICATION OF NISTRATIVE APPEAL OPTIONS AND PR
REQUEST FOR APPEAL
Applicant: File Number: SAW-2018-02113 Date: November 17,
North Carolina Department of Transportation, Div. 9 2023
Attached
is:
See Section below
INITIAL PROFFERED PERMIT Standard Permit or Letter of permission,
A
PROFFERED PERMIT Standard Permit or Letter ofpermission)
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 hqp://www.usace.g my.mil/Missions/CivilWorks/Re ug latoryProjzramandPermits.asi)x 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 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.
• 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 II 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 division engineer. This form must be received by
the division engineer within 60 days of the date of this notice.

SAW-2018-02113 NCDOT R-2577 ABC Forsvth &Guilford Counties. N.C.
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 II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your
objections to an initial proffered permit 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 Division,
MR. PHILIP A. SHANNIN
Attn: Stephen A. Brumagin
ADMINISTRATIVE APPEAL REVIEW OFFICER
Charlotte Regulatory Field Office
CESAD-PDS-O
8430 University Executive Park Dr., Suite 615
60 FORSYTH STREET SOUTHWEST, FLOOR M9
Charlotte, NC 28262
ATLANTA, GEORGIA 30303-8803
Phone: [phone]
EMAIL: stei)hen.a.brumazin(&usace.armv.mil
PHONE: [phone]; FAX [phone]
EMAIL: PHILIP.A.SHANNIN(&USACE.ARMY.MIL
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 opportuni 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: Stephen A. Brumagin
Charlotte Regulatory Field Office, 8430 University Executive Park Dr., Suite 615 Charlotte, NC 28262
For Permit denials, Proffered Permits and approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Phillip Shannin,
Administrative Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

Special Conditions
R-2577ABC, SAW-2018-02113
Special Condition 1: Work Limits: All work authorized by this permit shall be
performed in strict compliance with the attached permit plans as provided in the
February 3, 2023, permit application, 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 U.S. Army Corps of Engineers (Corps) prior to any active
construction in waters or wetlands.
Special Condition 2: 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 and drawings shall be available at
the project site during construction and maintenance of this project.
Special Condition 3: Preconstruction Meeting: The Permittee shall conduct an
onsite preconstruction meeting between its representatives, the contractor's
representatives, and the appropriate U.S. Army Corps of Engineers Project Manager
prior to undertaking any work within jurisdictional waters and wetlands to ensure that
there is a mutual understanding of all terms and conditions contained within the
Department of the Army permit. 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 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.
Special Condition 4: 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.
Special Condition 5: 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, Charlotte Regulatory Field
Office, Attn: Stephen Brumagin 8340 University Executive Park Drive, Charlotte, North
Carolina 28262, or stephen.a.brumagin usace.army. rn i 1. The Permittee shall
reference the following permit number, SAW-2018-00393, on all submittals.
Special Condition 6: 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

Special Conditions
R-2577ABC, SAW-2018-02113
or his authorized representative may direct, restore the water or wetland to its pre -
project condition.
Special Condition 7: 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: 704-798-6471 within
24 hours of the Permittee's discovery of the violation.
Special Condition 8: 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.
Special Condition 9: Endangered Species Act: The Permittee 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 Permittee discovers or observes an injured or
dead threatened or endangered species, the U.S. Army Corps of Engineers, Wilmington
District Charlotte Field Office, Attn: Stephen A. Brumagin at [phone], or
[e-mail] will be immediately notified to initiate the required
Federal coordination.
Special Condition 10: Endangered Species Act: The Wilmington District, U.S. Fish
and Wildlife Service (USFWS), and the North Carolina Department of Transportation
(NCDOT) have conducted Section 7(a)(2) consultation for the Tricolored bat (TCB) for
this project. The result of this consultation is a Conference Opinion (CO) letter from the
USFWS dated October 30, 2023, that includes conservation measures to minimize all
adverse effects specifically for the Tricolored bat. These conservation measures
include:
1. Tree clearing will not take place from April 1 — October 15, effective with the
federal listing of the tricolored bat (Perimyotis subflavus).
2. Tree clearing will be minimized to the maximum extent possible and limits will
be clearly marked for the contractor.
3. NCDOT will ensure that tree removal is limited to that specified in project plans
and ensure that contractors understand clearing limits and how they are
marked in the field. Clearing limits follow the most recent version of the
NCDOT Manual for Construction Layout and are typically marked by placing
blue and white striped flagging on 36-inch stakes or trees.
4. On the A section, NCDOT commits to planting native, fast-growing,
containerized trees at the following locations: -L- Sta. 139+50 to -L- Sta.
144+00+/- LT and -L- Sta. 147+50 +/- to -L- Sta. 151 +00 LT (plan sheet 15)
and -L- Sta. 164+00+/- to -L- Sta. 166+60+/- (plan sheet 16). If native trees are

Special Conditions
R-2577ABC, SAW-2018-02113
already established at any of the locations, then no planting will occur. Plan
sheets UO-13 (Figure 1), UO-14 (Figure 2), and UO-15 (Figure 3) with planting
locations highlighted in yellow are included for reference in Appendix A.
5. NCDOT will install riparian plantings utilizing native, fast-growing containerized
trees for the riparian areas in the B and C sections, where feasible. These
riparian areas include but are not limited to Belews Creek and Troublesome
Creek. These areas will be reviewed at Merger points CP4B and CP4C for
each section.
a. Note: Riparian plantings cannot be done in easements (utility, drainage,
and construction).
b. At the bridge sites, NCDOT cannot commit to planting riparian trees or
shrubs for the entire width of the right of way beginning at a station 3
feet beyond the beginning and ending extremity of the structure. If
excess property outside of normal maintenance limits is available at
bridge locations, riparian plantings will be installed where feasible.
6. NCDOT will use downcast lighting for all permanent lighting. Any existing lights
that are impacted by the project and relocated will be replaced with downcast
lights.
7. NCDOT will use shoulder/median mounted LED light fixtures with Backlight-
Uplight-Glare (BUG) ratings not to exceed 3-0-3. High mast lighting will have
BUG ratings not to exceed 5-0-5.
8. With the exception of high mast lights, NCDOT will use the shortest poles
possible that still meet highway requirements and safety parameters while
limiting excess lighting within the project area.
9. NCDOT will provide the U.S. Fish and Wildlife Service (Service) the
opportunity to review and comment on the lighting plans prior to finalization of
the plans for the B and C projects. Portions of lighting plans in proximity to
riparian corridors will be called out as priority sections for Service review.
10. Lighting used for nighttime construction will be limited to what is necessary to
maintain safety standards. Temporary lighting will only direct light towards
active work areas except in instances necessitating balloon lighting.
11. No blasting will occur at night.
12. Blast monitoring will occur per NCDOT standard specifications for all blasting
in the project area.
13. Blast mats or soil cover will be used over all blast sites, which minimizes noise,
air blasts, and debris. In general, NCDOT blasting activities are not strong
enough to cause trees to fall or glass to break.
14. Blasting and pile driving will not occur until the trees within the project clearing
limits that are immediately adjacent to the blasting site or pile driving site have
been removed.
15. Prior to modifying the Individual permit for final design of the B and C sections,
NCDOT will update the protected species surveys for each section at the time
of final design in accordance with the current NCDOT Protected Species
Protocols.

Special Conditions
R-2577ABC, SAW-2018-02113
Special Condition 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 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
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 adjacent waters or wetlands.
Special Condition 12: 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.
Special Condition 13: 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

Special Conditions
R-2577ABC, SAW-2018-02113
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 14 of this
permit. Additionally, the Permittee shall 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 14. 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.
Special Condition 14: 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.
Special Condition 15: 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

Special Conditions
R-2577ABC, SAW-2018-02113
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 culvert 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 culvert or pipe 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
altering flow velocity. Spring flow should be determined from gauge data, if available. In
the absence of such data, bank full 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.
Special Condition 16: Historic Properties: The Permittee shall implement all
necessary measures to ensure the authorized activity avoids or mitigates an adverse
effect upon eligible for listing historic properties, Edgewood Baptist Church, and Bel Air
Drive -In Theatre within the R-2577 A project. The initial findings were dated July 9,
2013, and were amended on September 22, 2015. Then on June 12, 2018, these
findings were superseded with an updated Concurrence Form for Assessment of Effects
for the NCDOT R-2577 A project. Finally, in a supplemental concurrence form signed
November 30, 2022, NCDOT and SHPO agreed that this minimization alternative
constitutes no adverse effect to the Edgewood Baptist Church if the specified
commitments are met. These commitments include the following;
Edgewood Baptist Church
• Incorporate best -fit widening with a reduced median (23 feet instead of 30
feet) and a retaining wall in front of the church to minimize impacts to both
the church and the residences located across from the church; will not
require relocations of residences across from the church but will result in
the loss of some parking spaces in front of the church and will require the

Special Conditions
R-2577ABC, SAW-2018-02113
church sign (two if needed) to be relocated.
• Include safety treatments along retaining wall in front (southeast of)
church building.
• The rear (northwest side) of the retaining wall facing the church building
will be finished with a brick veneer matching the church facade in bond
and color. The barrier with moment slab will receive a warm, neutral stain
to complement the brick veneer.
• The one -foot -tall fence will be black in color and conform.
• A seven -foot -wide grassed planting strip is also included in the design.
• The structure will not compromise any contributing element of the historic
property.
• The driveway on Churchland Drive will be relocated further from the
Reidsville Road intersection per request of the church. New location is at
similar grade to existing.
• Temporary construction easement will be shifted northwest, and existing
driveway removed (see attached aerial in the supplemental concurrence
form).
• Driveway relocation will not impact any contributing element of the historic
property.
Bel Air Drive -In Theater
Minimizes ROW acquisition to the drive-in; preservation of access; no
impacts to components; maintains 2:1 side slopes along the parcel.
Special Condition 17: 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.
Special Condition 18: Phased Construction: This permit only authorizes work on
Section A of TIP R-2577. Construction on Sections B and C of TIP 2577 shall not
commence until: (a) final design has been completed for those sections and submitted
to the U.S. Army Corps of Engineers (Corps); (b) the Permittee has minimized impacts
to waters and wetlands to the maximum extent practicable and the Corps concurs with
this assessment through standard Merger 4B and 4C meetings; (c) any modification to
the plans have been approved by the Corps in writing; and (d) a final compensatory
mitigation plan has been submitted by the Permittee and approved by the Corps

DocuSign Envelope ID: 734C96CE-8F76-482E-B4A6-D6840E4C30BS
ROY COOPER 060
Governor,
ELIZABETH S. BISER
secrrfar¢
RICHARD E. ROGERS, JR. NORTH CAROLINA
❑frecror Envfroranental Quality
March 28, 2023
Ms. Amy Euliss
NCDOT, Division 9 PDEA Engineer
375 Silas Creek Parkway
Winston Salem, NC 27127
Subject: 401 Water Quality Certification Pursuant to Section 401 of the Federal Clean Water Act with
ADDITIONAL CONDITIONS for proposed widening of US 158 from the 4-lane roadway north of I-40 in
,Fargyth County to US 220 in Guilford County (TIP No. R-2577ABC); NCDWR Project No. 20210452;
WQCNo. WQ005776.
Dear Ms. Euliss:
Attached hereto is a copy of Certification No. 005776 issued to NCDOT dated March 28, 2023.
This approval is for the purpose and design described in your application dated February 17, 2023. The plans and
specifications for this project are incorporated by reference as part of this Water Quality Certification. if you change
your project, you must notify the Division and you may be required to submit a new application package with the
appropriate fee. If the property is sold, the new owner must be given a copy of this Certification and is responsible
for complying with all conditions. [15A NCAC 02H .0507(d)(2)]. This Certification does not relieve the permittee
of the responsibility to obtain all other required Federal, State, or Local approvals before proceeding with the
project, including those required by, but not limited to, Sediment and Erosion Control, Non -Discharge, Water
Supply Watershed, and Trout Buffer regulations.
This letter completes the review of the Division under section 401 of the Clean Water Act and 15A NCAC 02H
_0500_ Please contact Dave Wanucha at 336-403-5655 if you have any questions or
concerns.
Lar:
Cam.
? Jr., Director
Division of Water Resources
Electronic copy only distribution:
Steve Brumagin US Army Corps of Engineers
Rebekah Reid, US Fish and Wildlife Service
David McHenry, NC Wildlife Resources Commission
Beth Harmon, NC DMS
Amanetta Somerville, USEPA
File Copy
DE North Carolina Department of Environmental Quality I Division of Water Resouroes
512 North Salisbury Street 11617 Mail Service Center, Raleigh, North Carolina 27699.1617
V 919.707.9000

DocuSign Envelope ID: 734C96CE-8F76-482F--64A6-D6840r=4C30BB
Individual 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 NCDOT to impact 1,632 linear feet of jurisdictional streams
and 0.06 acres of wetlands in Forsyth County related to Section A of R-2577. Preliminary impacts for future
Sections B and C are provided in Table 3 below. The project shall be constructed pursuant to your application dated
February 17, 2023. The authorized impacts are as described below:
Table 1. Stream Impacts in the Yadkin Pee Dee and Roanoke River Basin - R-2577A (linear feet).
Stream
Intermittent Stream
RequiringPerennial
Impacts
maaa®®aaaaa
mae®aavaaae
ma�aaaaaaaa
maa�aaaaaaa
®aaa�®aaaaa
�®aaa�aaaaa
maamaaaaaaa
mea�aaaaave
®aaa®�aaaaa
maaaaaaa�oa
�vaaaaa®ova
®aaaaaa®aaa
m�saaaa®nave
m®aaaaaaaaa
m�aaaaaaaaa
ma®aa®vaaa®
maaa®oaaaaa
mee®aveaave
�aamaaaaaaa
maaa®0aaaaa
�0aaa®aaaaa
*Roanoke River Basin. Total Stream Impacts for Project: 1,632 linear feet
DQ e
North Carolina DeparcrnenF of Envfronmenta! Quailty Ofvision of Water Resources
lc�E -)
512 North Salisbury Street 11617 Mail Service Center 1 Raleigh. North Carolins 27699-1617
� 919.707.9000

Docu5ign Envelope ID: 734C96CE-8F76-482F--64A6-176840r=4C30BB
Table 2. Wetland Imnacts (acres) in the Yadkin River Basin - R-2577A friverine).
site
Fill
Temporary
Fill
Excavation
Mechanized
Clearing
Hand
Clearing
Impacts Requiring
Mitigation
5B
0.02
-
<0.01
0.02
-
-
5C
0.02
-
-
-
-
-
Total
0.04
-
<0.01
0.02
-
-
Total Wetland Impact for Project: 0.06 acres.
Table 3. Summary of preliminary impacts for future sections of R-2577.
Section
Streams linear feet
Wetlands acres
B
2,210
0.32
C
4,179
1.36
Totals
6,389
1.68
Note: Mitigation for Sections Band C will be determined followingftnal design and subsequent permit modification(s).
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the NCDWR and submit a new application. If the property is said, 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 total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 300 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the
conditions Iisted in the attached certification(s) and any additional conditions listed below.
Condition(s) of Certification:
Project Specific Conditions
All work in or adjacent to stream waters shall be conducted per approved BMP measures from the most current
version of NCDOT Construction and Maintenance Activities manual. [15A NCAC 02H.0506(b)(3) and (c)(3)]
2. The Permittee shall ensure that the final design drawings adhere to the permit and to the permit drawings
submitted for approval. [15A NCAC 02H .0507 (c) and 15A NCAC 02H .0506 (b)(2) and (c)(2)]
Compensatory mitigation for 331 linear feet of impact to streams and is required. We understand that you have
chosen to perform compensatory mitigation for impacts to streams through a combination of public and private
mitigation service providers. North Carolina Division of Mitigation Service (DMS) (formerly NCEEP), and
that the DMS has agreed to implement the mitigation for a portion of the project. The DMS has indicated in a
letter dated January 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. Brushy Mountain mitigation site sponsored by Restoration Systems
provides additional credits as does NCDOT's Little Peters Creek mitigation site as explained in the application.
When final design plans are completed for R-2577 Sections B and C, a modification to the 401 Water Quality
Certification shall be submitted with five copies and fees to the NC Division of Water Resources. Final designs
shall reflect all appropriate avoidance, minimization, and mitigation for impacts to wetlands, streams, and other
surface waters, and Jordan Lake Riparian Buffers. No construction activities that impact any wetlands, streams,
surface waters, or buffers located in R-2577 Sections B and C shall begin until after the permittee applies for
and receives a written modification of the 401 Water Quality Certification including a Jordan Lake Riparian
Buffer Authorization (if applicable) from the NC Division of Water Resources.
D E Q
) North Carolina Department of Environmental Quailty I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center 1 Raleigh. North Carolina 27699-1617
`� 919.707.9000

DocuSign Envelope ID: 734C96CE-8F76-482F--64A6-176840r=4C30BB
5. Design and placement of pipes/culverts shall be installed in such a manner that the original stream profiles are
not significantly altered. The pipes/culverts shall be designed and installed, per the plans, and to prevent
upstream and downstream instability. Pipe installations at Permit Sites 1, 2, 3, 6 and 7 do net require burial as
explained in the application. [15A NCAC 02H.0506(b)(2)]
General Conditions
1. If concrete is used during construction, a dry work area shall be maintained to prevent direct contact between
curing concrete and stream water. Water that inadvertently contacts uncured concrete shall not be discharged
to samara )eaters due to the potential for elevated pH and possible aquatic life and fish kills. [I5A NCAC
02B.0200]
2. The dimension, pattern and profile of the stream above and below the crossing shall not be modified.
Disturbed floodp]ains and streams shall be restored to natural geomorphic conditions. [15A NCAC
02H.0506(b)(2)]
3. The use of rip -rap above the Normal High Water Mark shall be minimized. Any rip -rap placed for stream
stabilization shall be placed in stream channels in such a manner that it does not impede aquatic life passage.
[15A NCAC 02H.0506(b)(2)]
4. The Permittee shall ensure that the final design drawings adhere to the permit and to the permit drawings
submitted for approval. [I5A NCAC 02H .0507(c) and 15A NCAC 02H .0506 (b)(2) and (c)(2)]
5. No rock, sand or other materials shall be dredged from the stream channel except where authorized by this
certification. [15ANCAC 02H.0506(b)(3)1
6. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface waters
is prohibited. (I 5A NCAC 02H.0506(b)(3)]
7. The permince and its authorized agents shall conduct its activities in a manner consistent with State water quality
standards (including any requirements resulting from compliance with §303(d) of the Clean Water Act) and any
other appropriate requirements of State and Federal law. if the NCDWR determines that such standards or laws
are not being met (including the failure to sustain a designated or achieved use) or that State or federal law is being
violated, or that further conditions are necessary to assure compliance, the NCDWR may reevaluate and modify
this certification. [ 15A NCAC 02B.0200]
8. All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3: 1, unless otherwise
authorized by this certification. [15A NCAC 02H.0506(b)(2)]
9. A copy of this Water Quality Certification shall be maintained on the construction site at all times. In addition, the
Water Quality Certification, and all subsequent modifications, if any, shall be maintained with the Division
Engineer and the on -site project manager. [ 15A NCAC 02H .0507(c) and 15A NCAC 02H .0506 (b)(2) and (c)(2)]
10. The outside buffer, wetland or water boundary located within the construction corridor approved by this
authorization shall be clearly marked by highly visible fencing prior to any land disturbing activities. Impacts to
areas within the fencing are prohibited unless otherwise authorized by this certification. [ 15A NCAC 02H.0501
and .0502]
1], The imua€t - of this certification does not exempt the Permittee from complying with any and all statutes, rules,
regulations, or ordinances that may be imposed by other government agencies (i.e. local, state, and federal) having
jurisdiction, including but not limited to applicable buffer rules, stormwater management rules, soil erosion and
sedimentation control requirements, etc.
12. The Permittee shall report any violations of this certification to the Division of Water Resources within 24 hours
of discovery. [I5A NCAC 02B.0506(b)(2)]
D E Q
—) North Carolina Department of Environmental Quailty I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center 1 Raleigh. North Carolina 27699-1617
`� 919.707.9000

Docu5ign Envelope ID: 734C96CE-8F76-482F--64A6-176840r=4C30BB
13. Upon completion of the project (including any impacts at associated borrow or waste sites), the Division Engineer
(or appointee) shall complete and return the enclosed "Certification of Completion Form" to notify the NCDWR
when all work included in the 401 Certification has been completed. [15A NCAC 02H.0502(f)]
14. Native riparian vegetation must be reestablished in the riparian areas within the construction limits of the project
by the end of the growing season following completion of construction. [ l5A NCAC 02H.0506(b)(3) and (c)(3)]
15. There shall be no excavation from, or waste disposal into, jurisdictional wetlands or waters associated with this
permit without appropriate modification. Should waste or borrow sites, or access roads to waste or borrow sites,
be located in wetlands or streams, compensatory mitigation will be required since that is a direct impact from road
construction activities. [15A NCAC 02H.0506(b)(3) and (c)(3)]
16. Erosion and sediment control practices must be in full compliance with all specifications governing the proper
design, installation and operation and maintenance of such Best Management Practices in order to protect surface
water standards [15A NCAC 02H.0506(b)(3) and (c)(31):
a. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion Control
Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control measures must be
such that they equal, or exceed, the requirements specified in the most recent version of the North Carolina
Sediment and Erosion Control Manual. The devices shall be maintained on all construction sites, borrow
sites, and waste pile (spoil) projects, including contractor -owned or leased borrow pits associated with the
project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in accordance with the
requirements of the Sedimentation Pollution Contra] Act.
17. Where placement of sediment and erosion control devices in wetlands and/or waters is unavoidable, they shall be
removed, and the natural grade restored upon completion of the project. [15A NCAC 02H.0506(b)(3) and (c)(3)]
This approval and its conditions are final and binding unless contested [G.S. 143-215.5]. Please be aware that
impacting waters without first applying for and securing the issuance of a 401 Water Quality Certification violates
Title 15A of the North Carolina Administrative Code (NCAC) 2H .0500. Title 15A NCAC 2H .0500 requires
certifications pursuant to Section 401 of the Clean Water Act whenever construction or operation of facilities will
result in a discharge into navigable waters, including wetlands, as described in 33 Code of Federal Regulations
(CFR) Part 323. It also states any person desiring issuance of the State certification or coverage under a general
certification required by Section 401 of the Federal Water Pollution Control Act shall file with the Director of the
North Carolina Division of Water Quality. Pursuant to G.S. 143-215.6A, these violations and any future violations
are subject to a civil penalty assessment of up to a maximum of $25,000.00 per day for each violation.
This Certification can be contested as provided in Chapter 150E of the North Carolina General Statutes by filing a
Petition for a Contested Case Hearing (Petition) with the North Carolina Office of Administrative Hearings (OAH)
within sixty (60) calendar days. Requirements for filing a Petition are set forth in Chapter 150B of the North
Carolina General Statutes and Title 26 of the North Carolina Administrative Code. Additional information regarding
requirements for filing a Petition and Petition forms may be accessed a1httl1'J3hNWVVc 1tr-1R or by calling the
OAH Cleric's Office at [phone].
DE -)
Q e
✓ North Carolina l]eparcrnent of Envfronmenta! Quailty I Ofvision of Water Resources
512 North Salisbury Street 11617 Mail Service Center ] Raleigh. North Carolina 27699-1617
!� `� 919.707.9000

DocuSign Envelope ID: 734C96CE-8F76-482F--64A6-D6840r=4C30BB
party filing a Petition must serve a copy of the Petition on:
William F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, NC 27699-1601
lithe party filing the Petition is not the permittee, then the party must also serve the recipient of the Certification in
accordance with N.C.G.S 154B-23(a).
This the 28" March 2023
MVISION Or WATER RESOURCES
EDocSlotied uY;
G0UW12DC047'A
Richard E. Rogers Jr., Director
WQC No. 005776
DE -)
Q e
✓ North Carolina DeparcrnenF of Envfronmenta! Quailty I Ofvision of Water Resources
512 North Salisbury Street 11617 Mail Service Center 1 Raleigh. North Carolins 27699-1617
!� `� 919.707.9000

DocuSign Envelope 117: 734C96CE-8F76-482E-B4A6-O684oE4C30BG
ROY COOPER
Governor,
ELIZABETH S. BISER
sec wtal Y
RICHARD E. ROGERS, JR.
lJlrecror
NCDWR Project No.:
Applicant:
Project Name:
e,
r d
NORTH CAR01-INA
Environmental Quality
Date of Issuance of 401 Water Quality Certification:
County:
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 Cerd'frcation
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 Suffer 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
Pennittee 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
mailto:
Registration No.
Completed hard copies can be ernailed or mailed to:
NCDEQ Transportation Permitting
1617 Mail Service Center
Raleigh NC 27699-1617
North Carolina Department of Environmental Quality 1 Division of water Resources
...,.ia.., 512 North Salist}ury Street 1 1,617 Mail Service Center Raleigh, North Carolina 27699.1617
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-2018-02113
Project Name: NCDOT R-2577 ABC, US 158 Widening County: Forsyth and Guilford
Mitigation for R-2577A Section
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
1,024
I ,
*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
1,962
Mitigation Site Debited: RS Yadkin UMB-Brushy Mountain Mitigation Site.
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 Na
Name of Sponsor's Authorized Representative:
Signature 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:
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 RIBITS, and 4) the Wilmington District
Mitigation Office, 3331 Heritage Trade Drive, Suite 105, Wake Forest, NC 27587 (or by email to SAWMITOusace.armv.mill.
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 Drive, Suite 615
Charlotte, NC 28262
Email: [e-mail]
Digitally signed by
BRU MAGIN.STEPH EN.A.128
3520737
U
Date: 2023.11.15 07:57:15
-05,00, November 15. 2023
Wilmington District 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.army.mil.
Page 2 of 2

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: North Carolina Department of Transportation, Division 9 Action ID: SAW-2018-02113
Project Name: NCDOT R-2577 ABC, US 158 Widening County: Forsyth and Guilford
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that 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: 03010103, Roanoke River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
47.5
0.06
*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: 03010103, Roanoke River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
95
0.12
Mitigation Site Debited: NC DMS
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCDMS, list NCDMS. If the NCDMS
acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsibility for
providing the mitigation identified in this document (see the table above), associated with the USACE Permittee and Action
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:
Name of Sponsor's Authorized Representative:
Signature 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: NCDMS approved providing mitigation for 47.5 linear feet of stream impact and 0.06
acre of wetland impact in a letter dated January 23, 2023.
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 RIBITS, and 4) the Wilmington District
Mitigation Office, 3331 Heritage Trade Drive, Suite 105, Wake Forest, NC 27587 (or by email to SA WMITPusace.army. mil).
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 Drive, Suite 61S
Charlotte, NC 28262
Email: [e-mail]
Digitally signed by
p BRUMAGIN.STEPHEN.A.1283
520737
U Date: 2023.11.15 08:00:32
-05'00'
Wilmington District Project Manager Signature
November 15, 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 htt13://ribits.usace.army.mil.
Page 2 of 2

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: North Carolina Department of Transportation, Division 9 Action ID: SAW-2018-02113
Project Name: NCDOT R-2577 ABC, US 158 Widening County: Forsyth and Guilford
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Division of Mitigation Services (NCDMS), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to ensure
that 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: 03010103, Roanoke River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
130.5
*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: 03010103, Roanoke River Basin
Stream Mitigation (credits)
Wetland Mitigation (credits)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine
Non -Riparian
Coastal
261
Mitigation Site Debited: NCDOT Little Peters Creek Mitigation Site.
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:
Name of Sponsor's Authorized Representative:
Signature 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:
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 RIBITS, and 4) the Wilmington District
Mitigation Office, 3331 Heritage Trade Drive, Suite 105, Wake Forest, NC 27587 (or by email to SAWMITOusace.armv.mill.
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 Drive, Suite 615
Charlotte, NC 28262
Email: [e-mail]
Digitally signed by
[� BRUMAGIN.STEPHEN.A.12835
Date: Date: 2023.11.15 08:03:03
-05,00, November 15. 2023
Wilmington District 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.army.mil.
Page 2 of 2