SW6230806_Recorded Document_20240516 (3)

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee:Tri-South Builders Inc. Action ID:SAW-2018-01374
Project Name: Brookwood residential subdivision County: Moore
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:03030004, Cape Fear River Basin
Stream Impacts(linear feet) Wetland Impacts(acres)
Warm Cool Cold Riparian Riverine Riparian Non-Riverine Non-Riparian Coastal
0.373
*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:03030004, Cape Fear River Basin
Stream Mitigation (credits) Wetland Mitigation (credits)
Warm Cool Cold Riparian Riverine Riparian Non-Riverine Non-Riparian Coastal
0.746
Mitigation Site Debited: NCDMS
(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: NCDMS
Name of Sponsor's Authorized Representative: Kelly Williams
23 October 2020
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 [e-mail]).
Questions regarding this form or any of the permit conditions may be directed to the District Mitigation Office.
USACE Project Manager: James Lastinger
USACE Field Office: Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive,Suite 105
Wake Forest, NC 27587
Email:[e-mail]
October 8, 2020
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