20161016 Ver 1_copy PJD and MRT Form_20161209

TIR '17BP.6.R.63 (Bridge 230175) Columbus Goullty
PRELIMINARY:IURISDtGTIONAL DETERMINATION FORM
BACKGROUNUINFORMATIa.N
A. REPORT GOMPLETION
DETERMtNATtON (JD):
dATE FOR PRELIMINARY
�u��i(�
JURISDfCTIONAL
B. NqME RND ADDRESS OF PEFtSON REQUE$TING PRELIIVIIIVARY JD:
James J. Rerko, PWS NGDdT Box 1105 Fayetteville, NC 28302
C. DISTRIGT OFFICE, FILE NAME, ANp NUMBERs <`�(v- �c=}f �`" �`�3� �
D, PROJEC�T LOCATION(S) AND BACKGROUND INFORMATIONc0,88
m�les NW of tNe intersection df SR '1504 and US 76
(USE THE ATTACHED TABLE TO DOGUMENT MULTIPLE WIATERBODIF}S
�1T DIFFER�N7 SITES) ,
'State;NC County/parish/borough�olumbus Gity; Cerro GQrdo.
Genter coordinates of sfte (lat/iong in degree decirrial forniat): Lat. 34:3405°
Pick List, Long. -78.8718° Pick List.
Universal Transverse Mercator:
Name of nearest waterbody: Dunn Swamp
Identify (estimate) amount of waters in the review area:
Non-wetland watecs: 50 linear feet: ft.width (ft) and/or
Cowardin Class: Riverine
Streain Flow: Perennial �
Wetiancfs: 0.03 acres.
Gowardin Class forested
Name ofany water bodies on the.site that have been identif,ied as $ecfion 1Q
waters: '
Tidal:
Non-Tidal:
E. R�VIEW PERFORMED FOR SI7E EVALUAT[ON (CHECK ALL THAT
APRLY):
❑' Office,(Desk) Determitiafiqn. Date:
�-Field Determination. Date(s); ��,�1 �� � 3��%I �>
1. The Gorps of Engineers believes that there may be jurisdietion�l waiers of #he
United States on the subject site, and the permit appiiCant or other affected party
who requesfed this preliminary Jp is hereby advised of his or h@r option to

reque5t and obtain an approVed jurisdictional determinatiop (JQ) for that site.
Nevertheles.s, the permit.applicant ar ofher person who requested this
prelimiriary JD fias declined to exercise the .aption to obtain an approved JD in
this instance anc� at fhis time.
2. In any circumstance where a pe�mit appllcant obtains an individual perm'it, or
a Nationwide General Fermit (NWP) or offier general permit verification reguiring
"pre-construction notification" (PCN), or requests verlfica�ion fot a non-reporting
NVUP or other general permit, and �h� permif applicarik has not requested an
approved JD for fhe antivify, the permit applicant is hereby made aware of the
folloVvirig: (1j tHe permit applicant has elected to seek a permif authorizaf,ion
ba.sed on a preliminary JD, which does not make an o�bial determinatioYi of
jurisdietional waters; (2) that the applicanY has the option to request an ;approved
JD before accepting the teYms and conditions oF the permit authori?ation, and
that tiasing a perinit auth9riza#ion on an approved JD could ppssibly result jn less
compensafory mitigation being repuired or different special conditions; (3j that
the applican# has fhe right to request an individual permit rather fhan accepfing
the ferms and conditions of the. NWP or q#h�r gene[al p.ermit authorization; (4)
khat the apqlicant can accept a permit authorization and #herek�y agree to camply
with all the terms a�d .conditions of that peitriit, including Whatever miti.gation
requirerrtents the Corps has determfned to be necessary, (5) that undertaking
any activity in relianae upon the subject permit authotization wifhoutreguesting
an approved JR cons#itutes the applicant's aaceptance qf the use of tlie
preliminary JD, but that either form of JD will be proeessed as soon as is
practicable; (6) accepting a permit authorization �e,g., signing a proffered
individual permit) or undertaking any activity in raliance on any form of Gorps
permit authorization b�sed on a preliminary JD constitutes agreement that all
wetlands and other water tiodies on the site affec#ed in any way by that activity
are jurisdictional waters of the United States, and preciudes any challenge to
such jurisdic#ion in any administrative orjudicial compliance or eriforcement
a�tion, or in any administrative appeal oP in any Federal court; and (7) whether
the applicant elects #o use either an appr'oved JD or a prelirpjnary JD, #hat JD
wi1! b� processgd a� s9on as is p�acticabl.�. Further, an apProved JD, a profFered
individual permit (and all terms and aonditions cantained. therein), or individual
permit deniai can be administratively appealecl pursuant to 33 C:F.R. Part 331,
and t�tat �n any administPative appeal, jurisdiational issues can be raised (see 33
C.F.R. 331.5(a)(2)). 1f, dueing that admin,istrafive appeal, it becomes necessary
to maRe an official determination whether CWA jurisdic#ion exists over a site, o�
to provide an official delineation ofjurisdietionaf waters on tfie sife, the Co.rqswill
provide an approved JD to accoroplish ttiat result, as soon as is practicable..
This preliminary JD findsfhat there "may be"waters qf the Unfted S#ates on ihe
subject. project site, and identifies ail aquatic features on the site that could be
affected by the pr9posed actiuity; based on the following info[mationi
$UPPORTING DATA. Da#a reviewed for prelim,ina,ry JD (check all tha# apply
- chee►ced items sFiould be included in case file and, WHere clieeked and
requested, appropriately reference sou.rces below):
2

� Maps, plans, plots or plai submitted by or on behalf of the
applicant/consultant: .
� Data sheets prepared/submitted by or on behalf of #he
applicant/con sultant.
❑ Office concurs wifh data sneets/delineation report.
❑ Office does not concur with data sheets/delineation teport:
❑ Data sheets p�epared by the CorpS: .
❑ Corps navigable waters' study:
� U.S. Geological Survey Hydrologie Atlas: .
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
� U.S. Geological Survey map(sj. Cite scale & quad name: Chadbourn; NC.
❑ USDA Natural Resources Conservation Service Soil Survey. Citation:
❑ National wetlands inventory map(S). Cite name: ,
❑ State/Local wetland inventory map(s); .
❑ FEMA/FIRM maps: .
--
❑ 100-year Floodplain Elevation is: {National Geodectic Vertical Datum
of 1929)
❑ Photographs: � Aerial (IVame & Date); .
or � pther (Name & Date):
❑ PreVious determination(s). File no. and date of response fetter:
❑ Other information (please specify): .
� � � t } .�i ll ��s l�/�//�
nd date of 8`i�qnature ah date 6f
Rroject Manager derson �questing preliminary JD
�) �REQU ED, unless obtainirig
t e signature is impracticable)
7

`
17BP.6:R;63 Brid'e230775 Golumbus County.
Estimated
Site Gowardin amount of Class of
Latitude Longitude aguatic aquatic
number Class resource in resource
review area
1 34.3405 -78.8718 Riverine Q.03 aere Non-sectian 10
-wetland
1 34:3405 -78i8718' Riverine 50LF Non-section 10
non—wetland
�

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatorv Miti�ation Responsibilitv Transfer Form
Permittee: NC DOT, Mr. Jim Rerko, Division 6, DEO Action ID: SAW-2016-02399
Project Name: Bridge 175/Princess Ann Road/ SR 1504 County: Columbus
Instructions to Permittee: The Permittee must provide a copy of this form to the Mitigation Sponsor, either an approved
Mitigation Bank or the North Carolina Ecosystem Enhancement Program (NCEEP), who will then sign the form to verify the
transfer of the mitigation responsibility. Once the Sponsor has signed this form, it is the Permittee's responsibility to
ensure that to the U.S. Army Corps of Engineers (USACE) Project Manager identified on page two is in receipt of a signed
copy of this form before conducting authorized impacts, unless otherwise specified below. If more than one mitigation
Sponsor will be used to provide the mitigation associated with the permit, or if the impacts and/or the mitigation will occur
in more than one 8-digit Hydrologic Unit Code (HUC), multiple forms will be attached to the permit, and the separate forms
for each Sponsor and/or HUC must be provided to the appropriate mitigation Sponsors.
Instructions to Sponsor: The Sponsor must verify that the mitigation requirements (credits) shown below are available at
the identified site. By signing below, the Sponsor is accepting full responsibility for the identified mitigation, regardless of
whether or not they have received payment from the Permittee. Once the form is signed, the Sponsor must update the
bank ledger and provide a copy of the signed form and the updated bank ledger to the Permittee, the USACE Project
Manager, and the Wilmington District Mitigation Office (see contact information on page 2). The Sponsor must also comply
with all reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted Impacts Requiring Mitigation* 8-digit HUC
Stream Impacts (linearfeet)
Warm Cool Cold
3n Riverine
0.04
Basin: 03030004, Cape Fear River Basin
Wetland Impacts (acres)
Rioarian Non-Riverine Non-Riparian Coastal
*if more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Warm � Cool � Cold
HUC and
Wetland Mitigation
3n Riverine Riparian Non-Riverine
0.08
Basin
Coastal
Mitigation Site Debited: NC DMS
(List the name of the bank to be debited. For umbrella banks, also list the specific site. For NCEEP, list NCEEP. if the NCEEP
acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
Statement of Mitigation Liability Acceptance: I, the undersigned, verify that I am authorized to approve mitigation
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsibility for
providing the mitigation identified in this document (see the table above), associated with the USACE Permittee and Action
ID number shown. I also verify that released credits (and/or advance credits for NCEEP), as approved by the USACE, are
currently available at the mitigation site identified above. Further, I understand that if the Sponsor fails to provide the
required compensatory mitigation, the USACE Wiimington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the mitigation requirements.
Mitigation Sponsor
Name of Sponsor's Authorized
of Sponsor's Authorized
Date of Signature
Page 1 of 2 Form Updated 12 September, 2014

USACE Wilmington District
Compensatory Mitigation Responsibility Transfer Form, Page 2
Conditions for Transfer of Compensatory Mitigation Credit:
• Once this document has been signed by the Mitigation Sponsor and the USACE is in receipt of the signed form, the
Permittee is no longer responsible for providing the mitigation identified in this form, though the Permittee remains
responsible for any other mitigation requirements stated in the permit conditions.
• Construction within jurisdictional areas authorized by the permit identified on page one of this form can begin only
after the USACE is in receipt of a copy of this document signed by the Sponsor, confirming that the Sponsor has
accepted responsibility for providing the mitigation requirements listed herein. For authorized impacts conducted by
the North Carolina Department of Transportation (NCDOT), construction within jurisdictional areas may proceed upon
permit issuance; however, a copy of this form signed by the Sponsor must be provided to the USACE within 30 days of
permit issuance. NCDOT remains fully responsible for the mitigation until the USACE has received this form, confirming
that the Sponsor has accepted responsibility for providing the. mitigation requirements listed herein. .
• Signed copies of this document must be retained by the Permittee, Mitigation Sponsor, and in the USACE
administrative records for both the permit and the Bank/ILF Instrument. It is the Permittee's responsibility to ensure
that the USACE Project Manager (address below) is provided with a signed copy of this form.
• If changes are proposed to the type, amount, or location of mitigation after this form has been signed and returned to
the USACE, the Sponsor must obtain case-by-case approval from the USACE Project Manager and/or North Carolina
Interagency Review Team (NCIRT). If approved, higher mitigation ratios may be applied, as per current District
guidance and a new version of this form must be completed and included in the USACE administrative records for both
the permit and the Bank/ILF Instrument.
Comments/Additional Conditions:
This form is not valid unless signed below by the USACE Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, tNe Sponsor should provide copies of this form along with an updated bank ledger to: I) the Permittee, 2) the
USACE Pro%ect Manager at tNe address below, and 3J the Wilminqton District Mitigation Office, Attn: Todd Tugwell,
11405 Falls of Neuse Road, Wake Forest, NC27587 (email: [e-mail]). Questions regarding this form
or any of the permit conditions may be directed to the USACE Project Manager below.
USACE Project Manager. Liz Hair
USACE Field Office: Wilmington Regulatory Field Office
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, NC 28403
Email: sarah.e.ha�ir ausace.arm �.mil
igit� a�sign�by
� I HAI R,SARAH.EA.105469
`7���fk�w 3512
Datet2016.7 2.09 December 9. 2016
U Sighy;t�Ci'Q1 -OS'00' 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 htto://ribits.usace.armv.mil.
Page 2 of 2
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