20170185 Ver 2_USACE Permit_20171213

U.S. ARMY CORPS OF ENGINEERS
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GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION

3HUPLWWHHNCDOT
Attn: Jerry Parker
$GGUHVVP.O. Box 14996
Greensboro, NC 27415

6L]HDFUHV 0.51HDUHVW7RZQReidsville
1HDUHVW:DWHUZD\ Little Troublesome Creek 5LYHU%DVLQCape Fear
86*6+8& 03030002 &RRUGLQDWHV36.342939 N, -79.677503 W
/RFDWLRQGHVFULSWLRQThe site is located along SR 2686 (Richardson Drive) over Little Troublesome Creek at NCDOT Bridge
283 in Rockingham County, North Carolina.
'HVFULSWLRQRISURMHFWVDUHDDQGDFWLYLW\This authorization is for the discharge of clean fill material associated with replacing
an existing bridge with two 12 x 7 foot reinforced concrete box culverts with 1-foot and 2-foot sills. The project includes
permanent impacts to 57 linear feet (0.02 acre) of stream channel for culvert installation and 70 linear feet (0.02 acre) of
stream channel for bank stabilization, and temporary impacts to 23 linear feet (0.01 acre) of stream channel for construction
access and dewatering.

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$XWKRUL]DWLRQ 5HJLRQDO*HQHUDO3HUPLW1XPEHURU1DWLRQZLGH3HUPLW1XPEHUNWP 14 Linear Transportation Projects.
SEE ATTACHED RGP or NWP GENERAL, REGIONAL AND SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted application and attached information dated and received via email 2/14/2017. Any violation of
the attached conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration
order, a Class I administrative penalty, and/or appropriate legal action.
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SOHDVHFRQWDFWDavid Bailey at 919-554-4884 ext. 30 or [e-mail]


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Digitally signed by BAILEY.DAVID.E.1379283736
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI,
ou=USA, cn=BAILEY.DAVID.E.1379283736
Date: 2017.02.28 13:17:48 -05'00'


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Special Conditions:

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WKLVIRUPDUHKHUHE\LQFRUSRUDWHGDVVSHFLDOFRQGLWLRQVRIWKLVSHUPLWDXWKRUL]DWLRQ

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([SLUDWLRQ'DWHRI9HULILFDWLRQ03/18/2017







Digitally signed by
BAILEY.DAVID.E.1379283736
DN: c=US, o=U.S. Government,
ou=DoD, ou=PKI, ou=USA,
cn=BAILEY.DAVID.E.1379283736
Date: 2017.02.28 13:18:06 -05'00'
U.S.ARMYCORPSOFENGINEERS
WilmingtonDistrict
Page1of2FormUpdated23November,2015
CompensatoryMitigationResponsibilityTransferForm

Permittee:NCDOTActionID:SAWͲ2017Ͳ00378
ProjectName:NCDOT/Bridge283/SR2686/RichardsonDrive/RockinghamCounty/Division7County:Rockingham

InstructionstoPermittee:ThePermitteemustprovideacopyofthisformtotheMitigationSponsor,eitheranapproved
MitigationBankortheNorthCarolinaDivisionofMitigationServices(NCDMS),whowillthensigntheformtoverifythe
transferofthemitigationresponsibility.OncetheSponsorhassignedthisform,itisthePermittee’sresponsibilitytoensure
thattotheU.S.ArmyCorpsofEngineers(USACE)ProjectManageridentifiedonpagetwoisinreceiptofasignedcopyofthis
formbeforeconductingauthorizedimpacts,unlessotherwisespecifiedbelow.IfmorethanonemitigationSponsorwillbe
usedtoprovidethemitigationassociatedwiththepermit,oriftheimpactsand/orthemitigationwilloccurinmorethanone
8ͲdigitHydrologicUnitCode(HUC),multipleformswillbeattachedtothepermit,andtheseparateformsforeachSponsor
and/orHUCmustbeprovidedtotheappropriatemitigationSponsors.

InstructionstoSponsor:TheSponsormustverifythatthemitigationrequirements(credits)shownbelowareavailableatthe
identifiedsite.Bysigningbelow,theSponsorisacceptingfullresponsibilityfortheidentifiedmitigation,regardlessof
whetherornottheyhavereceivedpaymentfromthePermittee.Oncetheformissigned,theSponsormustupdatethebank
ledgerandprovideacopyofthesignedformandtheupdatedbankledgertothePermittee,theUSACEProjectManager,and
theWilmingtonDistrictMitigationOffice(seecontactinformationonpage2).TheSponsormustalsocomplywithall
reportingrequirementsestablishedintheirauthorizinginstrument.

PermittedImpactsandCompensatoryMitigationRequirements:
PermittedImpactsRequiringMitigation*8Ͳdigit HUCandBasin:03030002,CapeFearRiverBasin
StreamImpacts(linearfeet)WetlandImpacts(acres)
WarmCoolColdRiparianRiverine Riparian NonͲRiverineNonͲRiparian Coastal
57  
*Ifmorethanonemitigationsponsorwillbeusedforthepermit,onlyincludeimpactstobemitigatedbythissponsor.

CompensatoryMitigationRequirements:8Ͳdigit HUCandBasin:03030002,CapeFearRiverBasin
StreamMitigation(credits)Wetland Mitigation (credits)
WarmCoolColdRiparianRiverine Riparian NonͲRiverine NonͲRiparian Coastal
114   

MitigationSiteDebited:NCDMS
(Listthenameofthebanktobedebited.Forumbrellabanks,alsolistthespecificsite.ForNCDMS,listNCDMS.IftheNCDMS
acceptanceletteridentifiesaspecificsite,alsolistthespecificsitetobedebited).

SectiontobecompletedbytheMitigationSponsor

StatementofMitigationLiabilityAcceptance:I,theundersigned,verifythatIamauthorizedtoapprovemitigation
transactionsfortheMitigationSponsorshownbelow,andIcertifythattheSponsoragreestoacceptfullresponsibilityfor
providingthemitigationidentifiedinthisdocument(seethetableabove),associatedwiththeUSACEPermitteeandAction
IDnumbershown.Ialsoverifythatreleasedcredits(and/oradvancecreditsforNCDMS),asapprovedbytheUSACE,are
currentlyavailableatthemitigationsiteidentifiedabove.Further,IunderstandthatiftheSponsorfailstoprovidethe
requiredcompensatorymitigation,theUSACEWilmingtonDistrictEngineermaypursuemeasuresagainsttheSponsorto
ensurecomplianceassociatedwiththemitigationrequirements.

MitigationSponsorName:

NameofSponsor’sAuthorizedRepresentative: 


SignatureofSponsor’sAuthorizedRepresentativeDateofSignature
USACEWilmingtonDistrict
CompensatoryMitigationResponsibilityTransferForm,Page2

Page2of2

TheWilmingtonDistrictiscommittedtoprovidingthehighestlevelofsupporttothepublic.Tohelpusensurewecontinuetodoso,pleasecompletethe
CustomerSatisfactionSurveylocatedatourwebsiteathttp://regulatory.usacesurvey.com/tocompletethesurveyonline.

ConditionsforTransferofCompensatoryMitigationCredit:
x OncethisdocumenthasbeensignedbytheMitigationSponsorandtheUSACEisinreceiptofthesignedform,the
Permitteeisnolongerresponsibleforprovidingthemitigationidentifiedinthisform,thoughthePermitteeremains
responsibleforanyothermitigationrequirementsstatedinthepermitconditions.
x Constructionwithinjurisdictionalareasauthorizedbythepermitidentifiedonpageoneofthisformcanbeginonlyafter
theUSACEisinreceiptofacopyofthisdocumentsignedbytheSponsor,confirmingthattheSponsorhasaccepted
responsibilityforprovidingthemitigationrequirementslistedherein.ForauthorizedimpactsconductedbytheNorth
CarolinaDepartmentofTransportation(NCDOT),constructionwithinjurisdictionalareasmayproceeduponpermit
issuance;however,acopyofthisformsignedbytheSponsormustbeprovidedtotheUSACEwithin30daysofpermit
issuance.NCDOTremainsfullyresponsibleforthemitigationuntiltheUSACEhasreceivedthisform,confirmingthatthe
Sponsorhasacceptedresponsibilityforprovidingthemitigationrequirementslistedherein.
x SignedcopiesofthisdocumentmustberetainedbythePermittee,MitigationSponsor,andintheUSACEadministrative
recordsforboththepermitandtheBank/ILFInstrument.ItisthePermittee’sresponsibilitytoensurethattheUSACE
ProjectManager(addressbelow)isprovidedwithasignedcopyofthisform.
x Ifchangesareproposedtothetype,amount,orlocationofmitigationafterthisformhasbeensignedandreturnedto
theUSACE,theSponsormustobtaincaseͲbyͲcaseapprovalfromtheUSACEProjectManagerand/orNorthCarolina
InteragencyReviewTeam(NCIRT).Ifapproved,highermitigationratiosmaybeapplied,aspercurrentDistrictguidance
andanewversionofthisformmustbecompletedandincludedintheUSACEadministrativerecordsforboththepermit
andtheBank/ILFInstrument.

Comments/AdditionalConditions:






ThisformisnotvalidunlesssignedbelowbytheUSACEProjectManagerandbytheMitigationSponsoronPage1.Once
signed,theSponsorshouldprovidecopiesofthisformalongwithanupdatedbankledgerto:1)thePermittee,2)theUSACE
ProjectManagerattheaddressbelow,and3)theWilmingtonDistrictMitigationOffice,Attn:ToddTugwell,11405Falls
ofNeuseRoad,WakeForest,NC27587(email:[e-mail]).Questionsregardingthisformoranyofthe
permitconditionsmaybedirectedtotheUSACEProjectManagerbelow.

USACEProjectManager:DavidBailey
USACEFieldOffice:RaleighRegulatoryFieldOffice
USArmyCorpsofEngineers
3331HeritageTradeDrive,Suite105
WakeForest,NorthCarolina27587
Email:[e-mail] 



February28,2017
USACEProjectManagerSignatureDateofSignature

CurrentWilmingtonDistrictmitigationguidance,includinginformationonmitigationratios,functionalassessments,and
mitigationbanklocationandavailability,andcreditclassifications(includingstreamtemperatureandwetlandgroupings)is
availableathttp://ribits.usace.army.mil.
Digitally signed by BAILEY.DAVID.E.1379283736
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI,
ou=USA, cn=BAILEY.DAVID.E.1379283736
Date: 2017.02.28 13:18:29 -05'00'


Action ID Number:SAW-2017-00378 County: Rockingham

Permittee: NCDOT (attn: Jerry Parker)
Project Name: NCDOT / Bridge 283 / SR 2686 / Richardson Drive / Rockingham County / Division 7
Date Verification Issued: 2/28/2017
Project Manager: David Bailey
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
attn: David Bailey
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
_______________________________________ ______________________
Signature of Permittee Date