20170127 Ver 2_Mitigation Information_20170314

U.S.ARMYCORPSOFENGINEERS
WilmingtonDistrict
Page1of2FormUpdated23November,2015
CompensatoryMitigationResponsibilityTransferForm

Permittee:CityofGreensboroActionID:SAWͲ2013Ͳ01953
ProjectName:HorsePenCreekRoadwidening/CityofGreensboro/GuilfordCounty/transportationCounty:Guilford

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
0.19 
*Ifmorethanonemitigationsponsorwillbeusedforthepermit,onlyincludeimpactstobemitigatedbythissponsor.

CompensatoryMitigationRequirements:8Ͳdigit HUCandBasin:03030002,CapeFearRiverBasin
StreamMitigation(credits)Wetland Mitigation (credits)
WarmCoolColdRiparianRiverine Riparian NonͲRiverine NonͲRiparian Coastal
0.38

MitigationSiteDebited:CrippleCreekStream&WetlandMitigationBank
(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
Restoration Systems, LLC
John Preyer
3-14-2017
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] 



February3,2017
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: 2017.02.03 15:56:58 -05'00'