20160356 Ver 2_Mitigation Information_20180501

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatorv Miti�ation Responsibilit� Transfer Form
Permittee: NCDOT, Di�ision 14 (Attn: Dave McHenry)
Project Name: BR 76 on SR 1326,178P.14.R,8i3
����f 1�l�
Actlan ID: SAW-Z016-OOS4Z
County: Clay
instructions to Permlttee: The Permittee must provide a copy of this form to the Mitigation Sponsor, elther an approved
Mitigation eanl< or the North Carolina Division of Mitigation Services (MCDMS), who wlll then sign the form to verify the
transfer of the mltigation responsibility. Once the Sponsor has signed thls form, lt is the Permittee's responsibility to ensure
that to the U,S, Army Corps of Engineers {USACE) Project Manager identifled on page two is In recelpt of a signed copy of this
form before conducting authorized impacts, unless otherwise specified below. If more than one mitigat(on Sponsor will be
used to provfde the mitlgatlon associated with the permit, or if the impacts and/or the mitigatlon will occur in more than one
8-digit Hydrologic Unit Code (HUC}, multiple forms will be attached to the permit, and the separate forrns for each Sponsor
and/or HUC must be provided to the appropriate mitigatlon Sponsors.
Instructions ta Sponsor: The Sponsor must verify that the mitigation requirements (creditsj shown below are available at the
identified site, By signing below, the 5ponsor is accepting full responsibillry for the Identifled mitlgatlon, regardless of
whether or not they have received payment from the Permittee. Once the form is signed, the Sponsor must update the hank
ledger and provide a copy of the signed form and the updated bank ledger to the Permittee, the USACE Project Manager, and
the Wflmington DfsCrict Mitigatlon Offlce (see contact informatlon on page 2). The Sponsor must also comply with ail
reporting requ(rements establlshed In their authorizing instrument.
Permitted Impacts and Compensatory Mitigatton Requlrements:
Permitted Impacts Re ulring Mitigation* 8-digit HUC and Basin: 060Z0002, Hiwassee River Basin
Stream Im acts Ifnear feet Wetland Im acts acres
Warm Cool Cold RI arian Riverine Ri arian Non-Riverine Non-Riparian Coastal
40
'`If more than one mltigation sponsor wlll be used for the permit, only include impacts to be mltigated by this sponsor.
Stream
Warm
u Irements:
Caol Cold
80
MUC and Basin:
Riverine
6020002, Hiwassee River Basfn
id Mlti atlon credits)
Non-Rlverine Non-Riparfan Coastal
Mitigation Site Debited: NCDMS
(List the name of the bank to be debited. For umbrella banks, also Iist the speciflc site. For NCDMS, Iist NCDMS. If the NCDMS
acceptance letter identifies a speciflc site, also list the specific site to be deblted).
Sectlon to be compJeted by !Ne Mltigaflon Sponsor
Statement of Mitigation Lfability Acceptance: I, the undersigned, verlfy that I am autharfzed to approve mitigatlon
transactions for the Mitigation Sponsor shown below, and I certify that the Sponsor agrees to accept full responsiblllty for
providing the mitigatfon ident(ffed in th(s document (see the table abovej, assoclated with the USACE Permittee and Action
ID number shown. I also verify that released credits (and/or advance credits for NCDMSj, as approved by the USACE, are
currently avaflable at the mitigation site Identified above. Further, I understand that if the Sponsor fails to provide the
required compensatory mitigation, the USACE Wilmfngton District Engineer may pursue measures agalnst the Sponsor to
ensure compllance associated with the mitigation requirements,
M(tigation Sponsor Name:�Jl..�(�`_, „�)? l' ( �
fUame o onsor's Authorized Representative:����-J1'1 `��Tj ����
% � �- .�..��rY � . ' �. � 1
,. �
Signature of Spo sor's Authorized Representative Da e of Sig ature
Page 1 of 2 Form Updated 23 November, 2015

USACE Wilmington District
Compensatory Mitigation Responsibility Transfer Form, Page 2
Conditions for Transfer of Compensatory Mitigation Credit:
o Once thls document has been signed by the Mitigation 5ponsor and the USACE is in receipt of the signed form, the
Permittee is no longer responsfble for provfding the mitigaflon Identified in this form, though the Permittee remains
responsible for any other mitigation requirements stated in the permit conditions,
� Construction within jurfsdictional areas authorized by the permit identlfied on page one of this form can begin only after
the USACE is in recelpt of a copy of thls document signed by the Sponsor, confirming that the Sponsor has accepted
responsibility for provlding the mitigation requiremen#s listed hereln. For authorized impacts conducted by the North
Carolina Department of Transportatfon (NCDOTj, construction withln Jurlsdictional areas may proceed upon permit
issuance; however, a copy of this form signed by the Sponsor must be provided to the USACE wfthin 30 days of permit
issuance. NCDpT remains fully responslb�e for the mttigatfon untll the USACE has received this form, confirming that the
Sponsor has accepted responslbility for providing the mikigation requirements listed hereln.
e Signed coples of this document must be retained by the Permittee, Mitigatlon Sponsor, and In the USAC� adminlstrative
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 prov(ded with a signed copy of this form.
0 If changes are proposed to the type, amount, or location of m(tfgation 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 Distrlct guldance
and a new version of this form must be completed and included In the USACE administrative reoords for hoth the perm(t
and the Bank/ILF Instrument.
Comments/Additional Condittons:
No additlonal Comments or Condltlons.
This form is not valid unless signed below by the USACE ProJect Manager and by the Mitigation Sponsor on Page 1. Once
slgned, the Sponsorshauld provlde coples of thls form along wlth an updated bank ledger to;1) the Permlttee, Z) the USACE
Profect Manager at the address below, and 3J the Wllmingian Dlstrlct Mftlgaflon Offlce, Attn: Todd iugwe!!, 21AU5 Fa!!s
of Neuse Road, Wafce Forest, NC275a7 (ema11: todd.tugwell�usace.army.mllJ. Questlons regarding this form or any of the
permft conditlons may be directed to the USACE ProJect Manager below.
USAC@ ProJect Manager: Monte Matthews
USACE Field Office: Ralelgh Ffeld Offlce Name
US Army Corps of Engineers
3331 Herltage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Ematl; [e-mail]
�'�--� � �---- Mav 12. 2016
USACE ProJect Manager Signature Date of Signature
Current Wllmington District mitigation guidance, Including information on mitigation ratios, functlanal assessments, and
mitigat(on bank location and availabflity, and credit classiflcations (including stream temperature and wetland groupings) is
available at htt�Jlribits,usace.army.mil.
Page 2 of 2
The Wllmington Distrlct Is commltted to provlding the highest level of support to the public. To help us ensure we continue to do so, please camplete the
Customer SatisFaction Survey lowted at our webslte at htto://re¢ulatorv.usacesurvea.com/ to complete the survey online.