20141294 Ver 2_2015-04-21_Mit_Resp_Transfer_Form_FINAL_20180822 (2)

Permittee:
Project Name:
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Comaensatorv Miti�ation Resqonsibilitv Transfer Form
Charlotte-Mecklenbur� Storm Water Service Action ID: SAW-2014-00280
Mr. Isaac Hinson County: Mecklenbure
Orr Road Eatension
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 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
appropriate ledger and provide a copy of the signed form to the Permittee and to the USACE Bank/In-Lieu Fee Program
Manager. The Sponsor must also comply with all reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements:
Permitted
Warm
Stream Impacts (linear feet
Cool
' 8-digit HUC and Basin: 03050103, Catawba River Basin
Wetland Impacts (acres)
Cold Riparian Riparian
Non-Riparian Coastal
Riverine Non-riverine
I I � 0.36 � � I
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Warm
ory Mitigation Requirements: 8-digit HUC and Basin: 03050103*, Catawba Expai
Stream Mitigation (credits) Wetland Mitigation (credits)
Cool Cold Riparian Riparian
Non-Riparian
Riverine Non-riverine
0.72
ed Service Area
Coa sta I
Mitigation Site Debited: NCEEP
(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 Wilmington District Engineer may pursue measures against the Sponsor to
ensure compliance associated with the�i atio requiremen s.
Mitigation Sponsor Name: ��1��( i�lY� � ,��r�(Z'Yl ���i/�n�Q C
Name of
Signature o�5�qsor's Authorized Representative
w� f y �
02 i ¢�Vt � o�U I �
�
Date of Signature
Page 1 of 2 Form Updated 18 September, 2012

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 �s 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 fulfy responsible `or the mitigation until the USACE has received this form, confirming
that the Sponsor has accepted responsibility for providing the mitigation requirements listed herein.
• 5ignecf copies of this ciocument must be retained by the Permittee, Mitigatior Sponsor, and in the USACE
admiristrative records for both the �ermit and the Bank/ILF Instrument. It is ±he 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 rr�itigation after this form has been signed and returned to
the USACE, the Sponsor must obtain case-by-case approval from the USACE Project Manager anc!/or North Carolina
Interagency Review Team (NCIRT). !f approved, higher mitigation ratios may be appliecl, as per current District
guidance and a new vers�on 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 by the mitigation Sponsor and USACE Project Manager. For questions regarding this
form or any of the conditions of the permit authorization, contact the Project Manager at the au'dress below.
USACE Project Manager: Crystal Amschler
USACE Field Office: Asheville Regulatory Fieid Office
US Army Corps of Engineers
151 Patton Avenue, Room 208
Ashevi!le, North Carolina 28801-5006
Email:
AMSCHLER.CRYSTAL.CAMILLE.1238614: oN�� ���s,o=U.S.Go esn"e�R,oRYDoD,ouMPKEou3USA,178
-7 en=AMSCH LER.CRYSTALCAMI LLE.1238614178
1 / � Date: 2015.02.20 11:5738 -OS'0p'
G�1C�C �tEt'� �4i ��1$�'9' � C��ir?.
USACE 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 (inciuding stream temperature and wetiand groupings) is
available at http://rib�ts.usace.armv.mil.
Page 2 of 2
The Wilming±on District �s c�mmitted to providing the highest leve! of support to the pubfic. To help us ensure we continue to c#o so, pfease complete the
�ustomer Satisfactio� Survey located at our website aY ntt�://re��latory.usacesurvev.com; to complete the survey online.