20141049 Ver 1_Mitigation Information_20140930

Print Form
Statement of Compliance with Session Law 2009-337 An Act to Promote
the Use of Compensatory Mitigation Banks and SL 2011-343.
{link to SL 2009-337) pink to SL 2011-343)
Prior to accessing the Ecosystem Enhancement Program (EEP) In-Lieu Fee Mitigation
Program, all applicants requestinq wetlands stream and/or riparian buffer mitiqation are now
required by law to comply with Session Law 2009-337 An Act to Promote the Use of
Compensatory Mitigation Banks and Session Law 2011-343. All requests submitted on or
after June 27, 2011 MUST include this form signed and dated by the permit applicant or an
authorized agent. Please refer to DENR's Implementation Policy for more detailed guidance.
Compliance Statement:
I have read and understand SL-2009-337 and SL-2011-343 and have, to the best of my
knowledge, complied with their requirements. I understand that participation in the
NCEEP is voluntary and subject to approval by permitting agencies.
Please check all that apply:
� Applicant is a Federal or State Government Entity or a unit of local government
" meeting the requirements set forth in G.S. 143-214.11 (as amended by SL 2011-
343) and is not required to purchase credits from a mitigation bank.
� There are no listed mitigation banks with the credit type I need located in the
hydrologic unit where this impact will take place liink co owR i�st)
❑ Mitigation bank(s) in the hydrologic unit where the impacts will occur have been
contacted and credits are not currently available.
p The DWR or the Corps of Engineers did not approve of the use of a mitigation
bank for the required compensatory mitigation for this project.
p This is a renewal request and the permit application is under review. Bank
credits were not available at the time the application was submitted.
Enter date permit application was submitted for review:
Note: It is the applicanYs responsibility to document any inquiries made to private mitigation
banks regarding credit availability.
.�
inifial here
I have read and understand EEP's refund policies (attached)
Philip '�"�` °
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Signature of Applicant or Agent
September 30, 2014
Date
Bridge 84 Over Muddy Creek Along SR 1603
Philip Beach
Printed Name
Randolph County, NC
Project Name Location

�NORTH CAROLINA ECOSYSTEM ENHANCEMENT PROGRAM, NCEEP
IN-LIEU FEE REQUEST FORM Revised �une �s, Zo�4.
Complete requested information, siqn and date; email to kell�williams .ncdenr.qov . Attachments are acceptable for clarification
❑urooses (location mao. address or lat long is required). Information submitted is subject to NC Public Records Law and may b'e
requested�by third parties: Review meetings.are held on Tuesday afternoons. ___.._........___.__......._..___._... .... _._._..__._...........____......
_......__ ... .. ..........._
; CONTACT INFORMATfON i. APPLICANT'S AGENT � APPLICANT _'
....................................---................._._.._... _....... _.. . _.._._...... �
� 1. Business/Company Name � SEPI Engineermg Ina � NCDOT Division 8
_.... ._._............ l _....:._ ......_....: _..__....... _ ___ __ ----.. .:...--- -._. .__. _.._i
. _,.. _. . __.._. ..._._...: ....
� ..........:..._.........._..._......---..._..._...._.:....... . .__. _._... ,
� 2. Contact_Person.._._ ............._......._._.......................___. ._.__._......_..........._.....__.._Philip..._Beach...........__.........._..........__ ' Art King '
,.. .._.....:
. _� .............._._..............._ ---..._.. _._........... ...__ �
� 3 Street Address or P O Box � 1025 Wade Ave 902 N. Sandhills Blvd PO Box 1067 ;
I' _ !. . ___......_... __.... _ __ _..:... . _._ E .._.__ ... .........._._ __ . _......_ .._._... . _._....._ �
;-....__...._.._......._:..__......_._ _........__ ...:.......:...._................. ............_....... ._._..._.
� 4. Cif , State, Zi Raleigh, NC � Aberdeen NC ;
!__.._ ........:....._...._._y_.__............._....�.....__._p.__.._.......:._.........---- --..._.............:...:.........._;.............................._............_..................----._....._.................................._._..._................_.__:..___�...:._......_._.::._._..:....._::.._........._..._....:................_......'....:.......:..._....._................._.......__...._.i
! 5. Telephone Number ( 919 573 9936 ; 910-944-2344 ;
�._._..._......_.._..__._.........__._ .....:.....:...:..:.......:..----.........__.._..._..........::.........__._..__............._..------......._...__:......._................_..........__.............._...,.........._............._............_....---�._.....:....__.._..._.........:..._...----.............................._........_.....__...................__..__.:......:.._......._..;
�
� 6. E-Mail Address � [e-mail] ; [e-mail] i
� _......._ .............._._.._....._..:....._..!...._.........._..............._.......:.:_........._...__..........:.........................__.._...._._........__...-----............_:..._..__............._.........._._..........._.....__........................._....__...:.._........._..:._........:.._._.._............._..
...............................................-�----................................
..............._....._...._.........._._.._.__......_..._............_.........._........:....................................._.__..._............._.._.....__.,_.............._._.__..__..............._........................_.__......_........._.__......__......................_..__...................---..... . .
� PROJECT INFORMATION ;
(............_..._.__ ...._.._.._..------ ................---......................__ __..__................_....._....._........................_._...::.._J._..................:.........._..---.._:.....................__....._.......................---............._.._....................._._.__.....__ . ......_._.__._...._................._..............._..._._.._............_
7. Project Name ' Bridge 84 Over Muddy Creek Along SR 1603
�__....._ ...............----.........:..__..._:......_...........:_._...:........__.:.._._..__...................:..:._:....---..._...:..:........_.._.:_....----._._._...:........_.._..__._...__............._.._._......................_...__._......__................_.._.........._........_...._.........._......................._........_...................-------........ ,
� 8. Project Location (nearest town, cify) � Archdale � �
;
;.:._...........:---..........._--...__.:_.___._.........__._ .....:.......:............................................:.......:....-.__.__..__...........................:.,._..._i....._........:.....:................__..__.................:...............:.........._...:.__.._:._._......,....._......_..........:...:::...:...._...__._........_...................._._....._.....__....._.._.....:...........__......_.i
. i
� 9. Lat-Long Coordinates or attach a map Latitude: 35.899549° Longitude: 79.970819° ;
�
�...�:..._._._:._...__ ..............._........._...__....._._..............................__.._.__.............:.................._............................................._......:._..._..---..:..._.............................._...--- ----...._._.......................----._............_..._......_..__......_......-- ------............,....._..__._...................._'
; 10. County � Randolph ' �
� � j
; I � �
I._._ ......................_._........_...__................_.._____._..__..__..............._.....__.._.._...__.._.........._ -......_......_.....'__...._ -_..._.._..._......._..................................._...---._..._..................._.__..........................._.................._..__......_........................_.__..._...............__.._........__..__..._.i
; 11: River Basin & Cataloging Unit (8-digit) � Cape Fear 03030003
; (See Note 1) '
........................._.._......_........_.._._.._..............._.....-----........................_....._..__........._..............................._...._._._:.::....................._,_._.._._...................._._...:......:.._._....._.._.......:.........:..__......................_�:...................................:.._...._.._............_........_....---.....__..._................--- ----!
� 12. Project Type **indicate owner Cype and
; ., ._ —. i Owner Type: 0 Government � Private
� wnte in pro�ect type (e.g. school, church, retail, - '
i residential, apartments, road, utilities, military, Project Type: Culvert �
; etc.)** .............__...._................ - ---.._.. ..._...:.._._............,..........---...._..._� ..._...:.:.:._:_..:.._ _;:__...."..._._............... ..._ __._..__..._.. .__ '
I 13. Riparian Wetland lmpact (ac.) (e.g., 0.13) ; p �
i '
'- ..... .....:........ ... ... . � . - -_ ...................._..........._.._..............................._...:_.i_._................._........__......_......_.._.__...'""'...:._....:.............._.._..""_._..........._..__._..:....:._....._.........................._.._....__:..._.............:.....__..__........:....__i
. _
�_...........__._ ................ ... __. . . .. _. ._. _. ._. _.."_.._ ._ .._..
; 14: Non-Riparian Wetland Impact (ac.) p ;
� �
:.....:......__._.......'_'..._:_..__'..............__......._.__._....."___.............:....:....:................__....:........_......._..__..._............i...........:..............._.._......."'....................:.........:......._.....�__.._..:...._........_.:._..:..:..............._..................._._._.._..._........................_._.._._..............:._.........:..__...i
; 15. Coastal Marsh Impact (ac.) � p i
;
; , ; �
---..__.._......::._ ........:......---...---......._....._.._......_:.....-------._...._..................._..__._......................................._._.....__._...._.._.........._.._.._:......................:.._..............---...,.._....................____..._..............._........._......_._._._.._;__........._....-----..._..----.............._...._.......__,
r i
Warm ' Cool � Cold '
; 16. Stream Impact (ft.) (e.g. 1,234) � :............................_.._..................�......................:.......................................---..::.:._.._......_..........:....-----..._._.i..............:........_.....__....._..............................---.....
i i 83 !
I � ! , i
, .......:.........__. _. ' .
!. >:...---.. . ..... ... __._....,.:. _.._.. .. _:... ... . . ..
.......................:.._._........_.............�..................._....._...__..__......................:.............:..._....:................_.................:...._.::. . .. ._.....:......:...............:.........:......::...............:..:..._:._.__................:...........::........_!
.. � , i. ....... �
i 17. Riparian Buffer Impact (sq. ft.) ,.
; Include subwatershed if Jordan or Falls Lake; i Zone 1: � Zone 2:
; 03030003010 ' 2,479 1,341
�........_.........._...-----�--...__._.. ...... ............................_................._............_.._......_..._......._....._...._.._.......__ ........_......................__.._._.........._...._......_..............._..._.....__.._..............._......_........._....................------._....._._............._..............----........_....----......
_..:. I....: ; i
; 18. Regulatory Agency Staff Contacts � '
� � NCDWR:
! USACE: �s. Sarah Hair (Liz) ; Other: Mr. David Wainwright � �
;
. .................---..._ ....................... ....._.....:......... .. ---........__...._.....,_..: .. .�
_ _ _... _
Check (�1) below if #his request is for a: By signmg below, the applicant is confi�ming they have ;
0 revision to a current acceptance ; read and" understand EEP's refurid policy posted at
� nceep:net and attached to this form
;
� Signature of Applicant or Authorized Agent:
❑ renewal of an expired ac'ceptance I � oe�m�Nsio 46yPhlip I
i � ON:en•Phllp,o�8EP1EnpIn elg.lne..ou=Baa�h, �
; � �erqall=pbaach�seplen9��eenng.cam,o-US �
. i ��I I pale:2014.09.3009:07:75-0d'00' j
�
0 extension of unexpired acceptance ! Date: September 30, 2014 �
;
� i - �
i_.__...__._._......_ ............. - --------- - - --- - - - - ........._�..._........_..........._........_....__...........__.............___._.._..-----._.:.........................._...._........................_........_....................__.............._.............._................._....._....._..._,
........ . . .. .............._:.........._... ..... ..... ....
Note 1: For help in detemiining the Cataloging Unit, visit:www.nceep.net or contact EEP
Direct questfons to Kelly Williams at yTy-/Ui-t3��5 or KeuV.wuuams(o�ncaenr.qov or to tr.rs rront aesK az y ia-rui-ay�o

Refund Policy for Fees Paid to EEP''s ln-Lieu Fee Proqrams (9/21L2009)
Purpose: The purpose ofthis policy is to make clear the circumstances and' process under which a
permittee can obtain a refund while simultaneously balancing customer service and responsible
business practices. This policy applies to all refund requests made on or after the publication date of
this policy.
1. All refund requests must be�made in writing to EEP's In-Lieu Fee Program Coardinator at
kellv.williamsCc�,ncdenr.qov. .
2. All refund requests are subject to fund availability. EEP does not guararitee fund availability for
any request.
3. The request must either come from the entity that made the payment or from an authorized agent.
Third parties requesting refunds must provide writteri authorization from the entity that made the
payment specifying fhe name and address of the authorized refund recipient. -
4. Refund requests related to unintended overpayments, typographical errors or incorrect invoices
should be brought the attention of the In-Lieu Fee Program Coordinator as soon as possible, Such
requests are typically approved without delay. �
5. Payments made under EEP's incremental payment procedure are not eligible for refunds.
6. Refund requests made within nine months of payment to EEP will only be considered for requests
associated with projects that have been terminated or modified where the permittee's mitigation
requirements have beem reduced. Such requests must be accompanied by written verification from the
permitting agency that the project has been cancelled, the permits have been rescinded or have been
mbdified, or the mitigation requirements have been, reduced.
7. Refund requests made more than nine months from the payment date will only be considered for
permits that were terminated or modified to not require any mitigation. Such requests must be
accompanied by written verif cation from the permitting agency that the project has been cancelled, the
permits have been rescinded and/or mitigation is no longer required.
8. Refund requests riot meeting the criteria specified above are not eligible for a refund.
9. Refund requests that meet the criteria above will be elevated to EEP Senior Management for
review. The following considerations apply to all refund requests:
a. availability of funds after consideration of all existing project and regulatory obligations
b. the date the payment was made
c. the likelihood EEP can use the mitigation procured using tlie payrrient to meet other
mitigation requirements
10. Once a refund has been approved, the refund recipient must provide a completed W-9 form to
EEP's In-Lieu fee Program Coordinator within two weeks in order to process the refund thougli the
State Controller's Office.
1 L All decisions shall be firial.
- S