20180660 Ver 2_PCN Form Submission_20190315

DWR
IDIOM n of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
tial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change only if needed.
BIMS # Assigned
20180660
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office*
Central Office - [phone]
Information for Initial Review
1a. Name of project:
Autumn Lakes Phases 2 & 3
1a. Who is the Primary Contact?*
David Hensley
1b. Primary Contact Email:*
[e-mail]
Date Submitted
3/15/2019
Nearest Body of Water
Beaverdam Creek
Basin
Neuse
Water Classification
C NSW
Site Coordinates
Latitude:
35.8399
FA. Processina Information
County (or Counties) where the project is located:
Wake
Is this project a public transportation project?*
r Yes r No
Longitude:
-78.3076
1a. Type(s) of approval sought from the Corps:
* Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
P Nationwide Permit (NWP)
F- Regional General Permit (RGP)
F Standard (IP)
Version# *
2
What amout is owed?*
r• $240.00
* $570.00
Select Project Reviewer*
Paul Wojoski:EADS\pawojoski
1c. Primary Contact Phone:*
[phone]

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
F Non -404 Jurisdictional General Permit
F Individual Permit
29 - Residential Developments
r 401 Water Quality Certification - Express
W Riparian Buffer Authorization
1e. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
6 -Autumn Lakes -DMS Receipt.pdf
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
FB, Applicant Information
1d. Who is applying for the permit?
R Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
LGI Homes NC LLC
2b. Deed book and page no.:
017036/00567
2c. Responsible party:
David Hensely
2d. Address
Street Address
3037 Sherman Dr.
Address line 2
Qty
Lancaster
Pbstal / Zip Cade
29720
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
r Yes r No
r Yes r No
248.61 KB
State / Rovinee / Fbgion
SC
Country
us
2f. Fax Number:

1b. Subdivision name:
(if appropriate)
Autumn Lakes
1c. Nearest municipality / town:
Zebulon
2. Project Identification
2a. Property Identification Number:
2b. Property size:
2706513257,2706615785,2706729236
157.25
2c. Project Address
Street Address
Old Bunn Rd
Address Line 2
Qty
State / Rwince / Pagion
Zebulon
NC
F std / Zip Code
Ceuntry
US
3. Surface Waters
3a. Name of the nearest body of water to proposed project:`
Beaverdam Creek
3b. Water Resources Classification of nearest receiving water:*
C NSW
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12 -digit HUC in which the project is located.
030202030101
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
See cover letter and revised 2018 PCN. Rather than reproduce all items the PDF form is updated to include current impacts and attached to this electronic submittal.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4c. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW -0000-00000).
AID SAW -2017-00356
DWR# 18-0660
Project History Upload
2 -Autumn Lakes_ PCN_ Revised_031519.pdf
364.55KB
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Autumn Lakes USGS map.pdf 985.97KB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
4f. List the total estimated acreage of all existing wetlands on the property:
3.16
4g. List the total estimated linear feet of all existing streams on the property:
3,245
4h. Explain the purpose of the proposed project:*
See cover letter and PDF of 2018 PCN vdth current revised impacts.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
See cover letter and PDF of 2018 PCN Wth current revised impacts.
4j. Please upload project drawings for the proposed project.
5 -Autumn Lakes -Phase 3 Plan Set.pdf 126.03MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No f Unknown
Comments:
See cover letter and PDF of 2018 PCN with current revised impacts.

5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
SAW -2017-00356
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made bythe Corps or DWR
See cover letter and PDF of 2018 PCN with current revised impacts.
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
2a1 Reason (?)
R Yes r, No
2c. Type of W.
7b. If yes, explain.
2e. Forested*2f.
See cover letter and PDF of 2018 PCN with current revised impacts.
2g. Impact
area*
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
See cover letter and PDF of 2018 PCN with current revised impacts.
P
D. Proposed Impacts Inventory
Impact A
1. Impacts Summary
Both
1a. Where are the impacts associated with your project? (check all that apply):
W Wetlands W Streams -tributaries W Buffers
F Open Waters r Pond Construction
2. Wetland Impacts
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.000 0.140
2g. Total Wetland Impact
0.140
2h. Comments:
See attached impact tables for details and changes since 2018. Locations refer to attached impact drawings.
3. Stream Impacts
2a1 Reason (?)
2b. Impact type * (?)
2c. Type of W.
2d. W. name *
2e. Forested*2f.
Type of
Jurisdicition*M
2g. Impact
area*
W1
Riprap protection
P
Headwater Forest
Impact A
Yes
Both
0.000
(acres)
W2
Sewer crossing
P
Headwater Forest
Impact A
Yes
Both
0.020
W3
Road access
P
Headwater Forest
Impact B
Yes
Both
0.100
W4
Sewer easement
P
Headwater Forest
Impact B
Yes
Both
0.010
(acres)
W5
Riprap protection
P
Bottomland Hardwood Forest
Impact D
Yes
Both
0.010
(acres)
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.000 0.140
2g. Total Wetland Impact
0.140
2h. Comments:
See attached impact tables for details and changes since 2018. Locations refer to attached impact drawings.
3. Stream Impacts

S2
Greenway crossing
Y 9
Permanent
Culvert
UT to Beaverdam Cr
Perennial
Both
5
Average (feet)
44
(linearfed)
S3
Greenway crossing
Y 9
Permanent
Culvert
UT to Beaverdam Cr
Perennial
Both
6
Average (fed)
61
(linear fed)
3i. Total jurisdictional ditch impact in square feet:
Sewer Crossing
0
UT to Beaverdam Creek
31. Total permanent stream impacts:
3i. Total temporary stream impacts:
105
30
3i. Total stream and ditch impacts:
UT to Beaverdam Creek
135
2,391
3j. Comments:
Greenway Crossing
See attached impact tables for details and changes since 2018.
UT to Beaverdam Creek
6. Buffer Impacts (for DWR)
3,690
6a. Project is in which protect basin(s)?
Check all that apply.
rJ Neuse
r Tar -Pamlico
r- Catawba
r Randleman
F- Goose Creek
r Jordan Lake
F Other
6b. Impact Type 6c. Per or Temp 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact 6g. Zone 2 impact
Sewer Crossing
P 11
UT to Beaverdam Creek
No
683 11
1,210
Greenway Crossing
P
UT to Beaverdam Creek
No
2,391
1,210
Greenway Crossing
P
UT to Beaverdam Creek
No
3,690
1,700
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1
Zone 2
Total Permanent impacts: 6,764.00
4,120.00
Zone 1
Zone 2
Total combined buffer impacts: 6,764.00
4,120.00
6i. Comments:
See attached impact tables for more detailed breakdown of impacts and comparison to 2018 approved buffer impacts.
Supporting Documentation
3 -Autumn Lakes -Revised Impact Tables.pdf 40.06KB
4 -Autumn Lakes -Wetland Impact E)diibits.pdf 5.36MB
E. Impact Justification and Mitigation v
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
See cover letter and PDF of 2018 PCN with current revised impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
See cover letter and PDF of 2018 PCN with current revised impacts.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2c. If yes, mitigation is required by (check all that apply):
F DWR V Corps
2d. If yes, which mitigation option(s) will be used for this project?

r Mitigation bank W Payment to in -lieu fee r Permittee Responsible
program Mitigation
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
r Yes r- No
4b. Stream mitigation requested:
(linear feet)
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non -riparian wetland mitigation requested:
(acres)
4c. If using stream mitigation, what is the stream temperature:
4e. Riparian wetland mitigation requested:
(acres)
0.23
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
Mitigation was paid after 2018 permits issued. Only 200 square feet of additional wetland impact result from the current revisions to the greenway
crossings.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r- No
What type of SCM are you providing?
r" Level Spreader
F_ Vegetated Conveyance (lower SHWT)
F_ Wetland Swale (higher SHWT)
F_ Other SCM that removes minimum 30% nitrogen
F_ Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r^ Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater
program?
r Yes r No
2d. Which of the following stormwater management program(s) apply:
V Local Government r State
Local Government Stormwater Programs
,r! Phase II W NSW r USMP r Water Supply
Please identify which local government stormwater program you are using.
Zebulon
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r' Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15ANCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B.0200)?*
r Yes r No

3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
See cover letter and PDF of 2018 PCN with current revised impacts.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated
at a treatment plant, list the capacity available at that plant.
See cover letter and PDF of 2018 PCN with current revised impacts.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat? *
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f• Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
r Unknown
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
No significant change to 2018 plans which have been approved.
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
See cover letter and PDF of 2018 PCN with current revised impacts.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
See cover letter and PDF of 2018 PCN with current revised impacts.
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:

A small amount of rip -rap will be placed at the edge of the 100 -year floodplain to dissipate stream flow and prevent erosion. Rip -rap will be placed in a
manner not to change the wasting grades. Town approval is anticipated of a No -Rise under FEMA.
8c. What source(s) did you use to make the floodplain determination?*
See cover letter and PDF of 2018 PCN with current revised impacts.
Miscellaneous
Comments
Minor revisions to the prior permitted impacts are addressed in the attached cover letter. Rather than reproduce all the information on this form, the 2018 PCN Form is attached and
updated to include all revisions to impacts.
Miscellaneous attachments not previously requested.
1 -Autumn Lakes_RevisedPCNCover_031519.pdf
129.04KB
Signature v
P By checking the box and signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Philip May
Signature
Date
3/15/2019

�1CAROLINA
�lECOSYSTEMS
Mr. James Lastinger
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
RE: Revised PCN for Autumn Lakes Phases 2 and 3
Autumn Lakes Subdivision
Wake County, North Carolina
Dear Mr. Lastinger;
3040 NC Hwy 42 West; Clayton, NC 27520
P:919-359-1102 — F:919-585-5570
March 15, 2019
Carolina Ecosystems, Inc. (CEI) is providing the attached Pre -Construction Notification (PCN)
for the above referenced project for your review under Section 404 of the Clean Water Act. The
NC Division of Water Resources is copied on this submittal for Section 401 review as well as
Neuse River Buffer authorization.
As you may recall, a PCN was submitted in 2018 for Phase 2 of this three-phase project, and
upon review the Phase 3 impacts were included in a revised PCN. Approvals were issued and
the reference numbers are included in the attached PCN Form.
The impacts on Phase 3 consisted of two greenway crossings that were in preliminary design
phase at that time. Since issuance of the 404 and 401 approvals in 2018, Phase 3 design has been
advanced and resulted in changes to the approved impacts due to comments from Zebulon and
Raleigh on the greenway design. Rip -rap has been added to the culvert outlets into the
floodplain wetland system along Beaverdam Creek, along with storm drainage maintenance
easements and revised grading. Rip -rap will be embedded to allow aquatic passage while
preventing erosion of the stream bed at these locations where the streams discharge into the
floodplain of Beaverdam Creek.
The following Section 404/401 impacts have changed:
Stream Impacts — Increase of 41 linear feet
- S2 increased from 30 to 44 linear feet
- S3 increased from 30 to 61 linear feet
Wetland Impacts — Increase of less than 0.01 acres (200 sq. ft.)
- W5 was added to account for 200 square feet of wetland fill for a dissipator pad at the
outlet of the culvert.

Autumn Lakes
March 15, 2019
Page 2 of 2
In addition, for DWR review, the following buffer impacts have changed:
- B2 & B3 - utility crossing resulted in a slight reduction in permanent maintenance
corridor impacts and an equal increase in temporary impacts with no overall change.
- B4, B5, B7, & B8 — see the attached table for increased buffer impacts due to the changes
mentioned above for the stream channel crossings.
The attached PCN Form is included with the original information submitted, as well as revisions
to account for the changes above. For clarity, the impact tables in the original PCN have been
deleted and new tables are attached that show the changed from 2018 to the current application.
If you have any questions or need additional information, please contact me at your earliest
convenience at [phone] or [e-mail].
Sincerely,
Carolina Ecosystems, Inc.
Philip May
Senior Scientist
cc: Karen Higgins, DWR 401 Permitting Unit
Mike Roselli, P.E. Bohler Engineering
David Hensley, LGI Homes
Attachments:
- Pre -Construction Notification Form — Revised
- Revised Impact Tables
- Revised Impact Drawings
- Phase 3 Construction Drawings
- NC Division of Mitigation Services Receipt

wArE��Q�
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
NX 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express NX Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑X No
For the record only for Corps Permit:
❑ Yes ❑X No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
NX Yes ❑ No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below.
❑ Yes NX No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a.
Name of project:
Autumn Lakes, Phases 2 & 3
2b.
County:
Wake
2c.
Nearest municipality / town:
Zebulon
2d.
Subdivision name:
Autumn Lakes
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
LGI Homes NC LLC
3b.
Deed Book and Page No.
017036/00567
3c.
Responsible Party (for LLC if
applicable):
David Hensley
3d.
Street address:
3037 Sherman Dr
3e.
City, state, zip:
Lancaster, SC 29720
3f.
Telephone no.:
980-722-0391
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ❑ Other, specify:
4b.
Name:
4c.
Business name
(if applicable):
4d.
Street address:
4e.
City, state, zip:
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Phil May
5b.
Business name
(if applicable):
Carolina Ecosystems, Inc.
5c.
Street address:
3040 NC Highway 42 West
5d.
City, state, zip:
Clayton, NC 27520
5e.
Telephone no.:
919-606-1065
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
2706513257, 2706615785, 2706729236
1 b.
Site coordinates (in decimal degrees):
Latitude: 35.8399 Longitude: -78.3076
1 c.
Property size:
157.25 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
Beaverdam Creek (27-86-2-3)
2b.
Water Quality Classification of nearest receiving water:
C; NSW
2c.
River basin:
Neuse
3.
Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The project vicinity is primarily agricultural with residential and commercial developments interspersed. The existing conditions on-site consist of
maintained fields with mature forest to the north and east.
3b.
List the total estimated acreage of all existing wetlands on the property: 3.16
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 3,245
3d. Explain the purpose of the proposed project:
Provide single family residential development to help meet the growing housing demand in eastern Wake County.
3e.
Standard
Describe the overall project in detail, including the type of equipment to be used:
construction equipment will be used to construct the project. Phase 1 had no jurisdictional impacts. Phases 2 and 3 are included in this PCS
D
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases in the past?
0 Yes ❑ No ❑ Unknown
Comments: NBRRO #17 046
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
0 Preliminary ❑ Final
4c.
If yes, who delineated the jurisdictional areas?
Name (If known): Michael Zavislak
Agency/Consultant Company: Summit Engineering,
Other: Laboratory & Testing, P.C.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
NBRRO #17-046 (March 7, 2017 and August 22, 2017) PJD field verification by J. Lastinger in 2017
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
0 Yes ❑ No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
This is an update/revision to the previously issued permits from 2018 (AID SAW -2017-00356, DWR# 18-0660).
6.
Future Project Plans
6a.
Is this a phased project?
0 Yes ❑ No
6b. If yes, explain.
Project has three phases. Phase 1 had no jurisdictional impacts. Phase 2 and 3 impacts have been included in this revised PCN.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands ❑X Streams — tributaries ❑X Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of impact
Type of wetland
Forested
Type of jurisdiction
Area of
number
Corps (404,10) or
impact
Permanent (P) or
DWQ (401, other)
(acres)
Temporary T
W1
Choose one
Choose one
Yes/No
W2
Choose one
Choose one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
2h. Comments:
Please see attached Wetland Impact Table and Bohler Engineering Impact Exhibits. Impact Area A (W1, W2); Impact Area B (W3, W4), and Impact
Area D (W5). W5 is the only change from 2018 (200 additional square feet of impact).
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial (PER) or
Type of
Average
Impact
number
intermittent (INT)?
jurisdiction
stream
length
Permanent (P) or
width
(linear
Temporary (T)
(feet)
feet)
S1
Choose one
-
S2
Choose one
S3
Choose one
-
S4 -
Choose one
S5 -
Choose one
S6
Choose one
3h. Total stream and tributary impacts
3i. Comments:
Please see attached Stream Impact Table. S1 (Impact A) temporary stream crossing for utility construction. No impact is expected or proposed -the 30'
temporary impact requested is to cover installation of the aerial crossing only. S2 and S3 are Phase 3 greenway crossings (Impacts C and D).
Impacts S2 and S3 are revised as of March 2019 due to final greenway design.
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then indivi ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
O2 -
Choose one
Choose
03 -
Choose one
Choose
04
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑X Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
B1
Yes/No
B2
Yes/No
B3
Yes/No
B4 T
No
B5 P
No
B6 T
No
6h. Total Buffer Impacts:
6i. Comments: Please see attached table for breakdown of buffer impacts.
Page 5 of 10

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Phase 1 was designed without impacts. Phase 2 impacts are unavoidable; a utility crossing is required to serve the west side of the
site and access is required to maintain BMPs and infrastructure. An additional subsurface crossing is being bored to avoid impacts.
Phase 3 impacts have been avoided with the exception of two greenway crossings located along City sewer easement.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Best management practices and sedimentation and erosion control methods will be used during all construction techniques. No equipment refueling or
maintenance activities will occur adjacent to jurisdictional areas. All temporary impacts to jurisdictional wetlands during construction activities will be
returned to their original configuration and seeded in a timely manner for stabilization.
2.
Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a.
Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑X Yes ❑ No
2b.
If yes, mitigation is required by (check all that apply):
❑ DWQ ❑X Corps
2c.
If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑X Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3.
Complete if Using a Mitigation Bank
3a.
Name of Mitigation Bank:
3b.
Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c.
Comments:
4.
Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
❑X Yes
4b.
Stream mitigation requested:
0 linear feet
4c.
If using stream mitigation, stream temperature:
Choose one
4d.
Buffer mitigation requested (DWQ only):
0 square feet
4e.
Riparian wetland mitigation requested:
0.23 acres
4f.
Non-riparian wetland mitigation requested:
0 acres
4g.
Coastal (tidal) wetland mitigation requested:
0 acres
4h.
Comments: 0.23 acres of mitigation has been paid for the impacts (see attached DMS receipt).
5.
Complete if Using a Permittee Responsible Mitigation Plan
5a.
If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
❑ Yes ❑X No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments: Buffer impacts associated with allowable impact (utility and greenway crossings).
Page 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
❑X Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
Stormwater plan will be reviewed and approved by Zebulon under their Phase II Stormwater Permit
This include diffuse flow to the buffer
❑ Yes ❑X No
authority.
will measures ensure compliance with riparian rules.
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
30.1%
2b.
Does this project require a Stormwater Management Plan?
0 Yes ❑ No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative
description of the plan:
See explanation in 1 b, above.
2e.
Who will be responsible for the review of the Stormwater Management Plan?
Town of Zebulon
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
Town of Zebulon
0 Phase II
0 NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑X No
attached?
4.
DWQ Stormwater Program Review
❑Coastal counties
❑ HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ORW
(check all that apply):
❑Session Law 2006-246
❑ Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1 a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes
❑X No
use of public (federal/state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c.
If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes
❑ No
letter.)
Comments:
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑Yes
❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑Yes
❑X No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
F] Yes
❑X No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance
with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
The limited size of this development, including Phase III will not affect potential development in the area.
4.
Sewage Disposal (DWQ Requirement)
4a.
Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Sewer lines on site will tie into existing wastewater infrastructure maintained by the City of Raleigh. Adequate capacity is available for the potential flow
from this development.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ❑X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑X Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS website https:www.fws.gov/raleigh/species/cntylist/wake.html. NC Natural Heritage Data Explorer was performed (attached).
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
http://wwww.habitat.noaa.gov/protection/efh/efhmapper.htm1
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑X Yes ❑ No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
HPOWEB Map Service http://gis.ncdcr.gov/hpoweb/. National Register of Historic Place http://www.nps.gov/nr/research/. Building reference
#86000157. Occurs near Bunn, Bennett, Plantation
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Wake County GIS floodplain mapping, North Carolina Floodplain Mapping Program http://www.ncfloodmaps.com/
Philip May
� G
3/15/19
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided.
Page 10 of 10

CAROLINA 3040 NC Hwy 42 West; Clayton, NC 27520
ECOSYSTEMS, INC. P:919-359-1102 — F:919-585-5570
PROPERTY ACCESS AND AGENT AUTHORIZATION FORM
Property Information
Property Address
and/or Description
Parcel Identification
Number(s) (PIN)
City: Zebulon
1225 Old Bunn Rd
270-65-13-257
State: NC
Property Owner Information
County: Wake
Owner: ® Authorized Agent*: ❑
Name: LGI Homes NC LLC
Title
Street Address: 3037 Sherman Drive
City: Lancaster
State:SC
*Written proof of authorization from owner required.
Authorization
Property Size (Acres): 53
Zip Code:29720
I, the undersigned, a duly authorized owner of record of the property/properties identified herein, do authorize
representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps) to enter upon the property herein
described for the purpose of conducting on-site investigations and issuing a determination associated with Waters of the
U.S. subject to Federal jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors
Act of 1899.
Additionally, I hereby grant Carolina Ecosystems, Inc. (CEI) staff, their designated contractors and representatives, as
well as other Federal, State or local authorities access to the above referenced property when necessary for the purposes of
conducting on-site environmental consulting services. I also grant CEI the authority to act as authorized agent on behalf of
the owner of the above listed property for the communication, submission, and/or application to relevant government
entities, including local, state, and federal authorities, for the review, acceptance, concurrence, and/or approval of
environmental information, documents, and/or permit requests concerning the above listed property. These services may
include regulatory determinations of environmental features on my property such as issuing a determination associated
with streams and wetlands. I certify that I am the legal owner or authorized agent of the legal owner of the above property
and have authority to grant such access. I have made CEI aware of, and supplied all available records related to, previous
environmental investigations on the subject property of which I have knowledge.
e � �
Owner/Agent (signature) — `s�� Date 5/11/18

Autumn Lakes - Phases 2 and 3
March 2019 Permit Revision 3/15/2019
WETLAND IMPACT TABLE
2018
Impact
2019
Impact
Change
Impact
Wetland Impact No. Impact Wetland Type Forested
W1 - P
Fill
Rip. Headwater Forest
Yes
0
0
0
W2 - P
Conversion
Rip. Headwater Forest
Yes
0.02
0.02
0
W3 - P
Fill
Rip. Headwater Forest
Yes
0.1
0.1
0
W4 - P
Conversion
Rip. Headwater Forest
Yes
0.01
0.01
0
W5 - P
IFill
lBottomland Hardwood
IYes
0
0.01
0.01
TOTALS
I
1
1
0.13
0.14
0.01
STREAM IMPACT TABLE
2018
Impact
2019
Impact
Change
Impact
Stream Impact No. Reason Stream Name PER/INT
S1 - T Excavation
UT to Beaver Cr
Per
30
30
0
S2 - P Greenway
UT to Beaver Cr
Per
30
44
14
S3 - P Greenway
UT to Beaver Cr
Per
30
61
31
TOTALS
577
333
90
135
45
Note:
W1 is 0 to account
for minor impact
to correct total acres.
BUFFER IMPACT TABLE
2018
Zone 1
Zone 2
2019
Zone 1
Zone 2
Change
Zone 1 Zone 2
Buffer Impact No. Reason Stream Name Mitigation
131-A
Rip rap
UT to Beaver Cr
No
208
82
208
82
0
0
B2 - A
Temp Util
UT to Beaver Cr
No
262
577
333
761
71
184
B3 - A
Conversion
UT to Beaver Cr
No
214
550
142
367
-72
-183
B4 - C
Greenway
UT to Beaver Cr
No
948
566
948
566
0
0
B5 - C
Utility Temp
UT to Beaver Cr
No
1078
644
1443
644
365
0
B7 - D
Greenway
UT to Beaver Cr
No
887
745
887
747
0
2
B8 - D
Utility Temp
UT to Beaver Cr
No
1086
843
2803
953
1717
110
TOTALS
4683
4007
6764
4120
2081
113

7 .
i
Map Date: April 2018
N Study Area �� Streams
CAROLINA 77= Feet Revised:
ECOSYSTEMS 0 200 400 Wetlands Revised:
Zebulon (2013) USGS 1:24,000 Quadrangle Map Revised:
z
Autumn Lakes Subdivision: Phase II
Wake County, NC
Figure 2: USGS Map

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TIM BAUMGARTNER
Director
Bobby Macnaughton
LGI Homes
3037 Sherman Drive
Lancaster, SC 29720
Project: Autumn Lakes
County: Wake
401 permit#: 18-0660
404 permit#: 2017-00356
DMS ID#: MR -06881
Amount Paid: $13,843.12
Check Number: 00010600
NORTH CAROLINA
Environmental Quality
RECEIPT
November 27, 2018
The NCDEQ Division of Mitigation Services (DMS) has received a check as indicated above as payment for
the compensatory mitigation requirements of the 401 Water Quality Certification/Section 404 Permit(s)
issued for the above -referenced project. This receipt serves as notification that your compensatory
mitigation requirements assigned to DMS associated with the authorized activity as specified below have
been satisfied. You must also comply with all other conditions of this certification and any other state,
federal or local government permits or authorization associated with this activity including G.S. § 143-214.11.
The DMS, by acceptance of this payment, acknowledges that the Division is responsible for the
compensatory mitigation requirements indicated below associated with the project permit and agrees to
provide the compensatory mitigation as specified in the permit. Mitigation responsibility assigned to the
DMS is nontransferable. The mitigation will be performed in accordance with the In -Lieu Fee Program
instrument dated July 28, 2010,
River Basin
Mitigation Location
Mitigation Type ! Credits
8 -di it HUC
,
Neuse
03020203
Riparian Wetland 0.23 jl
J ,
Refunds of payments made to NCDMS are only approved under certain conditions. All refund requests
must be submitted in accordance with the Division's refund policy. If you have any questions or need
additional information, please contact Kelly Williams at [phone].
Sincerely,
a&—C(`�
u a n
Director
cc: Todd Tugwell, USACE - Raleigh; James Lastinger, USACE
Phil May, agent
��tze`A
�n cuxr vsn
�w.a�wn x em�w�r.ir pyn
North Carolina Department of Environmental Quality I Division of Mitigation Services
217 W. Jones Street 1 1652 Mail Service Center I Raleigh, North Carolina 27699-1652
919.707.8976

U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Compensatory Mitigation Responsibility Transfer Form
Permittee: LGI Homes NC, LLC Attn: David Hansley Action ID: SAW -2017-00356
Project Name: Autumn Lakes subdivision County: Wake
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 Division of Mitigation Services (NCDMS), 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 (credits) 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
bank ledger and provide a copy of the signed form and the updated bank ledger to the Permittee, the USACE Project
Manager, and the Wilmington District Mitigation Office (see contact information on page 2). The Sponsor must also comply
with all reporting requirements established in their authorizing instrument.
Permitted Impacts and Compensatory Mitigation Requirements
Permitted Impacts Requiring Mitigation*: 8 -digit HUC and Basin: 03020203, Neuse River Basin
Stream Impacts (linear feet)
Wetland Impacts (acres)
Warm
Cool
Cold
Riparian Riverine
Riparian Non-Riverine Non -Riparian
Coastal
0.13
*If more than one mitigation sponsor will be used for the permit, only include impacts to be mitigated by this sponsor.
Compensatory Mitigation Requirements: 8 -digit HUC and Basin: 03020203, Neuse River Basin
Stream Mitigation (credits) Wetland Mitigation (credits)
Warm CoolCold
Riparian Riverine Riparian Non-Riverine Non -Riparian
Coastal
0.23
Mitigation Site Debited: NCDMS
(List the name of the bank to be debited. For umbrella banks, also list the specific site.
NCDMS acceptance letter identifies a specific site, also list the specific site to be debited).
Section to be completed by the Mitigation Sponsor
For NCDMS, list NCDMS. If the
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 NCDMS), 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 mitigation requirements.
Mitigation Sponsor Name:
Name of
d�tr► '711 Z�?A) C
Representative Date of Signature
Page 1 of 2 Form Updated 14 September, 2017

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 is 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 fully responsible for the mitigation until the USACE has received this form, confirming
that the Sponsor has accepted responsibility for providing the mitigation requirements listed herein.
• Signed copies of this document must be retained by the Permittee, Mitigation Sponsor, and in the USACE
administrative 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 provided with a signed copy of this form.
• If changes are proposed to the type, amount, or location of mitigation 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 District
guidance and a new version 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 below by the USACE Project Manager and by the Mitigation Sponsor on Page 1. Once
signed, the Sponsor should provide copies of this form along with an updated bank ledger to: I) the Permittee, 2) the
USACE Project Manager at the address below, and 3) the Wilmington District Mitigation Office, Attn: Todd Tugwell, 3331
Heritage Trade Drive, Suite 105, Wake Forest, NC 27587 (email: [e-mail]). Questions regarding this
form or any of the permit conditions may be directed to the USACE Project Manager below.
USACE Project Manager: James Lastinger
USACE Field Office: Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
Email: [e-mail]
LASTI N G E RJ A M E Digitally
LASTINGAgned by
ERIAMES.C.1363642400
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI,
USA S.C.1363642400 Date: 2018A7.201343.31,04W 363642400
JUIY 20, 2018
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 (including stream temperature and wetland groupings) is
available at http://ril:its.usace.army.rrfl.
Page 2 of 2
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so, please complete the
Customer Satisfaction Survey located at our website at :llreRuldlory.trsatesw aL�y.curn to complete the survey online.