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HomeMy WebLinkAbout20200859 Ver 1_06_Yadkin_ILF-Request-20200603_Signed_20200629DMS ILF Mitigation Request Statement of Compliance with §143-214.11 & 143-214.20 (link to G.S. 143-214.11) Prior to accessing the Division of Mitigation Services (DMS), state law requires applicants to demonstrate compliance with G.S. § 143-214.11 and 143-214.20. All requests MUST include this form signed and dated by the permit applicant or an authorized agent. Compliance Statement: I have read and understand G.S. § 143-214.11 and 214.20 and have, to the best of my knowledge, complied with the requirements. I understand that participation in the DMS 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 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 (link to DWR list) Mitigation bank(s) in the hydrologic unit where the impacts will occur have been contacted and credits are not currently available. 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. 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 applicant’s responsibility to document any inquiries made to private mitigation banks regarding credit availability. I have read and understand the DMS refund policies (attached) initial here Signature of Applicant or Agent Printed Name Date Project Name Location DIVISION OF MITIGATION SERVICES (DMS) IN-LIEU FEE REQUEST FORM Revised 6/30/2019 Complete requested information, sign and date, email to kelly.williams@ncdenr.gov . Attachments are acceptable for clarification purposes (location map, address or lat long is required). Information submitted is subject to NC Public Records Law and may be requested by third parties. CONTACT INFORMATION APPLICANT’S AGENT APPLICANT 1. Business/Company Name 2. Contact Person 3.Mailing address 4. City, State, Zip 5. Telephone Number 6. E-Mail Address PROJECT INFORMATION 7. Project Name 8. Project Location (nearest town, city) 9. Lat-Long Coordinates or attach a map 10. County 11.River Basin & 8-digit HUC (link to Map) 12. Project Type Government Private Project Type: 13. Riparian Wetland Impact (ac.) (e.g., 0.13) 14. Non-Riparian Wetland Impact (ac.) 15. Coastal Marsh Impact (ac.) 16. Stream Impact (ft.) (e.g. 1,234)Warm Cool Cold 17.Riparian Buffer Impact (sq. ft.)Zone 1: Zone 2: 18. Regulatory Agency Staff Contacts USACE: NCDWR: Other: Check ( √) below if this request is for a: revision to a current acceptance renewal of an expired acceptance extension of unexpired acceptance By signing below, the applicant is confirming they have read and understand the DMS refund policy posted at nceep.net and attached to this form. Signature of Applicant or Authorized Agent: Date: Direct questions to Kelly Williams at 919-707-8915 or kelly.williams@ncdenr.gov or to the front desk at 919-707-8976 Refund Policy for Fees Paid to DMS In-Lieu Fee Programs (9/21/2009) Purpose: The purpose of this 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. Policy Statement: The policy of DMS is to allow for refunds under certain conditions. 1.All refund requests must be made in writing to the DMS In-Lieu Fee Program Coordinator at kelly.williams@ncdenr.gov. 2.All refund requests are subject to fund availability. DMS does not guarantee 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 written authorization from the entity that made the payment specifying the 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 an incremental payment arrangement are not eligible for refunds. 6.Refund requests made within nine months of payment to DMS will only be considered for requests associated with projects that have been terminated or modified where the permittee’s mitigation requirements have been reduced. Such requests must be accompanied by written verification from the permitting agency that the project has been canceled, the permits have been rescinded or have been modified, 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 verification from the permitting agency that the project has been canceled, the permits have been rescinded and/or mitigation is no longer required. 8.Refund requests not meeting the criteria specified above are not eligible for a refund. 9.Refund requests that meet the criteria above will be elevated to DMS 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 DMS can use the mitigation procured using the payment to meet other mitigation requirements 10.Once a refund has been approved, the refund recipient must provide a completed W-9 form to the DMS In-Lieu fee Program Coordinator within two weeks in order to process the refund though the State Controller's Office. 11.All decisions shall be final.