HomeMy WebLinkAbout20140244 Ver 1_Riparian Buffer Authorization_20140314DR 2 0 1 4 0 2 4 4 State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources Division of Water Resources
15A NCAC 026 .0233 (8)(b),.0243 (8)(b),.0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2) - Buffer Authorization
FORM: BA 10 -2013
Riparian Buffer Authorization Form
A. Applicant Information
1. Project Information
1 a. Name of project:
5 r O 9c-A,
_1b. County:
aPa & Ao r
1c. Nearest municipality:
CC bi L lei es IL-
-1d. d. Subdivision name:
1 e. Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer 1f below.
Yes El No
1f. Is the project located within a NC Division of Coastal
Management Area of Environmental Concern (AEC)?
[� Yes ❑ No
2. Owner Information
2a. Name on Recorded Deed:
p
2b. Deed Book and Page No.
p , i, re 1 20 no 730? 1
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
2d. Responsible Party
(for Corporations):
Er A e % FCLSr` ,e r
2e. Street address:
9X Lf
2f. City, state, zip:
06111alle. ft/G , 1%VO
2g. Telephone no.:
_ d, 9,6,Y
2h. Fax no.:
2i. Email address:
3. Applicant Information (if different from owner) LG ,
3a. Applicant is:
❑ Agent ❑ Other, specify:
3b. Name:
3c. Business name
(if applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
4. Agent/Consultant Information (if applicable)
4a. Name:
4b. Business name
(if applicable):
®R)
'
4c. Street address:
JUU
4d. City, state, zip:
Lull
4e. Telephone no.:
4f. Fax no.:
4g. Email address:
FORM: BA 10 -2013 Page 1 of 4
B.
Project Information and Prior :Project History
1.
Property Identification
1a.
Property identification no. (fax PIN or parcel ID):
D70
1'b.-
Site coordinates (in decimal degrees).
Latitude:
Longitude:
1c.
Property size:
13 acres
2.
Surface Waters,
2a.
Name of nearest body of water to proposed project:
,
2b.
Water Quality'Classification of nearest receiving water:
2c.
River basin:
3.
Project- Description
3a. ,Describe the existing condi 'ons on th- site and the ge eral land a in the /vicinit ofthe P{oject at'the tin]p of this
applicati%n: 0� , `D� /' /l�i �p i �1v %i��� Gi�CJ 5 tip°
3b.
Attach an 8'72 x 11 excerpt from the most recent version of the USGS topographic map indicating the location of
the site
3c.
Attach an 8'/ x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map
depictingthe project site
3d.
List`the total esti ted,linea feet existing strr ams (i ermittent and perennial) on the property:
/i • .
3e:
lain the purpose "the proposed project:
EPal-Coe
3f. De crib the ov rail projectrin detail, inclu ing,t/he,type of equipm nt to be u d:�.
Ca/�f`TI`l1G � Il G�6cx.t :�7Ui�C % � � fSCSr(/L�Z • ��n S
4.
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream- determinations by the
Corps or State been requested or obtained for,this property/
project (including all priorphases), in the past?
❑ Yes ANo ❑ Unknown
Comments:
4b.
If yes, who delineated the jurisdictional re s?
Name (if;khown):
Agency/ Consultant Company:
''Other:
4c.
If yes, list the -dates of the Corps jurisdictional, determinations or State determinations and attach documentation.
S.
Project History
5a..
Have permits or certifications been requested or obtained for this
project (including all prior phases) i'n the past?
❑ Yes X No ❑ Unknown
5b.
If yes, explain and detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project ?'
❑ YesIo
6b.
Ifyes, explain.
FORM: BA 10 -2013 Page 2 of 4
C. Proposed, Impacts Inventory
Impact Justification and Mitigation
1.
1. Buffer.lmpacts
ta.. Specifically describe measures taken to avoid or minimize the proposed impacts 1'Q- desi%��ing project.
1 b.
1'a. Project is in which protected basin?
❑ Neuse [ Tar - Pamlico ❑ Catawba
❑ Randleman Jordan ❑ Goose "Creek
1b. 'Individually list`all'bufferimpacts` below. Ifany impacts require mitigatioon, then you MUST fill out Section D of -this
form.
Buffer',impact
number —
Permanent (P)
or Temporary
Reason for
impact
Type,of, impact
(exempt, allowable,
allowable w/ mitigation)
Stream name
Buffer
mitigation
required?
Zone 1'
impact
(sq ft)
'Zone 2;
impact
(sq ft)
B1 PQ P El
0 pa d
a
Zone 1
❑Yes: ❑ No
3 (-2 for Catawba)
62 9 P ❑ T
Zone.2
❑ Yes. ❑,No
63 ❑ P ❑'T
Total buffer mitigation
required:
❑ Yes 'El No
If buffer mitigation is required, is paymentto a
mitigation'bank "or NC ,EEP proposed?
❑ Yes ❑ No
64 ❑ P ❑ T
If yes, attach the acceptance,letter from,the mitigation bank or-NC EEP.
2e.
If no, then discuss what type of mitigation'is proposed.
❑Yes ❑ No
Comments:
65 ❑ P ❑ T
❑ Yes ❑ No
86 ❑P El
❑Yes ❑No
'Total
Jbuffer,impacts
1'c. Comments:
D.,
Impact Justification and Mitigation
1.
Avoidance and Minimization
ta.. Specifically describe measures taken to avoid or minimize the proposed impacts 1'Q- desi%��ing project.
1 b.
Specifically describe measures talon to avoid or- ,minimize the prop osed impacts through nstruction techniques.
lrjdlTGl�/) SS t� "G /� m 441�G
2.
Buffer Mitigation
2a.
Will the project result in an impact within a protected riparian buffer that requires buffer
mitigation?
❑ Yes No
2b.
If yes, then identify the square feet of'impact to each zone ofthe-riparian buffer that requires mitigation and
calculate the; amount of mitigation required in the "table below.
Zone
Reason for impact
Total' impact
s uare�feet
Multiplier
Required mitigation
s uare'fe_ et
Zone 1
3 (-2 for Catawba)
Zone.2
1.5
Total buffer mitigation
required:
2c.
If buffer mitigation is required, is paymentto a
mitigation'bank "or NC ,EEP proposed?
❑ Yes ❑ No
2d.
If yes, attach the acceptance,letter from,the mitigation bank or-NC EEP.
2e.
If no, then discuss what type of mitigation'is proposed.
2f.
Comments:
FORM: BA 10 -2013 Page 3. of 4
E. Diffuse Flow Plan
All buffer impacts and high ground Impacts require diffuse flow or other form of
Diffuse'flow
stormwater treatment. Include,ta plan thatfully documents how diffuse flow will be
E] Other BMP
maintained. If 'a Level Spreader is proposed, attach a.Level Spreader Supplement Form.
1 a.
If due to site constraints,'a BMP other than a level spreader is proposed, please provide_ ,a
❑ Yes [X No
plan'for stormwater treatment as outlined in Chapter 8 of th&NC Stormwater BMP
public (federal /state), land?
Manual and attach a BMP Supplement Form..
1 b.
F.
Supplementary Information,
by First Class= Mail via the VS.Postal Service:
1.
Environmental Documentation
OR NO DWR, Transportation Permitting Unit
1 a.
Does the projectinvolve an expenditure of public (federal /state /local) funds or the use of
❑ Yes [X No
Raleigh, NC,27604
public (federal /state), land?
For all other projects sent'by delivery service
1 b.
If,you answered "yes" to the above, does the project require preparation of an
❑ Yes $�4o-
OR Karen Higgins
environmental document pursuant to the requirements of the National or State (North
NCDWR —401 & Buffer Permitting Unit
1650 Mail Service Center
Carolina) Environmental Policy Act (NEPA/SEPA)?
Raleigh, NC 27699 - 1650
1 c.
If you answered ",yes" to the above, has the document been finalized by the State
❑ Yes ❑ No
Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter')
Comments:
2.
Violations
2a.
Is the site in violation of DWR Wetlarid Rules (15A NCAC 02H .0500), Isolated Wetland
❑ Yes ANo
Rules (1;5A NCAC'�02H' 1300), DWR 'Surface Water or1U,lletland; Standards, or Riparian
Buffer Rules (15A NCAC 02B .0200)?
2b.
Is•this an .after-the-fact permit application?
❑ Yes X No
2c.
'if, you, answered "yes" to one or both of1the -above questions, provide anexplanationof the violation(s):
Er A�s
APP
nted Name
Appli6 ant/Agents Signature iDate
(Age nt's,signature�is valid only if.amauthorization letter from the applicant is provided)
Send 3 complete sets of this form and accompanying documents fo�the following:
Forgovernment transportation projects sent
For government 'transportaiibn<projects sent
by First Class= Mail via the VS.Postal Service:
by delivery service (UPS, FedEx, etc.)':
NC DWR, Transportation Permitting Unit
OR NO DWR, Transportation Permitting Unit
1650 Mall Service Center,
512 N. Salisbury, Street
Raleigh, NC 27699 - 1'650
Raleigh, NC,27604
For all other projects sent'by First Class Mail
For all other projects sent'by delivery service
via the US Postal Service
(UPS, FedEx, etc.):
Karen Higgins
OR Karen Higgins
NCDWR — 401 &'Buffer Permitting Unit
NCDWR —401 & Buffer Permitting Unit
1650 Mail Service Center
512 N. 'Salisbury Street
Raleigh, NC 27699 - 1650
Raleigh, NC 27604
FORM: BA.10 -2013 Page 4 of 4•
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