HomeMy WebLinkAbout20191646 Ver 1_Riparian Buffer Authorization_20191203DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources Division of Water Resources
15A NCAC 02B .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 D
1a. Name of project: U�j PS i Gr�?,.rGe PDn.C_ &Y of
1b. County:
1c. Nearest municipality:
Id. Subdivision name:
le. Is the project located in any of North Carolina's twenty coastal Yes No
counties? If yes, answer 1f below.
If. Is the project located within a NC Division of Coastal Management Area Yes No
of Environmental Concern (AEC)?
2. Owner Information
2a. Name on Recorded
Deed:
2b. Deed Book and Page )�
No. IJr�01�• 1>'17665- �P15- 7- 015-9
2c. Map Book and Page No.
(include a copy of the q n
recorded map that indicates 1 CEO k 1 1 s (° i t 5C �� 35 0
when the tot was created):
2d. Responsible Party
(for Corporations):
2e. Street address
2f. City, state, zip:
A'LY-r NC2:7 57d-
2g. Telephone no.:
! - S 1— r 9
2h. Fax no.:
2i. Email address: --`a,m e (y N C Lo vJ M i
3. Applicant Information (if different from owner)
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.:
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FORM: BA 10-2013 Page 1 of 6
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3h. Email address:
4. Agent/Consultant Information (if applicable)
4a. Name:
4b_ Business name
(if applicable):
4c. Street address:
4d. City, state, zip:
4e. Telephone no.:
4f, Fax no.:
4g. Email address:
FORM: BA 10-2013
Page 2 of G
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B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID): I i6 z
1 b. Site coordinates (in decimal degrees): Latitude:. 73 L L31 Longitude: _7$, 7735
1c. Property size: , I 1,3acres
2. Surface Waters - — ---- -
2a. Name of nearest body of water to proposed project: LA to,ycw d S#a!r 46hmanc(A
2b. Water Quality Classification of nearest receiving water:
2c. River basin:-
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:
5v1ou26,arl filCAc4 homy 1.4 SInb cG'w`s,' Yf L-
3b. Attach an 8 1/2x 11 excerpt from the most recent version of the USGS topographic map indicating the
location of the site ,.1 Y I-�Gh r� _
3c. Attach an 8'/ x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map
depicting the project site — /.I`..t+A Ck 2
3d. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3e. Explain the purpose of the proposed project: A old A /Lo vF ov&,_ A p0A 4• ,j
SCcararg�, cdo s-/v,e - eaTl�� x szN
3f. Describe the overall project in detail, including the type of equipment to be used:
92A w )a MoF+v u3crtfc. M�%v� Nn r nla_ f',%0A CT c j 5 ",LAow4W,;,r2 o t
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by Yes o Unknown
the Corps or State been requested or obtained for this Comments:
property/ project (including all prior phases) in the past?
4b. If yes, who delineated the jurisdictional areas? rAgencyl Consultant Company:
Name (if known): Other:
4c. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach
documentation.
5. Project History
5a. Have permits or certifications been requested or Yes No Unknown
obtained for this project (including all prior phases) in i
the past?
5b. If yes, explain and detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? Yes No
FORM: BA 10-2013
Page 3 of 6
�• 1
fib. If yes, explain,
C. Proposed Impacts Inventory
1. Buffer Impacts
1 a. Project is in which protected basin? euse Tar -Pamlico Catawba
Randleman _ Jordan Goose Creek
1b. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section
D of this form.
T
Buffer impact Reason for Type of impact Stream name Buffer Zone 1 Zone 2
number— impact (exempt, allowable, mitigation impact impact
Permanent (P) allowable wI required? (sq ft) (sq ft)
or Temporary mitigation)
(T) f ti jLc �• n M n rsd
B1 P T peck �uaf /l) 1po,a �(e LoN� �"" Yes N1
132 P T Yes No
B3 P T Yes No
B4 P T Yes No
B6 P T Yes No
B6 P T Yes No
Total buffer impacts�ITO
1c. Comments: U u)'-d( ,cocas w:l( COOL,-
}wa Spa-� � 6n• o� ; s � 2 ONi,f A Doti +—m a�' � c d r 3 J
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
6 M 4, {Le cj o f"t f a{
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. (V b i M/)A cff _ T
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that Yes No
requires buffer mitigation?
2b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation
and calculate the amount of mitigation required in the table below.
Zone Reason for impact Total impact I Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3 (2 for
Catawba)
Zone 2 j 1.5
FORM: BA 10-2013 Page 4 of 6
Total buffer mitigation required:
2c. If buffer mitigation is required, is payment to a mitigation bank or NC DMS Yes
proposed?
2d. If yes, attach the acceptance letter from the mitigation bank or NC DMS.
2e. If no, then discuss what type of mitigation is proposed.
2f. Comments:
E. Diffuse Flow Plan
s All buffer impacts and high ground impacts require diffuse flow or other form of
stormwater treatment. Include a plan that fully documents how diffuse flow will be
maintained. If a Level Spreader is proposed, attach a Level Spreader Supplement
Form.
If due to site constraints, a BMP other than a level spreader is proposed, please
provide a plan for stormwater treatment as outlined in Chapter 8 of the NC
Stormwater BMP Manual and attach a BMP Supplement Form.
F. Supplementary Information
1. Environmental Documentation
Diffuse flow
Other BMA
-1.4 It ne f wI' If1Gr,.c,r/
r'A'(o ,�J 5.t 44L1 `'• c f
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A v d /Gx S
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the Yes
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
(North Carolina) Environmental Policy Act (NEPAISEPA)?
1c. If you answered "yes" to the above, has the document been finalized by the State
Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter.)
Comments:
Yes NO
Yes Nn
2. Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated Yes
Wetland Rules (15A NCAC 02H .1300), DWR Surface Water or Wetland
Standards, or Riparian Buffer Rules (15A NCAC 02B .0200)?
2b. Is this an after -the -fact permit application? Yes
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
.-4
--1hcim5 E EgeR it ! f 27
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is
provided )
5h4.r,j
FORM: BA 10-2013 Page 5 of 6
Send 3 complete sets of this form and accompanying documents to the following:
For government transportation projects
sent by First Class Mail via the US Postal
Service:
INC DWR, Transportation Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
For all other projects sent by First Class
Mail via the US Postal Service
For government transportation projects
sent by delivery service (UPS, FedEx, etc.):
OR
NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
Karen Higgins OR
NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 -1617
For all other projects sent by delivery
service
(UPS, FedEx, etc.):
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
FORM: BA 10-2013 Page 6 of 6
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