20191758 Ver 1_Riparian Buffer Authorization Request_20191230

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/30/2019 7:50:07 AM (Start)
Approve by Carpenter, Kristi 12/31/2019 9:44:55 AM (DOT - Initial Review)
• The task was assigned to Carpenter, Kristi 12/30/2019 7:50 AM

Buffer Authorization Application Form
15ANCAC 02B .0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2) Buffer Authorization Online Fo
Update 10/23/2018
Original Submittal 12/30/2019
A. Owner/Applicant Information
General Information
Primary Contact Email: * [e-mail]
Rease list the contact person's en -ail for questions or payrrent on this project if needed.
Who is submitting the application?* r Owner
W Applicant other than Owner
r Agent
Is there an agent working on this application r Yes
but not submitting it? r No
1. Property Owner Information:
la. Name on Recorded Deed:*
1b. Responsible Party:
1c. Mailing Address:*
1d. Telephone:* [phone]
NCDOT Right -of -Way SR 1159 Flat Swamp
Road in Martin County
Paul Williams
(for Corporations)
Street Address
113 Airport Dr.
Address Line 2
aty
State / Province / Region
Edenton
NC
Rbstal / Zip Code
Country
27932
USA
2. Applicant's Information (if different from owner):
2a. Name: Paul Williams
1e. Email Address:* [e-mail]
2b. Company Affiliation:
NC Department of Transportation
2c. Mailing Address:
Street Address
113 Airport Dr.
Address Line 2
Cty
Edenton
Postal / Zip Code
27932
2d. Telephone:
[phone]
2e. Email Address:
[e-mail]
State / Province / Region
NC
Country
USA

B. Project Information and Prior Project History
1. Project Information
la. Name of Project:*
Bridge 71 Replacement Project in Martin County
(Subdivision, facility, or establishrrent narre)
1b. Is this a publicly -funded
transportation project?*
r Yes
r No
1c. TIP#
17BP.1.R.86
1d. Subdivision Name:
n/a
le. Nearest
Robersonville
Municipality:
1f. Property Size:
1.00
acres
1g. County (or Counties) where the project is located:*
Martin
1In. Property ID# Date of Purchase
Tax RN or Parcel id
1 i. Deed Information
Deed
Map
1j. Attach a copy of the recorded map that indicates when the lot was last platted.
nick the upload button or drag and drop files here to attach docurrent
FDF only
1k. How would you like to provide the Latitude and Longitude information?*
r Address Lookup
r Manually
Latitude * 35.815905 Longitude *-77.264146
11. Is the project located in any of North Carolina's twenty coastal counties?
r Yes
r No
2. Surface Waters ^
2a. Name of the nearest body of water to proposed project:*
Flat Swamp
2b. Water Quality Classification of nearest receiving water:*
C;Sw,NSW

2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:*
100
(linear feet only)
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:
Project area consist of NCDOT Martin County SR 1159 and Bridge #71. The
adjacent property use is a mix of agricultural and timber.
3b. Attach an 81/a x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
Click the upload button or drag and drop files here to attach docurrent
B-4577_QuadMap.pdf 2.66MB
FDF only
3c. Attach an 8 % x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the
project site.
Click the upload button or drag and drop files here to attach docunent
Soil_Map.pdf 622.51 KB
RDF only
4. Proposed Activity
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used:*
The existing 52' L X25' W 3-span bridge will be removed and replaced with the
proposed 70' L X 33' W single span concrete cored slab bridge. The project will
result in no impacts to jurisdictional wetlands or streams. This work will be
accomplished using cranes, track excavators,backhoes, and dump trucks.
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach docurrent
17BP.1.R.86_PermitDrawings_07302019.pdf 1.21MB
17BP.1.R.86_Permit Drawings_Buffer_07302019.pdf 779.68KB
FDF only
5. Jurisdictional Determinations
5a. Have jurisdictional wetlands or stream determinations by the Corps or State been requested or obtained for this
property/project (including all prior phases) in the past?*
r Yes
r No
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes
r No
7. Future Project Plans
7a. Is this project a phased project?* r Yes
r No
C. Proposed Impacts Inventory
Buffer Impacts
Project is in which protected Basin?*

r Neuse River Basin (15A NCAC 02B.0233)
r Catawba River Basin (15A NCAC 02B.0243)
f Randleman Lake Watershed (15A NCAC 0213.0250)
F Tar -Pamlico River Basin (15A NCAC 02B.0259)
r Jordan Lake Watershed (15A NCAC 02B.0267)
f Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 02B.0607)
Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of this form.
Site# - Reason
Stream Name
Buffer Impact *
Impact Type *
Zone 1
Zone 2
Bridge
Flat Swamp
Permanent
Allowable
1,219.
0.00
Nhp label (e.g. Ibad
(P)
00
Square
Crossing 1)
Perm orTerrp
Square
Feet
Feet
Road Crossing
Flat Swamp
Permanent
Allowable
887.00
1,209.
Nbp label (e.g. Pbad
(P)
Square
00
Crossing 1)
Perm orTerrp
Feet
Square
Feet
Total Zone 1 Impacts: 2,106.00
Total Zone 2 Impacts: 1,209.00
Total Buffer Impacts: 3,315.00
Comments:
Buffer impacts depicted on attached document 17BP.1.R.86_Permit
Drawing s_Buffer_07302019
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project.*
Bridge replacement will stay on the existing alignment and traffic will be detoured
around the site by using an offsite detour. This will reduce temporary impacts to
open waters by not utilizing an on -site detour and keeping the road open. Impacts to
jurisdictional wetlands and streams have been avoided.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
NCDOT BMP's will be followed during bridge removal/installation and erosion control
devices will be installed to prevent sediment loss from the project site.
E. Diffuse Flow Plan
1a. What type of SCM are you providing?*
r Level Spreader
IF Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
r Proposed project will not create concentrated stormwater flow through the
buffer
r Other SCM that removed minimum of 30% nitrogen
1c. Diffuse Flow Documentation* Click the upload button or drag and drop files here to attach docurrent
17BP.1.R.86_Permit Drawings_Buffer_07302019.pdf 779.68KB
FtDF only
F. Supplementary Information ^
............................................................................................................................................................................................................................................................................................................................................................................................................................

Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
F Yes
r No
1b. 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 (NEPA/SEPA)?
r Yes
r No
Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated Wetland Rules (15A NCAC 02H .1300), DWR
Surface Water or Wetland Standards, or Riparian Buffer Rules (15A NCAC 02B .0200)?
r
2b. Is this an after -the -fact buffer authorization application?
r Yes
No
G. Additional Information
Please upload any additional information you would like the Division to consider during application review.
Additional Attachments: dick the upload button or drag and drop files here to attach docurrent
FUF only
Additional Comments:
Met onsite with Kyle Barnes, US Corps of Engineers, on 11/1/2019 to verify project
would not impact adjacent wetlands.
H. Sign and Submit �J
..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
By digitally signing below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act')
o 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');
o 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 application form."
Print Name:* Paul Collins Williams, Jr.
Signature
, 411r1—,,. Cam.
Submission Date: 12/30/2019
(Auto populated field)

Initial Review
Is this accepted into the review process?*
Is this project a public transportation
project?*
ID#*
Version:*
Select Reviewer:
Select Reviewing Office*
Has payment been received?*
O Yes O No
O Yes
O No
20191758
1
Garcy Ward: eads\g pwa rd
Washington Regional Office - [phone]
C No Payment Needed
r Fee Received
r Need Fee - send electronic notification