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HomeMy WebLinkAbout20100323 Ver 1_401 Application_20100510?o kcid MicttAd Lr?(?14r I c 0 0 r ?0 fo? ,mv?+resv;??? ???<<e 106k' Illy 64 At P(vjc(-+Cqfe? cos W-(( cis Joe kIL)44z t O.jke Pc)Ljer , T,ey cill Gjree. +?t L,worh il-eed 5 ?o be. do n #- be(oft 4c wc41 I fclis i t fo ??c I Cif lC„ of,? eroper4y Joe, k I v44Z sc?ld k e i., ooij o K 4 h-e- h I s 1,??? ?,•?f -?O ffeueo4 -e irv5;oo aoaW musk re14 hopes. \1 v ' Gl J1 ve S f r Orl S cc, f?'1 e U d cj Ycl 607 5-326 $PAID Dim MAY ? Min DEAR•MkfEmu sAw- WETLANDS AND VORNMMATER BRANCH .. s 4. . 770 ti t T rt v _y f i `? S r f ., k f ? ??? a y r 4 Sy e? \ y y? t I t +s ?.g,._,,. .'? ?-: off. ?•?, A„?' ?r }'? Ao w. K ,0 . w "Jill r??t` r lJ," T `1 IL - ? r. ti" .yT ? 4t1 t 't? a 'k'EakYt Sri r \ '- ?? t ? 1. ? •..? Y #?2..?.I _ f??R .?? fi?? _ _.a .___R? S y ??- ...E ? R V ?;? ii ???y -. y??_ . \ ti 1 >ilk 9r.. ? if., A d 1 e 4 ?p y 1 ? i a? s a A _ l -7W ak, i P71 fffr' eb AT ; 9 Y _ _, ?rn?-? .r- ;?, . 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Lsi ? ?fO.o. b O A r'te' fb Mips On Us N 7212 Right Angle St, Sherrills Ford, NC 28673-7767 N C a° vai a 5 Hyd" 9?, w 4 WOO 3 a x i ? cat 9 ? Nurn?ve Ct '14 Sf a a _ -a Lot Y G s m 5` C10? .3. rs s ?'''aa Reid hda u m 3 tJ) 4p",-6, G' 16 C a C Q fi ?j i? nl: 'pb Deer 110110:x' 600 yds ® 2010 Microsoft Corporation ® 2010 NAVTEQ C AND To r PC CCT h"://www.mapsonus.com/mapsonus/printMap-jsrOSRC= 4/21/2010 J J ?. cr W ? 3 ?4? QL J s • t a °' S S N i-?- ??m ?uR. wa ?14 `?? ' :'?- {' yr• ? ? P e Office i 465-8399 Pax 1 465-8962 (Please print or type) PROP1171 LOCITIOI Physical Street Address 01111!/l131IM: late _ Address I P.O. Box 389 Newton, NC 28658 Date J ^ 1 C \%- Wphone _( ) Telephone ( ) State License No. Classification of License Address city state lip SIBC01lt?CTORS - Ilec. Plumb. Nech. Plans Drawn By Telephone ( 1 Address City State Sip TYPI of 9t11CT M (check all that apply) ( ) Single family ( ? Dopler ( ) Apartment ( ) Condoainina ( ? townhouse ( ) Assembly ( ? Business ( ? Iducational ( ? factory I Industrial ( ) Institutional ( ? lazardoas ( ? Nercantlle ( ) Residential ( } }torage ( ) Other ! CLASSUICITI01 of NOR[ ( ) lew ( ? Addition ) Rezodel/Alteration ( ) Other TYPE Of CONSTRUCTION (circle) III III TV V VI Protected Unprotected total No. Sq. It. leated It. Unheated ft. (basement, garage, porcbes, etc.) lo. of Stories lusher Units Building !eight fireplace Openings Total to. Rooms Bed Rooms Bath Roots family Was Garage Area Sq. It. Basement Area Sq. ft. (Unfinished) (finished) Length of Pier Depth of later (Pier) 51111 MI (Check One) ( ) Septic Tank ( ) City Sewer/ Private system laze of System 11Th SIPPLY (Check One) ( ) Nell ( ) Community fell ( ) City late of system toils DISTRICT Set Backs: front Sides Bear The undersigned makes aapppplication for permits and inspection of work described and agrees to comply with all applicable state, county codes, and laws regal atimg the work and understands that a Certificate of Occupancy is required prior to occupying the premises. t"M IM f00TIIC, f01111flM. SLY, MEN, MUM, KKTRICIL PIlNIM, 11MIA.C. 31 111 1. cat, r) Construction Cost Ownert gestlt? Signature Permit fee Improvement Permit i CAMM 9 CM M IP11PLICATT101 Pot BIILDIIC PIRIIT tar lap father 1 /K Ihite-Office Copy Yellow-Applicant Copy PIYSICAL DIRIC1I01 TO 308 SITI IBUXT' t1?T-MiG; P1 n1,4.I_s1' CATAWBA COUNTY BUILDING INSPECTION DEPARTMENT P.O. BOX 389 NEWTON, NC 28658 (724) 465-8333 OFFICE # rmit dumber: 9632209 rmission is hereby given to: Contractor: SAME AS OWNER #200 r Owners HAGER, BETTY perform the following works s 465-8962 FAX # Issue Date; 05/16/96 Phone: 704/ - Project Desc: DENNIS & BETTY HAGER--OWNER/ PVT SEA WALL W/ ATTACHED SUNDECK/ ZONING SETBACKS 10 FT FROM PROPERTY LINES Class of work: NEW Valuations $ 200 the following locations Tax Map Parcel.: 125-2-44 Pin Numbers PIN 4607-03-14-5076.0000 Addreess 7218 RIGHT ANGLE DRIVE SHERRILLS FORD, NC 28673 Directions: 150E/ LITTLE MTN. RD/ RT ANGLE ST/ EL HBH1 Q & ON d be used ass PIER/DOCK - RESIDENTIAL S s¢itllRR YM SB MIUS 118A it 1Y SIDI pernit is issued on the express condition that the above work shall conforn in all respects to the statewents certified to in the apelit Futt pent, and that all work shall be done in accordance with all applicable zoning, building, electrical, plabing and techanical Ord, to County of Catartka and the State of North Carolina. .ait Issued for work under this Code shall expire by lieitations sit sonths after the date of issuance if the work authorized (NOTINGS 1 ;GNSIbIRED 134 I13d?S 19181 91 COIS4R0101i has not been cowenced. If after ccuencevent the work is discontinued for a period of 1: is, the pernit therefore shall expire. :LDING $ 35.00 'AL DUE: $ 35.00 M ` 1 ?1.. ?7"M- UU ING INSPECTOR 'r%V^ W . 1WFd 1T% / r% ^rAV..I4r' M 71A17R)f4 4% A AM A\R 1 ti; 5 "l t i X? R;j please a?prOXirmimal Y sketch the forow.g idoringlion on this plan ,? provide dkomnsionsfor each lten, such as 10 IL x 190 ttr 1) AN proposed „ag on dewft (povMe diiioi,siofkd 3) LoLocation cation of r p ? oorr to be e placed babove low the - Ftd Pond etaining 4 The location of any propomd structures such as bdMkN M relevation wallao docks, etc. 5} The location of any excavation or dredgag below the Full Pond 6j Location of construction access corridors. Oave, 141 DUKE ENERGY LAKE SERVICES EC12-Q P O BOX 1006 CHARLOTCM NC 28201-1006 704-382-1567 or TOLL FREE 1-800-443-5193 APPLICATION FOR PERMIT TO STABILIIAB THE SHORELINE IN NORTH CAROLINA Please type or•print and fill in all blanks. If information is not applicable, so indicate by placing N/A in blank. PLEASE SUBMIT APPLICATION AND APPROPRIATE DUKE ENERGY FILING FEE, PAYABLE TO DUKE ENERGY, TO ABOVE ADDRESS. L Applicant Information \ i A. Nana; J n 11 N V a.' --x C. V1 ?1 t c` B. Mailing Address 7 ?.. 11 ? ; 4 to 61., 6A er r i 1 IS Ford A1( 2903 c. Telephone: `lOy (d 0 -7 3 2 I -;t?o n e) i s4m j P: er ? 75-7 IL Location of Proposed Project A. Lake (Uor m-"h B. Street Address -7)-I X at gl. A lA it e S f C. County Ck?,wl? D. City, town, community or lark ?, E C C i?? c r E. Section I f A Lot # Subdivision ?i! f F. Directions to property by road N t3y w-- / ISO -+v ;-A1, g 4 in g o4d 41-, - !i_ -_ n;_, i A-, i A.. I- --I I G. Latitude and longitude for the project site :_ZS ° aS' M, IR" N H. Please submit a map showing the coordinates or a detailed map (USGS quad map, city map, etc,) showing the exact location of the project site. (NOTE: Latitude/ longitude coordinates can be found on internet site, www•naRsonus•com. Directions: Don't register, click "Maps", enter address, draw map, select "Map Clicking Will...", select "LattLong", click map) in. Description of Project A. Length of wall Ptftq I ()9 B. Material "T,4br,' c _ 4 C. Distance from property line/shoreline y IV. Intended Use of Project Area A. Private L B. Commercial A V. Applicant Signature Date ?- ) d ' a O r PLEASE NOTE THE FOLLOWING: 2 COPIES OF THE "DUKE ENERGY APPLICATION FOR PERMIT TO STABILI2E THE SHORELINE IN NORTH CAROLINA", PHOTOGRAPHS OF THE SHORELINE TO BE STABEL ZED, AND FIVE (5) COPIES OF THE COMPLETED "NC DIVISION OF WATER QUALITY PRE-CONSTRUCTION NOTIFICATION APPLICATION" MUST BE SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO: NC DIVISION OF WATER QUALITY ?LL 9 leg ATTENTION: CYNDI KAROLY PARKVIEW BLDG., 2321 CRABTItEEBLVD. klAy 4 RALEIGH, NC2760t 919-733-1786 DENR • WAFER OLIgLITy 0AN0s"YaAfa8WQ4 VAI f _Fr 20100323 The following is an abbreviated application form for those applying for a 401 Water Quality Certification to impact FERC (Federal Energy Regulatory Commission) regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used for wetland or stream impacts. Please provide seven (7) copies of this application and supporting information as well as a / non,refundable application fee to the Division of Water Quality of $200.00 for impacts of to lake bottom of leis than 1 acre and $475A for impacts to lake bottom of greater or equal to 1 acre. Applications should be sent to: Division of Water Quality Wetlands Unit 16M Mail Service Center Raleigh, NC 27699-1650 S PAID L Applicant Information 1. OwnedApplicant Mailing Telephone Number:? - (O -, Z4 Fax Num ' Email Address: C?f?t1V? uchCl tntc?F'('?f"-?e?', rle-- 2. Agent information (A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signatory authority for the owner/applicant.) Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: II. Project Information Attach a vicinity map clearly showing the location of the property with respect to local landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and development plans in relation to surrounding properties. You may use the diagram below to make a hand sketch of r ?. ,?:: your project. Also, we the example below for guidance. Both the vicinity map and site plan must include a scale and north arrow. The footprints of all buildings, impervious surfaces, or other facilities must be included. 1. Locadon. County ??1??`- Nearest Town: S*P?S L? subdivision name or site address (include phamU mm?ba):._ ki.. at Direc tions to site please include road numbers, landmarks, etc.t(ice is not necessary if an ~ vicinity snap isiacluded): AALj jC,h-{? U A& - - , - & - -,L 2. Describe the esis land use or condition of the site at the time of this app??; ri?St*??iMtRk. - t^P11r tcl1? of ? ? • 3. Property size (acres): 7 4. Nearest body of water (stream/river/sound/oceanl BW: LAk-& 14 O? non 5. Describe the purpose of the proposed woric SVW1f I tr1, *A.W(Za4 "tt/ 6. Lishe of equipment to be used to construct the project: 4 W Wtekr h? Cc _L 7. Amount of impact (including all excavation, backfili, rip rap, retaining walls, etc.) below the normal pool lake level in square feet or acres: r-I P O U t Da x 5461-deW 8. a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.) above the normal pool lake level and 50 feet laird-ward in square feet or acres: (D wV-b S l f' I _I QR b. Please describe vegetation above the normal pool lake level and 50 feet land- ward to be impacted. (number of trees for instance):, CY[?5? I IF F, - Appli 's signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided.) Office Use Only: Version March 08 Form USACE Action ID No. DWQ No. (If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".) 1. Processing 1. Check all of the approval(s) requested for this project: Section 404 Permit Riparian or Watershed Buffer Rules Section 10 Permit DWQ 401 Water Quality Certification Certification Isolated Wetland Permit from Express 401 Water Quality 22. Nationwide, Regional or General Permit Number(s) Requested: 3. If this notification is solely a courtesy copy because written approval for the 401 Certification is not required, check here: 4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII, and check here: 5. If your project is located in any of North Carolina's twenty coastal counties (listed on page 4), and the project is within a North Carolina Division of Coastal Management Area of Environmental Concern (see the top of page 2 for further details), check here: II. Applicant Information 1. Owner/Applic Information Name: "n (d a& Mailin A dress: 5+- kG 7e-1 CD-AO11Ca4-H 4hVl" New ke_z S-4,'.,y P;u -t'-5 # KM Telephone Number:7 -- b07-- ?r' 5Z(p Fax Number: E-mail Address: 3"q6 w bal to t c. (2 c iDr4ar. hef- 2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signatory authority for the owner/applicant.) Name: Company Affiliation: Mailing Address: Telephone Number. Fax Number: E-mail Address: M. Project Information Attach a vicinity map clearly showing the location of the properly with respect to local landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and development plans in relation to surrounding properties. Both the vicinity map and site plan must include a scale and north arrow. The specific footprints of all buildings, impervious surfaces, or other facilities must be included. If possible, the maps and plans should include the appropriate USGS Topographic Quad Map and MRCS Soil Survey with the property boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion, so long as the property is clearly defined. For administrative and distribution purposes, the USACE requires information to be submitted on sheets no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DWQ prefers full-size construction drawings rather than a sequential sheet version of the full-size plans. If full-size plans are reduced to a small scale such that the final version is illegible, the applicant will be informed that the project has been placed on hold until decipherable maps are provided. 1_ Name of project: tr re.?tacown4 uof rnL45K1?Q- buhW9W 2. T.I.P. Project Number or State Project Number (NCDOT Only): 3. Property Identification Number (Tax PIN): -?, r c e I I D y 60 7 O3 115 117 TAJ ACto,,y4 -* 1313 Gam{ 4. Location C _ , A i «S County: .ww' Nearest Town: Subdivision name (include phase/lot number): Directions to site (include road numbers, landmarks, etc.): . Ri "4 150 4V Ut f. MoMtlm UadWh,P•rl thz Mete, on 10pon '-tgh}- ANie. &?rer+ 3rA-homy on tef- Arr?ha - 5. Site coordinates (Lat/Long or decimal degrees):- (Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the coordinates for each crossing of a distinct waterbody.) 7. 9 n! g`iD W 149. ;Z9 w ?6 (3? 0 7 6. Property 7. Name of nearest receiving body of water: It?? f'1'1QIt 8. River Basin:. U WbA. QWCr &Sin (Note - this must be one of North Carolina's seventeen designated major river basins. The River Basin map is available at littp:Hh2o.enr.state.nc.us/admin/mal?s/.) 9. Describe the existing conditions on the site and general land use in the vicinity of the project at the time of this application: CeS i df,04 a L - rMC f (o pd-+t j Itne, 10. Describe the overall project in detail, including the type of equipment to be used: r,P =i&- AecHee ltd! i dsrf behlAcL cf to Crete - a = l slopes 5 atfz*te. -(tr'' 6prest,p sFa.,4,i laH.Ow 11. Explain the purpose of the proposed work: ?7lC1. ?.??n?Y1 W&tl -ro ptw?oe avdvps? b? use, Serb - tnft the lajk-f. 4ha? C?441- 6n.fp h{,cmai,s f w?ldlrTt?• IV. Prior Project to If jurisdictional determinations and/or permits have been requested and/or obtained for this project (including all prior phases of the same subdivision) in the past, please explain. Include the USACE Action ID Number, DWQ Project Number, application date, and date permits and certifications were issued or withdrawn. Provide photocopies of previously issued permits, certifications or other useful information. Describe previously approved wetland, stream and buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project, list and describe permits issued for prior segments of the same - T.I.P. project, along with construction schedules. 5??1niS Se+4y 4,e,;nctldfd W?Cn-Fhb vvutl., ?5 ?:tS-? ?0?5-?,+x.Yec? gin. ?Qf??lTht ?atl SP-Ins Gcro55 _7X18' 7111 , r,?d W,r4 of -7208 kli? 'w, Anyi? srV. Future Project Plans cos seta e, rec.t (n-4. ,-c vdfd , Are any future permit requests anticipated for this project? If so, describe the anticipated work, and provide justification for the exclusion of this work from the current application. VI. Proposed Impacts to Waters of the United States/Waters of the State It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to wetlands, open water, and stream channels associated with the project. Each impact must be listed separately in the tables below (e.g., culvert installation should be listed separately from riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts, permanent and temporary, must be listed, and must be labeled and clearly identifiable on an accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial) should be shown on a delineation map, whether or not impacts are proposed to these systems. Wetland and stream evaluation and delineation forms should be included as appropriate. Photographs may be included at the applicant's discretion. If this proposed impact is strictly for wetland or stream mitigation, list and describe the impact in Section VIII below. If additional space is needed for listing or description, please attach a separate sheet. 1. Provide a written description of the proposed impacts:Akae- 2. Individually list wetland impacts. Types of impacts include, but are not limited to mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure ,._a n--A;-- 011 n culu ii Wetland Impact Site Number (indicate on map) w?aau / Type of Impact Type of Wetland ?'Pe (e.g., forested, marsh, herbaceous, bog, etc.) Located within 100-year Floodplar (yes/no) Distance to Nearest Stream (linear feet) Area o Impact (acres) Total Wetland Impact (acres) 3. List the total acreage (estimated) of all existing wetlands on the property:-A(A, 4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included. To calculate acreage, multiply length X width, then d'v'de b Al 560 MA , ii Stream Impact Number (indicate on map) , Stream Name ype of Impact Perennial or Intermittent? Average Stream Width Before Impact Impact Length (linear feet) Area of impact (acres) Total Stream impact (by length and acreage) sounds, Atlantic Ocean and any other water of the U.S.). Open water impacts include, but are not limited to fill, excavation, dredging, flooding, drainage, bulkheads etc GL' Open Water Impact Site Number (indicate on map) Name of Waterbody (if applicable) Type of Impact Type of Waterbody (lake, pond, estuary, sound, bay, ocean, etc.) Area of Impact (acres) Total Open Water Impact (acres) 6. List the cumulative impact to all Waters of the U.S. resulting from the project. "Z e _ Stream Impact acres : Wetland Impact acres : Open Water Impact acres : Total impact to Waters of the U.S. acres Total Stream hn t linear feet : 7. Isolated Waters Do any isolated waters exist on the property? Yes I') gowDater k, Describe all impacts to isolated waters, and include the typ(wetland or stream) and the size of the proposed impact (acres or linear feet). Please note that this section only applies to waters that have specifically been determined to be isolated by the USACE. 8. Pond Creation nlG-? If construction of a pond is proposed, associated wetland and stream impacts should be included above in the wetland and stream impact sections. Also, the proposed pond should be described here and illustrated on any maps included with this application. Pond to be created in (check all that apply): uplands stream wetlands Describe the method of construction (e.g., dam/embankment, excavation, installation of draw-down valve or spillway, etc.): Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond, local stormwater requirement, etc.): Current land use in the vicinity of the pond: Size of watershed draining to pond: Expected pond surface area: VII. Impact Justification (Avoidance and Minimization) Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide information related to site constraints such as topography, building ordinances, accessibility, and financial viability of the project. The applicant may attach drawings of alternative, lower-impact site layouts, and explain why these design options were not feasible. Also discuss how impacts were minimized once the desired site plan was developed. If applicable, discuss construction techniques to be followed during construction to reduce impacts. VIII. Mitigation DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC Division of Water Quality for projects involving greater than or equal to one acre of impacts to freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial streams. USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide Permits, published in the Federal Register on January 15, 2002, mitigation will be required when necessary to ensure that adverse effects to the aquatic environment are minimal. Factors including size and type of proposed impact and function and relative value of the impacted aquatic resource will be considered in determining acceptability of appropriate and practicable mitigation as proposed. Examples of mitigation that may be appropriate and practicable include, but are not limited to: reducing the size of the project; establishing and maintaining wetland and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of aquatic resource functions and values by creating, restoring, enhancing, or preserving similar functions and values, preferable in the same watershed. If mitigation is required for this project, a copy of the mitigation plan must be attached in order for USACE or DWQ to consider the application complete for processing. Any application lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete. An applicant may also choose to review the current guidelines for stream restoration in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at littp://h2o.enr.state.nc.us/ncwetlands/strmgide.htm1. 1. Provide a brief description of the proposed mitigation plan. The description should provide as much information as possible, including, but not limited to: site location (attach directions and/or map, if offsite), affected stream and river basin, type and amount (acreage/Imear feet) of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view, preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a description of the current site conditions and proposed method of construction. Please attach a separate sheet if more space is needed. -4/ae 2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at (919) 715-0476 to determine availability, and written approval from the NCEEP indicating that they are will to accept payment for the mitigation must be attached to this form. For additional information regarding the application process for the NCEEP, check the NCEEP website at http://h2o.enr.state.nc.us/wEp/index.htm. If use of the NCEEP is proposed, please check the appropriate box on page three and provide the following information: / Amount of stream mitigation requested (linear feet): nco`' Amount of buffer mitigation requested (square feet): Amount of Riparian wetland mitigation requested (acres):_ Amount of Non-riparian wetland mitigation requested (acres): Amount of Coastal wetland mitigation requested (acres):_ I. Environmental Documentation (required by DWQ) 1. Does the project involve an expenditure of public (fede te/local) funds or the use of public (federal/state) land? Yes No 2. If yes, does the project require preparation of an environmental document pursuant to the requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)? Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA coordinator at (919) 733-5083 to review current thresholds for environmental documentation. Yes No hta-, 3. If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a copy of the NEPA or SEPA final approval letter. Yes No ht?- X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ) It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to required state and local buffers associated with the project. The applicant must also provide justification for these impacts in Section VII above. All proposed impacts must be listed herein, and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ Regional Office may be included as appropriate. Photographs may also be included at the applicant's discretion. 1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233 (Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B.0243 (Catawba) 15A NCAC 2B.0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please identify? Yes No a/&, 2. If "Yes", identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer mitigation is required calculate the required amount of miti 'on b applying the buffer multi 'ers. Zone* Impact (square feet) Multiplier Required Mitigation 1 3 (2 for Catawba) 2 1.5 Total * Zone I extends out 30 feet perpendicular from the top of the near mK of cnannei; c.onC z extends an additional 20 feet from the edge of Zone 1. L If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as identified within 15A NCAC 2B .0242 or .0244, or .0260. - ?h XI. Stormwater (required by DWQ) Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss stormwater controls proposed in order to protect surface waters and wetlands downstream from the property. If percent impervious surface exceeds 20%, please provide calculations demonstrating total proposed impervious level.- ill6k- XII. Sewage Disposal (required by DWQ) 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. n10- I. Violations (required by DWQ) Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules? Yes No Is this an after-the-fact permit application? Yes N(?o? XIV. Cumulative Impacts (required by DWQ) Will this project (based on past and reasonably anticipated future impacts) result in additional development which could impact nearby downstream water quality? Yes 0 If yes, please submit a qualitative or quantitative cumulative impact ana ysis in accordance with the most recent North Carolina Division of Water Quality policy posted on our website at httL://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:- XV. Other Circumstances (Optional): It is the applicant's responsibility to submit the application sufficiently in advance of desired construction dates to allow processing time for these permits. However, an applicant may choose to list constraints associated with construction or sequencing that may impose limits on work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and Threatened Species, accessibility problems, or other issues outside of the applicant's control). if-- is Veiq un s-ablc,, SeeaMa Aed-,powes (61 ? *,Z?- to Applicant/Agent's Signature " - Date (Agent's signature is valid only if an authorization letter from the applicant is provided.)