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HomeMy WebLinkAbout20140561 Ver 1_Application_20140604a } x � �� � �a d ��� �� � j��"+� � � � �}�� ` �`� ���r � �T�TE C��' l�t�►I�..`�� +���.CJ�I�A I�:�P.��.T��,��I' C�� "���l��a�'C��.`�A�'I+C�� PAT �c��.tJ►�.�Y` �'. +C3. �t�� �.S��J �, I�',�,I�i�k� :�� �?� I 1 �-�2t�2 TC��+�`�' T''A�'A ���';ERi�TC�R I�':HtJ�:E: '� 1'�—'733—��2� S:�CRETA�..� - • � � :��ar. A�:�� �V�Til��aan� �. � . A�y t��r�� +��" �,�:�%�.�er� �:�+�igh 1��,��.�ata� �"ie�t� t���+� � � � � �eri�a�� '�r�d+� �►r�v+�, ��it� �. C� � '�4��:�e �'c�r���t, I�T� �?�8'7 �ub� �ect . :��.�i+�r��c�e �'�r��� � �. 3 �:�. �. � 1 � �l�►p+e �'�,i1�u�r� �JV��.�au,�a C��u��r, ���h �a�+�lir�a �`ra�j �c� �ur��a�r: 11...,�.U��+��� �l'�� ��!�t;� �'�er�m�� :��t�uYr��� I�►��.r l��r. '�'Vil�i�,n��: T'h� �+� :�ep�artm+��:t a�' i'ra�a:s�+c�r��tic��: ha.� �+��p1�t�� r�p��� c�r� �. ���:1 ��i�� ��.��+��r�� �t� ��i� ��'�ta�u�� �'��r+�� (t�l�a��: �; "�'r��r�� �+��V'�� �:+��� �t�� ���►�+��t r����. �"�u ��r� ���i�.�� ��� �rr�:��� c�� �,� 111 � �t�.at vc�� vv�r� ��c�c���in� wi��i r���i�� ����c� ��� r�c���. ��� �� ���1. �"�t�� c�i������ +a�' �►��% �ar��.c�r��.,� �v�� �.��re��:ma��+��y � 0 �x�n+�ar �"+��� o �"�i.s pr�j��� �w�.� v�� lir�ut+�d. ir� s�a►pe ��.d l��d n+� e��c� �►n �n� �"�d.�ra��y �i��+��d �n�+��r����re�d �l�r�� �r �:�na�l ��►+��i��. '�"�� �r+�j+��t im�a��� �.�°+� r�a��t �i,�r��.+��:r�t �� ���t��+� ��� �1��►u���. ����r�►�r� ����� �u�.l�t� b�r �e�i��a�ti�.� t�:� +���+ain,� �erc����� i����. A�it���:�d i� �. �'r��+�n�tru�ti�� 1'��til���.ti�� �"�r��., a �r�r.�k�d �t��+���ra�►�i� :�a� ��.d ��i+��+�,��r���is. �Cy �c��►y c��'t�is +e�+���rc�r�ic l�e�tt+�r, it is� requ��t��: �I��,i �!�s. ����� ��.�a�.�►��r� �v�1��. ��� ��+��t�a. ��ar+�li�:�. �x�+�li�'� �:�s�au�r��s +��mr��issi+��. �c���rr��r�t d�rect��r tt� �c�� +���.�c�r��i�.� �h+� �t�4� :�����►���.� ���r���. a�p�i�aii�n �%t� a cc��►� s�nt �a m.�e. ��' ���+�r i��'�r��a�ic�n i� r�q�:ire�, p�+��.se l�� �ra.e ��+�v�. �''�►�r ��r�� r����� �:�.�. ���s�id����.���� ��� b� a�pr����.ted. �i���r��y� � � ����t� �I�u�h�t�� :�i�.si�►�: ��.�r�r�►��+��.ta�. t�►:����r F. C�. ��o� �.�t�, N. 'i�"�.,:����c�Ra, �� �8��9 P�ct��:� (33�� �f?'�-��.11 F� (�36� ��'�-4��� l��r. Afir�,d� �i�V'illia��n:s 5:�.111 �, �"�tt�ug�, S�o�►+� F"a.ilure ���� `� �ta�� 4, �t� 14 ��:��+��ur�� cc: ���rla +�ha��b►��r�, N��V��.+� .�►��y t���pn���, I�iv�sic�n c��''�'��.t�r t�ualit� �� �cc��i+�s� �k:� �'��ty�j+��r�� �'�,, �i�.���►� :��.�i��er :�Jca�,� �ll�er, ::����tri+��t :���in��r �evin �i�:�t�t���tc��., t��u�,t� i1��.i�t��a:i��� ��.�i�.��� ��e�t�. �l�u,�ht+�r, :�►ivi�ic�r� �r��vir�,nar�+�r���.l t���.�+er :��il �'ri�r��t�, :�+aa�s��+�� �,r�virc�nar��n��l :�i�l� +�►��rati+o�� ��.�ir���r "� ro �i Y'� ur � a a'� iF 4v- i r �SY��� r� M'�6� �US�C �' �Si2 G�Uyt��.n;�i d � �` g � � y��w� ��;,��4����� �3� ��!? �����`,�"i�i?s'�� ` � ����b�=� �,, ��i �� � �¢ � q �� ��� �� � � � k�e, � �� ���� ;� , �.�' ��F�'g r'� ��tn f{ir�s�;vM1�ti� t�?4i"�2"3i��l��t� ``� �o� fj .� 9�,��ti� ��� 1 �� .M�'� �, ��. � � E � � '� :. � t'�'�G� ��►�* '�iC1l�f: ���"'�iS ��10►1"'t i C� t"1t�, t�V�'C�: pr�►jecfi nc�. �t��"� �'l�f �lOC1 'i . � �i�»'C i C� �Q�}� �`re-�t�o�stru�tion ���.fi+�a�i�� �`�� �'+��� A., �. �i�an:t Infi�rrnr�ti�n 1. �`r�►+�+�s�i�� �1 �. T"yp���� +�f �pprc�val �vu��t frc�m the ,��cti�r� ��� Perr�i� �+�+��t�n � t� �"ermi� , � � Carps. 1 b. �p��ify �rl�tianwic�� P+�rmit ��JI�'��'} r�u�mb�r. '�'� c�r �en�ra! �'�rmit �ta�'} numrber: 1 c. Has the Rll'1�11'i� c�r t�P numb�r be+�r� v�ri�i�+d �y �he �c�rp��` � Y+�� � Na 1 c�. Typ�e��) of appro�ral souc�ht frorn th� C�W'4� �+���e�k a�l that �pply�}: � 4�1 W�ter G2uali� +�erti�i��tic�n � �+�gu��r � ��r�-4{�4 �luri�di+��i+�rt�l Cener�l I�ermi� [,� 4�� V11�t�r Qu�l�ty ���if+��ti+�n -- Expr�:�� [� F���a�ri�r� �u�'�r Au�hc���at'ra�n '1 e. 1� this na�ifr�atic�n sc��ely fic�r the c�cc�r+� �`ar th�e rec�rd v�ly fc�r QV"�Q �Q'� ��r th��e r�c��r� �r�ly f�►r C��rr�a� P�rmit. �e+�aus� wri�ten �pprc�val i� nc�� requir+�d'� �er��f c�tion: � Y+�� � �lc� � Yes � �1+� � f. i� paym�nt ir�t� a m�tigatia►rt ��r�k c�r ir�-1i�� �e+e p�r+�c�r�m p�rc�p►c��+�d f�r �ni�e���a� � 1�';�� ��� �►� imp����'� If �o, attach the ��c�ptarrc� ��tter frc�r� mi�����n b�nk vr �n�ii+�u fi�e program. 'I . Is� th�e ro'ecfi I+�c�t�d �r� �n o� �tC's finr+ent�r +����#al �aur�t�es. If y�e�, an�vrr+�r 1 h �`�'+�s ��� � � J '� b�+�i�►vr►. 1 h. l� the p�r�►ae+ct lacat�d wi�hin a NC C�+�t� �re� r�f �nv�r�►nm�n�a�� ���c�rr� ��►�t��'� ��`�� � 1�+� �. Prr�j�ct inf+�rma�tic►r� '�a. �lam+e c�f prt�je+�t: �R '� �[ 1 � �Ivpe Failur� '�b. �ouniy: it'�fat�u�� '�+�. �le�r���t muni�ip��lifiy ! �towr�. V�1l� �ruc�� Zd. �ubdivis��n name: 2+�. Nt�C�C�1� only, T.I.P. +�r �tate 11 �.4����� p►r� je+�t nc�►: �. C�wn+�r �nfc�r�rrr���c►rr 3�r. IVann+e�s� �►n �:�c�rd��! C�+eed: N�C���" '3b. D�ed �c�ak and Pa�e �o. 3�. �e�pc�n�ible P�rt�► �for LLt� ifi �p�Plicabrle}: 3c�. �treet �ddre�s: 8t�'1 �t�t�svilfe �c�ad 3�. �ifiy, �ta�e, zip: �Uc�rt�i 1�#���C+�sbr�r�►, N+� ����9 3f. Tel+ephon+� nc�.: �" ��-�t�3-9�t�'� ��. �ax no.: 33�-��?'��r4� 3h. �.rr��il ad+dr+��s: hslau�t��er+(�ncd�#.�+�v ��g� �. �►f � � ���I �`�►rr� � 1��r�i�►n 1.3 t�e�+�m�r � �, ���� V����� 4. l�i►ppli��nt �nfc���tic�rr �if di�f�rer�� �r�►m c�w►r�+�r} ��. �►pp�icant i�. � Agent ❑ C�er, �pec�f�: ��. Nar�n�: 4c. �u�ine�� narn►� ; ��f appli��bl�}. 4d. �tr+�et �ddr+e�s: 4�. �ity, state, zip►: ��r� {� VR�����V► ��r• ��. ��� 1"1t�.: 4�t. �rrlall at�dre��: �� Ag+�r�tl��►rr��u�tant Inf�rrr��tican ��' app1���+1e} ��. �I�m�: �►k�. �u�ir�e�� nam� �i� ��plic�ble�: �c�. �tre+�t addres�: 5d. +Cifiy, �t�t�, �ip: �►e. �"+�i+�p�h�►r�e nc�►.. 5f. �'�x n�►.: �g. �,r�ail ad�dr���: �►��_ � �, � � � � ; ,� � �� r �� � � - �, - �#���� � 1� i :�, � �� � � E3� Prc�j��t �r�form�titarn �►nd Pr�a►r �rt�j+��� �i��t+�r�yr �1. P`rc�per�y Id�:r�tifi+��tion '1 �. F'rc�perl�� iden�i�rcat�+�n n�. �ta�c P�N or parc�� iC�}. . . . . , I..a#�UC� `�..'• �" �.21 �`?9 C.Cii�lc�itl�C��. ~ �'� •�%8i+$Ct�4 1 b. ��fie caordrnates {�n +�ec�mat d+�gr�es�. (C��}.C�DC�DC��} �-[�C�.C�[�[�t�C�C3} 1�. I�roperty size: i�.�l a�cre� 2. �ur�a+�e Wa�+�r� �a. l�am+� ofi ne�re�t b�dy of water ���re�m, riv+�r, �t�.� to ti�'�t�u ��iv�r prop+�s+ed pra►je�t: � 2�►. Water Gtuality ��a��i�i�atic�r� c�f neare�t re���rin� w�t�r: +�; Tr�ut, Ht�VIJ' 2+�. �iv�r basin: 'I�l�#�u�a �. P rt�j�ct D��cri p�iorr ��. D+�s�cr�b+e th� existi�tg c�►n+d�tio�s r�n the ��te an+d �he gen+�ral ��nd �us� in th� vicir�� af th+� p►r�j�ct a�t �e �tim+� Q� fihi� applic�tion: �'a�ved re��d w�th gr����d �hc�uld+�rs in a rur�� s�tting alc�ng a t�� rc�c�#+�. 3k�. L.is�t t�re to#al +��tirr�ate+� acr�ag� a� �i� +���stin� �v���n+d� c�n �� p�r�►p�r�y: t3 acr�� 3c. Li�t the �atal e�tima�ed �ir��ar feet �f �tl ��ri���g st�ear�s �int�rm�itt+�r�t artd p�renr�i��} an the �r+�p�rty. �t���r� paralle�s ro�d 3+�. Expl�ir� th+� purp�►�e �f the prc�pr���ed prv��+�t: �tabiri�+� �h+aul�d�r ar�d r�c�adw►�y� 3e. C►�s+�r�be the �v+�ra11 prv►��ct in detail, i��ludi�c� th+e typ� c�f +e�qui�r�+�r�t tt� b� us+�c�; See att�ach+�d +�c�ver ��tter. 4. Juri��i�+�ti�►n�l [�+�t+e:rrn�in�ti�►�s 4�. Have jur��dict�+�na� vu�etland r�� strearn� d�t��rirn�n��or�s by the t��rp� or ��a�e k�eer� requ��ted c�r c�bta�r�+�� �c�� t�i� prc�per�y►1 r�'ect ir�cludin all r��►r h�a�es in th� ��t�' � Y'�� ��� � l�nknr�wn p 1 � 9 � i� } 1� ��r�m�r�t�: 4b. If th�� Cc�r�s rr�ade th� jur��dicti�n�l d��fi�rr�inat��►n, rrvh�rt fiy�►� �r+��im�r�� �'ir�al . . � �'J rY � of d���rr��nat�a►n �v�►�.� made . 4+c, If yes, wh� �eiin+eated th+� jur��dictit�nal �re��? ���r�+�yl�onsul��ir�t +Cr�r�par�y: �Jame �if kn�►wn�: �'�+��`: ��d. 1f y+�s, list the dat�s �►f the Gc�rps jur���dic��rnai d�terr�ination� �r ��t� +d�t�rmin�tivns and �t���h dc��ument�ti+�rr. �►. �'rc►j+��ct M i�t+�ry 'Sa, H�ve permi�� c�r +�e�t�fi�c�ti�ns b�e�n reque�t�+d �ar obt�in+�+d �or �,� Unknc�vrr� ' ' ' ' rior hases in th� �s�"? � Y"e� � [� th�s pr��ect ��n+clu��ng �11 � p � � 5►b. �f y�s, e�pl��n in det�xl a+�+�c�rding t�► "h+��p f���'� instr�ct�c���. �'. Futur+� �r�rje�t Plar�� �a. Is thi� � p►ha�ed prc�j�ct? � Y'es � l�Ic� �b. If yes, e�cplair�. "`.�;. • i '� � - • �� � •: � i1«� � � �t Prr�p�►se+d lmpact� Inven#ory 1. Ir�pa+cts �ummar�r 1 a. Vt�'hic� s+�+c�ia►n� �w�re �c�►nrrpleted ��lov� fc�� yr�ur pra���ct �ch+�ck �il th�t app�Y�: � W�etlands � �tr+��ms �- �rib►ui�ri�� � B+uf�ers � �pen 1Nater� � P�r�+d t�+�n��ru+�tivn �. V'U+��and lmp�ct� [f ther� are w�tl�nd impacts prap��ed on th� ��e, then connpl�te th�is que�#i�►n f�r ea� rnr��ar�d ar+ea imp�rct+�d. 2�. '�b. "�c. ��. ''�+�. 2�. WetE�n�d impa�t Ty�e c�f juri�di�ti�n number — T�ae c�f impa�� T�pre c�f vv���nd Fore�ted ���rp� - 4�4�, 1� A►rea afi ir�pr�+�� F�ermaner�t �P} �r �if �Cnovtim} C�1NC� -- r�+�n-4��4, o�her} �a�r��� �`�m �r� T � �'+�� � �orps '�`1 ❑ � �� T hi�o D�#'G� � � � Y�s j� �orp� u�r� p � � �r �� ��vc� � � � `�e� [� �+�r�� 1�V� � P � i �o Ct'�t� � � � Y+�s � t� o�� 'V�'�' � P � T r�� �U�kt� � � � �e� � +��►,�� v�►� a� L�I -r c�� t��r� 1� � t� � Y+�� � �:c�r�►s �'�l� � � � �' �t� C�V'��► � � C`� ��. Tota1 we�tl�d i�np�+��s �h� �o�r�n�nt�. 3. ,�tr�e:�m Imp�+�� I� th�r� are per��ni�l �r �ntermit�ent ��ream impa+ct� {�n��u+d�r�c� temp�rary impa�t�� �ra�a+����d ar� the �i�e, th+�r� c�om�p�l+�t+� thi� q+��stic�n far a11 ��ream si�e� impact+�d. ��1Aw ��.+Ir �Ya �Mr � �iRr ��• . . .��• . . �tr��m imp�ct 1"yp� of inrrpact �tr�arn rt�nr�e F�er�nn�a� Type c�f jurisdictian Av+�r��� Imp��r�t number � {t��R� or ���rp�� - 4��, '� t� �tre�m l+�n�th Perman+ent �1�� vr in�t��m�ttent DV11C� �- nan-4�4�.y wi+�� �I�r�ea� T�r�np�rary ��} �INT�'� �►�h+�r} �fi���t} fi+e�t} . . � PEi� � C+�rp� ��1 ��i P [�j T ��prap '�ata�ga ��ver I�VT �3'�11C� �� �� � � � PEl� �� t�c�rp� �'� �,� t� [� T 1 �T �►'�i11C� � � � P�R � �cy►rps �� D R Q �r � ���r � �w��t � P�I� � ��rps 54 � P � T INT` �V1�Q � � � PE� � C��rp� �� � � � T I�`� C�WC� � � � PEF� 0 �c�rp� �+� � P � T I�T C}UVt� � � ��.. '`�+�tal �t�~eam and tribu�tary impacts �►t� '�Ir �C1i"1"li1"1+�'.t1iS. �'��+�' � C�� i � �''�hl �t�►i�r � '��r�i��o '� .� �����b�C � �, ��t�� V'�r���� �r' V�11 ��fr "�'� �1'�'1�i�1�wJ►W If th�r� are propc�sed impa+�t� t� lakes, pond�, e�tu�ries, �rib�utari�s, �c�un+ds, the ,A��n�i� t�ce�n, ar a�y oth+�r c�p+�n w�t+�r c�f the U.�. �en ir�dividu�lly list �i� a►p��n virat+er im�a+ct� belavrr. 4�. 4b. ��. �4d. �e. C�p�r� w�t+�r Nar�ne c�f waterba►dy ir���+ct nunr�b�r �- �if appli�cabr�+�� Typ+� af ir�p►�ct '411�'a��terb�►dy ty!�e� r�r+ea� �f irr�pa�t �a�cre�� �+�rm�n+�r�� �P� �r T+�m �►ra T' +�1 ��'[�T C)2 � �` �] �` C►3 �P'�T t�4 � P [�] T 4f� Tc�tai open vv�ter� �mpa�t� �4g. �c�mrinents. �' . Pc�r�d c�r L,�k� �+�r��tr�r+�tic�r� �f v►nd c�r lake cc�nstru�twiarn r+� osed� th�n +�om I�t� th+� �h�� b�lcaw. ��. at�. 5�. �►c�. ��. 'V'1tet�and �mp�act� �acr+�s} �tr�earrr Im�a+�ts �feet� 1J�►1ai�+� �c�nd IC� Proposed use c�r p►urpose ��c�r��} r►um��r �tf pon+d Fl+�c��ed �'it��c1 ��c+�av�t+�� Flc��ad+ed �i11+ec� E�+��va��d �'Ic�c���d �'� �� :�f� T"�r��i ��. C��mrr�enfi�: hJlA 5h. I� � d�m high ha��rd p�er'r�n�t requir�ed? . � ''t�'`�s j� �1a If yr�s, ��rm�t �C� nc�: �►i. �xpe�t+�d par�d �urfa+�e �r+�a ��cre�}: 5j. �ize c�f ��rnd �va�ter�hed ���r��): 5k. Meth+�d �f +c�r��truc���n. �6� �3�rff�r Irir�pa��► (f�r D1Nt,�� l�f p�rc�ject rnrill imp���ct a pr�►t+��ted ripari�n buffer, tl�en cc�rr�p��efi� t�� cha�rt b�+el+�w. lf �r+es, then ��rdividual�y li�� �li bufi��r imp��� k�e#t�w. !f an im �ct� re uir+� mi� ati+�n, then �►u 11�I1��'i" ��i c�ut �'+�c#it�r� C� c�f thi� fic�r�. 6�. ��u�+� `T�r-P�mli�o t�ther: � 0 � Pr+�ject is in which prat�c#e+d �►asin�` � t�at�wk�� ���r��1+�man �b. �c. �d. �+�. �f. �c�. �u�fer �mpact r�umb�r � R+���c�n �c�ff�r ��►n� 'i impa�t �c�n� � irr►p��� I�ermanent �P� c�r f�r �tr��m n�me r»�g�fic�n ��quar�e fe+�t� ��q�ar� f��t� Tem c�ra T im �ct re uir�d'� � �'e� �� ���� r�� � r� � ��� �� � �' � � r�� � � `�e� �� �I �► p � �v� � ��►. �r,a►��a ��t��� ����.�,�� �61r trUi"i11"i"i+�t"i"t�• I�a�g+� � taf 1 � ■ �� ���� �� i� � '���� { r� �M'��������■ � '4/ � ��\rl�� �7✓�V'��� D. 1nr�p�+ct Ju�ti�ic�►t�an �nd �it�g�tic�r� '� . Av+�i�i�r�c+� and Min�rr��z�tiar� ��. �pe�i�ic�ily► c���+�r�i�►+� mr�a��r+�s t�k�n t� �vc�id �►r mir�inni�e �� pr+�pa►��� i�p�+ct� ir� +�e�ig�r��nc� pr�j�ct. R�pr�� ler�c�th w�s t�►e mirrirnc�m► ne�de� t� �#��►i�i�e th+e �lop+� fi�ilur+�. '1 b. �p��ificalty describ►e m�e�r�ure� t�ic+�n t� av�id or m�r�im��e th� pr+�p+���d fmp►acl� thraugh c�►n�truc�ti�an �fi��hniqu+��. l�l arp�propria�e BM�'s �rvill b�� u��e� during cc�r�stru+ction �. �Gc�mpr�:n��t+�r� Miti��tic�r� fc�r �mpra�c�t:�► tc► V�t�t+�r� c�f f�r� U�,S. ar Wat�r� c�f t�� �t�te �2�r. Ci+��s the prc�j�ct r+�quire �nmpen��t�ry 11�it�c�ation fi�►r ��`es ��o i r�n pa �cfis t+� il'�ater � of the �J .�.+�r 1tll�iers t�� i�►� �t�te? �b. If ��s, rr��i.ti�atic�n i� r�c�.i�ed �►y �ch+ec� all th�t ap�p���= � CC��%�l►C� � E�t�t�� � �itigation bar�k 2+�. 1� yes, vv�hich mit�gatio�n option will b�� us�c� ft�r this Pa rr��ent tc� ir��-1�+�u fi+�e rc� ram rc�'ec�t"? �..� Y p � � J � P�rmiit�e �+����r�sibte Mitig��t�c�n �. �r�mpl�te if U�in� a �li��ga�ic►n B�nk '��. I�am� c�f �li�gatiar� �arrk. "�b. �r�d�ts Purch�sed �atGG��h� rec�ipt and I�tter� °T��� C�u�ntityr �+�. t�ommen�s: �. +�arr�pl��+� �f Mal�ing � Pay►��t�r�t �t� �n-��eu �'�e �'r+r��m �4�M Apprc�va� lett+�r �rc�m in�-I�eu f�e� prac�r�m �s �tta�hed. � Y`�� ��►. �tream miti��fiior� r+�quested: ��n��r f+��t 4�. If u�ing s�tr�am mit�g��iarr�, �tre�rr� temp��r��ture: � rn�arm [�� +�aol Qc�ld 4+�. Buf��r �i�tiga�c�n r+��ue.��ed �D'U'�Ct ar�ly�: sq��r� �ee�t �4�. ����ri�n r�ve�l�nd rr�i�gati�►n requ�sted: a�cr�� �4f, �+�r�-ripariar� we�ar�� mit�c�ation re+qu�e�t�d: ��r�� �4c�. �r���t�l �tidal) we�ian+d mitig�tion requested: a�r�s 4h� t�ammer�t�: 5r. �annpl�t� if U�ing � Permitt �. R�:�pc�ns�ble I'�iti��ti+��r P'I��n �a. �f u�inc� � perrrii�tt�ee r�sp��►n�ibl� miti�at�an p�la�n, �r�vid� a c�escriptia►r� of the pr�pvsed rrtitig�ti�n pl��. .w�„ ,� � � � • - .• !• - �- 1 �i» � � �. Bu�r �itig�ti�►n �5t��e t�+�ula�d Rip�►r��n 8�r1��er Ru�+��� -- r+�uir�� b�r 1�W`t� �5a. V�1E'ill the �►rc�j�+ct r�s�i� ir� an imp�rct �vit�ir� a prc�t+�cted riparian buff�r f��� r�quir�s Q`�'"es ��Ja► b�uff�r rni�ti�a�ic�n'� �b. If y+�s, then ic�entify th+e �qu�re fee�t c�f im�a� ta� e�ch �an+� +af the �p�����t bu�er t�rat r+�qt��r+es mitic��ti�r�. ����ul�rte th+� amo+�nt �►f mitigatia►n requir�d� �+c. �d. �e. R��s�n far impa�# "�'c�tal impa�� �u�ipfi+�r ��quir�d rr�itigatio�n Z��� s u�►re fe+�t ��are f��t c� � i�► � ���� � � �� ��� +��t���� ��►�� � � .� +�f, 'f�►�t� buf�+�r m�ti���c��r ��uir��d: ��. !fi bu�fer m�tig�tir�n is required, discuss wh�t �� c�f rr�i��a�an i� �rap�c���d {e.�., paymer�t t� �ri�rate mitig�ti�n bar��, p�rmittee respan�ibl� r�p�ri�n buffier re�t�t�ratic�n, p�ay►r�ent in�t� �n a�p�rc�ve� in--1��eu fe� �urtd�. �6h. C�+�mm+�nt�: »��,,. ,� � �' ,� - �► � - � � � +� � i� : - • �� �tarrnwater Ma�rr�aa�+�m�r�t �nd �i�f�us+� �1a�r Pta� �re�uir+� b�r [�'1�'1�'Q� 1. C�if�us�e FI+�w► F�tan '[ �. C�c�+�s i�►e projec� [n+�lude c�r i� �t �+�j2�c�nt t� prate�ted: rip�ari�rr� bt�ff+er� �denti�ied within c�n�e c�f the i�+C Ri ari�n �uff+e� I�ro�ect�crn �uie�"� ��'�"� (� No � 1 b. If yes, �then i� a d�ffu�e fl�av�r p���n includ�d"? If rt�►, e�c���in �u��� � 'Y"es � 1��► " �ommenfis: 2. ��c�rrnw���r �lana +�m+�n� Pla�r� '��. 1Nhat is the av+�r�l� percent �r�rpe�vic��sn�ss �►� th�s prc��+�c�?" °'!� "�b. CJo+�� this praject r+equir� �,�t�armw��+�r 1l�anag��ment P�ar�"� � Ye� � N� 2�, If #l�is praject C�i��� �I+�T requir+� a�tarmvtir�ter M�na�e�+ent Plan, exp►la�n wh�►: Les�s than 1 acr�. ��. �f �is prc�je�t Dt��� require a:�t�armwa�ter Nl�nag�rner�t P��r�, th�� p�rc�vide a brief, narrative descri�ti+�r� a►f th��e plan� � 4�e��i�d L�c�l U�v�rnm+ent 2e. �Nhr� vv�ll be r�spc�nsib�+� f�r the rerriew c�f the �#�rmv�rat�� �llar���+�rn�er�t P'tar�? � C�'�lt"� �t�rm�v�t+�r I�rr��ram � C�VV�i 4�'� �!r�i� 3. ��rtified Lc�al t��►vernnr�n� �t+armwat�r Revi+�r�r ��. In wrhich lacal �ov�rnrnent's �uri�di+c�an is thi� proj�c�? � �'ha�e � � . . . � t�,�Vif '�b. 1tVhrch of the �a►11c�v�ng I�ca�ly-�r�nptemente+d �t+�rmwater r�r��na�ement prc�g�rar�� � , � �.1�h��' ��p�Y Cch�ck al! tha�t ����Y�• [� V�Vater �upply V�t�t�r�hed � t'�t1�+�r: 3�� Ha� the appraved �#c�rmwat�r I��n�g+�m�r�� P��n �h prc�+�f �►f �pproval b+�en ��`e� � 1��► attache��` 4� C�W'''t� '' tormwr�t+�r !�r r�m �2+�vi�vrr � +�a���tal �r�un�i�e� w r r� iwwr! ' `�� . 4�. Wh��h af t�+� f�l��►�nc� state��mpl�m�nted s�tc��rnw��+�r �rt�n�c�em��t �rc�gr�m� ��p�"� � C��.V1�' �check �tl th�t a�p�p��"� � � :�+�����r� ��w ����--��� p ��her. 4b. Ha� the ap�p��v�d ��tvrmwater ��n�g�ment Plan �h p�rc�c�� c�f appra�r�f b+�en �itached? � Yes � No 5. [�Wt� d�t��1 Ur�it �t�r�mr�a�t�er �+�r�i+�w 5�. C?+�es th�e �tc�rmw�ter 11�anac�ern�n� �'ian m�+�# i�h+e �ppr�►�ri�t� re�uir�err�+ent��' � Y'es � i�c� 5b. I�av�e afii c�f th� �4t�'� �1n�t �ubrrrit��l r+�quirem+�nts been met?' � Ye� e� �,� ���e$�f�� P�� �`��r�n � 1l�r�i�r� `I �� ����r����° �I �y ,���� �+'����+�� �. �upplem+�n��ry Ir�fi�rmatior� � . �r�virc�nm+�ntal C�+r�uccum�ntati�►rr {C�1Nt� R+�qu�r�m+�r��� 1 a. C��►�s the project ir�v��v� �n expenditure c�f pu�lic �f��der�allst��ellv►�a�i� funds or �h� �, � N� � ,� � � � us+� v►f publ�c �fed�r�ll�ta�+�� I�nd . � b. �f you ar��wered "yes�" fia� the ak�c�r�e, �c�e� t�e proj��t r+�+�uir� prep��a�tic�n t�f an en�rirc�nmental dca�ur�r�►ent pursuant tc� th+� �requirem�ents �f the Nat�c�na! or �tate �'Y�� � N�► �(North C�rnlir�a) E�vir�nm�ntal �c�ficy A�� ���P�►1��i���? 1�. Ifi ��u answered i`yes�` tc� th� �bc�v�, has th� do�urn+�nt �evie�rv �een �n�li�e� by the ' Sfi�t� �I+�arin� Hc�u��e? �If sc�, attach a�op�r c�� th� N��'� c�r �EF�� finaf app�r�v�� ie�ter.� a �`es � �� �a►mmen�s: �w V�+�1�t�+��s �DW+Q 1�+�quic+�rn�rrt� 2�. 1s the �ite in �riolatir�n a►f �1�"1�C� 1�'�et��rnd �,c�l�s �'i �►A ��1�� �� .C�50fl��, ��o�at�d 'Vit'etland Rute� {15A �1�A� '�H ,� ��fl}� C��1►fC� �urfa+�+� 1t�#'at+�r �r'V'�'et�a�d �tand�rc��, ❑ Yes � �Vc� ar �ip�rian �u�'+�r Ru1es {1 �A �J�A� 2� .Q�t�t�j�"? 2�. is �his �n aft+er�-th�-��+�t p+�rm� applicatior��" � Yes � Nc� '�+�. If you answ�red '"ye�� tc► +�ne ar both �� �e a�bcrv� +questi�n�, pr�vide �n exp�anation +�f �he vic�latic�n��}: em�il nc��i�ca��n w►as prc�vid+�d. �. Curnu�lativ+� lnr�pa+ct�► {C�V�t+Q ��+quirem�nt� 3�. V'ltill this proje+�t (b�s�d on ���t �n�d �easorr�bl� ant�cipa��ec� fc.�uu�-+� irr�p�+�ts� r+esu�t �n 4'�� �� ac� itic�nal �develc� mer�t whri+�h c�►u�� im ar�� r�e�rb dc�wr���r�a�m wa�t+�c u�l' � � d � , t� Y � �'Y��` �b. If yvu answered "ye�" tc� th�e abc�ve, subt�i� � quali�ative �►r quanti�ativ+� cum�ulativ� im�p�act �na�ly►�i� �n �c+c+�rdar�c�; wit�h th� rn�►�t rec+�nt CJ1l'll`+� policy. �f you a�n�w�red �na," pr�c��ride a s�c�rt r��rr�t�v� c�es�ription. 4� �+�war�� C��sp�asal �C�VVC� �t�:+quirement� ��. G�l��rly d�t�il the ulfimate treatm�r�t methad� an+� d�spc���ia►n �r��n--discharg�e �r �di�ch�rge} �f �nrastev��t+�r gen�rat�+d �rc�rr� fihe prc�p+�s+�d prc�jec�, c�r a�ai�ab�� �apaci� c�f �h+� sub��c� fa�+cilirt�. t�l/A� " . � .. +r ,� � "' • � �r � • � •: ! i �. - �r 5. �r�dang�re�d Spe�ci+e� �r��i C�esi�r��ted �riti�� H�bi�;� �+�+�rp:� R�qui�:rr�er�t� 5�. 1141r11 this praject c�c+��r ir� �r ne�r �n area w�h f�d�rally �ro►t�+c�ed spe�i�s or Y�� �� . ,�, � i� habrt�t . 5b. Nav+e yau ch+�+�k�d with the U��1lU� c�n�+�rnin� �.n+�ang�er�d �p��ies �ct Y�� �� . � � �mpacts? . . . � R��I�i�� �i+�. !f yes, rr�dM+cate th�e IJS�'V1�t� �reld CJffi�� y�►u �arv� cv►nt�cted. � Ash�vill� �d� 1Nha�t dat� �aurce� did yc�u u�� tc� d+��erm�ne w�l��fiher� yc�ur �i�+e w�►u�t� innp�act End�n��red �pe�ci+�� c�r C�e�i�nated �ri�i��� H�b�at? +�1� �nd vi�ual c�bs�ervatior� �. ���ent�al �i�h Hab�t �C.c�rp� �t�quir�m+��t� ��W'�N�II this �rc��ect �ccur ir� c�r r��ar ar� �rea� d���gnat�d �� essential ��h hab�t�t? � Yes � Na �b. 'UiJ'h�t data sc�urce� did you use ta de�ermin� a�rheth+�r your ��� w�u�d irnpact E���nt�al �is� N�bit�t'? WR� r�vili comnnent 7. Histc►ri� crr Pr�hi�t+�r�+c �u�ur�l R+es+ac��es +��orps �t+�quir+�m+�r�� 7�. Vllill thi� project c�ccur in c�r near ar� �rea th�t the stat�, f�d�r�l or �rib�l c�+�v+�rr►ment� h�v� de���n�ted as hauirr� his�tori� c�r cu�tural p�res�rv�tion �,�s �� ` is c�ric Trust d+�si r�a�c�n or ra ertie� s�� ni�cant in � � ���tus (e.g., �Jafiortal N � c� p p � I�c�t�t� +�arc�lin�t 1�`rst�ry an+d arch�er�#a►gr���' 7b. V'Vh�rt data sourc�s did you use t�► determir�� �rvh+�ther yar�r sit+e vv�►u�c� �mp�rt h��tc�ric c�r �r�h�c�lc�c�i+��� r��a�rce�'� �. Flc�ard �arn� De�ignatior� ��c�rps �+�quir�rrnen�� �a. UVill thi� project o+�cur �n a FElk���-d��ignat�d 't Q��-y��r �+�c�dplain'� �'��s � Nc� ��►, lf y�s, explain hc�w► proje�t rr�eet� FEM1� requ�remen��: ba�se �oc�d elevatic�r�� w�er� nc�t �h�nc��d �c.lNhat sa►urc�(s� did yv►u use t€� mak+� the fi��a�dplain c�et�rmin�tivn�' ncfla�dm�p�s � . � g t,bmnwuw.mw.,,.. ����� � J. I-�i.��.th Sl�.u:�hter � ��` . � . r'�� �� � "�� , �, v�: � o � � m� r A iicantfA er�t'� Printed Name �4pp►l�can�,�g�+�nt's �ic�n �� ��t� �� � {Agent`s sigr�ature is v►alid +�nly �f an a�horizatic�n +etter fra►m the ap�plicant is rov►id+�d. �'��� �1 t� c�f '� � �"�►� �C3Y"t"i'i -- �%'�":SiE�t"1 "� .'� ��C�!'"i"1���" "i �, :�i�C�$�► '�%�Itt��i1