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Home My WebLink About20141068 Ver 1_Riparian Buffer Authorization_2014100920 1 41 068 DW.R State of North Carolina Department of Environment and Natural Resources Division of Water Resources Division of Water Resources I 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 30 -2013 Riparian Buffer Authorization Form A. Applicant Information 1. Project Information 1 a Name of project j �&/ lb County 6&1 _dz 1c Nearest municipality rito , Id. Subdivision name s r s c S o r OL/ le Is the project located in any of North Carolina's twenty coastal counties. If yes, answer 1f below ps ❑ No 1f Is the project located within a NC Division of Coastal Management Area of Environmental Concern (AEC)? Domes ❑ No 2. Owner Information 2a Name on Recorded Deed: Fw "v 2 2b Deed Book and Page No , y q 4 S'? 2c Map Book and Page No (include a copy of the recorded map that !nd /cates when the lot was created) 2d Responsible Party (for Corporations) 2e Street address 2f City, state, zip 2g Telephone no „ c- -5 2 76 °- w o 17 i[v / 2h Fax no. 21 Email address, 3. Applicant Information (if different from owner) 3a Applicant is ❑ Agent ❑ Other, specify 3b Name �o li v u j Gr�lcuvf S/l. 3c Business name (if applicable) 3d Street address p c 13 ,Dh 9 33 3e City, state, zip KIr- '2-7 3f Telephone no 51 c> '-(c,01'7 ftyllj - - 3g Fax no IV 3h Email address 4. Agent/Consultant Information (if applicable) 4a Name WX l J 401 8 BUFF R P RMI7TING 4b Business name (if applicable) l`Qr ✓r =/�a'. c�.X' ��r.��i96' 4c Street address 4d City, state, zip Z! ;4rI C' ' 4e Telephone no w og i 4f Fax no 4g Email address ° % fx FORM BA 10 -2013 Page 1 of 1 B. Project Information and Prior Project History 1. Property Identification 1a Property identification no (tax PIN or parcel ID) ( d ? 1 b Site coordinates (in decimal degrees) Latitude. Longitude, 1c Property size 0 ' •7 acres 2. Surface Waters 2a Name of nearest body of water to proposed project* U, TO P/4-1 (-Q o 12 i 2b Water Quality Classification of nearest receiving water 2c River basin, -7 6Z _ /iM o 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 TI& ,lrlun6¢V?4 S7) lob Trw fn.oc.roL6 3b Attach an 8 % 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 Sod Survey Map depicting the project site 3d List the total estimated linear feet of all existing streams (intermittent and perennial) on the property IOU 3e Explain the purpose of the proposed projects- 1`�S fVtt LD�C� A t 3f Describe the overall project in detail, including the type of equipment to be used L /A-,7 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 prior phases) in the past? ❑ Yes [5 No ❑ Unknown Comments PV r+ 4b If yes, who delineated the jurisdictional areas? Name (if known) Agency/ Consultant Company Other, 4c If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation 6. Project History 5a Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? ❑ Yes o ❑ Unknown 5b If yes, explain and detail according to "help file" instructions 6. f=uture Project Plans 6a Is this a phased project? ❑ Yes D No� 6b If yes, explain FORM BA 10 -2013 't'1.0 SITS $ Page 2 of 2 1.) O &V 1Z/►xffP2 ,,,r,�,ra•+nt C. Proposed Impacts Inventory Impact Justification and Mitigation 1. Avoidance and Minimization 1. Buffer Impacts Specifically describe measures taken to avoid or minimize the proposed impacts in designing project I 'o OWE- /1 a,-05 lkq- it @ 6A/ 12-am -A/Z? IC6-1 r T 2- 7 ir-f CG"irc2' 5c&rzZe st krzwl ./I h! v/ LTU 17'6 E a4i✓> r-'djLn loot, rt,'.A 1 b Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques (' 04 Hsv)C .) Aryn I i N1Q 1 a Project is in which protected basin? ❑ Neuse 0 Tar - Pamlico ❑ Catawba Randleman 0 Jordan ❑ Goose Creek 1 b Individually list all buffer impacts below If any impacts require mitigation, 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 DIP ❑ T R�5z4cNrm, (rte_ /11 c..,,,/v a t '�M Q El [5 No 3 (2 for Catawba) �- B2 0 ❑ T L: u<- Lt' "" rn w 11 :) Yes No o f tL B3 ❑ P ❑ T 2c If buffer mitigation is required, is payment to a mitigation bank or NC EEP proposed? ❑ Yes ❑ No 2d If yes, attach the acceptance letter from the mitigation bank or NC EEP 64 ❑ P ❑ T If no, then discuss what type of mitigation Is proposed 2f Comments ❑ Yes ❑ No B5 ❑ P ❑ T ❑ Yes ❑ No B6 ❑ P ❑ T ❑ Yes ❑ No Total buffer Impacts °7 gfiN 1c Comments D. Impact Justification and Mitigation 1. Avoidance and Minimization la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project I 'o OWE- /1 a,-05 lkq- it @ 6A/ 12-am -A/Z? IC6-1 r T 2- 7 ir-f CG"irc2' 5c&rzZe st krzwl ./I h! v/ LTU 17'6 E a4i✓> r-'djLn loot, rt,'.A 1 b Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques (' 04 Hsv)C .) Aryn I i N1Q 2 Buffer Mitigation 2a Will the protect result in an Impact within a protected riparian buffer that requires buffer mitigation? ❑ Yes BIG 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 s uare feet Multiplier Required mitigation (s qua feet Zone 1 3 (2 for Catawba) Zone 2 15 Total buffer mitigation required: 2c If buffer mitigation is required, is payment to 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 3 E. Diffuse Flow Plan All buffer Impacts and high ground Impacts require diffuse flow or other form of a6l'ifuse flow stormwater treatment Include a plan that fully documents how diffuse flow will be ❑ Other BMP maintained If a Level Spreader is proposed, attach a Level Spreader Supplement Form la If due to site constraints, a BMP other than a level spreader Is proposed, please provide a A16 (&, /10,1) C77* plan for stormwater treatment as outlined In Chapter 8 of the NC Stormwater BMP k":L,- 14.4 V6 Manual and attach a BMP Supplement Form 6 v17 -efj F. Supplementary Information by First Class Marl via the US Postal Service 1. Environmental Documentation OR NC DWR, Transportation Permitting Unit la Does the project Involve an expenditure of public (federal /state /local) funds or the use of ❑ Yes 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 ❑ No 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 9-Nb 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 Wetland Rules (15A NCAC 02H 0500), Isolated Wetland ❑ Yes CIN':� 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 QTIo 2c If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s) Applicant/Agent's Printed Name Appli ant%A nt' Sign ture Wate Agent's signature is valid only if an authorization letter from the applicant Is provided ) Send 3 complete sets of this form and accompanying documents to the following For government transportation projects sent For government transportation projects sent by First Class Marl via the US Postal Service by delivery service (UPS, FedEx, etc) NC DWR, Transportation Permitting Unit OR NC DWR, Transportation Permitting Unit 1650 Mail Service Center 512 N Salisbury Street Raleigh, NC 27699 -1650 Raleigh, NC 27604 For all other projects sent by First Class Marl 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 SCALE 1.12000 0 1000 2000 3000 FEET �4AT p •.DIN r 350006 5 M58 43` 080E ./� �► 1Q^ I all 4 r7 & AC I 5' i4q, D LQ,0 6.\ �1 n1 1 l V ! (1l Vil CD s z CO) I I 27 13�W - N 39 02 7 13" . 3' ,1 O O.00' ''DAM, �e,�ir�',�LL' , 4 ' mftfVAT E RIGHT- OF - WAY I Authorized Agent Consent Agreement l 1v�iy' L' alb, ^ /�;y�s z� , hereby authorize Zriyrm yJ%�j�c�� o act on (Property Owner) (Authorized agent) my behalf in obtaining CAMA permits for the location listed below This agency authorization is Imted to the specific activities described above Property Address Property Owner's Mailm& Address and Phone Number: �J f Property Owner's Signature: / r Authorized Agent Signature &I Form Authorized Agent Agreement as developed by NCDCN4 revised 7/29109