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Home My WebLink About20150244 Ver 1_Riparian Buffer Authorization_2015030420150244 f-11'f1T1'TTT-*"-1k NEITTXII 41,11, 420 NORTHWOOD DRIVE RALEIGH, NC 27609 919- 786 -0106 02/23/15 Chern Smith NCDENR Division of Water Resources Raleigh Regional Office 1628 Mail Service Center Raleigh, NC 27699 -1628 ph 919- 791 -4251 Dear Cherri, Attached are the forms for the repair project at 3013 Medlin Drive in Raleigh Please call or email me if you have any questions I will certainly adhere to guidelines that you recommend in the repair Thanks 11 John K Brown President .25P�Y� Nr- DENR R,ale; '1 Regional CMce #:ARMER OUTDOOR Professional Tree & certified ` Arbonst SO -4398 John K. BROWNT Landscape Services 786 -0106 420 NorthwoodOc��e Raleigh, NC 27609 Brown wwwfarmerbrown biz fax 919 - 782 -2316 Riparian Buffer Authorization Form A. Applicant Information 1. Project Information la Name of project lb County 1c Nearest municipality ld Subdivision name s le Is the project located in any of North Carolina's twenty coastal counties If yes, answer if below ❑ Yes 2,K0 1f Is the project located within a NC Division of Coastal Management Area of Environmental Concern (AEC)? ❑ Yes 2. Owner Information 2a Name on Recorded Deed cia 45 2b Deed Book and Page No 2c Map Book and Page No (Include a copy of the recorded map that Indicates when the lot was created) 2d Responsible Party (for Corporations) 2e Street address Ha 16— 2f City, state, zip ` .boo 2g Telephone no i 2h Fax no a 21 Email address N) 3. Applicant Information if different from owner) 3a Applicant is ❑ Agent Other, specify 401 8 BUFFER P F 3b Name ' 3c Business name (if applicable) G'y GWL a 3d Street address 3e City, state, zip 3f Telephone no 3g Fax no a 3h Email address NG lPi 4. Agent/Consultant Information (if applicable) v. Lang 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 1 of 4 B. Project Information and Prior Project History 1. Property Identification 1a Property identification no (tax PIN or parcel ID) OQ b 17 011149 13J6 1 b Site coordinates (in decimal degrees) Latitude S C>C1S I Longitude -74,.4#7411 1c Property size acres 2. Surface Waters 2a Name of nearest body of water to proposed project 2b Water Quality Classification of nearest receiving water 2c River basin Nf�tS� 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 3b Attach an 8'/i 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 Soil Survey Map depicting the project site 3d List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 4 b Fftr 3e Explain the purpose of the proposed project w d 3f Describe the overall project in detail, including the type of equipment to be used R o�►�r�s 9 #* -0- . 4. Jurisdictional Determin tions 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 o ❑ Unknown Comments 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 5. Project History 5a Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? ❑ Yes ❑ No 8- d<nown 5b If yes, explain and detail according to "help file" instructions 6. Future Project Plans 6a Is this a phased project? ❑ Yes 2<0 6b If yes, explain FORM. BA 10 -2013 Page 2 of 4 C. Proposed Impacts Inventory Impact Justification and Mitigation 1. 1. Buffer Impacts 1a Specifically describe measures taken to avoid or minimize the proposed Impacts In designing protect 1a Protect Is in which protected basin? / �,I Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Jordan ❑ Goose Creek 1b Individually list all buffer Impacts below form If any Impacts require mitigation, then you MUST fill out Section D of this Buffer Impact number — Permanent (P) or Temporary T 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) 61 ❑P ❑T Multiplier Required mitigation (square feet Zone 1 ❑Yes El No 3 (2 for Catawba) B2 ❑ P ❑ T Zone 2 ❑ Yes ❑ No 133 ❑ P ❑ T Total buffer mitigation required: ❑ Yes ❑ No If buffer mitigation is required, is payment to a mitigation bank or NC EEP proposed? ❑ Yes ❑ No B4 ❑ P ❑ T If yes, attach the acceptance letter from the mitigation bank or NC EEP 2e If no, then discuss what type of mitigation is proposed ❑ Yes ❑ No Comments B5 ❑ P ❑ T ❑ Yes ❑ No B6 ❑ P ❑ T ❑ Yes ❑ No Total buffer Impacts 1c Comments D. Impact Justification and Mitigation 1. Avoidance and Minimization 1a Specifically describe measures taken to avoid or minimize the proposed Impacts In designing protect 1 b Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques 2. Buffer Mitigation 2a WIII the protect result In an Impact within a protected riparian buffer that requires buffer mitigation? ❑ Yes ❑ No 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 (square feet Multiplier Required mitigation (square feet Zone 1 3 (2 for Catawba) Zone 2 1 5 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 4 E. Diffuse Flow Plan All buffer Impacts and high ground Impacts require diffuse flow or other form of ❑ Diffuse 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 ❑ Yes No plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP public (federal /state) land? Manual and attach a BMP Supplement Form 1 b 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 1617 Mail Service Center Carolina) Environmental Policy Act (NEPA /SEPA)? Raleigh, NC 27699 - 1617 1c If you answered "yes" to the above, has the document been finalized by the State ❑ Yes ❑ No 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 P140 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 No 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 Applicant/Agent's Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided ) Send this completed 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 1617 Mail Service Center 512 N Salisbury Street Raleigh, NC 27699 - 1617 Raleigh, NC 27604 For all other projects sent by First Class Mail 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 1617 Mail Service Center 512 N Salisbury Street Raleigh, NC 27699 - 1617 Raleigh, NC 27604 FORM BA 10 -2013 Page 4 of 4 EXAMPLE AGENT AUTHORIZATION FORM Property Legal Description //�q q� Parcel ID. B q 9 �`J� 1310 I'v Lot No. (if applicable) Plan No. (if applicable) �"� � C! Z� Street Address (if applicable) � _WE: � Property Owner: Owner Name (print) 12ift''SV I A4 4941Ai —< Property Owner's Address (if different than the above) Owner Signature* The above registered property owners of the above property, do hereby authorize of Agent Name Jq IL'ITT :►.f:...' W92,73 s. Agent Company Name (if applicable) to act on my behalf and take all actions necessary for the application, processing, issuance and acceptance of this permit, certification or authorization including all standard and special conditions attached. I hereby certify that the above information submitted on this form and application is true and accurate to the best of my knowledge Authorized Agent Name / Company Authorized Agent Signature Date: NDisclaimer Maps makes every effort to produce and publish 0 25 50 100 Feet the most current and accurate information possible. I I I I I I 1 I I However, the maps are produced for information purposes, 1 inch = 50 feet and are NOT surveys. No warranties, expressed or implied .are provided for the data therein, its use,or its interpretation.