HomeMy WebLinkAbout20160841 Ver 1_Riparian Buffer Authorization_20160830201 60 84DWR 1
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources Division of Water Resources
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 10-2013
Riparian Buffer Authorization Form
A. Applicant Information
1. Project Information
1 a. Name of project:IlArVeq {-testi' 'l.f
1 b. County: WA 06 CO3
1c. Nearest municipality: G .I' U i` JZA L.,e i 'I JA
1d. Subdivision name: ide r
le. Is the project located in any of North Carolina's ❑ Yes No
twenty coastal counties. If yes, answer 1 f below.
1f. Is the project located within a NC Division of Coastal
Management Area of Environmental Concern (AEC)?
❑ Yes No
2. Owner Information
2a. Name on Recorded Deed:
I oL t„
2b. Deed Book and Page No.
3 ' a
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
3 j C1 9 P/Ac r,
2d. Responsible Party
(for Corporations):
2e. Street address:
i ver Pi
2f. City, state, zip:
a e /L} , (-s
2g. Telephone no.:
C _
2h. Fax no.:
2i. Email address:
ark ('� i�A 6 A CCi
3. Applicant Information (if different from owner)
3a. Applicant is: ❑ Agent ❑ Other, specify:
3b. Name:
3c. Business name
(if applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.: Q�6
3g. Fax no.:
3h. Email address: URCES
4. Agent/Consultant Information (if applicable) QA g�FFER PER
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):
PIN —
1 b. Site coordinates (in decimal degrees):
Latitude: 3 si ,J� Longitude:'" 7 9. -53
1c. Property size:
acres Q, S �j
2. Surface Waters
2a. Name of nearest body of water to proposed project:
L4 p (, j,( i ve
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
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 thi
application: / Alle f /�M I L /J0M � P011-1/ a i-r 4 ,S f-/ 4140 I_AfYe ?/1
3b. Attach an 8'/2 x 11 excerpt from the most recent vers' n of the USGS topographic map indicating the location of
the site c$ e e QeV Q Lhe
3c. Attach an 8'/2 x 11 excerpt from the ost recent version of the p lished County NRCS Soil Survey Map
depicting the project site G"p i*ei61j e
3d. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
/o/ e/-
3e. Explain the purpose of the proposed project:
3f. Describe the overall project in detail, including the type of equipment to be used:
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 ❑ No ❑ Unknown
Comments:
Imew
4b. If yes, who delineated the jurisdictional areas?
Name (if known): bjel&61,,S%ell��%e 4 'S,
Agency/ Consultant Company:
Other:
4c. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
zo/�,
5. Project History
5a. Have permits or certifications been requested or obtained for this
project (including all prior phases) in the past?
❑ Yes No ❑ Unknown
5b. If yes, explain and detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes Pf No
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 project.
Heti- f ti .3 a i- 'et,
1a. Project is in which protected basin?
Neuse
❑ Randleman
❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek
1b. 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 T
Reason for
impact
Type of impact Stream name Buffer Zone 1 Zone 2
(exempt, allowable, mitigation impact impact
allowable w/ mitigation) required? (sq ft) (sq ft)
Bi ❑ P ❑ T
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.
f� [ Q ' y
U `T [:1 Yes No q 2-
B2 ❑ P ❑ T
Zone 1
❑ Yes ❑ No
B3 ❑ P ❑ T
1.5
❑ Yes ❑ No
B4 ❑ P ❑ T
Total buffer mitigation required:
2c.
❑ Yes ❑ No
B5 ❑ P ❑ T
2d.
If yes, attach the acceptance letter from the mitigation bank or NC EEP.
❑ Yes ❑ No
B6 ❑ P ❑ T
2f.
Comments:
❑ Yes ❑ No
Total buffer impacts 2-
1c.
1c. Comments:"e i GS
Lf f 6X
iAe 0 ; A vcl 4 C 4,
i Breeze t)t-y .
D.
Impact Justification and Mitigation
1.
Avoidance and Minimization L 14ea%j e U i { E rf, F dl et f—Ek
1a.
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Heti- f ti .3 a i- 'et,
1b.
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
A^vr (-tea cl C� L4 r e f 6 L't Ff='_>_
2.
Buffer Mitigation
2a.
Will the project result in an impact within a protected riparian buffer that requires buffer
mitigation?
❑ YesNo
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 Multiplier Required mitigation
(square feet (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
r
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.
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
L
/�u �� v&,6plan
❑ Yes ❑ No
aP i 0a i3
for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
raf b4 Sk1W
4
✓
F. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of
❑ Yes No
public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
❑ Yes ❑ No
environmental document pursuant to the requirements of the National or State (North
Carolina) Environmental Policy Act (NEPA/SEPA)?
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 No
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):
(ifX� J r,Gc- g 2
Applicant/Agent's Printed Name Applicant/Agent's Signature D e
(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 Mail 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
W
7igg
t "ervice
ins
401 & Buffer Permitting Unit
ervice Center
27699 - 1617
For all other projects sent by delivery service
(UPS, FedEx, etc.):
OR Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4
16-275: 6204 River Landings Drive
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