VIABILITY ASSESSMENT REQUEST FORM 2019

BUFFER MITIGATION &/OR NUTRIENT OFFSET
SITE VIABILTY ASSESSMENT REQUEST
(Form must be complete and all attachments included to process request)
☐ BUFFER MITIGATION ☐ NUTRIENT OFFSET ☐ BOTH

Name

Company

Address

Phone

Email

Do you have the right to access the property?
☐ YES ☐ NO

PARCEL/SITE DETAILS
Proposed Site Name

Address City:
Site Coordinates County:

River Basin 8-Digit HUC:

Sub-watershed (if in
Jordan Lake or Falls)

Will this be part of a stream or wetland project/bank?
☐ YES ☐ NO
Has anyone from DWR or the USACE visited the site in the past 12 months? ☐ YES ☐ NO
Has a riparian buffer or stream call been performed by Division of Water Resources staff on the
subject site? ☐ YES ☐ NO
Is the project receiving any state or federal grant money? ☐ YES ☐ NO
Are there any State, Local or Federal Permits associated with the subject site? ☐ YES ☐ NO
PARCEL/SITE ATTACHMENTS (provide items 1-4 as a separate attachment, not to exceed 10 pages)
1. Detailed description of the site including existing site conditions and Aerial Site Map;
2. Include a timeline of landuses and landuse changes from 1990-Present;
3. Most recent 1:24,000 scale USGS Topo Map showing the site; AND
4. Most recent published NRCS county soil survey showing site;

_______________________________________________________________________________________________________________________________________________________________
NCDWR - 401 & Buffer Permitting Branch
Attn: Katie Merritt

SEND COMPLETE REQUEST TO: 1617 Mail Service Center
Raleigh, NC 27699-1617
or by email to [e-mail]