20190462 Ver 1_Nunn_Signed Application Page_20190603

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
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
F.
Supplementary Information
1.
Environmental Documentation
1 a.
Does the project involve an expenditure of public (federal/state/local) funds or the use
❑ Yes
® No
of public (federal/state) land?
1 b.
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)?
I
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 ate
(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
by First Class Mail via the US Postal Service:
NC DWR, Transportation Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
For all other projects sent by First Class Mail
via the US Postal Service
Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
For government transportation projects sent
by delivery service (UPS, FedEx, etc.):
OR NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
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 7 of 7