20181505 Ver 1_Riparian Buffer Authorization_20181105

New Submission
Page I of 3
Buffer Authorization Application Form"'
+� Water Resources
HVIRONMENTAL QUALITY
15A NCAC 02B.0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267
(11)(c), .0607 (e)(2) Buffer Authorization Online Form - Update 10/23/2018
A. Owner/Applicant Information
B. Project Information and Prior Project History NOV 02 2018
C. Proposed Impacts Inventory D. Impact Justification and Mitigation
E. Diffuse Flow Plan F. Supplementary Information
G. Sign and Submit
For instructions on how to fill out this form, see the Buffer Authorization Application Help
Document(https://edocs.deq.nc.govlWaterResources101docl760531/Page1.aspx) posted on
DWR's 401 & Buffer page.
,r
Please note: fields marked with a red asterisk below are required. You will not be able to submit the
form until all mandatory questions are answered.
A. Owner/Applicant Information
General Information
Primary Contact Email:" [e-mail]
Please list the contact person's email for questions or payment on this
project if needed.
Who is submitting the ❑./ Owner
application?* ❑ Applicant other than Owner
Agent
1. Property Owner Information:
1a. Name on Recorded Deed:"
1b. Responsible Party:
Clark Properties of Ocracoke
Hubert Wayne Clark Jr.
(for Corporations)
Z—.----'-
https://edoes.deq.ne.gov/Forms/Buffer-Authorization 10/26/2018

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1c. Mailing Address:*
Street Address
PO Box 262
Address Line 2
City State / Province / Region
Ocracoke NC
Postal / Zip Code Country
27960 USA
1d. 2529288028 1e. Email lhubertclark@hotma
Telephone: * Address: *
2. Applicant's Information (if different from owner):
2a. Name:*
2b. Company Affiliation
2c. Mailing Address:*
2d. Telephone: *
2e. Email Address:*
Street Address
Address Line 2
City State / Province / Region
I I
Postal / Zip Code Country
2f. Attach a signed and dated copy of the authorization granting the applicant owner
approval. An agent authorization form is acceptable.
Click the upload button or drag and drop files here to attach document
Upload
PDF only
Page 2 of 3
https://edocs.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018

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3. Agent Information:
3a. Name:*
3b. Company Affiliation:*
3c. Mailing Address:*
Street Address
Address Line 2
City State / Province / Region
Postal / Zip Code Country
3d. 3e. Email �—
Telephone: * Address:
3f. Attach a signed and dated copy of the agent authorization form.*
Click the upload button or drag and drop files here to attach document
Upload
PDF Only
Fage 3 of 3
If the applicant is not the property owner, in addition to providing the Agent's information, select
`Applicant other than Owner' above, enter the applicant's information, and attach an authorization
granting the applicant owner approval.
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https://edocs.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018

New Submission
�rn �2r/ �arV
Buffer Authorization Application Form
15A NCAC 02B.0233 (8)(b), .0243 (8)(b)..0250 (11)(b), .0259 (8)(b), .0267 (11)(0), .0607 (e)(2) Buffer Authorization
Online Form - Update 10/23/2018
A. Owner/Applicant Information B. Project Information and Prior Project History
C. Proposed Impacts Inventory D. Impact Justification and Mitigation E. Diffuse Flow Plan
F. Supplementary Information G. Sign and Submit
B. Project Information and Prior Project History
1. Project Information
1a. Name of Project:"
;lark Properties of Ocracoke Dock House
(Subdivision, facility, or establishment name)
KC
Page 1 of 4
If your project has a formal name please use this. If your project does not have a formal name, please
identify your project by the ower name and proposed activity (Jones Property Access Road, Smith Guest
House, etc.) List in parenthese¢ any other names that have been used to identify the project in the past.
1 b. Is this a publicly -funded transportation project?`
p Yes
Q. No
1 d. Subdivision Name: Oyster Creek Banks
1e. Nearest Municipality: Ocracoke
1f. Property Size: 0. 1
acres
tg. County (or Counties) where the project is located:"
Hyde
Add additional county
1h. Property ID# Date of Purchase
40 Lfa i'+ to
Tax PIN or Parcel id
Add another lD
1i. Deed Information
1 a/is/aot( Fn
Type of Book
Book#
Page#
Deed
P50
815
https:Hedocs.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018

New Submission
Page 2 of 4
Ma��,a K� S8.
L A
SL 103A
11. Attach a copy of the recorded map that indicates when the lot was last platted.
Click the upload button or drag and drop files here to attach document
Upload
PDF only
1 k. How would you like to provide the Latitude and Longitude information?
0 Address Lookup
e Manually
Latitude" 35.117544
Longitude"` -75.974800
11. Is the project located in any of North Carolina's twenty coastal counties?* a Yes
0 No
1m. Is the project located within a NC Division of Coastal Management Area of Environmental Concern (AEC)?
e Yes
0 No
Coastal Management information can be found at:
• About Coastal Management(https://deq.ne.gov/about/divisionsicoastal-management/about-coastal-management)
• Staff Listing (https://deq.nc.gov/aboutidivisions/coastal-managemenVabout-coastal-managemenYstaff-listing)
• Coastal County Lookup (https://deq.nc.govlabouVdivisions/coastal-managemenVabout-coastal-managemenVcama-counties)
2. Surface Waters
2a. Name of the nearest body of water to proposed project:" iPamlico Sound
Link to Soil Surveys for North Carolina Counties (https:/Aw .nres.usda.govlwps/portal/nres/suweylist/soils/survey/state/?stateld=NC).
(Please see instructions in the Help Document (https://edocs.deq.nc.gov/WaterResources/0/doc[760531/Pagel.aspx) to determine the most
recent published version.)
2b. Water Quality Classification of nearest receiving water: I""
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:`
50
(linear feet only)
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 Y x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
Click the upload button or drag and drop files here to attach document
Upload
PDF only
Link to TOPO Map lookup: https://viewer.nationalmap.gov/basic (https:/Iviewer.nationalmap.gov/basic
https://cdocs.deq.nc.gov/FormsBuffer-Authorization 10/26/2018

New Submission
Page 3 of 4
3c. Attach an 8 %x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the project
site.
Glick the upload button or drag and drop files here to attach document
Upload
PDF only
Link to Soil Surveys for North Carolina Counties (https://www.nres.usda.govAvps/portal/nrGs/suweylist/soils/survey/statenstateld=NC).
(Please see instructions in the Help Document (https://edom.deq.nc.gov/WaterResouroes/0/docf760531/Pagel.aspx) to determine the most
recent published version.)
4. Proposed Activity
Provide a detailed description of the proposed activity including Its purpose and include the type of equipment to be used:
[Add uncovered raised deck on canal side of house and cover with roof the current deck on street side of house.
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach document
Upload
PDF only
" Below is a link with instructions on what you will need to show on your site plan.
htip://edocs.deq.nc.gov/WaterResourees/0/docf4O2224/Pagel.aspx (http://edocs.deq.nc.govNVaterResouroes/0/doc]402224/Pagel.aspx)
5. Jurisdictional Determinations
5a. Have jurisdictional wetlands or stream determinations by the Corps or State been requested or obtained for this
property/project (including all prior phases) in the past?'
0 Yes
p No
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
O Yes
0 No
6b. List any permits/approvals that have been requested or obtained for this project in the past.
Application Date
Dale Issued
Permh Type
RvIT- ®1
F U310qlit I
El
4il4-7;W1
Add
6c. Please explain and detail according to "help file" instructions. *
7. Future Project Plans
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7a. Is this project a phased project?* O Yes
.Q No
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Map Locator I USGS Store
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(haps:/lwww.(6gy�gdis'eoinl�stg�'/0+lkd�tigwgov/lbglP$d$/oovo+cgS�wdabOa6`rch
(https:/Iwww.usgs.gov)
USGS Store
36 Gaskill Ln, Ocracoke, North Carolina, 27960
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Map Locator
To use the map locator to find map products use the search bar or drop a pin by double clicking on the mapview.
Name LoolLA
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Map location pins dropped or searched for by address/place provide products within a 15 mile radius of specified location.
If you have any questions or Issues please click here (mailto:[e-mail]7subject=Map-Iocator%20Question) to email [e-mail]
(mailto:usgsstore.usgs.gov7subject=Map-Imator9620Questlon).
Jump to Popular Areas
GREAT SMOKY MOUNTAINS
ROCKY MOUNTAIN NATIONAL PARK
https:Hstore.usgs.gov/map-locator 10/26/2018

New Submission
Buffer Authorization Application Form
15A NCAC 02B.0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c),
.0607 (e)(2) Buffer Authorization Online Form - Update 10/23/2018
A. Owner/Applicant Information I B. Project Information and Prior Project History
C. Proposed Impacts Inventory I D. Impact Justification and Mitigation
E. Diffuse Flow Plan ) F. Supplementary Information I G. Sign and Submit
C. Proposed Impacts Inventory
Buffer Impacts
1a. Project is in which protected Basin?"
Q Neuse River Basin (15A NCAC 02B.0233)
Q Catawba River Basin (15A NCAC 02B.0243)
Q Randleman Lake Watershed (15A NCAC 02B.0250)
Q Tar -Pamlico River Basin (15A NCAC 02B.0259)
Q Jordan Lake Watershed (15A NCAC 02B.0267)
Q Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 02B.0607)
You can find which river basin you live in at the link below.
Page 1 of 2
water Resources
ENVIRONMENTAL OVALITY
http://www.eenorthcarolina.org/riverbasins-gis-map.asp (hftp://www.eenorthearolina.org/riverbasins-gis-
map.asp)
1c. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out
Section D of this form.
Please note: if the impact you list below requires mitigation choose "allow w/ mitigation" under impact type.
https://edocs.deq.ne.gov/Forms/Buffer-Authorization 10/26/2018
Site# -Reason
Stream Name
Buffer*
Impact Type"
Zone 1
Impact
open decking additioi
Oyster Creek
Permaner v
Allowable v
228.00
Map label (e.g. Road
Perm or Temp
Square Fee
Crossing 1)
https://edocs.deq.ne.gov/Forms/Buffer-Authorization 10/26/2018

New Submission
Page 2 of 2
Add another impact
Total Zone 1 Impacts: 228.0
Total Zone 2 Impacts: 273.0
Total Buffer Impacts: 501.0
Comments:
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https://edocs.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018
roof addition over exi
Oyster Creek
Permaner', v
Allowable'v
�—
273.00
Map label (e.g. Road
Perm or Temp
Square Feet
Square Feet
Crossing 1)
Add another impact
Total Zone 1 Impacts: 228.0
Total Zone 2 Impacts: 273.0
Total Buffer Impacts: 501.0
Comments:
Previous Next
Save as Draft
https://edocs.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018

New Submission
Hy Ga, fUa.�
Buffer Authorization Application Form
15A NCAC 028 .0233 (8)(b),.0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(C)..0607 (e)(2) Buffer Authorization
Online Form -Update 10/23/2018
A. Owner/Applicant Information I B. Project Information and Prior Pmjed History I C. Proposed Impacts Inventory
D. Impact Justification and Mitigation I E. Diffuse Flow Plan i F. Supplementary Information
G. Sign and Submit
D. Impact Justification and Mitigation
1. Avoidance and Minimization
Page 1 of 1
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project. *
standards.
ib. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.*
to be placed in non -vegetated area on-site or outside buffers. All construction debris to be
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https://edocs.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018

New Submission
Buffer Authorization Application Form
15A NCAC 02B.0233 (8)(b),.0243 (8)(b),.0250 (11)(b),.0259 (8)(b),.0267 (11)(c),
.0607 (e)(2) Buffer Authorization Online Form - Update 10/23/2018
A. Owner/Applicant Information I B. Project Information and Prior Project History
C. Proposed Impacts Inventory I D. Impact Justification and Mitigation
E. Diffuse Flow Plan I F. Supplementary Information I G. Sign and Submit
Page 1 of 1
+: Water Resources
ENVIRONMENIAL QUALITY
E. Diffuse Flow Plan
All buffer impacts & high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer program, upload a plan that fully documents how
diffuse flow will be maintained. All stormwater control measures (SCMs) must be designed in accordance
with the NC Stormwater Design Manual (https://deq.nc.gov/sw-bmp-manual). Associated supplement
forms and other documentation must be provided.
For a list of options to meet the diffuse flow requirements, click here (https://files.nc.gov/ncdeq/Water%
7 a. What type of SCM are you providing?*
❑ Level Spreader
❑ Vegetated Conveyance (lower SHWT)
❑ Wetland Swale (higher SHWT)
❑ Proposed project will not create concentrated stormwater flow through the buffer
❑ Other SCM that removed minimum of 30% nitrogen
1c. Diffuse Flow Documentation * Click the upload button or drag and drop files here to attach document
Upload
PDF only
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https:Hedocs.deq.ne.gov/Forms/Buffer-Authorization 10/26/2018

New Submission
Buffer Authorization Application Form
15A NCAC 02B.0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267
(11)(c), .0607 (e)(2) Buffer Authorization Online Form - Update 10/23/2018
A. Owner/Applicant Information
B. Project Information and Prior Project History
C. Proposed Impacts Inventory D. Impact Justification and Mitigation
E. Diffuse Flow Plan F. Supplementary Information
G. Sign and Submit
F. Supplementary Information
Environmental Documentation
Page 1 of 2
Water Resources
ENVIRONMENTAL QUALITY
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land?
0 Yes
Q No
Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated Wetland
Rules (15A NCAC 02H .1300), pWR Surface Water or Wetland Standards, or Riparian Buffer
Rules (15A NCAC 02B.0200)?
0 Yes
O No
2b. Is this an after -the -fact buffer authorization application?
0 Yes
0. No
G. Additional Information
Please upload any additional information you would like the Division to consider during application
https:Hedoes.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018

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review.
Additional Attachments
Additional Comments:
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https:Hedocs.deq.ne.gov/Forms/Buffer-Authorization 10/26/2018

New Submission
Buffer Authorization Application Form::I
15A NCAC 0213 .0233 (8)(b),.0243 (8)(b), .0250 (11)(b),.0259 (8)(b),.0267
(11)(c), .0607 (e)(2) Buffer Authorization Online Form - Update 10/23/2018
A. Owner/Applicant Information
B. Project Information and Prior Project History
C. Proposed Impacts Inventory D. Impact Justification and Mitigation
E. Diffuse Flow Plan F. Supplementary Information
G. Sign and Submit
G. Sign and Submitt
By digitally signing below, I certify that:
Fage 1 01 1
Water Resources
ENVIRONMENTAL OVALITV
• I have given true, accurate, and complete information on this form;
• I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC
General Statutes (the "Uniform Electronic Transactions Act")
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC
General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the
same way as a written signature; AND
• I intend to electronically sign and submit the application form."
Print Name:*
Signature* / n
Submission Date: l0{d 61' �1$
(Auto populated field)
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https:Hedocs.deq.nc.gov/Forms/Buffer-Authorization 10/26/2018

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