20191594 Ver 1_Riparian Buffer Authorization_20191119

qx
DWR 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
A.
Applicant
Riparian Buffer Authorization Form Information
1.
Project Information
1 a.
Name of project:
Shott Residence
1 b.
County:
Iredell
1 c.
Nearest municipality:
Mooresville
1 d.
Subdivision name:
N/A
1 e.
Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer 1f below.
❑ Yes ® No
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:
J Shott Holdings, LLC
2b.
Deed Book and Page No.
2514 / 765
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created).
67-139
2d.
Responsible Party
(for Corporations):
Jason C Shott
2e.
Street address:
109 Travis Point
2f.
City, state, zip:
Mooresville NC 28117
2g. Telephone no.:
704-309-9880
2h.
Fax no.:
2i.
Email address:
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Applicant is:
❑ Agent ® Other, specify: Owner
3b.
Name:
Jason Shott
3c.
Business name
(if applicable):
3d.
Street address:
3e.
City, state, zip:
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
4.
Agent/Consultant Information (if applicable)
4a.
Name:
John Kinnaird, PE
4b.
Business name
(if applicable):
Brooks Engineering Associates, PA
4c.
Street address:
17 Arlington Street
4d. City, state, zip:
Asheville, NC 28801
4e. Telephone no.:
828-232-4700
4f.
Fax no.:
828-232-1331
4g.
Email address:
[e-mail]
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):
4645-06-4336
1 b. Site coordinates (in decimal degrees):
Latitude: 35.5378
Longitude:-80.8806
1 c. Property size:
6.266 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Lake Norman
2b. Water Quality Classification of nearest receiving
water:
WS-IV,B;CA
2c. River basin:
Catawba
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:
Currently vacant land surrounded by single family residential.
3b. Attach an 8'/z x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8'/2 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:
0
3e. Explain the purpose of the proposed project:
Single family residence.
3f. Describe the overall project in detail, including the type of equipment to be used:
The project involves placing 2-T of fill in the low area. A bulldozer and trackhoe will 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:
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 ❑ Unknown
5b. If yes, explain and detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
FORM: BA 10-2013 Page 2 of 4

C. Proposed Impacts Inventory
1. Buffer Impacts
1 a. Project is in which protected
basin?
❑ Neuse
❑ Randleman
❑ Tar -Pamlico ® Catawba
❑ Jordan ❑ Goose Creek
1 b. 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
(exempt, allowable,
allowable w/
mitigation)
Stream name
Buffer
mitigation
required?
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
B1 ❑ P ® T
Grading
Allowable
N/A
❑ Yes ® No
7,500
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total
buffer impacts
7,500
1 c. Comments:
D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1 a.
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The entire area will be re -planted with native vegetation immediately after grading is complete.
1 b.
Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. The area is very flat with little runoff. No sedimentation will reach the lake.
2.
Buffer Mitigation
2a.
Will the project 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.
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)?
1 c.
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):
'J�C,J C
Applicant/Agent's Printed Name Applicant/Agent's Signature Date'
(Agent's 2nature 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
by First Class Mail via the US Postal Service: 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 Branch NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699 - 1617 Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4

DWR
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
A.
Applicant
Riparian Buffer Authorization Form Information
1.
Project Information
1 a.
Name of project:
Shott Residence
1b.
County:
Iredell
1 c.
Nearest municipality:
Mooresville
1d.
Subdivision name:
N/A
1e.
Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer 1f below.
❑ Yes ® No
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:
J Shott Holdings, LLC
2b.
Deed Book and Page No.
2514 / 765
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
67-139
2d.
Responsible Party
(for Corporations):
Jason C Shott
2e. Street address:
109 Travis Point
2f.
City, state, zip:
Mooresville NC 28117
2g.
Telephone no.:
704-309-9880
2h.
Fax no.:
2i.
Email address:
[e-mail]
3.
Applicant Information (if different from owner)
3a. Applicant is:
❑ Agent ® Other, specify: Owner
3b.
Name:
Jason Shott
3c.
Business name
(if applicable):
3d.
Street address:
3e.
City, state, zip:
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
4.
Agent/Consultant Information
(if applicable)
4a.
Name:
John Kinnaird, PE
4b.
Business name
(if applicable):
Brooks Engineering Associates, PA
4c.
Street address:
17 Arlington Street
4d.
City, state, zip:
Asheville, NC 28801
4e.
Telephone no.:
828-232-4700
4f.
Fax no.:
828-232-1331
4g.
Email address:
[e-mail] 71
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):
4645-06-4336
1b. Site coordinates (in decimal degrees):
Latitude: 35.5378
Longitude:-80.8806
1 c.
Property size:
6.266 acres
2.
Surface Waters
2a. Name of nearest body of water to proposed project:
Lake Norman
2b. Water Quality Classification of nearest receiving
water:
WS-IV,B;CA
2c.
River basin:
Catawba
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:
Currently vacant land surrounded by single family residential.
3b.
Attach an 8'/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8'/2 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:
0
3e.
Explain the purpose of the proposed project:
Single family residence.
3f.
Describe the overall project in detail, including the type of equipment to be used:
The project involves placing 2-T of fill in the low area. A bulldozer and trackhoe will 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:
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 ❑ Unknown
5b.
If yes, explain and detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ® No
6b.
If yes, explain.
FORM: BA 10-2013 Page 2 of 4

C. Proposed Impacts Inventory
1. Buffer Impacts
1a. Project is in which protected
basin?
❑ Neuse ❑ Tar -Pamlico ® Catawba
❑ Randleman ❑ Jordan ❑ Goose Creek
1 b. 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
(exempt, allowable,
allowable w/
mitigation)
Stream name
Buffer
mitigation
required?
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
131 ❑ P ® T
Grading
Allowable
N/A
❑ Yes ® No
7,500
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total
buffer impacts
7,500
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 project.
The entire area will be re -planted with native vegetation immediately after grading is complete.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. The area is very flat with little runoff. No sedimentation will reach the lake.
2. Buffer Mitigation
2a. Will the project 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
stormwater treatment. Include a plan that fully documents how diffuse flow will be
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.
® Diffuse flow
❑ Other BMP
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)?
1 c.
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):
7 �So (t C S �( 1
Applicant/Agent's Printed Name /� Applicant/Agent's Signature
(Agent's sigrfature 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
by First Class Mail via the US Postal Service:
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 Branch
NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
512 N. Salisbury Street
Raleigh, NC 27699 - 1617
Raleigh, NC 27604
Date
FORM: BA 10-2013 Page 4 of 4

State of North Carolina
11h1L'3
Department of Environment and Natural Resources
Division of Water Resources Division of Water Resources
15A NCAC 026 .0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2) - Buffer Authorization
FORM: BA 10-2013
A.
Applicant
Riparian Buffer Authorization Form Information
1.
Project Information
1 a.
Name of project:
Shott Residence
1 b.
County:
Iredell
1 c.
Nearest municipality:
Mooresville
1 d.
Subdivision name:
N/A
1e.
Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer 1 f below.
❑ Yes ® No
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:
J Shott Holdings, LLC
2b.
Deed Book and Page No.
2514 / 765
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
67-139
2d.
Responsible Party
(for Corporations):
Jason C Shott
2e. Street address:
109 Travis Point
2f.
City, state, zip:
Mooresville NC 28117
2g. Telephone no.:
704-309-9880
2h.
Fax no.:
2i.
Email address:
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Applicant is:
❑ Agent ® Other, specify: Owner
3b.
Name:
Jason Shott
3c.
Business name
(if applicable):
3d.
Street address:
3e.
City, state, zip:
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
4.
Agent/Consultant Information (if applicable)
4a.
Name:
John Kinnaird, PE
4b.
Business name
(if applicable):
Brooks Engineering Associates, PA
4c.
Street address:
17 Arlington Street
4d.
City, state, zip:
Asheville, NC 28801
4e.
Telephone no.:
828-232-4700
4f.
Fax no.:
828-232-1331
4g.
Email address:
[e-mail]
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):
4645-06-4336
1b. Site coordinates (in decimal degrees):
Latitude: 35.5378
Longitude:-80.8806
1 c. Property size:
6.266 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Lake Norman
2b. Water Quality Classification of nearest receiving
water:
WS-IV,B;CA
2c. River basin:
Catawba
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:
Currently vacant land surrounded by single family residential.
3b. Attach an 8'/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8'/2 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:
0
3e. Explain the purpose of the proposed project:
Single family residence.
3f. Describe the overall project in detail, including the type of equipment to be used:
The project involves placing 2-T of fill in the low area. A bulldozer and trackhoe will 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:
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 ❑ Unknown
5b. If yes, explain and detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
FORM: BA 10-2013 Page 2 of 4

C. Proposed Impacts Inventory
1. Buffer Impacts
1 a. Project is in which protected
basin?
❑ Neuse ❑ Tar -Pamlico ® Catawba
❑ Randleman ❑ Jordan ❑ Goose Creek
1 b. 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
(exempt, allowable,
allowable w/
mitigation)
Stream name
Buffer
mitigation
required?
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
B1 ❑ P ® T
Grading
Allowable
N/A
❑ Yes ® No
7,500
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total
buffer impacts
7,500
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 project.
The entire area will be re -planted with native vegetation immediately after grading is complete.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. The area is very flat with little runoff. No sedimentation will reach the lake.
2. Buffer Mitigation
2a. Will the project 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.
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)?
1 c.
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):
Ap licant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's Sig ture 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
by First Class Mail via the US Postal Service:
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 Branch
NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
512 N. Salisbury Street
Raleigh, NC 27699 - 1617
Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4

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CURRENT 3G' BUFF R
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PRELIMINARY DRAWINGS

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PRELIMINARY DRAWINGS

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PRELIMINARY DRAWINGS

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APPROX. }
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TRACT #2 ON SURVEY FOR
JASON SHOTT HOLDINGS, LLC BY JORDAN GRANT
NOTE:
A NEW IRRIGATION SYSTEM TO BE DESIGNED
AND INSTALLED BY IRRIGATION CONTRACTOR
WITH SPRAY HEADS FOR ALL NEW PLANT
MATERIAL.
PLACEMENT OF NEW PUMP AND CLOCK TO BE
\NEAR BOAT DOCK.
O DENOTES PINES TO REMAIN
DENOTES PINES TO BE REMOVED
AREAABOVE 760' CONTOUR
0.574 ACRES
1 /2" PIPE
wr r r,
FA A r
7AYS TO BE
ZENTAL GRAVEL OVER
D BED OF SCREENINGS .
EDGING AS BORDER
lr,
20'-0"
10'-0"
SCALE OF DRAWING:
1" = 20'
M
PIN: 4645-06-7440
Joseph M. Mabry &
Kathryn Mabry
D.B. 1565) Pg. 227
Lot 7 - P.B. 461 Pg. 76
Zoned: R-20
r 2
760,50
13-Swit grass - 3 gallon
/ ,—I 6-Tus,.Sedge - 1 gallon
BENCHMARK
TOP #5 PIN
761.25' /
e rass - 3 gallon +
Swale to
storm
drain
NEW
AL Water Iris gallon
\�-Sjlkv Dog1vod - 3 gallon
\_9-Cardinal Flower - 1 gallon 18-Switch grass - ga on
�- Reed Grass - 3 gallon -Elderberry - 3 gallon
5 Wax Myrtle - 5 gallon 8 Wax Myrtle - 5 gallon
\--.8-Elderberry - 3 gallon DOCK
18-Broom Sedge - i gallon
9-Spicebush - 3 gallon50-New England Ater - 1 gallon
12- Iris Cristata - 1 gallon 17-Black Chokeberry - 3 gallon
0-Silky Dogwood - 3 gallon LAKE
i Wax Myrtle - 5 gallon
NO RMAN-���
ANY DOCKS, PIERS OR OTHER J
IMPROVEMENTS BUILT ON LAKE , J
ARE NOT SHOWN ON THIS
-SURVEY PLAT. �-- .-
:=e.•�,ND3C try ':
872 � *'
J'NELL BRYSON LANDSCAPE ARCHITECTURE
2743 NORMANDY ROAD, CHARLOTTE, NC 28209
www jbryson.com
[phone]
PROJECT:
SHOYr RESIDENCE
TRAVIS POINTE DRIVE
MOORESVILLE, NC
SHEET:
SITE
DATE:
10-31-2019
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