20200044 Ver 1_Riparian Buffer Authorization_20200107

State of North Carolina
DWR
Department of Environmental Quality
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:
Holly Street Park
1 b. County:
Nash
1c. Nearest municipality:
Rocky Mount
1 d. Subdivision name:
NIA
1 e, Is the project located in any of North Carolina's twenty coastal counties?
If yes, answer if below.
❑ Yes ® No
1f. Is the project located within a NG Division of Coastal Management Area of
Environmental Concern (AEC)?
❑ Yes ® No
2.
Owner Information
2a. Name on Recorded Deed:
City of Rocky Mount
2b. Deed Book and Page No.
Does not exist
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was create
1001 East Holly Street
Parcel No. (PIN) 386000580100
2d. Responsible Party
for Corporations):
Scott Miles
2e. Street address:
331 S Franklin St
2f. City, state, zip:
Rocky Mount, NC
2g. Telephone no.:
252-972-1340
2h. Fax no.:
2i. Email address:
[e-mail]
3.
Applicant Information (if different from owner)
3a. Applicant is:
® Agent ❑ Other, specify:
3b. Name:
Same as owner
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:
Same as owner
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

13. Project Information and Prior Project History
1. Property Identification
la. Properly identification no. (tax PIN or parcel ID):
3860005801
1b. Site coordinates (in decimal degrees):
Latitude:
77°46'57.418"W
Longitude:
35056'37.261"N
1 c. Property size:
4 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Tar River
2b. Water Quality Classification of nearest receiving water:
WS-IV:NSW
2c. River basin:
Tar 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
this application:
Existing ark renovated to include greenway P—ath with observation deck.
3b. Attach an 8'/ x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8 % 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:
660
3e. Explain the purpose of the proposed project:
Construct Observation deck overlooking stream
3f. Describe the overall project in detail, including the type of equipment to be used:
Construct deck using conventional materials and tools
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by
the Corps or State been requested or obtained for this
property/ promect(including all priorphases) in thepast?
❑ 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 priorphases) in thepast?
❑ 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
❑ Randleman ❑ Jordan
❑ Catawba
❑ 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
Reason for
impact
Type of impact
(exempt, allowable,
allowable wl
mitigation)
Stream name
Buffer
mitigation
required?
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
131 ® P ❑ T
Greenway/deck
allowable
Cowlick Branch
❑ Yes ® No
170
160
82 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
Yes ❑ No
B5 El ❑T
El Yes ❑No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total buffer impacts
1c. Comments: Greenway and observation deck to run parallel to stream.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Minimal grading around deck. Deck will be slated so as to not create impervious surface
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. Hand constructed to minimize impact
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 DMS
proposed?
❑Yes ❑ No
2d. If yes, attach the acceptance letter from the mitigation bank or NC DMS.
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
❑x 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
® Yes ❑ No
use 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
❑ Yes ® No
Wetland 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):
ApplicanVAgent's Printed Name
Applicant/Agent's Signature
Agent's s nature is valid only !tan 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
l-I--Zc12a
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.):
Karen Higgins Karen Higgins
NCDWR — 401 & Buffer Permitting Branch OR 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

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PUBLIC WORKS
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PROPOSED OVERLOOK DECK
HOLLY 5TREET PARK
HOLLY 5TREET, ROCKY MOUNT, N.C.
EDGECOMDE COUNTY
JANUARY G, 2020
5cale: I" = 30'