20200773 Ver 1_Riparian Buffer Authorization_20200609

State of North Carolina
Department of Environmental Quality
DMsion of Witter Resources Division of Water Resources
1SA NCAC 028.0233 (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
is. Name of project:
Lot 389 Eagle Ridge
lb. County:
Wake County
1c. Nearest municipality:
Gamer
1d. Subdivision name:
Eagle Ridge
le. is the project located in any of North Carolina's twenty coastal counties?
If Yes, answer 1f below.
El 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:
JLS Homes LLC
2b. Deed Book and Page No.
017532
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
01864
2d. Responsible Party
for Co orations :
2e. Street address:
115 Owensboro ct
2f. City, state, zip:
Raleigh, NC 27603
2g. Telephone no.:
9194227306
2h. Fax no.:
2i. Email address:
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
❑ Agent ® Other, specify: Owner
3b. Name:
3c. Business name
if applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
4. AgentfConsultant Information (If applicable)
4a. Name:
4b. Business name
if applicable):
4c. Street address:
4d. City, state, zip:
4e. Telephone no.:
4f. Fax no.:
4g. Email address:
)f 4

B. Project infonnation and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
01609191759
1b. Site coordinates (in decimal degrees):
Latitude: 35.672310 1 Longitude: 78.659420
le. Property size:
.29 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Swift Creek/ Lake Benson
2b. Water Quality Classification of nearest receiving water:
WS III; NSW; CA
2c. River basin:
Neuse
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:
Wooded
3b. Attach an 8 Y2 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:
3e. Explain the purpose of the proposed project:
3f. Describe the overall project in detail, including the type of equipment to 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 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.
S. Project History
5a. Have permits or certifications been requested or obtained
for this project(including all priorphases) in the st?
Yes No Unknown
5b. ff 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 law 2 of 4

C. Proposed bnpacts Inventory
1. Buffer Impacts
1a. Project is in which protected basin?
Neuse
❑ Randleman
❑ Tar -Pamlico
❑ Jordan
❑ Catawba
❑ Goose Creek
1 b. Individually list all buffer impacts below. If any Impacts require mitigation, then you MUST
this form.
fill out Section D of
Buffer impact
number —
Permanent (P)
or Temporary
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)
61 P T
❑ Yes ® No
585
B2 ❑ P OT
❑ 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
1 c. Comments: Deck on the Proposed Home is over 8' AFG
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques.
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. Diillfuse 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 stonnwater treatment as outlined in Chapter S of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
F. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/statellocal) funds or the
❑ Yes ® No
use of public federal/state land?
1b. 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
❑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):
� L
Les Clark 5-20-20
Applicant/Agents Printed Name Applicant/Agenrs Signature Date
(Agents signature is valid only if an autho&aum letter from the appkard is provided)
Send 3 complete sets of this form and accompanying documents to the following:
For government transportation projects sent by For government transportation projects sent by
First Class Mail via the US Postal Service: delivery service (UPS, Fed Ex, 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 via
the US Postal Service
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch OR
1617 Mail Service Center
Raleigh, NC 27699 -1617
For all other projects sent by delivery service
(UPS, FedEky etc.):
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
512 N. SWWxjry Street
Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4

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REF: B.O.M.2013 PG.988-990
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S 06'15'12
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(55' PUBLIC R/'W)
OPEN
SPACE
30 0 30 60 90
GRAPHIC SCALE - FEET
THIS IS TO CERTIFY THAT THIS MAP WAS
PRELIMINARY PLOT PLAN FOR:
PREPARED ANPREMISES, FROMUAL SURVEY OF
JLS HOMES
MADEUNDERT MY SUPERVISION, AND
THAT THERE ARE NOT ANY ENCROACHMENTS,
EXCEPT AS NOTED TO THE BEST OF MY KNOWLEDGE.
THAT THE RATIO OF PRECISION AS CALCULATED BY
LATITUDES AND DEPARTURES IS 1:10,000.
PANTHER CREEK TWSP., WAKE CO., N.C.
THIS MAP WAS PREPARED FOR TITLE COMPANY USE
SCALE 1 " = 30' APRIL 6, 2020
AND IS NOT INTENDED FOR RECORDATION OR
CONVEYANCES WITHOUT WRITTEN AUTHORIZATION
MAULDIN - WATKINS SURVEYING, P.A.
OF THE SURVEYOR AND OTHER APPROPRIATE OFFICIALS.
P.O. BOX 444 / 1301 W. BROAD ST.
PROFESSIONAL LAND SURVEYOR
PRELIMINARY PLAT
FUQUAY VARINA, NORTH CAROLINA 27526
L-3247
NOT FOR RECORDATION
[phone]
2768-389