20200969 Ver 1_Riparian Buffer Authorization Request_20200728

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/28/2020 12:25:37 PM (Start)
Approve by Carpenter, Kristi 7/29/2020 1:12:34 PM (DOT - Initial Review)
• The task was assigned to Carpenter, Kristi 7/28/2020 12:27 PM

Buffer Authorization Application Form
15ANCAC 02B .0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2) Buffer Authorization Online Fo
Update 10/23/2018
Original Submittal 7/28/2020
A. Owner/Applicant Information
General Information
Primary Contact Email:* [e-mail]
Rease list the contact person's en -ail for questions or payrrent on this project if needed.
Who is submitting the application?* r Owner
W Applicant other than Owner
r Agent
Is there an agent working on this application r Yes
but not submitting it? r No
1. Property Owner Information:
la. Name on Recorded Deed:*
David Madures
1b. Responsible Party:
David Madures
(for Corporations)
1c. Mailing Address:*
Street Address
581 Hwy 13 Bypass
Address Line 2
aty
Snow Hill
Fbstal / Zip Code
28580
1d. Telephone:* 252 439 2821
State / Province / Pbegion
NC
Country
US
le. Email Address:* [e-mail]
2. Applicant's Information (if different from owner):
2a. Name: NCDOT
2b. Company Affiliation:
2c. Mailing Address: Street Address
1037 WH Smith Boulevard
Address Line 2
aty
Greenville
Fbstal / Zip Code
27834
2d. Telephone: [phone]
2e. Email Address: [e-mail]
State / Province / Fbgion
NC
Country
US

B. Project Information and Prior Project History
1. Project Information `A
........................................................................................................................................................................................................................................................................................................................................................................................................ ......
la. Name of Project:*
US 13 Snow Hill project R-5812
(Subdivision, facility, or establishrrent narre)
1b. Is this a publicly -funded transportation project?*
r Yes
r No
1c. TIP# R-5812
1d. Subdivision Name:
le. Nearest Snow Hill
Municipality:
1f. Property Size: 0.00
acres
1g. County (or Counties) where the project is located:*
Greene
1h. Property ID# Date of Purchase
Tax RN or Parcel id
1 i. Deed Information
Type of Book Book# Page#
Deed
Map
1j. Attach a copy of the recorded map that indicates when the lot was last platted.
nick the upload button or drag and drop files here to attach docurrent
RDF only
1k. How would you like to provide the Latitude and Longitude information?*
f Address Lookup
r Manually
Latitude * 35.45856
Longitude* 77.67545
11. Is the project located in any of North Carolina's twenty coastal counties?*
r Yes
r No
2. Surface Waters
2a. Name of the nearest body of water to proposed project:*
Contentnea creek
2b. Water Quality Classification of nearest receiving water:*
C,SW, NSW
A

2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:*
0
(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:
Project will restore eroded banks from an adjacent NCDOT construction project.
2 Excavators, 4 Dump trucks, will place rip rap on the eroded banks. An impervious
dike will be used to pump water around the project so that it can be done in the dry.
3b. Attach an 8'/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
gick the upload button or drag and drop files here to attach docurrent
ACME Mapper 2.2 - 23.4 km N)M of Kinston NC.pdf 285.9KB
FDF only
3c. Attach an 81/. x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the
project site.
aick the upload button or drag and drop files here to attach docurrent
Snow Hill Soil map.pdf 99.6KB
FDF only
4. Proposed Activity
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used:
Project will restore eroded banks from an adjacent NCDOT construction project.
Total of 65' of linear shoreline impact.
Attach a site plan as applicable to the project:
gick the upload button or drag and drop files here to attach docurnent
Snow Hill R-5812 plan view and cross section.pdf 21.6KB
FDF only
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?*
4 Yes
O No
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes
r No
7. Future Project Plans
7a. Is this project a phased project?* O Yes
a No
C. Proposed Impacts Inventory
Buffer Impacts
Project is in which protected Basin?*

F Neuse River Basin (15A NCAC 02B.0233)
r Catawba River Basin (15A NCAC 02B.0243)
r Randleman Lake Watershed (15A NCAC 02B.0250)
f Tar -Pamlico River Basin (15A NCAC 026.0259)
r Jordan Lake Watershed (15A NCAC 02B.0267)
r Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 026.0607)
Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of this form.
Site# - Reason Stream Name Buffer Impact* Impact Type * Zone 111 Zone 2
Ivbp label (e.g. Road Temporary Allowable 0.00 0.00
Grossing 1) (T) Square Square
Perm orTenp Feet Feet
Total Zone 1 Impacts: 0.00
Total Zone 2 Impacts: 0.00
Total Buffer Impacts: 0.00
Comments:
No Buffer impacts.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project.*
Only Armoring the shoreline that was disturbed and not going above the top of
bank.
Total of 65' of linear shoreline impact.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.*
Only Armoring the shoreline that was disturbed and not going above the top of
bank.
Total of 65' of linear shoreline impact.
E. Diffuse Flow Plan
..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
la. What type of SCM are you providing?*
r- Level Spreader
r- Vegetated Conveyance (lower SHWT)
r- Wetland Swale (higher SHWT)
W Proposed project will not create concentrated stormwater flow through the
buffer
r- Other SCM that removed minimum of 30% nitrogen
1c. Diffuse Flow Documentation* aick the upload button or drag and drop files here to attach document
Snow Hill R-5812 plan view and cross section.pdf 21.6KB
FDF only
F. Supplementary Information
Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
f• Yes
f No

1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental Policy Act (NEPAISEPA)?
r
1c. If you answered "yes" to the above, has the document been finalized bythe State Clearing House?
r v
1d. Attach a copyof the NEPAor SEPAfinal approval letter.
dick the upload button or drag and drop files here to attach docurrent
FUF only
Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated Wetland Rules (15A NCAC 02H .1300), DWR
Surface Water or Wetland Standards, or Riparian Buffer Rules (15A NCAC 02B .0200)?
r
c
2b. Is this an after -the -fact buffer authorization application?
C'
.11
G. Additional Information A
.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Please upload any additional information you would like the Division to consider during application review.
Additional Attachments: Click the upload button or drag and drop files here to attach document
FDF only
Additional Comments:
H. Sign and Submit
By digitally signing below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
o I intend to electronically sign and submit the application form."
Print Name:* Jay B Johnson
Signature
Submission Date: (Auto populated field)

Initial Review
Is this accepted into the review process?*
Is this project a public transportation
project?*
ID#*
Version:*
Select Reviewer:
Select Reviewing Office*
Has payment been received?*
r Yes r No
r Yes
r No
20200969
1
Garcy Ward:eads\gpward
Washington Regional Office - [phone]
r No Payment Needed
f Fee Received
r Need Fee - send electronic notification