20201193 Ver 1_Riparian Buffer Authorization_20200916

DWR
State of North Carolina
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
1a. Name of project:
REMODELING & ADDITION MUKESH SHAH'S RESIDENCE IN SUBDIVISION
SHERBOURNE
1 b. County:
Wake
1c. Nearest municipality:
Town of Cary
1d. Subdivision name:
SHERBOURNE
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:
Mukesh Shah and Sandhya Shah
2b. Deed Book and Page No.
Book# 008120 Page # 00698
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
Maps 1995 pages 530& 531
2d. Responsible Party
for Corporations):
2e. Street address:
103 Hanahan Court
2f. City, state, zip:
Cary, NC 27513
2g. Telephone no.:
919-523-1041
2h. Fax no.:
n.a.
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.
Agent/Consultant 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:
FORM: BA 10-2013 Page 1 of 5

FORM: BA 10-2013 Page 2 of 5

B.
Project Information and Prior Project History
1.
Property Identification
1 a.
Property identification no. (tax PIN or parcel ID):
0743697013
1 b.
Site coordinates (in decimal degrees):
Latitude: 35.780450
Longitude:-78.842530
1 c.
Property size:
0.56 acres
2.
Surface
Waters
2a.
Name of nearest body of water to proposed project:
2b.
Water Quality Classification of nearest receiving water:
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:
Single family dwelling unit
3b.
Attach an 8'h x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c.
Attach an 8'h 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:
None
3e.
Explain the purpose of the proposed project:
House extension
3f.
Describe the overall project in detail, including the type of equipment to be used:
Backhoe loader
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.
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 3 of 5

C. Proposed Impacts 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 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
❑ Yes ® No
B2 ❑ P ❑ T
❑ Yes ® No
B3 ❑ P ❑ T
❑ Yes ® No
134 ❑ P ❑ T
❑ Yes ® No
B5 ❑ P ❑ T
❑ Yes ® No
136 ❑ P ❑ T
❑ Yes ® No
Total buffer impacts
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.
Silt fence
1 b.
Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. Do not use equipment next to protected area.
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.
Not Applicable
2f.
Comments:
FORM: BA 10-2013 Page 4 of 5

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
❑ 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):
Mukesh Shah
Applicant/Agent's Printed Name
Applicant/Agent's Signature Date
(Agent's signature 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 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
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
FORM: BA 10-2013 Page 5 of 5