20210610 Ver 1_Buffer Authorization Application Form_3.26.21_20210322

Bu ffer Auth orization Ap plication Form
15A NCAC 02B .0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2) Buffer Authorization Online Form -
Update 10/23/2018
A. Owner/Ap plican t In formation
For instructions on how to fill out this for m, see the Buffer Authorization Application Help Document posted on DWR's 401 & Buffer page.
Please note: fields mark ed with a red asterisk * below are required. You will not be able to submit the form until all mandatory questions are answered.
Primar y Contact Email:*
Is this pr oje ct a public transportation
proje ct?*
Who is submitting the application?*
Is the r e an age nt working on this application
but not submitting it?*
1. Property Owner Information:
2. Applicant's Information (if differe nt from owner):
A. Owne r/Applicant Information
General Information
[e-mail]
Please list the contact person's email for questions or payment on this project if needed.
Yes
No
Owner
Applicant other than Owner
Agent
Check all that apply
Yes
No
1a. Name on Re corde d De e d:*
1b. Re sponsible Party:
1c. M ailing Addre ss:*
1d. Te le phone :*1e . Email Addre ss:*
SOUTHERN REPAIR SERVICE INCORP
(for Corporations)
City
Durham
State / Province / Region
NC
Postal / Zip Code
27702
Country
USA
Street Address
P O BOX 685
Address Line 2
919-493-1541 [e-mail]
2a. Name :*
2b. Company Affiliation:
Mateo Burbano
If the applicant is not the property owner, in addition to providing the Agent’s information, select ‘Applicant other than Owner’ above, enter the applicant’s
information, and attach an authorization granting the applicant owner approval.
2c. M ailing Addre ss:*
2d. Te le phone :*
2e . Email Addre ss:*
City
Holly Springs
State / Province / Region
NC
Postal / Zip Code
27540
Country
US
Street Address
1335 Vine Street
Address Line 2
3157062951
[e-mail]
B. Project In formation an d Prior Project History
1a. Name of Proje ct:*
If your project has a formal name please use this. If your project does not have a formal name, please identify your project by the owner name and
proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any other names that have been used to identify the
project in the past.
1b. Is this a publicly-funde d transportation proje ct?*
1d. Subdiv ision Name :
1e . Ne are st
M unicipality:
1f. Prope rty Size :
1g. County (or Countie s) whe re the proje ct is locate d:*
1h. Prope rty ID#Date of Purchase
1i. Deed Information
Type of Book Book#Page #
De e d
M ap
1j. Attach a copy of the re corde d map that indicate s whe n the lot was last platte d.
1k. How would you like to prov ide the Latitude and Longitude information?*
B. Project Information and Prior Project History
1. Project Information
923 Clarendon Street - Building Rehabilitation and Expansion
(Subdivision, f acility, or establishment name)
Yes
No
THE SUBURBAN L&P CO
0.16
acres
Durham
101700
Tax PIN or Parcel id
1054 1
171 266-268
Click the upload button or drag and drop files here to attach document
Development Plat.pdf 441.61KB
923 Clarendon PLat.pdf 1.97MB
PDF only
Address Lookup
Manually
Addre ss Lookup
Latitude *Longitude *
1l. Is the proje ct locate d in any of North Carolina’s twe nty coastal countie s?*
Coastal Management information can be found at:
About Coastal Management
Staff Listing
Coastal County Lookup
2a. Name of the ne are st body of wate r to propose d proje ct:*
Link to Soil Surveys for North Carolina Counties. (Please see instructions in the Help Document to determine the most recent published version.)
2b. Wate r Quality Classification of ne are st re ce iv ing wate r:*
2c. List the total e stimate d line ar fe e t of all e xisting str e ams (inte rmitte nt and pe re nnial) on the prope rty:*
3a. De scribe the e xisting conditions on the site and the ge ne ral land use in the v icinity of the proje ct at the time of this
application:
3b. Attach an 8 ½ x 11 e xce rpt from the most re ce nt v e rsion of the USGS topographic map indicating the location of the site .
Link to TOPO Map lookup: https://viewer.nationalmap.gov/basic/
3c. Attach an 8 ½ x 11 e xce rpt from the most re ce nt v e rsion of the publishe d County NRCS Soil Surv e y M ap de picting the
proje ct site .
Link to Soil Surveys for North Carolina Counties. (Please see instructions in the Help Document to determine the most re ce nt publishe d version.)
City
Durham
State / Province / Region
NC
Postal / Zip Code
27705-4209
Country
US
Street Address
923 Clarendon Street
Address Line 2
36.0130712 -78.918415
Yes
No
2. Surface Waters
South Ellerbe Creek from the Neuse River
Basin
Water Supply IV (WS-IV), Nutrient Sensitive
Waters (NSW), Critical Area (CA)
0
(linear f eet only)
3. Project Description:
This property seems to have a stable grassy vegetation and grade although some
ponding was observed in the backyard close to the existing sewer structure. An
existing structure is present . Property seems to be located in a highly developed
residential area. Both adjacent lots directly north to the property also seem to be
developed and existing structures and grass covered yards were observed.
Additionally, a gravel public alley (15 ft) at the east limit was observed.
Click the upload button or drag and drop files here to attach document
NC_Northwest_Durham_20190807_TM_geo.pdf 108.38MB
PDF only
Click the upload button or drag and drop files here to attach document
Soils Report Map.pdf 2.35MB
PDF only
Prov ide a de taile d de scription of the propose d activ ity including its purpose and include the type of e quipme nt to be use d:*
Attach a site plan as applicable to the proje ct:
** Below is a link with instructions on what you will need to show on your site plan.
http://edocs.deq.nc.gov/WaterResources/0/doc/402224/Page1.aspx
5a. Hav e jurisdictional we tlands or stre am de te rminations by the Corps or State be e n r e que ste d or obtaine d for this
prope rty/proje ct (including all prior phase s) in the past?*
6a. Hav e pe rmits or ce rtifications be e n re que ste d or obtaine d for this proje ct (including all prior phase s) in the past?*
7a. Is this proje ct a phase d proje ct?*
4. Propose d Activ ity
Per the engineer’s report, there is very little that can be used from the existing
structure. Any salvageable material(s)/components will be given to the reclaimed
market for reuse/resale. For the new/replacement structure, we propose to build the
front wall in the same location, the side walls in the same location (in other words,
retain current front and side setbacks) but bump-out the rear (of the current
improvement) 14’ 6” (ext wall dimensions). There will be a 2nd floor above most of
the main floor. Since the subject is an existing duplex, the new/replacement
improvement will also be duplex; a 7-3-2.1 room count is anticipated for each side –
7 rooms, 3 bedrooms, 2.5 baths. The improvement will also comply with (in) height
restrictions. Careful attention will be given during construction to existing site
protection and preservation, including: a silt fence where specified, any hazardous
material remediated and disposed of properly and consistent/thorough site clean-up
as well as regular/consistent removal of debris/materials. A medium sized excavator
is planned for razing/removal of the existing improvement and a small sized (rubber
tracks) excavator is anticipated for the new footings. A mid-sized skid steer is also
anticipated for rough grade, final grade and shaping of the dirt berm (approx. 2’ in
height) to be built/added near/parallel with the existing creek; this is for additional
protection against possible future flooding/erosion of the subject site as well as
protecting adjoining sites.
We very much appreciate the opportunity to improve the subject site to a higher and
better use than what currently exists.
Click the upload button or drag and drop files here to attach document
923 CLARENDON ST-2.pdf 421.75KB
PDF only
5. Jurisdictional Dete rminations
Yes
No
6. Project History
Yes
No
7. Future Project Plans
Yes
No
C. Proposed Impacts Inventory
1a. Proje ct is in which prote cte d Basin?*
You can find which river basin you live in at the link below.
http://www.eenorthcarolina.org/riverbasins-gis-map.asp
1c. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of this form.
Please note: if the impact you list below requires mitigation choose "allow w/ mitigation" under impact type.
Site # - Re ason Stre am Name Buffe r Impact *Impact Type *Zone 1 Zone 2
Total Zone 1 Impacts:
Total Zone 2 Impacts:
Total Buffe r Impacts:
Comme nts:
C. Proposed Impacts Inventory
Buffer Impacts
Neuse River Basin (15A NCAC 02B.0233)
Catawba River Basin (15A NCAC 02B.0243)
Randleman Lake Watershed (15A NCAC 02B.0250)
Tar-Pamlico River Basin (15A NCAC 02B.0259)
Jordan Lake Watershed (15A NCAC 02B.0267)
Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 02B.0607)
House 1-
Proposed bump
out
Map label (e.g. Road
Crossing 1)
South
Ellerbe
Creek
Permanent
(P)
Perm or Temp
Exempt 0.00
Square
Feet
217.50
Square
Feet
0.00
217.50
217.50
D. Imp act Ju stification an d Mitigation
1a. Spe cifically de scribe me asure s take n to av oid or minimize the propose d impacts in de signing the proje ct.*
1b. Spe cifically de scribe me asure s take n to av oid or minimize the pr opose d impacts through construction te chnique s.*
D. Impact Justification and Mitigation
1. Avoidance and Minimization
n/a
n/a
E. Diffuse Fl ow Plan
All buffer impacts & high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented
riparian buffer program, upload a plan that fully documents how diffuse flow will be maintained. All stormwater control measures (SCMs) must be
designed in accordance with the NC Stormwater Design Manual. Associated supplement forms and other documentation must be provided.
For a list of options to meet the diffuse flow requirements, click here.
1a. What type of SCM are you prov iding?*
1c. Diffuse Flow Docume ntation *
E. Diffuse Flow Plan
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Proposed project will not create concentrated stormwater flow through the
buffer
Other SCM that removed minimum of 30% nitrogen
Click the upload button or drag and drop files here to attach document
Diffused Flow Documentation.pdf 70.87KB
PDF only
F. Su pp l ementary Information
Environmental Documentation
Violations
Please upload any additional information you would like the Division to consider during application review.
Additional Attachme nts:
Additional Comme nts:
F. Suppleme ntary Information
1a. Doe s the proje ct inv olv e an e xpe nditure of public (fe de ral/state /local) funds or the use of public (fe de ral/state ) land?
Yes
No
2a. Is the site in v iolation of DWR We tland Rule s (15A NCAC 02H .0500), Isolate d We tland Rule s (15A NCAC 02H .1300), DWR
Surface Wate r or We tland Standar ds, or Riparian Buffe r Rule s (15A NCAC 02B .0200)?
2b. Is this an afte r -the -fact buffe r authorization application?
Yes
No
Yes
No
G. Additional Information
Click the upload button or drag and drop files here to attach document
Owner Authorization.Letter.pdf 131.85KB
PDF only
G. Sig n an d Su bmit
By digitally signing be low, I ce rtify that:
I have given true, accurate, and complete information on this form;
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”);
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
I intend to electronically sign and submit the application form.”
Print Name :*
Signature *
Submission Date :
G. Sign and Submitt
Mateo Burbano
(Auto populated field)