20210788 Ver 1_Riparian Buffer Authorization Request_20210414

Action History (UTC-05:00) Eastern Time(US&Canada)
Submit by Anonymous User 4/14/2021 9:34:21 AM(Start)
Approve by Carpenter,Kristi 4/16/2021 11:19:25 AM(DOT- Initial Review)
• The task was assigned to Carpenter,Kristi 4/14/2021 9:35 AM

Buffer Authorization Application Form IC ENVIRONMENTAL Water Resources QUALITY
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 4/14/2021
A. Owner/Applicant Information
General Information A
Primary Contact Email:* [e-mail]
Rease list the contact person's email for questions or paynrent on this project if needed.
Who is submitting the application?* 17 Owner
✓ Applicant other than Owner
✓ Agent
Is there an agent working on this application r Yes
but not submitting it? C No
1. Property Owner Information:
1a.Name on Recorded Deed:* public right-of-way
lb.Responsible Party: (for Corporations)
1c.Mailing Address:* Street Address
City of Greensboro
Address Line 2
P O Box 3136
City State/Rovince/Region
Greensboro NC
Rzstal/Zip Code Country
27402 USA
Id.Telephone:* 336-373-4313 le.Email Address:* [e-mail]
B. Project Information and Prior Project History
.................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. ....................................
1. Project Information A
.................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. ......................:............
1a.Name of Project:* Friendway Road Sidewalk
(Subdivision,facility,or establishrrent nano)
lb.Is this a publicly-funded transportation project?*
t: Yes
r No
1c.TIP# N/A
Id.Subdivision Name: N/A
le.Nearest Greensboro
Municipality:

1f.Property Size: 1.40
acres
1g.County(or Counties)where the project is located:*
Guilford
1h.Property ID# Date of Purchase
N/A
Tax RN or Parcel id
1 i.Deed Information
Type of Book Book# Page#
Deed N/A
Map
1j.Attach a copy of the recorded map that indicates when the lot was last platted.
aick the upload button or drag and drop files here to attach docurrent
FOF only
1k.How would you like to provide the Latitude and Longitude information?*
r Address Lookup
r Manually
Latitude* 36.084336 Longitude* -79.904706
11.Is the project located in any of North Carolina's twenty coastal counties?*
r Yes
C' No
2. Surface Waters
2a.Name of the nearest body of water to proposed project:*
Horse Pen Creek Tributary I
2b.Water Quality Classification of nearest receiving water:*
WSIII,NSW
2c.List the total estimated linear feet of all existing streams(intermittent and perennial)on the property:*
300
(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:
Friendway Road is a city street with ribbon pavement and no sidewalk in the area
that construction will take place.
Fuquay Place is a private drive to Western Guilford High School,no sidewalk or
curb in the area that construction will take place.
The general vicinity is suburban residential with a mix of housing types plus the
school.
3b.Attach an 8 1/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.

Click the upload button or drag and drop files here to attach docurrent
TopoMap.pdf 662.25KB
FDF only
3c.Attach an 8 1/2 x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the
project site.
Click the upload button or drag and drop files here to attach docurrent
Soil Survey 26.pdf 923.82KB
FCF only
4. Proposed Activity
..................................................................................................
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used:*
Friendway Road will be widened by about six feet with the addition of curb&gutter
and sidewalk.
Fuquay Place will have curb&gutter and sidewalk added without any widening.
Principal equipment to be used will be a mini-excavator and motor grader.Trucks
delivering materials as well as removing materials will be involved as well.
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach docurrent
2019074_ALL.pdf 7.23MB
FCF 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?*
✓ Yes
t: No
6. Project History
6a.Have permits or certifications been requested or obtained for this project(including all prior phases)in the past?*
C Yes
✓ No
7. Future Project Plans
7a.Is this project a phased project?* r Yes
C No
C. Proposed Impacts Inventory
Buffer Impacts
Project is in which protected Basin?*
✓ 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)
C' Jordan Lake Watershed(15A NCAC 02B.0267)
✓ Goose Creek Watershed(15A NCAC 02B.0606&15A NCAC 02B.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*_JL Impact Type* Zone 1 Zone 2
B1 -Construction UT of King Permanent Allowable 143.00 278.00
of curb&gutter, George (P) Square Square
sidewalk branch FbrmorTerrp Feet Feet
Map label(e.g.Fbad
Crossing 1)
B2-temporary UT of King Temporary Allowable 94.00 137.00
construction work George (T) Square Square
area branch Ft;rmorTerm Feet Feet
Map label(e.g.Fdbad
Crossing 1)
B3-Upgrade UT of King Permanent Allowable 30.00 0.00
existing storm George (P) Square Square
pipe,add rip-rap branch FbrmorTerrp Feet Feet
and wingwall
Map label(e.g.Finad
Crossing 1)
B4-temporary UT of King Temporary Allowable 92.00 0.00
construction work George (T) Square Square
area branch FttrmorTerrp Feet Feet
Map label(e.g.R ad
Crossing 1)
Total Zone 1 Impacts: 359.00
Total Zone 2 Impacts: 415.00
Total Buffer Impacts: 774.00
Comments:
D. Impact Justification and Mitigation
1.Avoidance and Minimization
.....................................................................................................................................................
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project.*
minimal or no grass strip at the sidewalks;retaining wall;curb ramps kept as small
as possible to minimize disturbance
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.*
silt fence will be installed around disturbed areas.retaining wall will minimize impact
to slope.
E. Diffuse Flow Plan
1a.What type of SCM are you providing?*
r Level Spreader
r Vegetated Conveyance(lower SHWT)
r Wetland Swale(higher SHWT)
17 Proposed project will not create concentrated stormwater flow through the
buffer
I— Other SCM that removed minimum of 30%nitrogen
lc. Diffuse Flow Documentation* Click the upload button or drag and drop files here to attach document
DiffuseFlowDoc.pdf 17.14KB
F CF only
F. Supplementary Information

Environmental Documentation
1a. Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?
r
lb.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(NEPA/SEPA)?
r Yes
C•No
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)?
C
ivo
2b.Is this an after-the-fact buffer authorization application?
C Yes
C: No
G.Additional Information
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 docunent
2019-074 Letter of No Practical Alternative.pdf 94.34KB
BufferPermitExhibit_041221.pdf 687.89KB
FCF 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;
• 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")
o 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
o I intend to electronically sign and submit the application form."
Print Name:* Eric Tart
Signature
Submission Date: (Auto populatedfidd)

Initial Review
Is this accepted into the review process?* C Yes r No
Is this project a public transportation C Yes
project?* r No
ID#* 20210788
Version:* 1
Select Reviewer: Dave Wanucha:eads\djwanucha
Select Reviewing Office* Winston-Salem Regional Office-[phone]
Has payment been received?* (' No Payment Needed
C Fee Received
r Need Fee-send electronic notification