20131167 Ver 1_Riparian Buffer Authorization_20131105

20 13 1 167
State of North Carolina
Department of Environment and Natural Resources
9_.JL_000�
of Water Resources Division of Water Resources
15A NCAC 0213.0233 (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:
, ha%tve
1b. County:
A ho-
1c. Nearest municipality:
1d. Subdivision name:
1e. Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer If below.
❑Yes (lo
It 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:
2b. Deed Book and Page No.
7
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
P6 Afet-tic- 0 610
2d. Responsible Party
(for Corporations):
2e. Street address:
712 0 1v.
2f. City, state, zip
a Q C.
2g. Telephone no.:
2h. Fax no.:
2i. Email address:
i oAN e r er+
3. Applicant Information (if different from owner)
3a. Applicant is:
❑ Agent Other, specify: r ' r ►k ot.,
3b. Name:
o�
3c. Business name
(if applicable):
3d. Street address:
Q
e
3e. City, state, zip:
j c, u Q16ol
3f. Telephone no.:
NLS a Lf 3 2Z
3g. Fax no.:
--�-
3h. Email address:
6L,rr n 4b✓l • ctnid a; . Go
4. Agent!Consultant information (if applicable
4a. Name:
4b. Business name
(if applicable):
�]
(1
4c. Street address:
4d. City, state, zip:
- 5 2011
4e. Telephone no.:
yy WAiLR 0
4f. Fax no.:
4g. Email address:
r nch
FORM: BA 10 -2013 Page 1 of 4
lR

B. Project Information and Prior Project History
1. Property identification
1a. Property identification no. (tax PIN or parcel ID):
577 —00000 — ©` s5
1b. Site coordinates (in decimal degrees):
Latitude: 35, 961
Longitude: - 7g, 69 5
1c. Property size:
,5 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
2b. Water Quality Classification of nearest receiving water.
C
2c. River basin:
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:
Vaunt sjvl �2 %�1 "USGS esJC)e4t;-2
3b. Attach an 8'r4 x 11 excerpt from the most recent version of topogr aphic map indicating the location of
the site
3c. Attach an 8'r4 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:
176 A.
3e. Explain the urpose of the proposed project:
w� walc 'am I �' XC.
3f. Describe the ov rall project in d , including the type of equipment to be used:
'l 0, `M le � 1 3W a 94 P1001te Z 1 r`hb 'I 4 r� n,,e4
4. Jurisdictional Detenninatio s
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property/
project (including all prior phases) in the past?
0Yes ❑ No ❑ Unknown
Comments: ,� Dah ,'cI 'I?+crn •
oh A to fAtc
4b. If yes, who delineated the jurisdictional areas?
Name (if known): i es7
Agency/ Consultant Company.
Other.
4c. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
13
S. Project Hisiory
5a. Have permits or certifications been requested or obtained for this
project (including all prior phases) in the past?
❑Yes ❑ No nknown
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 2 of 4
Ell

C. Proposed Impacts Inventory
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1. Buffer Impacts
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that requires buffer
mitigation?
1a. Project is in which protected basin?
7 Neuse ❑ Tar - Pamlico ❑ Catawba
❑ Randleman Jordan ❑ Goose Creek
1 b. Individually list all buffer impacts below. If any impacts require mitigation, then you MIUST fill out Section D of this
form.
Buffer impact
number —
Permanent (P)
or Tempgrary M
Reason for
impact
St'.14AW"'Ift
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
HW&t
Zone 2
❑ Yes No
1.5
82 El ❑T
Total buffer mitigation
required:
[I Yes [I No
❑ Yes ❑ No
2d. If yes, attach the acceptance letter from the mitigation bank or NC EEP.
B3 ❑ P ❑ T
2f. Comments:
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
86 ❑ P ❑ T
❑ Yes ❑ No
Total
buffer Impacts
1 c. Comments: ✓ 1 e
n ' /mod Al's A
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.
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 EEP proposed?
❑ Yes ❑ No
2d. If yes, attach the acceptance letter from the mitigation bank or NC EEP.
2e. If no, then discuss what type of mitigation is proposed.
2f. Comments:
FORM: BA 10 -2013 Page 3 of 4

E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of
❑ Diffuse flow
storrnwater 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.
1b. If you answered °yes° to the above, does the project require preparation of an
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
environmental document pursuant to the requirements of the National or State (North
plan for stornw ater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Carolina) Environmental Policy Act (NEPA/SEPA)?
Manual and attach a BMP Supplement Form.
1c. If you answered 'yes' to the above, has the document been finalized by the State
F. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federallstate/local) funds or the use of
❑ Yes ®'No
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 Wetland
es ❑ No
Rules (15A NCAC 02H .1300), DWR Surface Water or Welland Standards, or Riparian
Buffer Rules (15A NCAC 02B .0200)?
2b. Is this an after- the -fact permit application?
❑ Yes
2c. If you answered 'yes" to one or both of the above questions, provide an explanation of the violation(s):
11etd c. NauI/ A oKN1' o "ow.. Ire a pk lr y Vr+V'IQ� �jk f7te ✓ 2AHe
40" -t
h
916n�d /D W I,'/-?
plicant/Agerirs Printab Name V Applidud4bents Signature Date
(Agents signature is valid only if an suftrWd on letter from the applicant is provided.)
Send this completed form and accompanying documents to the following:
For government transportadon projecis seat
by First Class Mail via the US Postal Service:
NC DWR, Transportation Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
For aU other projects sent by First Class Mail
via the US Postal Service
Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
For government transporrtation projects sent
by delivery service (UPS, FedEx, etc.):
OR NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
For aU other projects sent by delivery service
(UPS, FedEx, etc.):
OR Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
FORM: BA 10 -2013 Page 4 of 4

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Web Soil Survey
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WDEMR.
North Carolina Department of 5nYlrOrarrjlenf,,and Natucai, Resources
.Division of'Vllatef'R'esources . • . '
: Water Quality .0gram. S
r
Pat Wormy - 'Tbornas A. Reeder John E: gkvad, a,,,lll
Govemor. `Director Secretary
Octutlgt Zit 200
'William ariaJessieS:bert _ - - _ '
3230,G1en Royal.RbaB
.Raleigh, NC 2x76 � � _ '
Subject Sur[aee WaterDetermination Letter'
NBRRO#13 =29..7
Wake County
project Name:
• ibtP/Du�ectidits:
smject Stream:
• ,571�.Caftoii•Drive, Raleigh '
Piopert3± iia private undevefoped rdt located at Qioject ad&e .
UT. td'1•Iare.Sniprrt,'r��`c _
Deorn"ation'Dam. Oaobe'rai1 20 31 ' Staff: Sars -Knies
Feature
'
BWbr Caill
Isolated'oi EIP Call -
,MINeuse (1$A NCAC 2B :Q23S)'
.
[� Tar.- PamGoo�(1`5AlNC'AC 26 ;0259)
'
Q Ephememi4ntermrttpo'w ennial•DetemllniOoo�
Q ;Isolated VIJetland,Detteiminahon
O.Jotdaft (1'5A NCAC 26..028+7')
.
project Name:
• ibtP/Du�ectidits:
smject Stream:
• ,571�.Caftoii•Drive, Raleigh '
Piopert3± iia private undevefoped rdt located at Qioject ad&e .
UT. td'1•Iare.Sniprrt,'r��`c _
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Explanation: The•eatute(s) listed,above has or have beentlocated- on 'theSo`il:Sucveyof.Wake �otmty;.Nbiiii
Carovna or lhe.most recent cop }+ of'the L�SGS Topographic �iiap =attra 1:24,000 scik, Each feature that is chOked
"NobSubject"'has been detenminedliot.to Be a stream or ismot.present:bn bb property. )reatUies•dM;am dhe&dd•
"Subject" have.6een located,onuhe property and possess characteristics &KgtWify into be a stream: :Mere piasy:lie .
other streams located on your pmpercy tBat,dd not,s}toW tip bn'tlie maps re�ereneed -aliove bait; still mi4Y =be•
considered' jurisdictionabaccordmg*&e 11S Artny'Corps,of ):itgineers an&br to the Division of Water'ltesburces
Ttiiiz pihi =bite deterimibadonstiaP.ea�,6ve (�yofi the_•dste�ofthis letter:• 'LsgBotvners or,at�ected-parties that
disptYte� determinatlbn aade.*,,.the.DWR br D'eie aWd I:ocai- AQthority may request a determination b -the,
r '
. North- eamlma Dmsm-of,V46wr Resources 1628 t bfi Service Center AsII gh,,NC 27899.1628.Ftiorre•(9.1'9) 791 -4200• ' -
dritemet.amnorratlimushtvom Location•3800,Bbm*Dme Raleigh, NC 2780l1S Fax [phone],
lW�h!�Ce' Aeon', Faye r- 5o96tReclydedM096•Post•Peper .

Alf 2 C�el„tO,lf�,Dl ive .
ObtOberr'Zl t6r3
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Director. A•u appeal:request must7bc made-within sixty (60),days otdate'of tius'leaer -or• from dlic date-the a8e2ted'
party (including downstream and/or adj'seeni-e vaers).is:nodfied of this•Ietter..A.requat:for a,d'eteragination by,tbe•
.Diiactor shall be�rlelevred'to the Director !n•wMi .,eIb Karen Higgins; DWR WeBSWe Unit, 16M.M 11 Seyvmf
Ceriter,;''l�aleigh,,(•1C .27699.• '
This determinstioq is fmsl and binding unless; as detailed above, .you•ask,fbr a• hearing. or appeal whbin,sb* (60)
days: '
The owner %fhhureowngrs•shourd.notify the ,.Division of Water R_mpmes (inrludiWan. oiher•Loca'II,rSta* aad
�FederaiAgencies) of di s decision eoricerninkany- future correspondence§ regarding•the sub'e�t pribp�rty, (atsted
above TGis iin dct +inay rggnir'e a. S"o 1404%401, PermitFforthe pro�1. -0 activity. A q - quiri�s�sh01 --d be
�lireEtedrto the Diy,Woa, b> @I��ter l�tesonr(es (COntral Of5cOat.(f Ii) ,7_!0* and the USA Army Corp of Engineer:
(R@Ibikb Regutat6f lField gffice)'at (919}554 =488n. - If y-66 Gave quesfioris regtn§ deern3 1 f$.to ga (99) 791206i .•
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5712 Calton Drive,
Raleigh
PIN 0796276354 000
Real Estate I D 0064357
Map Name 079610
Owner WI LLIAM 8 JESSIE SIBERT LLC
Mating Address 1 3230 GLEN ROYAL RD
Mailing Address 2 RALEIGHNC27617 -7404
Deed Book 12787
Deed Page 1243
Deed Dale 10102007
Deeded Acreage 0 5
Assessed Building Value SO
Assessed Land Vakie. 577.000
Total Assessed Value $77,000
Billing Class CORPORATE LISTING
Property Description LOdl3 GREATER PT OF
SIR WALTER FILLS
Heated Area 0
Ste Address 5712 CALTON DR
City Raleigh
Township HOUSE CREEK
Year But" 0
Total Sale Price. $O
Land Class VACANT
Old Parcel Number 377 -00000 -0235
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