20140306 Ver 1_Riparian Buffer Authorization_20140402

2 0 1 40 3 0 6
RState of North Carolina
Department of Environment and Natural Resources
DWLslon of Water llll arces 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
1 a. Name of project: tJ
ib. County: +NAi.F-
1 c. Nearest municipality:
1d. Subdivision name:
plu-5-kW V, O e
1e. 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 j�No
2. Owner Information
2a. Name on Recorded Deed:
W t �\ t WNe L_ $ S /v 4 E LE
2b. Deed Book and Page No.
V300C 61 3,15 f pr,-2 oa a 33
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
M P,10 0 -7 y 5- b3
~� '=`- --
2d. Responsible Party
(for Corporations):
2e. Street address:
10 -1 R Be C 0
2f. City, state, zip:
C APL L Q"7 5101 ; rY
2g. Telephone no.:
9 lq - �j l'7 - O
2h. Fax no.:
2i. Email address:
, , co ` :�
3. Applicant Information (if different from owner)
3a. Applicant is:
❑ Agent J4 Other, specify: Co
3b. Name:
7-0
3c. Business name
(if applicable):
ex C,0 J SA-ev,G�� o�
3d. Street address:
1 y
3e. City, state, zip:
VL d-7 3
3f. Telephone no.:
q- D I- D /SSA
3g. Fax no.:
t - Cj _
3h. Email address:
FXCEA qE+hE.#- S q&tML .Can AR 2 8 ?C;f
4. Agent/Consultant Information (if applicable)
4a. Name:
0� I
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 4
V
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B. Project Information and Prior Project History
1.
Property Identification
1a
Property identification no..(tax PIN or parcel ID)
4 3 0 SD )c Ooo
1 b.
Site coordinates (in decimal degrees)*
Latitude
Longitude.
1c.
Property size.
acres q a
2.
Surface Waters
2a
Name of nearest body'of water to proposed
project.
L
C �A6�a PA '
2b.
Water'Quality Classification,of nearest receiving
water.
I v NSvJ
2c
River basin.
�'U S�-
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, siks oN +C>p cx ik`%\ V.*ex -a v, OA L is +'0 fie comp4e
Rail ks fvV 49,,4,ss Aft M94 CaN S l sf s or- &L44 *r
3b
Attach an 6'/Z x 11 excerpt,froth the most recent version of the USGS topographic map indicating the location
of the,site
3c.
Attach an 8' /z x 11 excerpt-from the, most recent'version,of the published County NRCS Sod Survey Map
depicting the project,site
3d.
List the total estimated linear feet�of,all existing streams (intermittent and perennial) on the property.
Xq. v
3e
Explain the purpose of-the proposed project: Col. J" uPPM F*tA r1Wq' Oe ` }o R Sc.REEri ' PbAeA
C,uNSk¢JC.F- Mow i ow,�e �� -
3f. Describe the overall project in detad,'including the type of equipment to be used. CA')PSN&%9A-
KODIP OVeA- 64"S*1NV CN* W 6Wftt 6 Sd2.V-L 3," 4geoa8a Aerie
4.
Jurisdictional Determinations
4a
Have junsdictional wetland orstream determinations by the
Corps or State been requested or obtained for this property/
project (including�all prior phases) in the past?
❑ Yes ❑ No Unknown
Comments
4b.
If yes, who delineated the jurisdictional areas?
Name (d known)
Agency/ Consultant Company.
Other.
4c.
If yes, list the dates of the Corps junsdictional determinations or'State determinations and attach
documentation.
5.
Project History -
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes o ❑ Unknown
5b.
If yes, explain and detail_ according to "help'file" instructions
6.
Future_ Project Plans -
6a. Is thisa phased project?
❑ Yes o
6b. If'yes, explain.
FORM: BA 10 -2013
Page 2 of 4

C. Proposed Impacts Inventory
1. Avoidance and Minimization
1. Buffer Impacts
1 b. Specifically describe measures•taken to avoid or minimize,the,proposed impacts through construction
tech�ni es. All s�ta�o MA�6QtAtPO DrJ pew6wr+•j .�bt C.V+t OFn"-,,�
f5►h�
2. Buffer Mitigation
la. Project is in which protected
basing
❑Ye N0
Neuse ❑ Tar - Pamlico ❑ Catawba
❑ Randleman ❑ Jordan ❑ Goose Creek
1b Individually list, all lbuffer impacts below If any impacts require, mitigation, then you MUST fill,out Section D'of
this form.
Buffer impact
number –
Permanent (P)
or Tem a T
Reason for
impact
Type of impact
(exempt, allowable,
allowable w/ mibgabon)
Stream name
Buffer
mitigation
required?
Zone'1
impact
(sq ft)
Zone 2
impact
(sq ft)
131 P ❑ T
QM
_
❑ Yes No
1.5
70
B2 ❑ P 111
Total buffer mitigation required:,
2c. if buffer, mitigationdis required, is °payment to;a
mitigation bank or NC EEP proposed?
❑ Yes ❑ No
_
2e. If no, then discuss what type of mitigation is proposed.
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
_
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
_ Total buffer impacts
1c. Comments-
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
W"J- pR,t,it: W zo.� X, Un411 '6-%-%L1 hA'Vi: ExIShnAWf vega+o.AK, --J -tm 4A,., ! A swc-
1 b. Specifically describe measures•taken to avoid or minimize,the,proposed impacts through construction
tech�ni es. All s�ta�o MA�6QtAtPO DrJ pew6wr+•j .�bt C.V+t OFn"-,,�
f5►h�
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that requires buffer
mitigation?
❑Ye N0
2b. If yes, then identify the square feet,of impact to each•zone of the riparian buffer that, equires mitigation and
calculate the amount of mitigation required in the table below.
Zone
Reason for impact
Total impact
(square feet
Multiplier
Required mitigation
s uare,feet
Zone 1
3 (2,for Catawba)
Zone-2
_
1.5
Total buffer mitigation required:,
2c. if buffer, mitigationdis 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
stormwater treatment Include,a plan that fully documents how diffuse flow will', be
❑'Other BMP
maintained. If a Level Spreaderis 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
environmental document, pursuant to the requirements of the National or State (North
a plan,for stormwater treatment as outlined in CHapter 84 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
la. Does the project involve, an expenditure of public (federal /stateAocal) 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 Welland Rules,(15A NCAC 02H 0500), Isolated
❑Yes o
Wetland Rules (15A NCAC,02H .1300), DWR Surface,Water or °Wetland Standards, or
Ripanan Buffer Rules (15A NCAC 02B .0200)?
2b Is this an after - the -fact permit applications
❑ Yes o
2c. If you answered "yes" to one or both of the above questions, provide,an explanation of the wolation(s)_
lV o� _ -- as- y
Applicant/Agent's Printed Name App ca t/Agent's Signature Da e
'(Agenrs signature is valid only H authorization lletter from the applicant is provided )
Send this completed,form and accompanying documents,to the following:
For government,transportadon projects send
by First Class Mail vzwthe' US Postal Service
NC DWR, Transportation Permitting Unit
1650 Mail,Service Center
Raleigh, NC 27699 -1650
For all'other projects send 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 transportation projects send
by delivery service (UPS,' FedEx, etc')
OR NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
For all'other projects send by delivery service
(UPS, FedEx, etc).
OR Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
512 N. Salisbury,Street
Raleigh, NC 21604
FORM: BA 10 -2013 Page 4 of 4

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