20220319 Ver 1_Riparian Buffer Authorization Request_20220225

Buffer Authorization Application 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
Water Reources
ENVIRONMENTAL QUALITY
Original Submittal 2/25/2022
A. Owner/Applicant Information
General Information
Primary Contact Email:*
Who is submitting the application?*
[e-mail]
Please list the contact person's email for questions or payment on this project if needed.
Owner
Applicant other than Owner
Agent
Is there an agent working on this application but Yes
not submitting it? • No
1. Property Owner Information:
....................................................................................................................................
la. Name on Recorded Deed: *
1b. Responsible Party:
lc. Mailing Address:*
Id. Telephone:*
1-919-622-9858
Richard K Frie Jessica L Frie
(for Corporations)
Street Address
436 Queen Anne Drive
Address Line 2
City
Bath
Postal / Zip Code
27808
B. Project Information and Prior Project History
1. Project Information
1a. Name of Project: *
State / Province / Region
NC
Country
United States
1e. Email Address: * [e-mail]
Rich Frie
(Subdivision, facility, or establishment name)
1b. Is this a publicly -funded transportation project?*
Yes
No
Id. Subdivision Name:
le. Nearest Municipality:
If. Property Size:
acres
1g. County (or Counties) where the project is located:*

Beaufort
1h. Property ID#
Tax PIN or Parcel id
Deed Information
Date of Purchase
Type of Book
Deed
Map
Book#
Page#
1 j. Attach a copy of the recorded map that indicates when the lot was last platted.
Click the upload button or drag and drop files here to attach document
PDF only
1k. How would you like to provide the Latitude and Longitude information?*
Address Lookup
Manually
Address Lookup
Latitude* 35.4300143
Street Address
436 Queen Anne Drive
Address Line 2
City State / Province / Region
Bath NC
Postal / Zip Code Country
27808-9447 US
Longitude *
11. Is the project located in any of North Carolina's twenty coastal counties?*
Yes
No
-76.7793439
1m. Is the project located within a NC Division of Coastal Management Area of Environmental Concern (AEC)?
Yes
No
2. Surface Waters
2a. Name of the nearest body of water to proposed project:*
Pamlico river
2b. Water Quality Classification of nearest receiving water: *
Unknown
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: *
0
(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:

3b. Attach an 8'/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 document
PDF only
3c. Attach an 8'/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 document
PDF only
4. Proposed Activity
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used: *
See uploaded file attached
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach document
img20220225_09471327.pdf 502.8KB
PDF 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
No
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
Yes
• No
7. Future Project Plans
7a. Is this project a phased project?*
C. Proposed Impacts Inventory
Buffer Impacts
Yes
No
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)
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*
Impact Type
Zone 1
Zone 2
Map label (e.g. Road
Crossing 1)
Permanent
(P)
Perm or Temp
Allowable
0.00
Square
Feet
0.00
Square
Feet
Total Zone 1 Impacts: 0.00

Total Zone 2 Impacts: 0.00
Total Buffer Impacts: 0.00
Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
................................................................................................................................
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project.
Unknown
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Unknown
E. Diffuse Flow Plan
la. What type of SCM are you providing?*
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
1 c. Diffuse Flow Documentation Click the upload button or drag and drop files here to attach document
img20220225_09471327.pdf 502.8KB
PDF only
F. Supplementary Information
Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes
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)?
Yes
No
2b. Is this an after -the -fact buffer authorization application?
Yes
No
G. Additional Information
Please upload any additional information you would like the Division to consider during application review.
Additional Attachments:
Additional Comments:
Click the upload button or drag and drop files here to attach document
PDF only

H. Sign and Submit
By digitally signing below, I certify that:
• I have given true, accurate, and complete information on this form;
o 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");
o 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: * Richard K Frie
Signature
Submission Date:
2-25-2022
(Auto populated field)

Initial Review
Is this accepted into the review process?* • Yes No
Yes
• No
ID#* 20220319
Version:* 1
Select Reviewer: * Robert Tankard:eads\rbtankard
Select Reviewing Office* Washington Regional Office - [phone]
Is this project a public transportation project?*
Has payment been received?* • No Payment Needed
Fee Received
Need Fee - send electronic notification

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