20140437 Ver 1_Riparian Buffer Authorization_20140424

2 0 1 4 0 4 3 7 State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources 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
la
Name of project
/ y,(, , , i}' 5
1 b
County
AA e c k ems► b jr '
1c
Nearest municipality
1 d
Subdivision name
Cry � •� S o
le
'
Is the project located in any of North Carolina's
twenty coastal counties If yes, answer 1f below
E] Yes X No
if
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
'621ArJ ►C w11 -i-14,-Yl S
2b
Deed Book and Page No
2c Map Book and Page No
(Include a copy of the recorded
map that indicates when the lot
was created)
r Z -7 t�
e
See 4' <c,"-d Tl&l - 6
2d
Responsible Parry
(for Corporations)
2e
Street address
2f
City, state, zip
N c- g yo-t, j
2g
Telephone no
2-18 -7 -7 4-7
2h
Fax no
21
Email address
rc,M
3.
Applicant Information (if different from owner)
3a
Applicant is
❑ Agent ❑ Other, specify
- n
3b
Name
'
3c
Business name
(if applicable)
-A 7niA—i
3d
Street address
3e
City, state, zip
3f
Telephone no
u,r=rw Branch
3g
Fax no
3h
Email address
4.
Agent/Consultant Information (if applicable)
4a
Name
4b
Business name
(if applicable)
4c
Street address
`emu �3
4d
City, state, zip
,-yV1
4e
Telephone no
701f - ! - 3 c! i-
4f
Fax no
cp` - G 3 - S`Z
4g
Email address
FORM BA 10 -2013 Page 1 of 4

B.
Project Information and Prior Project History
1
Property Identification
la
Property identification no (tax PIN or parcel ID)
Ay -T f FJ c/
lb
Site coordinates (in decimal degrees)
Latitude :K5- 1' � -
Longitude
1c
Property size
L acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
2b
Water Quality Classification of nearest receiving water
145 4-
2c
River basin��
„��y
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 �;ts�dPr�`uj �/%o4 -, ` ele, %5 e/m5� -oo o� a h-lilG tl� 1::o,i- 3' k y4
v4xx -5 l�Li ffG [v•� "•! -14e - ' he, "I"'e,- Y e & Ae : ,s a JI 55e b bacCV&4
3b
Attach an 8'/ x 11 excerpt from the most recent version of the USGS topographic map indicating the location of
the site
3c
Attach an 8 Y2 x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map
depicting the project site ,! �-- e ”
3d
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
/4
3e
Explain the purpose of the proposed project 5yeb (,•yf �,4e, Nf��, ���9/( h� 7t,5(4 l�yl
a h kz,& rcXa , -,at , d 1e0
3f
Describe the �overall project in detail, including the type Dorf equipment to be used
/f / °�vi�: (�KCa�`��l u�rli U"we,'ff�
4.
Jurisdictional Determinations
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?
❑ Yes No ❑ Unknown
Comments
4b
If yes, who delineated the jurisdictional areas?
Name (if known)
Agency/ Consultant Company
I Other
4c
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
S.
Project History
5a
Have permits or certifications been requested or obtained for this
project (including all pnor phases) in the past?
❑ Yes ;9No ❑ Unknown
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
//

C. Proposed Impacts Inventory
Impact Justification and Mitigation
1.
1. Buffer Impacts
la
Specifically describe measures taken to avoid or minimize the proposed impact in desig /ning project
/`jp ` ice` t1 �; ll S{ f �J�� �, � ; /f-0��5�Gji �L � r � i, ( }��1� 4 ' &'l,�lIe �r�E�k •,r�
K e e ,T5 ¢ `�- es rc ��v : p',sga 1'I 4 2v�,
la Project is in which protected basin?
❑ Neuse
❑ Randleman
❑ Tar - Pamlico Catawba
❑ Jordan ❑ Goose Creek
1 b Individually list all buffer impacts below If any impacts require mitigation, then you MUST fill out Section D of this
form
Buffer impact
number —
Permanent (P)
or Tem ora
Reason for
impact
Type of impact
(exempt, allowable,
allowable w/ mitigation)
2b
Stream name
Buffer
mitigation
required?
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
B1 0 P 9T
44,_ 1/a
w /.a 6 t'e
Yes IN No
ZkYa
B2 ❑ P ❑ T
1 5
❑ Yes ❑ No
Total buffer mitigation required:
B3 ❑ P ❑ T
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
❑ Yes ❑ No
if no, then discuss what type of mitigation is proposed
2f
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total buffer impacts
/-Z:?,
�[JP
1c Comments i

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 Spreader is proposed, attach a Level Spreader Supplement Form
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
la
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
❑ Yes No
Manual and attach a BMP Supplement Form
public (federal /state) land?
F.
Supplementary Information
by First Class Mail via the US Postal Service
1
Environmental Documentation
OR NC DWR, Transportation Permitting Unit
la
Does the project involve an expenditure of public (federal /state/local) funds or the use of
❑ Yes No
Raleigh, NC 27604
public (federal /state) land?
For all other projects sent by delrvery service
lb
If you answered "yes" to the above, does the project require preparation of an
❑ Yes ❑ No
Karen Higgins
OR
environmental document pursuant to the requirements of the National or State (North
NCDWR — 401 & Buffer Permitting Unit
1650 Mail Service Center
Carolina) Environmental Policy Act (NEPA/SEPA)?
Raleigh, NC 27699 - 1650
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
❑ Yes j No
Rules (15A NCAC 02H 1300), DWR Surface Water or Wetland Standards, or Riparian
Buffer Rules (15A NCAC 02B 0200)?
2b
Is this an after - the -fact permit application?
❑ Yes rV No
2c
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s)
q / J
Applicant/Agent's Printed Name i Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided )
Send 3 complete sets of this form and accompanying documents to the following
For government transportation projects sent
For government transportation projects sent
by First Class Mail via the US Postal Service
by delivery service (UPS, FedEx, etc)
NC DWR, Transportation Permitting Unit
OR NC DWR, Transportation Permitting Unit
1650 Mall Service Center
512 N Salisbury Street
Raleigh, NC 27699 - 1650
Raleigh, NC 27604
For all other projects sent by First Class Mail
For all other projects sent by delrvery service
via the US Postal Service
(UPS FedEx, etc)
Karen Higgins
Karen Higgins
OR
NCDWR — 401 & Buffer Permitting Unit
NCDWR — 401 & Buffer Permitting Unit
1650 Mail Service Center
512 N Salisbury Street
Raleigh, NC 27699 - 1650
Raleigh, NC 27604
FORM BA 10 -2013
Page 4 of 4

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NOTES:
• AREA DETERMINED BY COORDINATE METHOD.
•SUBJECT PROPERTY DESCRIPTION RECORDED IN DEED BOOK 28293 PAGE 702
• THIS SURVEY WAS COMPLETED WffHOUT THE BENEFIT OF A TITLE REPORT. THIS PROPERTY MAY BE SUBJECT TO RECORDED OR UNRECORDED
i EASEMENTS, RIGHT OF WAYS, SETBACKS AND /OR RESTRICTIVE COVENANTS NOT SHOWN HEREON. • THIS MAP IS NOT INTENDED TO MEET G.S. 47 -30 AND IS NOT TO BE RECORDED AS A PLAT.
• SUBJECT PROPERTY IS LOCATED IN A SPECIAL FLOOD ZONE o
AS PER FIRM PANEL 3710463300J, DATED MARCH 2ND, 2009.
• NO EXAMINATION OF ZONING COMPLIANCE.
VICINITY MAP (NO SCALE)
LINE
IBEARINn.
DISTANCE
U
S 85. 5941" E
10.57'
L2
S 43'37'04" W
13.57'
L3
N 68'24507" W
32.64'
L4
S 71'55'17" W
18.15'
L5
N 71'05'47" W
15.92'
DUKE POWER CO
PID: 00178178 }s
MB 24 PAGE 9 IPF
I�
` J4 �N
IPF
V
NOTE:
LOTS 64-73 ARE SUBJECT
TO A DUKE POWER
I 10' FLOOD EASEMENT
T
W
W
N
(T
0
f
j LOT 66
I PID: 00178108 N
MB 27 PAGE 102
LEGEND
• = IRON PIN FOUND
0 = CALCULATED POINT
MB = MAP BOOK
BW = BRICK WALL
POE = PUBLIC DRAINAGE EASEMENT
I PID = PARCEL IDENTIFIER
/4
IPF
Is 30 so
GRAPHIC SCALE
I inch - 30 feet
20' PDE
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R PID: 00178109
MB 27 PAGE 102
g
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IPF
BALTIC DRIVE
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PHYSICAL SURVEY
21409 BALTIC DRIVE
LOT 55 MAP i
CAPTAIN'S POINT
MAP BOOK 27 PAGE 102
CORNELIUS, MECKLENBURG COUNTY, NORTH CAROLINA
PREPARED FOR: BRIAN K. WILLIAMS
MCMURRAY LAND SURVEYING INC. C -3906
MICHAEL P. MCMURRAY, NCPLS L -4880
318 E OLD HIGHWAY 74, MONROE, N.C.
mcmurroWlsOgmail.com
704 - 254 -2736
1
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:E nES IN 0.62'
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i
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PID: 00178110
MB 27 PAGE 102
``,,`,11111111111!!f / / //r
OG�.�pfESS/q� few
SEAL�YC
_+ L -4880 �+=
f! /f llli17111111
I hereby certify that this map was drawn under my
supervision from on actual survey mcde under my
supervision; that the ratio of precisicn or positional
accuracy Is 1:10,000+; that the boundaries not surveyed
are shown as broken lines Plotted from information found
in (references as shown), and that this map meets the
requirements of the Standards of Practice for Land
Surveying In North Carolina (21 NCAC M. 1600). Witness
my original signature, registration number and seal this
27th day of February, 2014.
Professional Land Surve
This survey is of an existing parcel
Registration Number
of land.

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DRAMI DATE:
BMCS 0412211
APPROVED DATE:
By:
PROJECT WNMCER: DATE:
MAD 0412211
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APPROVED DATE:
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PROJECT WNMCER: DATE:
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