20140605 Ver 1_Major Variance_20140612

WITHERS &- RAVENEL
ENGINEERS I PLANNERS I SURVEYORS
115 MacKenan Drive
CARY, NORTH CAROLINA, 27511
(919) 469 -3340
FAX [phone]
TO: NCDENR
Attn: Cherri Smith & James Graham
1601 Mail Service Center
Raleigh. NC 27699 -1601
WE ARE SENDING YOU ❑ Attached via
❑ Shop Drawings ❑ Prints
❑ Copy of Letter ❑ Change order
2 0 1 4 0 6 0 5
LETTER OF ITRANOMMAL
DATE June 9, 2014
1 JOB NO.
ATTENTION Cherri Smith & James Graham
PHONE #
RE: Logan Residence
Ti. t.
1
Buffer Variance Submittal
jUN 10 2014
❑ Plans
❑ Diskette
v - -- .7' -.— vn�yQ
_ the following items:
❑ Samples ❑ Specifications
El
COPIES
DATE
NO.
DESCRIPTION
3
6 -9 -14
1
Buffer Variance Submittal
17 �
1
- WATgp QUA I
"r firanch
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
E For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FOR BIDS DUE 20 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS: James & Cherri — attached please find a variance application for the Logan Residence,
located on Turnbridge Drive in Raleigh. As I understand, James has had multiple conversations with the
homeowner regarding this proiect. If you need anv additional information please ask.
COPY TO: W &R FILE SIGNED: Hunter Freeman, PE
if enclosures are not as noted, kindly notify us at once.

WITHERS
May 19, 2014
NCDENR
Division of Water Quality
1601 Mail Service Center, Raleigh, NC 27699 -1601
Attn: James Graham
Dear Mr. Graham
20 140 6 05
RAVEN EL
ENGINEERS , PLANNERS S
JUN 10 2014
NC DENR Raleigh Reglonal Office
Attached please find our request for permission to install playground equipment and associated
construction within the Neuse River Buffer area. Neuse River Buffer rules for 2867 sf of Zone 1 of the
buffer adjacent to an existing residence on Turnbridge Drive in Raleigh, NC. There are no permanent
stream impacts as the proposed bridge will span both banks of the channel.
The project is located on a lot which platted in 2005. It appears as though the lot closely resembles an
original lot which was originally created in 1947 Although the playground equipment is an exempt activity
(no vegetation will be removed during installation), the homeowner would also like to install a path,
bridge, and small seating area adjacent to the playground. Such activities would require removal of
limited vegetation, however the plan also includes a re- vegetation plan to add landscaping to the lot.
There will be no stormwater pipes installed; all water will leave the area as sheet flow
We ask that you consider this application for approval. Should you have any questions regarding this
request, please do not hesitate to call me directly at (919) 535 -5137.
Sincerely.
WITHERS _'o'RAVENEL
7 � /
L
f�
Hunter C. Freeman, PE
I[�C��QdCC� p
I
JUN 1 2 2014
wA _OUAAOTy
v, MacKenan Drive I Cary, NC 27511 1 tel.: 9i9.469.3340 1 fax: [phone] I www.withersravenet.com I License No. C -o832
1410 Commonwealth Drive Suite ioi I Wilmington, NC 28403 1 tel: [phone] fax: [phone]
7011 Albert Pick Road, Suite G I Greensboro, NC 27409 1 tel: 336.6o5.3oog Fax: g19.467.600g

LVMWA
HCDEHR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
� «.,�i... 6,da
Variance Request Form JUN 1 0 2014
(For Minor and Major Variances)
Protection and Maintenance of Riparian Areas Rules NO DENR Raleigh Re91onal office
NOTE: T his form may be photocopied for use as an original.
Check the appropriate box below:
Li Major Variance
X Minor Variance
Please identify which Riparian Area Protection Rule applies (Note -this must be one of
North Carolina's four buffered river basins. The River Bain map is available at
htti)://h2o.enr.state.nc.us/a<lmin/mag!s/.)
�C( Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC 02B.0233)
o Tar - Pamlico River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC 02B.0259)
Part 1: General Information
(Please include attachments if the room provided is insufficient.)
1. Applicant's name (the corporation, individual, etc. who owns the property):
Molly and David Logan
Print owner /Signing official (person legally responsible for the property and its compliance)
Name:
Molly Logan
Title:
Street address:
3517 1'urnbridge Drir�
City, State, Zip:
Raleigh. NC 27609
Telephone:
(()I')) d 1.3.198O
Fax:
3. Contact person who can answer questions about the proposed project:
Name: Hunt�r Freeman, PF:
Telephone: ;'319) 169-3340
Version 6 July 2009

Fax [phone]
Email- hfreeman @withersravenel com
4 Project name (Subdivision, facility, or establishment name - consistent'with project name on plans,
specifications, letters, operation and maintenance agreements, etc )
Logan Residence
5 Project location:
Street address
City, State, Zip:
County
Latitude /longitude
3517 Turnbrige Drive
Raleigh, NC 27609
Wake
35 850 / -78 640
6 Date property was purchased 5/30/2013
7 Directions to site from nearest mayor intersection (Attach an 8 '/z x 1 1 copy of the USGS
topographic map indicating the location of the site)
From 1 -440 and Six Forks Road, take Six Forks Road south, turn right on Rock Creek Dr, right on
Terrace Drive, left on Bellevue Road, right on Turnbridge Drive Property is on the right
8 Stream to be impacted by the proposed activity
Stream name (for unnamed streams label as "UT" to the nearest named stream):
UT to Crabtree Creek
9 Which of the following permits /approvals will be required orhave been received already forthis
project?
Required Received. Date received. Permit Type
CAMA Mayor
CAMA Minor
401 Certification /404 Permit
On -site Wastewater Permit
NPDES Permit (including stormwater)
Non - discharge Permit
Water Supply Watershed Variance
Erosion /Sedimentation Control
Others (specify)
Part 2: Proposed Activity
(Please include attachments,if the room provided is insufficient)
Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat map
or site plan in Adobe (pdf) format) to accurately delineate the boundaries -of the land to be utilized
in carrying out the activity, the location and dimension of any disturbance in the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area of
buffer impact in ft2.
This project is for the construction of playground �equipment, seating area, footbridge, and walking
path in Zone l of the buffer behind an existing dwelling The footprint of the project will impact
868 sf of the buffer The impacts are all within Zone I The playground equipment has been
included in this total despite being an exempt activity within the buffer Stormwater runoff from
Vananee Request Form. page 2
Version 6 July 2009

the project will all be sheet flow or infiltration into the in -situ soils The bridge will span the banks
of the creek, causeing no impacts of the stream
2 Fill in the table below to identify the square footage of impact to Zones 1 & 2 in the protected
riparian buffers and the required mitigation (Fill in the impacts portion of the table, even if
mitigation is not required):
*Zone I extends out 30 feet perpendicular from the most landward limit of the top of bank or the, rooted, herbaceous
vegetation Zone 2 extends an additional 20 feet from the edge of Zone I
3 State reasons why this plan for the proposed activity cannot be practically accomplished, reduced
.or reconfigured to,better minimize or eliminate disturbance to the riparian buffers
The existing lot has limited available space outside of the buffer The house and driveway occupy
most of the available footprint, and installing these uses in,the buffered area poses little threat to
water quality
Description•of any best management practices to be used to control impacts � associated with the
proposed activity (i.e , control of runoff from impervious surfaces to provide diffuse flow, re-
planting vegetation or enhancement,of existing vegetation, etc )
Runoff from all surfaces will remain as sheet flow and will generally be located under thick tree
canopy The new impervious surfaces will see very little direct rainfall Additionally, significant
revegetation of the buffer has been proposed by the land owner
Please provide,an explanation of the following.
(1) The practical difficulties or hardships that would result from the,strict application of°this Rule
The location of the proposed construction is driven by the constraints present on the,existmg lot
Direct impacts to the buffer have been minimized and the stream will be spanned by the proposed
bridge
(2) How these difficulties or hardships result from conditions, that are unique to the property
involved.
The lot was originally created ,m 1947 in its current dimensions At some point the lot was
combined with a neighboring lot, and then re- divided in 2005 There were no opportunities for the
Current owner to construct,a,house in keeping with neighborhood character using a significantly
smaller footprint The original lot was created prior to buffer regulations, and there was little way
for the original planners of forsee the current building requirements or style preferences
(3) If economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire value,of the project.
Variance Request Form page 3
Version 6 July 2009
Buffer Impact
Zone of
Impact in
Number
Purpose for
Multiplier
Required
Impact
Square Feet
(Indicate on
the Impact
Mitigation
Plan Sheet
Zone 1
868'
Playground
3
equipment &
associated
seating area
Zone 2
1 5
Total
*Zone I extends out 30 feet perpendicular from the most landward limit of the top of bank or the, rooted, herbaceous
vegetation Zone 2 extends an additional 20 feet from the edge of Zone I
3 State reasons why this plan for the proposed activity cannot be practically accomplished, reduced
.or reconfigured to,better minimize or eliminate disturbance to the riparian buffers
The existing lot has limited available space outside of the buffer The house and driveway occupy
most of the available footprint, and installing these uses in,the buffered area poses little threat to
water quality
Description•of any best management practices to be used to control impacts � associated with the
proposed activity (i.e , control of runoff from impervious surfaces to provide diffuse flow, re-
planting vegetation or enhancement,of existing vegetation, etc )
Runoff from all surfaces will remain as sheet flow and will generally be located under thick tree
canopy The new impervious surfaces will see very little direct rainfall Additionally, significant
revegetation of the buffer has been proposed by the land owner
Please provide,an explanation of the following.
(1) The practical difficulties or hardships that would result from the,strict application of°this Rule
The location of the proposed construction is driven by the constraints present on the,existmg lot
Direct impacts to the buffer have been minimized and the stream will be spanned by the proposed
bridge
(2) How these difficulties or hardships result from conditions, that are unique to the property
involved.
The lot was originally created ,m 1947 in its current dimensions At some point the lot was
combined with a neighboring lot, and then re- divided in 2005 There were no opportunities for the
Current owner to construct,a,house in keeping with neighborhood character using a significantly
smaller footprint The original lot was created prior to buffer regulations, and there was little way
for the original planners of forsee the current building requirements or style preferences
(3) If economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire value,of the project.
Variance Request Form page 3
Version 6 July 2009

Part 3: Stormwater
I Provide a description of all best management practices (BMPs) that will be used to control
nutrients and sedimentation impacts associated with the proposed activity Please ensure to include
all applicable operation & maintenance agreements and worksheets for the proposed BMPs Also,
include the BMPs on your plan sheets The area within the buffer will be re- vegetated and
,maintained by the homeowner, runoff from impervious surface will remain as sheet flow-
2 Attach a description of how diffuse flow will be maintained through the protected riparian buffers
Please ensure to include-�all applicable operation & maintenance agreements and worksheets for
the,pfoposed diffuse flow measure(s). Also, include the,diffuse flow - measure(s) on your plan
sheets.
3 What will be the annual nitrogen load contributed by this site after,development in pounds per
acre per�year without structural'BMPs ( stormwater pond, wetland, infiltration basin, etc)? Attach a
detailed plan for all proposed structural stormwater BMPs.
Drainage
Size'of
Post - development
BMP nitrogen
Final
Final
basin
drainage
nitrogen 61 loading
removal
nitrogen
nitrogen
basin
rate without BMPs4
efficiencys
loading rate
loading '
(ac)
(lbs/ac/yr)
(%)
(11is/ac/yr)
from
drainage
basin lbs
/
21 2
0
212
2
12
0
12
3
4
5
4 Attach calculations and references
5 Attach calculations and references
6 Include Phosphorus to the Tar- Pamhco Basin
4 Attach all applicable supplement form(s) and Inspection and Maintenance (I &M) Fornf(s) to this
completed application- The applicable supplemental form(s)'and I &M form(s) for the proposed
BMPs noted in your application can be downloaded from the following website
http//h2o enr state nc us /su/bmp forms htm
Variance Request Foi n page 4
Version 6 July 2009

Part 4: Proposed Impacts and Mitigation
Provide a description of how mitigation will be achieved at your site pursuant to 15A NCAC 2B 0242
for the Neuse Basin and 15A NCAC 2B 060 for the Tar - Pamlico Basin
If,bufferrestoration is the method you,are requesting, be sure to include a detailed planting plan t&
include plant type, date of plantings, the date +of the�one -lime fertilization,in the - protected riparian
buffers and a plan sheet showing the pioposed location of the plantings. A guide to,buffer restolation
can be downloaded at the following website http: / /www.nceep .net /news /reports /buffers.pdf
If payment into a buffer restoration fund is how you,plan to, achieve your mitigation requirement, then
include an acceptance lefter *oin the mitigation bank you propose to use stating they have the
mitigation credits,available`for the mitigation requested
Part 5: Deed Restrictions
By your signature in Part 6 of this application, you certify that all structural stormwatei BN4Ps
required by this variance shall be located in recorded stoifnwater easements, that the easements will
tun with the land, that the easements cannot be changed of deleted without concurrence from the State,
and that -the easements will be recorded prior to the sale of any lot
Part 6: Applicant's Certification
I Molly Logan (print or type name of person listed in
Part I, Item 2), certify that the information included on this peimit application form is coirect, that the
project will be constructed m,conforinane"e with the approved plans and that the deed restrictions in
accordance with Part'5 of this form will be recoided with all required peiniit °conditions
S ignature
Date
Title
Part 7: Plan Sheets
Be sure to include a copy, of all of your completed application form, plan sheetsxand maps in Adobe
(pdt) foimat on a,CD or floppy disk
Variance Request Form, page 5
Vernon 6 July 2009

Part 8: Checklist
A complete application submittal consists of the following components incomplete submittals will be
returned to the,applicant The complete variance request submittal must be received 90 days prior to
the EMC meeting at which you wish the request to be heard Initial below to indicate that the
necessary information has been provided
Applicant's Item
Initials
• Ongmal and two copies of the Variance Request -Form and the attachments
listed' below.
• A vicinity map of the project (see Part l,, Item 5,)
• Narrative demonstration of the need for a variance (see Part 2)
• A detailed narrative description of stormwater treatment /management (see Part
4)
• Calcul'ations supporting nitrogen (phosphorus in the Tar - Pamlico Basin)
loading estimates (see Part 4)
• Calculations,and references.,supporting nitrogen (phosphorus in the Tar - Pamlico
Basin) removal from proposed BMPs (see Part 4)
• Location,and details for all proposed structural stormwater BMPs (see Part 4)
• Three copies of the applicable Supplement Form(s) and I &M Form(s) for each
BMP'and &or narrative forreach innovative BMP (see Part 4)
• Three copies of plans and specifications, including
0 Development/Project name
0 Engineer and firm
0 Legend and north arrow
0 Scale (I "' = 50' is preferred)
0 Revision number & date
0 Mean high water line (if applicable)
0 Dimensioned property /project boundary
0 Location map with named,streets or NC State Road numbers
0 Original contours, proposed contours, spot elevations, finished floor
elevations,
0 Details of roads, parking, cul -de -sacs, sidewalks, and curb and gutter
0 Footprint of any proposed buildings or other structures
0 Wetlands delineated, or a note on plans that none exist
0 Existing drainage (including off - site), drainage easements, pipe,sizes, runoff
calculations
0 Drainage basins delineated
0 Perennial and intermittent streams, ponds, lakes, rivers and estuaries
0 Location of forest vegetation along the streams, ponds, lakes, rivers and
estuaries
Variance Request Form page 6
Version 6 July 2009

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources Division of Water Resources
15A NCAC 026 .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:
Logan Residence
1 b.
County:
Wake
1c.
Nearest municipality:
Raleigh
1d.
Subdivision name:
le-
Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer if below.
❑ Yes ® No
1f.
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:
David and Molly Logan
2b.
Deed Book and Page No.
BK015294 PG02636
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
BKBM2005 PGO1736
2d.
Responsible Party
(for Corporations):
2e.
Street address:
3517 Turnbridge Drive
2f.
City, state, zip:
Raleigh NC 27609
2g.
Telephone no.:
919- 413 -1980
2h.
Fax no.:
2i.
Email address:
Molly.logan @natpow.com
3.
Applicant Information (if different from owner)
3a.
Applicant is:
❑ Agent ❑ Other, specify:
3b.
Name:
3c.
Business name
(if applicable):
3d.
Street address:
3e.
City, state, zip:
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
4.
Agent/Consultant Information (if applicable)
4a.
Name:
Hunter C. Freeman
4b.
Business name
(if applicable):
Withers & Ravenel, Inc.
4c.
Street address:
115 Mackenan Drive
4d.
City, state, zip:
Cary NC 27511
4e.
Telephone no.:
919 - 469 -3340
4f.
Fax no.:
919 - 467 -6008
4g.
Email address:
hfreeman(,@withersravenel.com
FORM: BA 10 -2013 Page 1 of 4

B.
Project Information and Prior Project History
1.
Property Identification
1a-
Property identification no (tax PIN or parcel ID)
1705666885
lb
Site coordinates (in,decimal degrees)
,Latitude 35 85 N
Longitude 78 64'W
1c
Property size
2957 acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
UT to Crabtree Creek
2b
Water Quality Classification of nearest receiving water
C, NSU
2c
River basin
Neuse
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
Wooded narrow lot in quarter acre residential area House has been constructed
3b
Attach an 8' /Z x 11 excerpt from the most,recent version of the USGS topographic map indicating the location of
the site
3c
Attach an 8'/2 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 ofalLexisbng streams (intermittent and perennial) on the property
68 If
3e Explain the purpose of the proposed project
Install playground equipment with associated access path, seating area, and landscaping
3f
Describe theoverall project in detail, including the type of equipment to be used
Construction of a small footbridge with patio and additional'landscaping to the backyard of a proposed house
Small equipment such as bobcats may be used
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) James Graham
Agency/ Consultant Company NCDENR
Other-
4c
If yes, list the dates of the Corps jurisdictional determinations or State determinations and,attach documentation
April 2014
5.
'Project History
,5a Have permits +or certifications been requested ot,obtained for this
project (including all,pnor phases) in the past?
® Yes ❑ No ❑ Unknown
5b
If yes, explain and detail according to "help file" instructions
Budding Permit for house, No buffer disturbance
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 impacts in designing,project
There is no ,,other available space in the Lot Buffer revegetation is shown on the plan
1a Projectis in which protected basin?
® Neuse ❑ Tar - Pamlico, ❑Catawba
❑ Randleman ❑ Jordan ❑ Goose Creek
lb 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 Temporary, T,
Reason for
impact
Type of impact
(exempt, allowable,
allowable•w/ mitigation)
Stream name
Buffer
mitigation
required?
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
B1 '® P ❑ T
Bridge and
Seating
Multiplier
UT Crabtree Crk
❑ Yes ® No
206
62 ❑ P ® T
Landscaping
Zone -2
UT Crabtree Crk
❑ Yes ® No
1 661
B3 ❑ P ❑ T
Total buffer mitigation required:
❑ Yes ❑ No
If'buffer mitigation is required, is payment to a
mitigation bank'or NC EEP proposed?
❑ Yes ❑ No
B4 ❑ P ❑ T
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
❑ Yes ❑ No
B5 ❑ P ❑ T
❑'Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total buffer impacts
867
1c Comments All impacts are directly
related to installation of recreation/playground equipment
D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
la
Specifically describe measures taken to avoid or,minimize the proposed impacts in designing,project
There is no ,,other available space in the Lot Buffer revegetation is shown on the plan
lb
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Construction will include no heavy equipment- All construction will be done by hand or small equipment similar to
a bobcat
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 impactto each zone of the riparian buffer that requires mitigation and
caiculate,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
stormwater treatment Include a plan that fully documents how diffuse flow will be
El Other BMP
maintained If a Level Spreader`is proposed, attach a Level Spreader Supplement Form
la
If due to site constraints, a BMP other than "a level spreader is proposed, please provide °a
❑ Yes ® No
plan,for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
public (federal /state) land?
Manual`and attach a BMP Supplement'Form
lb
F.
'Supplementary Information
1
Environmental Documentation
la
Does the project involve an expenditure of public (federal /state /local) funds or the use of
❑ Yes ® No
public (federal /state) land?
lb
Ifyou answered "yes`to4he 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
❑ Yes ® No
Rules (15A NCAC 02H 1300)_, `DWR Surface Wateror Wet land °Standards, or- "Riparian
Buffer`Rules (45A NCAC 02B 0200)?
2b
Is this an'after- the -fact permit application?
❑ Yes ® No
2c
If you answered "yes" to one,or both of the above questions, provide an explanation of the violation(s)
A Vi A I mk-� )
MAJ WWII - I Gf
Applic nt/A�g nt's Printed Name pli n Agent's Signature Date
(Agent's signatur is v id only illianlauthorization letter from the applicant is provided )
Send this,complefed form and accompanying documents'to the following
For government transportation projects-send
by First Class iLlarl via the US Postal,Service ,
N,C DWR„ Transportation Permitting Unit
165&Mail Service Center
Raleigh, NC 27699 - 1650
For all other projects send by First Class lWcnl
via the US Postal Sei vice
Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699'- 1'650
For`government transportation projects send
by deliveiy senuce (UPS, Fed&r, etc)
OR NC DWR, Transportation Permitting, Unit
512 N Salisbury Street
Raleigh, NC 27604
For all other projects send by delivery service
(UPS, FedE-r, etc)
OR Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
512 N Salisbury Streef
Raleigh, NC 27604
FORM BA 10 =2013 Page 4 of 4

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