20220894 Ver 1_Riparian Buffer Authorization_20220428

DWR
Division of Water Resources
wQ 2A.1108R4
State of North Carolina
Department of Environmental Quality
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:
1 b. County:
13 e 4 u 1e;, ,^ f-
lc. Nearest municipality:
13 �, t h
1 d. Subdivision name:
(3 ;, , , i; _5 h • r e
le. Is the project located in any of North Carolina's twenty coastal counties?
If yes, answer 1 f below.
[3-Yes ❑ No
1 f. Is the project located within a NC Division of Coastal Management Area of
Environmental Concern (AEC)?
❑ Yes
lS-No
2. Owner Information
2a. Name on Recorded Deed:
A O n h; .., ._ s h et r., r. 1 o L c ,- fs
2b. Deed Book and Page No.
0 7 7 .3-- q )..
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
,5 3 ) 9
2d. Responsible Party
(for Corporations):
R ,) n f, , Y. g o L> e r -'1"S
2e. Street address:
S 2 7 O, n n; n c Ad
2f. City, state, zip:
13 e n S , r, 111 c- 2 7 .5 o
2g. Telephone no.:
2h. Fax no.:
2i. Email address:
3. Applicant Information (if different from owner)
3a. Applicant is:
D Agent ❑ Other, specify:
3b. Name:
.-; . 5441c-
3c. Business name
(if applicable):
$ /� `f a L 4 �,� s c. /' N cr �y, c
3d. Street address:
3 p ,, ; , f c /n
3e. City, state, zip:
t3 ,:. , f A N c- 2' -
3f. Telephone no.:
2.( , y5';5- 2 s' 7 a.
3g. Fax no:
2 {3- y 3 3 - .2 i 9Y
3h. Email address:
e r; 4 .54 e.I 7) ,, y ,... k. / - ` „Y,
4. AgentlConsultant Information (if applicable)
4a. Name:
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

B. Project Information and Prior Project History
1.
Property Identification
la. Property identification no. (tax PIN or parcel ID):
4 b ' 3 - 8s - 9 i ... 9
1 b. Site coordinates (in decimal degrees):
Latitude: is' sae ,32 iv Longitude: "7 6 y 9 ', 3 ,w
1 c. Property size:
acres 3,5 /
2.
Surface Waters
2a. Name of nearest body of water to proposed project:
(j 4 •h h <- r e cc_ 1:
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
P. ,i-, , /; c. 0
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: /0,nd ,.5Pc.rr,'4ly oictred and renc/e/ tw 6,, /ci"1 /
SJre
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'/z 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:
3e. Explain the purpose of the proposed project: B / ti 9 S. / e
3f. Describe the overall project in detail, including the type of equipment to be used: .5 e / ec- t• v e tt, /ru .,",
//��
n't' Rkla .5/,, -e /,'kt a L.'.. la NP hi-2, ✓ .�et tic; 4, cr L.-J4h S'c-c. v. ,'it2 14wfl
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:
Other:
4c. If yes, list the dates of the Corps jurisdictional 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?
[3'Yes ❑ No ❑ Unknown
5b. If yes, explain and detail according to "help file" instructions
E;I1;e,y 13 G:,;id ,<P p.,ap<rt.,
6.
Future Project Plans
6a. Is this a phased project?
❑ Yes age
6b. If yes, explain.
FORM: BA 10-2013
Page 2 of 4

C. Proposed Impacts Inventory
1. Buffer Impacts
la. Project is in which protected basin?
❑ Neuse [a tar -Pamlico ❑ Catawba
❑ Randleman ❑ 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 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 E P ❑T
y.rwto a„ Nahls
t.th cr.ecK
❑Yes [I -No
3bcra
boo rti
B2 ■ P ■ T
■ Yes ❑ No
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
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1�--..,,r 4, . Won C. eft, <er '%H4n 6cy/hy eY b'k hits t — /1otsc
lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. 'l"k ' ., ya a 9 c c, / $, h f- c v ' Pin - ti z
2. Buffer Mitigation
2a. WII the project result in an impact within a protected riparian buffer that
requires buffer mitigation?
❑ Yes E. -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 DMS
proposed?
■ Yes ❑ No
2d. If yes, attach the acceptance letter from the mitigation bank or NC DMS.
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
stormwater treatment. Include a plan that fully documents how diffuse flow will be
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
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
❑ Diffuse flow
❑ Other BMP
F.
Supplementary Information
1.
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
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State (North
Carolina) Environmental Policy Act (NEPA/SEPA)?
❑ Yes ❑ No
1 c. If you answered "yes" to the above, has the document been finalized by the State
Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter.)
Comments:
❑ Yes ❑ No
2.
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 permit application?
❑ Yes ❑ No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
v. c- 51ecd
Applicant/Agent's Printed Name
Applicant/Agent's Signature
(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 by
First Class Mail via the US Postal Service:
NC DWR, Transportation Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
For all other projects sent by First Class Mail via
the US Postal Service
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 - 1617
For government transportation projects sent by
delivery service (UPS, FedEx, etc.):
OR NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
OR
For all other projects sent by delivery service
(UPS, FedEx, etc.):
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
.2)-
Date
FORM: BA 10-2013
Page 4 of 4

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