20221041 Ver 1_Riparian Buffer Authorization_20220728

DWR State of North Carolina
Department of Environmental Quality
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
1 a. Name of project: � Sea Y,ta t-t_
1 b. County: M eck Let l
1 c. Nearest municipality: C©R,N eLl US
1 d. Subdivision name:
le. 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)? 0Yes No
2. Owner Information
2a. Name on Recorded Deed: I1-et• aNI.o xsp; ©Utj4C(
2b. Deed Book and Page No. cK 2 A--13 •P IS5G
2c.Map Book and Page No. Mali "Boo1v I9- PS Qe
(include a copy of the I
recorded map that indicates
when the lot was created):
2d. Responsible Party
(for Corporations):
2e. Street address: �,1005 L9La1'40 .ec t1Zi'e
2f. City,state, zip: RA\1e Ll 134 NC 2430 3)
2g. Telephone no.: 3)6 .3 I--I .04-0n.
2h. Fax no.:
2i. Email address: 1 , eta
Lj� b M
r �(.C
3. Applicant Information(if different from owner) �J
3a. Applicant is: 0 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:
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 f 2 v 1IJ V i Page 1 of 4
JUL 2 8 2022
DENR-WATER RESOURCES
TRANSPORTATION PERMITTING UNIT

8. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees):
1 c. Property size: o s1 s a opy
2. Surface Waters
2a. Name of nearest body of water to proposed project:
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
3. Project Description
OW- III -0A.
Latitude:Se. Piesterjb l Longitude:261'-1p. o
acres r 2"2.n
C.2Taw8a
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: fDeli-aL
3b. Attach an 8 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site /4"ITHt] 1
3c. Attach an 8 %: x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map
depictingthe project site �
3d. List the total estimated linear feet of all e�xis�tiing streams (intermittent and perennial) on the property:
SIe'a'OH—en
3e. Explain the puroose of the proposed project:G;.pi je. 4 co�ow OF CD4PoWre 01' bbCiL EtsresiN t?e &Tipp [ji e ' (B A, 2a . )
3f. Describe the overall Pro actin detail, includin the tye of a uipment 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?
4b. If yes, who delineated the jurisdictional areas? Agency/ Consultant Company:
Name (if known): Other
4c. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach
documentation.
5. Project History
❑ Yes ❑ No, Unknown
Comments:
5a. Have permits or certifications been requested or obtained I ❑ Yes ❑ No Unknown
for this project (including all prior phases) in the past?
5b. If yes, explain and detail according to "help file" instructions
6. Future Project Plans
6a. Is this a phased project? I ❑ Yes
6b. If yes, explain.
No
FORM: BA 10-2013
Page 2 of 4

C. Proposed Impacts Inventory
1. Buffer Impacts
1a. Project is in which protected basin?
❑ Neuse
0 Randleman
ICI Catawba
❑ Goose Creek
1b. Individua ly 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)
61 P �T
B2 ❑ P T
B3❑P[]T
B4❑P❑T
B5❑P❑T
B6❑P❑T
Reason for
impact
Type of impact
(exempt, allowable,
allowable w/
mitigation)
ALLD I +'1AtJTl .
Stream name
CaTamita
❑ Tar -Pamlico
❑ Jordan
Buffer
mitigation
required?
0 Yes o
—0 Yes No
0 Yes -0 No
lc. Comments:
❑Yes No
❑ Yes ❑ No
❑ Yes ❑ No
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
Total buffer impacts
IDO F
Stoc
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques.
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that
requires buffer mitigation?
0 Yes ❑ 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
Zone 1
Zone 2
Reason for impact
Total impact
(square feet)
Multiplier
3 (2 for Catawba)
1.5
Required mitigation
(square feet)
Total buffer mitigation required:
2c. f buffer mitigation is required, is payment to a mitigation bank or NC DMS
proposed?
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:
❑ Yes I] No
FORM: BA 10-2013
Page 3 of 4

'CIF`
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
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
F. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public(federal/state/local)funds or the ❑Yes 'No
use of public(federal/state)land?
1 b. 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)?
lc. If you answered"yes"to the above, has the document been finalized by the State 0 Yes R''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 ❑Yes I'No
Wetland 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? 0 Yes 57.No
2c. If you answered"yes"to one or both of the above questions,provide an explanation of the violation(s):
Applicant/Agent's Printed Name Applicant/Agent's S nature Da
(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 For government transportation projects sent by
First Class Mail via the US Postal Service: delivery service(UPS,FedEx,etc.):
NC DWR, Transportation Permitting Unit OR NC DWR, Transportation Permitting Unit
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699- 1617 Raleigh, NC 27604
For all other projects sent by First Class Mail via For all other projects sent by delivery service
the US Postal Service (UPS,FedEx,etc.):
Karen Higgins Karen Higgins
NCDWR—401 & Buffer Permitting Branch OR NCDWR—401 &Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699- 1617 Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4

LEGEND
ww. icor onna-i-
311.2311SACK
DP-CA.CULATEDPOINT
AC -AIR som nDNER
The Lake 7 Bollon Contour
Follows
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100+1 Floodfine
Per FEMA Panel
03710463400 K,
Dated: March 2, 2009
NOW OR FORMERLY
PhUUp M. Soho
Deed Bk. 0914. Pg. 770
Parcel 10000111101
Mecklenburg Co. ReglexY
1111rI
4 � 8 ~, PIP
49 -
s ¢ SEAL r a
i ns L-4444 it
1...`` N
30 16 0 30
Lake Norman
Additional Tract
COrieeyed in
Deed Bk. 7063, P .121
N 69'09'2:' E 70.61'
BAR GRAPH
i, R. gee Dyet.ettilly Mail* 5'medeet.ermysyipy� wddrorb' *aaaragusl
greed desrelpflon recorded In Book 31912.1rege 83
tmai; that the6andelas not stamped are dearly trakoolae as Mom nom Infattnation
endreau Mai Ip meatx eaemrataarpreddmat del:10,000:
n"abr mote rs for The .158»,BantlsdeaPwaim Lend
mown*. molrrmead gfs e, AD
Berea "yed °bnelet.
Island Forest Drive
50' Pub0cRAN
DRAWN eY: 6. ISruey
DATE AM 3.2020
CP
PIPE
Renee C. Kososo� FORMERLY us,d
uaber4 Demon K
Dead 8k 3204e. pg. 430
Parcel ID 000111103
Mecklenburg Co. Regkey
imDervioua A+9e
House 2669 7 ef4
Mechanical -979gaf
Stucco Well - 22.49 of
Sea Waft-132.34 sf
TOTAL-3746.06 st
Max. Allowable Impervious
2, Area = 7976.06 of
PIPE ._-----
NOTES:
• Deed Refvanca- Peed 8k 32912 Pg.88 O nlor Eafea a Spouse flukey Ewa
Oared
P Reference -Wand August 19. 201a Recorded N MaeWenteug Co. Registry
Forest Dahl orator, mos
Map Ns 12. Pg. 341 Retarded In Macllenbu gCe, RegIstry
Perform Pmpaly subject by R. Moan, Surveyor
agreements*. may appear. unrecorded right reveres. aasanaidsand
NORSTAR LAND SURVEYING, IN
552-8 Nowell Street NW
Concord, ND 28028
Ph 704 7216651
Fax [phone]
Firm L1o. # C-2294

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rhis map or report is prepared for the inventory of real properly war* Mecklenburg County and is compiled from recorded deeds, plats, tax maps, survey 's,planimetrio maps, and other public records and data
tsars of this manor report am hereby notified that the abrementioned pudic primary information sources should be consulted for vertication. Mecklenburg County and its mapping contractors assume no regal
esponsibility for the information contained herein.

Polaris 3G Map — Mecklenburg County, North Carolina
21005 Island Forest Drive
Date Printed: 7/21/2022 12:22:23 PM
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this map or report la prepared forthe inventory of real property within Mecklenburg County and is eompeed from recorded deeds, plats, tax maps, surveys, planimetric map,,, and .,,,,o, pumm records and dele.
raspobfty for the infomration contained herein.
Useof this map or report are hereby notified that the aforementioned public primary information sources should be consulted forvedticeMe
cklenburg ecklenburg County and its mapping contractors assume no legal
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