20221390 Ver 1_Riparian Buffer Authorization Request_20221006

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 10/6/2022
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:*
252-975-9319
City of Washington
Jonathan Russell
(for Corporations)
Street Address
102 E 2nd St
Address Line 2
City
Washington
Postal / Zip Code
27889
B. Project Information and Prior Project History
................................................................
1. Project Information
1a. Name of Project: *
State / Province / Region
North Carolina
Country
United States
1 e. Email Address: * [e-mail]
Playground bench installation at Havens Gardens
(Subdivision, facility, or establishment name)
1b. Is this a publicly -funded transportation project?*
Yes
No
Id. Subdivision Name: NA
le. Nearest Municipality: City of Washington
If. Property Size: 4.00
acres

1g. County (or Counties) where the project is located: *
Beaufort
1h. Property ID#
Tax PIN or Parcel id
1 i. 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.
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doc03137020221005134658.pdf 126.99KB
PDF only
1k. How would you like to provide the Latitude and Longitude information?*
Address Lookup
• Manually
Latitude* 35.535953 Longitude* -77.039474
11. Is the project located in any of North Carolina's twenty coastal counties?*
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:
SC NSW
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1,800
(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:
This property is used for passive and active recreation. We have a handicap
accessible fishing pier, fully inclusive playground, 2 shelters for group gatherings and
plenty of open space for sitting, walking, running or playing.
3b. Attach an 8'/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
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PDF only
3c. Attach an 81/2 x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the project site.
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4. Proposed Activity

Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used: *
Installation of 2 playground benches for viewing the water and playground.
Equipment to be used will be shovels.
Attach a site plan as applicable to the project:
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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
6b. List any permits/approvals that have been requested or obtained for this project in the past.
A
Application Date
Date Issued
7/2/2020
Permit Type
Major CAMA Permit
6c. Please explain and detail according to "help file" instructions.
Havens Gardens has recently had many upgrades. The playground has been
redesigned and constructed to provide a fully inclusive area for children and adults to
play. In addition, the fishing pier was reconstructed to provide better accessibility for
individuals with disabilities wanting to fish.
We propose adding 2 playground benches for individuals to sit and watch the river or
any other scenery on along the park area.
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

Playground Bench
Pamlico
Permanent
Allowable
0.00
0.00
Installation
River
(P)
Square
Square
Map label (e.g. Road
Perm or Temp
Feet
Feet
Crossing 1)
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.
The only equipment that will be used for this project will be shovels. Staff will hand
dig all areas. This will minimize all impacts to the area.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The only equipment that will be used for this project will be shovels. Staff will hand
dig all areas. This will minimize all impacts to the area.
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
lc. Diffuse Flow Documentation
F. Supplementary Informi ` --
..........................................................................................................
Environmental Documentation
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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:
H. Sign and Submit
By digitally signing below, I certify that:
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• 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: * Kristi Roberson
Signature
Submission Date:
10/6/22
(Auto populated field)

Initial Review
Is this accepted into the review process?* • Yes No
Yes
• No
ID#* 20221390
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

EXHIBIT "A.1"