20150287 Ver 1_Application_20150319

r
WR
State of North Carolina
: 2 0 1 5 0 2 8 7 Department of Environment and Natural Resources
Div" ision 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
1a
Name of protect
107 i1 hlv0•ef19k4 ,01( 94*;KS
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County
43E4.4 Focu
1c
Nearest municipality
&Jq SN To-#J
1d
Subdivision name
SgAOY AAWAS
le ; Is the project located in any of North Carolina's
• twenty coastal c6un' ties If yes,`answer if below
®Yes
El
if
Is the project located within a NC Division of Coastal
Management Area of Environmental Concern (AEC)
®Yes
El No
2
Owner Information
2a
Name on Recorded Deed
CcTq W mL .4crt L
2b
Deed Book and Page No
1Yg9 /4,800
-2c'- Map Book and Page No
(include a copy of the recorded
map that indicates when the lot
was created)
1G
I
Q I l E
2d
Responsible Party
(for Corporations)
_` ; •1 �"
2e
Street address
1305' °v0o [K •
15
2f
City, state, zip
ec"Ew/u-E C. J)p r10
i
2
Telephone no
ao� a sup
2h
Fax no
21
Email address
4LZTAVee4 ® S&4A0 ,E^141A1X . A-146"%
3.
Applicant Information (if different from owner)
3a
Applicant is
® Agent ❑ Other, specify
3b
Name,
AXAD Agitrow;
3c
Business name
(if applicable)
Hor7oa tovTtgcTo+Gf ,1•vL
3d
Street address
lluv W STN tT
3e
City, state, zip
t.7 S)4#Wc -v.d AM-
3f - .Telephone no
?fs - f. >r- �Y•
3g
Fax no
),Jr- 10
3h
Email address
13tA46 �►owT+v�✓to ✓TiLAct�tC• �o.K
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
Page 1 of 4

B.
Project Information and Prior Project History
1.
Property Identification
la
Property identification no (tax PIN or parcel ID)
S'G 9 4 - 81. 3101
--161
Site coordinates (in decimal degrees)
Latitude 3S: "(11OV -3
Longitude *.-PC. ggq��q
1c
Property size sox SS �
acres cf. /9
2.
Surface Waters
2a
Name of nearest body of water to proposed project
PAMW cv L4✓Zd-
26
Water Quality Classification of nearest receiving water
S �s�✓
2c
River basin
T`qll:. +_ p19.ac itd
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 "
CLE41Lf4 LOT w.TN ErslTI:JG 414,LKNe40. 49Fv19'r* ✓t SN .4D%✓sloo•J 1J#TA GNSToOf ajuMEQ
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 Sod Survey Map
depicting the project site ,
3d
List the total estimated linear feet of all existing streams (intermittent and perenrnal) on the property
.t'o' o•✓ NO"" to 01VZ t
3e
Explain the purpose of the proposed project
Cv.✓i T cwcT A 4260 pivgiE
3f Describe the overall project in detail, including the type of equipment to be used
todSTcVCT -goo or v" No-t& 44s94117 EQ•.sP T✓Pc 4 A Wt4 Foyer GrF%
4.
Jurisdictional Determinations •,, , , ft
4a
Have jurisdictional wetland or stream determinations by thlB,
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 jurisdictiogal,areasZ
Name (if known)
A.gency/ 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 o6tained'for`this
project (including all prior phases) in the pasty °•
x❑ Yes ❑ No El Unknown
�.
5b If yes, explain and detail according to "help file',' instructions
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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
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
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1. Buffer Impacts
2 Buffer Mitigation
2a Will the project result in an impact within a protected riparian buffer that requires buffer
mitigation?
1a Project is in which protected basin?
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
❑ Neuse ® 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 Tem ra 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)
61 P ❑ T
5LtiC -t6 12AmaY(ZC
14 0 LC
121 -m C,(o r GAOL
❑ Yes E3ko
d
�YS`
B2 ❑ P ❑ T
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
63 ❑ P ❑ T
❑ Yes ❑ No
134 ❑ P ❑ T
❑ Yes ❑ No
65 ❑ P ❑ T
❑ Yes ❑ No
66 ❑ P ❑ T
❑ Yes ❑ No
Total buffer impacts
1c Comments
D. Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
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lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
cw,ot. 4LA01 w,ce 6,e Pu4G.&0 yvae4_ Npvst Iv 6AuIG% To 06f•
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 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 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

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
la
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
✓rai oac
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
dry jjsl a,
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 ❑x No
public (federal /state) land
lb
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)?
1 c
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 (1Nk NCAC-02H 1300), °DWR Sufface Water or Wetland Standards, or Riparian. ,
,
Buffer Rules (15A NCAC 02B 0200) +
2b
Is this an afte( =the -fact permit applications
❑ Yes,- © No
2c
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s)
1h,040 Am7vy /l r-- 3 - K -i r-
Applicant/Agent's Printed Name 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 Mail 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 delivery service
via the US Postal Service (UPS, FedEx, etc)
Karen Higgins OR Karen Higgins
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

SCALE 1:12000
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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
LOT NO t ( PLAN NO PARCEL ID V0)1-191-1181
STREET ADDRESS 10 S1IA0V JA.✓K f 00
LO 4114 1.04IVA; AK- .i�ttS
Please print,
Property Owner A tC TA Nfc (-
Property Owner
The undersigned, registered property owners of the above noted property, do hereby authorize
4Co9Q 1-jav -✓ of 140ItrOJ C04J 94t iV4Cf , IIV
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached ,
Property Owner's Address (if different than property above)
190T I10.v oo 0C. ,- .vc. ,;t rP
Telephone .ZS'J - >1Y -StiY
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge
Authorized Signature Authorized Signature
Date 3—/3-1,,5 Date

Center of SR 1321
2 Lane Paved Roadway
50' Right of Way S 4502921' E
I
IN
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IN
•
SR 1320
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o7--- — — --- ---7
50.02' I 43 53' I
I I
Lot 11
I Map Book 2 I
S 44 °2328' E 58.28'
I Page 10 I (Now or Formerly)
►. I David D. Lewis
I o ^ I Deed Book 1162 Page 513
CO I w`O o l Lot 10& 9 Map Book 2 Page 10
(Now or Formerly) Existing
I I
Leslie S. Schmidt Septic Tank I I'll
Deed Book 1848 Page 685
Lot 12 Map Book 2 Page 10 I 1
O V'
I Propose
I
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0 0�
►'
I 75' Buffer
334 27 sq ft
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of proposed
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oo
house is to
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Zone 2
' Water Qua_iiV I
50' Buffer If
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Zone2 Io
Zone ,1
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Zone Io
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wood Bu /khead
Cono te Bulkh�d
Pamlico River
30 15
60
0 30
O V'

ISIMFORT COUNTY LAND RECORDS
LR - FORMOOl -6, F4
ACCEPTED
tend Records Official Dab
NORTH CAROLINA
BEAUFORT COUNTY
RX 499PG880
FOR REGISTRATION REGISTER OF DEEDS
JENNIFER LEGGETT WHITEHURST
BEAUFORT COUNTY NC
2006 AN 1'/ 03.04 49 PM
BK 1499 PG 880 -884 FEE $23 00
?NSTRUMENT # 2006000504
PREPARED BY GRAHAM, SILVER, NUCKOLLS &
BROWN, P L L C
No Title Exannnation was Made
Mail to Aleta H Neel
1305 Rondo Dr
Greenville, NC 27858
THIS LIMITED WARRANTY DEED RESERVING A LIFE ESTATE made this the 16
day of January, 2006, by WALTER W. HILL, widower, of Beaufort County, North Carolina,
hereinafter called GRANTOR, to ALETA H. NEEL of Pitt County, North Carolina, hereinafter
called GRANTEE.
WITNESSETH:
That GRANTOR, to consideration of TEN DOLLARS and other valuable considerations to
him paid by GRANTEE, the receipt of wtuch is hereby acknowledged, has bargained and sold, and
by these presents, does hereby grant, bargain, sell and convey unto GRANTEE, his heirs or
successors, and assigns, the following described real estate in Beaufort County, North Carolina and
being more particularly described on the attached Exhibit A.
GRANTOR, WALTER W. HILL, RESERVES A LIFE ESTATE IN THE ABOVE
DESCRIBED PROPERTY

P1499PC882
The property heremabove described was acquired by GRANTOR in Deed Book 469, page
269, Beaufort County Registry.
TO HAVE AND TO HOLD the above - descnbed premises and all privileges and
appurtenances thereunto belonging, or in anywise appertaining to the said GRANTEE, his heirs, or
successors and assigns, in fee simple forever, subject to GRANTOR'S life estate
And the GRANTOR covenants with the GRANTEE, that GRANTOR has done nothing to
impair such title as GRANTOR received, and GRANTOR will warrant and defend the title against
the lawful claims of all persons claiming by, under or through GRANTOR
When reference is made to the GRANTOR or GRANTEE, the singular shall include the
plural, and any reference to gender shall include masculine, feminine and neuter
IN TESTIMONY WHEREOF, GRANTOR has hereunto set his hand and adopts the
designation "(SEAL)" printed beside his name as his personal seal this the day and year written
above
WALTER W. HILL

CK1499PC883
STATE OF NORTH CAROLINA
COUNTY OF PITT
I certify that WALTER W. HILL personally appeared before me this /0 day of January,
2006 and acknowledged to me that he voluntarily signed the foregoing document for the purpose
stated therein
[ ] I have personal knowledge of the identity of the principal; or
[Vj I have seen satisfactory evidence of the principal's identity by a current state or
federal identification with the principal's photograph in the form of a
NC Df 1 ✓el'� L.. i f enz , or
[ ] A credible witness has sworn to the identity of the principal
Notary Public
(Pnnt or Type Name of Notary Here)
My Commission Expires
Bqq •.
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q,,Cou�; p

sKj999PG884
JENNIFER LEGGETT WHITEHURST
BEAUFORT COUNTY REGISTER OF DEEDS
COURTHOUSE BUILDING
112 W. 2ND STREET
WASHINGTON, NC 27889
Filed For Registration 01117/2006 03.04.49 PM
Book: RE 1499 Page, 880 -884
Document No.: 2006000504
DEED 5 PGS $23 00
Recorder. GALEN DERIK DAVIS
t--Z11v-1p-N - -
P4. poct z /z,
*2006000504*
2006000504

iKi499pc881
EXHIBIT A
Being a part of Lot No 11 as shown on map of the "Mackey Tract ", of record in the
Register's Office of Beaufort County in Map Book 2, Page 10, beginning at the Northwest corner of
said Lot No. 11 and running thence in a Southwardly direction toward Pamlico River along the line
dividing Lots Nos 11 and 12 a distance of 100 feet, thence in an Eastwardly direction at right angles
to said line 5 feet; thence in a Southwardly direction to Pamlico River and with Pamlico River 45
feet to the Eastern Line of Lot No 11; thence with said line Northwardly to the back line of said Lot
No 11 and with said back line in a Westwardly direction 50 feet to the beginning, and being the
same conveyed to Allen H Moore and wife, Faye A Moore, by deed dated October 24, 1956, of
record in said Register's Office in Book 469, at page 269

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