20230563 Ver 1_Riparian Buffer Authorization Request_20230418

Original Submittal 4/18/2023
A. Owner/Applicant Information
General Information
Primary Contact Email: *
Who is submitting the application?*
Is there an agent working on this application but
not submitting it?
1. Property Owner Information:
1a. Name on Recorded Deed:*
1b. Responsible Party:
1c. Mailing Address:*
1 d. Telephone:* 19196015811
[e-mail]
Please list the contact person's email for questions or payment on this project if needed.
Owner
Applicant other than Owner
Agent
Yes
No
Mark Delaney & Anna Preseren
Smith Designbuild Inc
(for Corporations)
Street Address
125 Lord Ashley Rd
Address Line 2
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27610-2436
us
le. Email Address:*
[e-mail]
2. Applicant's Information (if different from owner):
2a. Name:
Jordan Smith
2b. Company Affiliation:
Owner
2c. Mailing Address:
Street Address
9400 S Mere Ct
Address Line 2
City
Raleigh
Postal / Zip Code
27615-2319
2d. Telephone: [phone]
2e. Email Address: [e-mail]
State / Province / Region
NC
Country
us

2f. Attach a signed and dated copy of the authorization granting the applicant owner approval. An agent authorization form is
acceptable.
Click the upload button or drag and drop files here to attach document
313 Gary St DEQ Authorization. pdf 218.77KB
PDF only
3. Agent Information:
3a. Name:
3b. Company Affiliation:
3c. Mailing Address: Street Address
Address Line 2
City
Postal / Zip Code
3d. Telephone:
3f. Attach a signed and dated copy of the agent
authorization form.
State / Province / Region
Country
3e. Email Address:
Click the upload button or drag and drop files here to attach document
PDF Only
B. Project Information and Prior Project History
1. Project Information
1a. Name of Project:*
313 Gary St
(Subdivision, facility, or establishment name)
1b. Is this a publicly -funded transportation project?*
Yes
No
1d. Subdivision Name: Mt. Vernon Park Subdivision
le. Nearest Municipality: City of Raleigh
1f. Property Size: 0.47
acres
1 g. County (or Counties) where the project is located:*
Wake
1 h. Property ID# Date of Purchase
0784-23-9623 10/27/2021
Tax PIN or Parcel id
1i. Deed Information
Type of Book Book# Page# I
Deed
Map =F

1j. Attach a copy of the recorded map that indicates when the lot was last platted.
Click the upload button or drag and drop files here to attach document
PDF only
1 k. How would you like to provide the Latitude and Longitude information?
Address Lookup
Manually
Address Lookup
Street Address
313 Gary Street
Address Line 2
City
Raleigh
Postal / Zip Code
27606-1327
Latitude* 35.79299719999999 Longitude*
11. Is the project located in any of North Carolina's twenty coastal counties?*
2. Surface Waters
2a. Name of the nearest body of water to proposed project: * Richland Creek
2b. Water Quality Classification of nearest receiving water: Class C
State / Province / Region
NC
Country
us
-78.7202742
Yes
No
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
120
(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:
Renovation of existing home with addition of porch and paver patio
3b. Attach an 8 % x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
Click the upload button or drag and drop files here to attach document
PDF only
3c. Attach an 8 % x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the project site.
Click the upload button or drag and drop files here to attach document
313 Gary St Topo Map.pdf 49.72MB
PDF only
4. Proposed Activity
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used:
Renovation of existing home and addition of screened porch and paver patio
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach document
313 Gary St DEQ Survey.pdf 283.12KB
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
O

6. Project History
....... __..... _............ ...... ..... ...... ............
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?
Yes
No
7. Future Project Plans
7a. Is this project a phased project?* Yes
No
C. Proposed Impacts Inventory
Buffer Impacts
..................................................
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
Map label (e.g. Road Crossing 1) Permanent (P) Exempt 19.49 347.85
Perm or Temp Square Feet Square Feet
Total Zone 1 Impacts: 19.49
Total Zone 2 Impacts: 347.85
Total Buffer Impacts: 367.34
Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project.
Using existing footprint of structure and going vertical with addition. Only additional footprint is screened porch.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Using existing footprint of structure and going vertical with addition. Only additional footprint is screened porch.
E. Diffuse Flow Plan
1a. 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

1 c. Diffuse Flow Documentation Click the upload button or drag and drop files here to attach document
313 Gary St Permit Survey.pdf 369.26KB
PDF only
F. Supplementary Information
Environmental Documentation
1a. 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
n
G. Additional Information lJ
..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Please upload any additional information you would like the Division to consider during application review.
Additional Attachments: Click the upload button or drag and drop files here to attach document
PDF only
Additional Comments:
H. Sign and Submit
By digitally signing below, I certify that:
o I have given true, accurate, and complete information on this form;
• 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:* Jordan Smith
Signature
9011-0-1?W t-1: / --M
Submission Date: 4/18/23
(Auto populated field)

Initial Review
Is this accepted into the review process?* Yes No
Is this project a public transportation project?* � Yes
No
ID#* 20230563
Version: *
Select Reviewer: *
Select Reviewing Office*
Has payment been received?*
Zachary Thomas:[e-mail]
Raleigh Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification