20230921 Ver 1_Riparian Buffer Authorization Request_20230626

Original Submittal 6/26/2023
A. Owner/Applicant Information
General Information Q
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Primary Contact Email: * [e-mail]
Please list the contact person's email for questions or payment on this project if needed.
Who is submitting the application?* O Owner
0 Applicant other than Owner
O Agent
Is there an agent working on this application but Yes
not submitting it? No
1. Property Owner Information:
............................................................................................................
1a. Name on Recorded Deed:*
1b. Responsible Party:
1c. Mailing Address:*
1 d. Telephone:* 252-714-1477
Justin and Amanda Haddock
(for Corporations)
Street Address
1696 Haddock Rd
Address Line 2
City
Winterville
Postal / Zip Code
28590-7819
2. Applicant's Information (if different from owner):
State / Province / Region
NC
Country
us
le. Email Address:* [e-mail]
2a. Name:
Worth Lewis
2b. Company Affiliation:
C.A. Lewis, Inc.
2c. Mailing Address:
Street Address
2825 Charles Boulevard
Address Line 2
City
Greenville
Postal / Zip Code
27858-5934
2d. Telephone: [phone]
2e. Email Address: [e-mail]
State / Province / Region
NC
Country
us

B. Project Information and Prior Project History
1. Project Information 0
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1a. Name of Project:*
Haddock House
(Subdivision, facility, or establishment name)
1b. Is this a publicly -funded transportation project?*
Yes
No
1d. Subdivision Name:
le. Nearest Municipality:
1f. Property Size: acres
1 g. County (or Counties) where the project is located:*
Pamlico
1 h. Property ID# Date of Purchase
Tax PIN or Parcel id
11. Deed Information
Type of Book Book# Page# I
Deed
Map
1 j. 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
401 Silverwood Dr
Address Line 2
City
Merritt
Postal / Zip Code
28556
Latitude* 35.10512 Longitude*
11. Is the project located in any of North Carolina's twenty coastal counties?*
State / Province / Region
NC
Country
USA
76.60284
Yes
No
1m. Is the project located within a NC Division of Coastal Management Area of Environmental Concern (AEC)?
Yes
No

2. Surface Waters
2a. Name of the nearest body of water to proposed project: * Pamlico
2b. Water Quality Classification of nearest receiving water: B
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1
(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:
3b. Attach an 8'/z 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
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:
Building a residence small tools and equipment
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach document
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?*
6. Project History
Ga. 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
a 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 0.00 0.00
Perm or Temp Square Feet Square Feet
Total Zone 1 Impacts: 0.00
Total Zone 2 Impacts: 0.00
Total Buffer Impacts: 0.00
Comments:
CAMA Inspection and Building Inspector at site; inspected and measured with flags
Property is exempt per inspector.
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.
site has been marked so that only construction area can be accessed.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
site has been marked so that only construction area can be accessed.
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
401 Silverwood Dr Merritt NC.pdf 1.01 MB
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)?
2b. Is this an after -the -fact buffer authorization application?
Yes
p No
G. Additional Information
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:
0
o 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:* Worth Lewis
Signature
& /-A—
Submission Date: 6/26/20223
(Auto populated field)

Initial Review
Is this accepted into the review process?* Yes No
Is this project a public transportation project?* � Yes
No
ID#* 20230921
Version: *
Select Reviewer: *
Select Reviewing Office*
Has payment been received?*
Robert Tankard:robert.tankard
Washington Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification