20230951 Ver 1_14199 Preserve West BA 10-2013_Buffer Auth Form_06-30-2023_signed_20230630

State of North Carolina
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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
la. Name of project:
Preserve West -Phase 1
1 b. County:
Granville
1c. Nearest municipality:
Wake Forest
1d. Subdivision name:
Preserve West
1e. 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)?
❑ Yes ® No
2.
Owner Information
2a. Name on Recorded Deed:
Wilson Sonya Garner
2b. Deed Book and Page No.
DB:02000, DP: 0165
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
Recorded map not available. Project engineer original deed that dates back to
10/05/58 (attached).
2d. Responsible Party
(for Corporations):
2e. Street address:
5592 Via Mira Flores
2f. City, state, zip:
Thousand Oaks, CA 91320
2g. Telephone no.:
2h. Fax no.:
2i. Email address:
3.
Applicant Information (if different from owner)
3a. Applicant is:
❑ Agent ® Other, specify: Owner
3b. Name:
Alex Bailey
3c. Business name
(if applicable):
3d. Street address:
10931 Strickland Road, Suite 111
3e. City, state, zip:
Raleigh, NC 27615
3f. Telephone no.:
[phone]
3g. Fax no.:
3h. Email address:
[e-mail]
4.
Agent/Consultant Information (if applicable)
4a. Name:
Deborah Shirley
4b. Business name
if applicable):
Soil & Environmental Consultants, PA
4c. Street address:
8412 Falls of Neuse Road, Suite 104
4d. City, state, zip:
Raleigh, NC 27615
4e. Telephone no.:
[phone]
4f. Fax no.:
[phone]
4g. Email address:
[e-mail]
FORM: BA 10-2013 Page 1 of 5

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
182400277071 & 182400175596
1 b. Site coordinates (in decimal degrees):
Latitude: 36.079992 Longitude:-78.590081
1 c. Property size:
77.82 acres (Phase 1)
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Smith Creek
2b. Water Quality Classification of nearest receiving water:
WS-IV;NSW
2c. River basin:
Neuse River
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:
Existing conditions of Phase 1 consist of two parcels with Bruce Garner Road to the south. The land
is primarily wooded. There are four streams (B, D, E and M) and two wetlands (W1 & W3). General land
use in the vicinity consist of residential communities, wooded and agricultural land.
3b. Attach an 8 '/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8'/2 x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map
depicting the project site
3d. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Approximately 4,685 LF of stream
3e. Explain the purpose of the proposed project:
Proposed single-family residential subdivision.
3f. Describe the overall project in detail, including the type of equipment to be used:
The overall project consists of single-family residential development and the construction of roadway
infrastructure, single-family lots, and Stormwater Control Measures (SCM). Specifically, there are
riparian buffer impacts associated with a stormwater discharge. Equipment typically used for
construction and earthwork such as backhoes, bulldozers, excavators, graders, and pavers etc. will
be utilized for this project
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by
® Yes ❑ No ❑ Unknown
the Corps or State been requested or obtained for this
Comments:
property/ project(including all priorphases) in thepast?
4b. If yes, who delineated the jurisdictional areas?
Agency/ Consultant Company: S&EC
Name (if known): Joshua Harvey
Other:
4c. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach
documentation.
USACE: Jurisdictional Determination Package submitted to the USACE on 21212023, S&EC received
email indicating that the package was received but a PJD/AJD/ concurrence email not received to date
(SAW-2023-00313)
NCDWR: Buffer determination completed 31912023 NBRRO #23-052
5. Project History
5a. Have permits or certifications been requested or obtained
❑ Yes ® No ❑ Unknown
for this project(including all priorphases) in thepast?
5b. If yes, explain and detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ® Yes ❑ No
6b. If yes, explain.
Yes. Future phases will require a Section 404 & 401 permit for a road crossing of a buffered stream.
FORM: BA 10-2013 Page 2 of 5

C. Proposed Impacts Inventory
1. Buffer Impacts
1a. Project is in which protected basin?
® 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 Temporary
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)
B1 ® P ❑ T
Storm water
discharge
Stream E
❑ Yes ® No
0
304
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total buffer impacts
0
304
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.
S&EC completed a wetland and stream delineation, and Neuse Buffer evaluation so that the project
could be designed to avoid & minimize impacts to jurisdictional areas to the maximum extent
practicable. Phase 1 does not include impacts to wetlands or streams, however there are two
locations where discharge is directed to a stream buffer, between lots 17-20 and 20-21. The flow rate
through the two proposed channels meet 15A NCAC 02B.0714.(9)(b) and require written authorization.
Impacts to Zone 1 have been avoided.
1 b.
Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. There are no stream crossings proposed with this phase. Standard erosion control
measures like skimmer sediment basins and silt fences will be used during construction.
2. Buffer Mitigation
2a.
Will the project result in an impact within a protected riparian buffer that
❑ Yes ® No
requires buffer mitigation?
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
Multiplier
Required mitigation
(square feet
(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 DMS
❑ Yes ❑ No
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:
FORM: BA 10-2013 Page 3 of 5

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.
Per the project engineer: The only locations where discharge is directed to a
stream buffer is between lots 19-20 and 20-21. The flow rate through the two
proposed channels are below 0.5 cfs for the 0.75 in/hr storm and therefore should
not require a levels reader.
F. Supplementary Information
1. Environmental Documentation
1 a. 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 ?
1c. 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
❑ Yes ® 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?
❑ Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
Digitally signed by Deborah E.
Deborah E. Shirley Shirley
Deborah Shirley Date:2023.06.30 14:46:23-04'00' June 30,
Applicant/Agent's Printed Name Applicant/Agent's Signature 2023
(Agent's signature is valid only if an authorization letter from the applicant is provided.) Date
Send 3 complete sets of this form and accompanying documents to the following:
For government transportation projects sent by
First Class Mail via the US Postal Service:
NC DWR, Transportation Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
For all other projects sent by First Class Mail via
the US Postal Service
For government transportation projects sent by
delivery service (UPS, FedEx, etc.):
OR NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
OR For all other projects sent by delivery service
(UPS, FedEx, etc.):
FORM: BA 10-2013 Page 4 of 5

Karen Higgins Karen Higgins
NCDWR — 401 & Buffer Permitting Branch 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 5 of 5