20171062 Ver 2_updated BA 10-2013_Buffer Auth Form_06-22-23_0_20230817

State of North Carolina
Department of Environmental Quality
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
FORM: BA 10-2013 Page 1 of 5
Riparian Buffer Authorization Form
A. Applicant Information
1. Project Information
1a. Name of project: BRIDGE #94
1b. County: CHATHAM
1c. Nearest municipality: PITTSBORO
1d. Subdivision name: N/A
1e. Is the project located in any of North Carolina’s twenty coastal counties?
If yes, answer 1f below. Yes X No
1f. Is the project located within a NC Division of Coastal Management Area of
Environmental Concern (AEC)? Yes X No
2. Owner Information
2a. Name on Recorded Deed: NCDOT
2b. Deed Book and Page No. NA
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
NA
2d. Responsible Party
(for Corporations):
NCDOT HWY. DIV. 8
2e. Street address: 121 DOT DR.
2f. City, state, zip: CARTHAGE NC 28327
2g. Telephone no.: 910-773-8000
2h. Fax no.: 910-947-3873
2i. Email address: [e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is: Agent Other, specify:
3b. Name:
3c. Business name
(if applicable):

3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
4. Agent/Consultant Information (if applicable)
4a. Name: BEN FURR
4b. Business name
(if applicable): ICA ENGINEERING
4c. Street address: 5121 KINGDOM WAY
4d. City, state, zip: RALEIGH NC 27607
4e. Telephone no.: 910-900-1613
4f. Fax no.:
4g. Email address: [e-mail]

FORM: BA 10-2013 Page 2 of 5

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): SR-1520 @DRY CREEK CROSSING
1b. Site coordinates (in decimal degrees): Latitude: 35.802065 Longitude: --
79.206773
1c. Property size: NA acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: DRY CREEK
2b. Water Quality Classification of nearest receiving water: WS-IV; NSW
2c. River basin: CAPEFEAR
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:
Dry Creek is a perennial tributary 20 to 30 feet wide with gravel/cobble substrate, consistent bed and banks,
and riffle/pool profile
3b. Attach an 8 ½ x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8 ½ 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:
100
3e. Explain the purpose of the proposed project:
The purpose of the project is to replace Bridge No. 94 over Dry Creek on SR 1520 with a single span bridge.
3f. Describe the overall project in detail, including the type of equipment to be used:
The existing three-span bridge will be replaced with a single-span bridge on existing alignment. The
roadway approaches will be widened to accommodate the new bridge and Class II rip rap will be placed
around the bridge abutments. A floodplain bench will be excavated between the right top of bank and the rip
rap abutment protection. 2:1 roadway fill slopes with guardrail will be used to minimize buffer impacts.
Standard heavy highway construction equipment will be used to construct the project (excavators, dump
trucks, etc.). Traffic will be maintained with an off-site detour.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by
the Corps or State been requested or obtained for this
property/ project (including all prior phases) in the past?
Yes X No Unknown
Comments:
4b. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/ 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 obtained
for this project (including all prior phases) in the past?
Yes X No Unknown
5b. If yes, explain and detail according to “help file” instructions.

6. Future Project Plans
6a. Is this a phased project? Yes X No
6b. If yes, explain.

FORM: BA 10-2013 Page 3 of 5
C. Proposed Impacts Inventory
1. Buffer Impacts
1a. Project is in which protected basin?

Neuse Tar-Pamlico Catawba
Randleman Jordan Goose Creek
1b. 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 BRIDGE Allowable Dry Creek Yes No 4,171 104
B2 P T Road Crossing Allowable Dry Creek Yes No 93 1,199
B3 P T Yes No
B4 P T Yes No
B5 P T Yes No
B6 P T Yes No
Total buffer impacts 4,264 1,303
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.
The project has been designed to minimize environmental impacts. 2:1 roadway fill slopes were used to
minimize buffer impacts and there will be no grading or fill material placed below existing top of bank to avoid
stream impacts to Dry Creek. Grated inlets and pipes will be used to collect and discharge bridge storm water
through rip rap outlet protection to dissipate energy and provide diffuse flow. Existing concrete sills along the
banks will be retained to minimize impacts to the bank of the channel underneath the bridge
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. Construction will be conducted from high ground on each side of the bridge. No temporary
crossings will be used to construct the new bridge. Erosion control measures will be installed to maintain
sediment on-site during construction.
FORM: BA 10-2013 Page 4 of 5
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that
requires buffer mitigation?
Yes x 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 DMS
proposed?
Yes No

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:

E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of
stormwater treatment. Include a plan that fully documents how diffuse flow will be
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.
Diffuse flow
Other BMP

F. Supplementary Information
1. 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
1b. If you answered “yes” to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State (North
Carolina) Environmental Policy Act (NEPA/SEPA)?
Yes No
1c. If you answered “yes” to the above, has the document been finalized by the State
Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter.)
Comments:
Yes No
2. 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 permit application? Yes No
2c. If you answered “yes” to one or both of the above questions, provide an explanation of the violation(s):

__________________________
Applicant/Agent's Printed Name

________________________________________________
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

__________
Date

Type text hereArt C. King 8/15/2023
FORM: BA 10-2013 Page 5 of 5
Send ONE complete set of this form and accompanying documents to the following:
For government transportation projects sent by
First Class Mail via the US Postal Service:

OR
For government transportation projects sent by
delivery service (UPS, FedEx, etc.):
Amy Chapman
NCDWR – 401 & Buffer Transportation
Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 - 1617
Amy Chapman
NCDWR – 401 & Buffer Transportation
Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604

For all other projects sent by First Class Mail via
the US Postal Service
OR
For all other projects sent by delivery service
(UPS, FedEx, etc.):
Stephanie Goss
NCDWR – 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 - 1617
Stephanie Goss
NCDWR – 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604