20151135 Ver 1_Riparian Buffer Authorization_20151005

State of North Carolina
""'" «. _ Department of Environment and Natural Resources
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
1 a. Name of project:
f D "
1 b. County:
e,
1c. Nearest municipality:
rl I
1d. Subdivision name:
a
1e. Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer If 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:
-.-54a4l2 W K1L-
2b. Deed Book and Page No.
1P tv
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
Lo+ J L.) 1� M E, 0 04 I C -P O t n
-Ph 3 Z p NA Z �� 9 1 y O
2d. Responsible Party
(for Corporations):
2e. Street address:
2f. City, state, zip:
0--
2g. Telephone no.:
_ (o
2h. Fax no.:
2i. Email address:
3. Applicant Information (if different from owner)
3a. Applicant is:
❑ Agent ❑ Other, specify:
3b. Name:
3c. Business name
(if applicable):
T
5
3d. Street address:
°-
3e. City, state, zip:
" 7 -_ _
3f. Telephone no.:
3g. Fax no.:
�. .
3h. Email address:
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 30 -2013 Page 1 of 4
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S. Project Information and Prior Project History
t. Property Identification
la. Property identification no. (tax PIN or parcel ID):
1 "t 'r,- cp – O
1b. Site coordinates (in decimal degrees):
Latitude: . S1 l,, k" Longitude:
XI acres
1c. Property size:
2, surface Waters
2a. Name of nearest body of water to proposed project:
2b. Water quality, Classification of nearest receiving water:
2c. River basin:
ckvw 4.
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: (2k.--aa" pac1 °Ci�'���+� 1a1 C4• ,5+-�rua};o.,
3b. Attach an 8'/ x 11 excerpt from the most recent version of the USGS topographic map indicating the location of
the site
30. Attach an 8 % x 11 excerpt from tho 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:
3e. Explain the purpose of the proposed project; c —%A Co
3f. Describe the overall project in detail, including the type of equipment to be used:
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 4!;b 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 © Yes JQNo Q Unknown
project (including all prior phases) in the past? _
5b. If yes, explain and detail according to "help file' instructions.
6. Future Project Plans
Ga. Is this a phased project? ❑ Yes No
8b. If yes, explain.
FORM. BA 10 -2013
Page 2 of 4
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C. Proposed Impacts Inventory
I. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
I. 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? ,�S(Neuse
❑ Tar - Pamlico ❑ Catawba
❑ Randleman ❑ Jordan ❑ Goose Creek
1b. Individually list all buffer impacts below. if any impacts require mitigation, then you MIUST fill out Section D of this
form.
Total impact
(square feet
Multiplier
3 (2 for Catawba)
1.5
Buffer impact Reason for
number — impact
Type of impact
(exempt, allowable,
Stream name Suffer Zone 1 Zone 2
Permanent (P)
allowable w/ mitigation)
mitigation impact impact
required? (sq ft) (sq ft)
or T e
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.
B1 P T
❑ Yes ❑ No
p
Z,(D
132 ❑P ❑T
[1 Yes No
83 ❑P ❑T
13 Yes [I No
B4 ❑ P T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
136 0 El
[I Yes [I No
1c. Comments:
Total buffer impacts
D, impact Justification and Mitigation
I. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
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
Zone 1
Zone 2
Reason for impact
Total impact
(square feet
Multiplier
3 (2 for Catawba)
1.5
Required mitigation
s uare feet
Total buffer mitigation
required:
2c. If buffer mitigation is required, is payment to a
mitigation bank or NC EEP proposed? 7
❑ 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.
A Comments:
FORM: BA 10 -2013 Page 3 of 4

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.
1 b. If you answered "yes" to the above, does the project require preparation of an
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
environmental document pursuant to the requirements of the National or State (North
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Carolina) Environmental Policy Act (NEPA/SEPA)?
Manual and attach a BMP Supplement Form.
1c. If you answered 'yes' to the above, has the document been finalized by the State
F. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federallstate/local) funds or the use of
❑ Yes jj to
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 Wetland
❑ Yes $No
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 E No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
ApplicantfAgenVs Printed Name
V Ap
(Agents signature is valid offly
D e
nt/Agents Signature
if an authorization letter from the applicant is provided.)
Send this completed 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 aH other projects sent by First Class Mail
via the US Postal Service
Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
For government transportation projects sent
by delivery service (UPS, FedEx, eta):
OR NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
For all other projects sent by delivery service
(UPS, FedEx, eta):
OR Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
FORM: BA 10 -2013 Page 4 of 4

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LEGEND
ERALD Lines Surveyed
— — Lines not surveyed
FORESTVtLLERI) x E.I.P. Existing Iron Pipe
I.P.S. Iron Pipe Set
° P.P Power Pole
HWY 64 M. H. Manhole
40' W 0 4a
VICINITY MAP (N.T.S)
GRAPHIC SCALE
1 "= 40'
1 HEREBY CERTIFY THAT THIS MAP IS CORRECT AND THAT THE BUILDING
FOUNDATION WILL LIE WHOLLY ON THE LOT AND THAT THERE ARE NO
ENCROACHMENTS ON SAID LOT EXCEPT AS NOTED. I FUTHER CERTIFY
THAT THIS PROPERTY BeIRMOES NOT LIE IN A SPECIAL FLOOD HAZARD
AREA AS DETERMINED BY F.E.M.A.
Id Radius Arc Length Chord Ch Bear
C1 325 00' 76 00' 75 AfT R 610 11'SQ" W
Id Bearing Distance
LL1 S 54 °29'53" W 3-1-6.
TOP OF
T=
60' NEUSE RIVER I
RIPARIAN BUFFE
MEASURED FROM 1 N
TOP OF BANK
253 I o
20' PUBLIC
DRAINAGE
EASEMENT
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49'x9° r 83.4 _
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DECK N CJ1 I
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PROP. HOUSE m I 255
I 20' PUBLIC
I I UTILITY
EASEMENT
11.00' o I
DRIVE I I
I I ,
254 c
0.17 AC.
L1
MORGANITE CT.
(50' R/M
LOT 254, EMERALD POINTE, PH. 3,
RECORDED IN B.O.M. 2006, PG. 1408, WAKE CO.
I, David W Barrier,certify that this plat
was drawn under my supervision from
an actual survey made under my
supervision; that the boundaries not
surveyed are clearly indicated and any
encroachments are shown.
PRELIMINARY PLOT
PROPERTY OF
PROFILE CONSTRUCTION
402 MORGANITE CT
SCALE; 1 "=40'
DATE; 6/25/14
BOOK;
KNIGHTDALE, N.C.
David W. Barrier
Licensed Surveyor
421 S. Harrison Ave.
Cary, N.C. 27511
(919) 469 -2834