20160008 Ver 1_Riparian Buffer Authorization_20151229

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources Division of Water Resources
15A NCAC 020.0233 (8)(b),.0243 (8)(b),.0250 (11)(b), .0259 (8)(b), .0267 (11)(c),.0607 (e)(2) —Buffer Authorization
FORM: BA 10-2013
2 0 1
60 0 0 8
Riparian Buffer Authorization Form
A. Applicant Information
1. Project Information
1a. Name of project:
Retaining Wall Erosion Control
1b. County:
Franklin
1c. Nearest municipality:
Bunn
1 d. Subdivision name:
Lake Royale
le. Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer 1f below.
No
1f. Is the project located within a NC Division of Coastal
Management Area of Environmental Concern (AEC)?
No
O
2. Owner Information
EC
2a. Name on Recorded Deed:
Teresa Siebert and Ginger Cribb
75
2b. Deed Book and Page No.
BK 2002 PG 878-877
Qor 8 ArfR
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
PERMNGs
2d. Responsible Party
(for Corporations):
2e. Street address:
527 Sagamore Dr, (735 LR)
2f. City, state, zip:
Louisburg, NC 27549
2g. Telephone no.:
919-218-0321
2h. Fax no.:
2i. Email address:
Sieberttl(aacl.com
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:
FORM: BA 10-2013 Page 1 of 7

INTERNAL DRAFT- NOT FOR PUBLIC USE
Section A. Applicant Information, continued
4. Agent/Consulfant 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: SSGP3080 8-13 Page 2 of 7

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees):
Latitude:
Longitude:
1c. Property size:
.45 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Lake Royale
2b. Water Quality Classification of nearest receiving
water:
2c. River basin:
Tar -Pamlico River Basin
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: Back yard lake front is steep with erosion, this is residential property
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:
3e. Explain the purpose of the proposed project: Build retaining walls to prevent additional erosion — see photos
3f. Describe the overall project in detail, including the type of equipment to be used: Two retaining walls on each
side of steps to the lake with back fill to level ground. Equipment: Bobcat T450
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 ❑ 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?
Unknown
5b. If yes, explain and detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
No
6b. If yes, explain.
FORM: BA 10-2013 Page 3 of 7

C. Proposed Impacts Inventory
1. Buffer Impacts
1a. Project is in which protected
❑ Neuse
X Tar -Pamlico ❑ Catawba
basin?
❑ Randleman
❑ Jordan ❑ Goose Creek
1 b. Individually list all buffer impacts below. If any impacts
require mitigation, then you MIUST fill out Section D of
this form.
Buffer impact
Reason for
Type of impact
Stream name
Buffer
Zone 1
Zone 2
number—
impact
(exempt, allowable,
mitigation
impact
impact
Permanent (P)
allowable w/
required?
(sq ft)
(sq ft)
or Temporary
mitigation)
T
B1 XP ❑ T
Prevent Erosion
Allowable
Lake Royale
❑ Yes ❑ No
820
350
Retaining Wall
B2 X P ❑ T
Prevent Erosion
Allowable
Lake Royale
❑ Yes ❑ No
1026
400
Backfill
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑P ❑T
El Yes 0 N
Total
buffer impacts
1846
750
1c. Comments: see attached landscaping Ian. Total Retaining
wallsquare feet 1,320 and total backfill
Is 1,706 square feet.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Slit screen will be used to minimize anything from entering the lake
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques.
Same as item D 1 a
FORM: BA 10-2013 Page 4 of 7

C. Impact Justification and Mitigation, continued
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 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 EEP proposed?
❑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.
2f.
Comments:
FORM: SSGP3080 8-13 Page 5 of 7

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
El Other BMP
maintained. If a Level Spreader is proposed, attach a Level Spreader Supplement Form.
Ia.
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
❑ Yes X No
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
of public (federallstate) land?
Manual and attach a BMP Supplement Form.
1b.
F.
Supplementary Information
by First Class Mail via the US Postal Service:
1.
Environmental Documentation
OR NC DWR, Transportation Permitting Unit
Ia.
Does the project involve an expenditure of public (federal/state/local) funds or the use
❑ Yes X No
Raleigh, NC 27604
of public (federallstate) land?
For all otherprojects sent by delivery service
1b.
If you answered "yes" to the above, does the project require preparation of an
❑ Yes X No
OR Karen Higgins
environmental document pursuant to the requirements of the National or State (North
NCDWR-401 & Buffer Permitting Unit
1617 Mail Service Center
Carolina) Environmental Policy Act (NEPA/SEPA)?
Raleigh, NC 27699 - 1617
1c.
If you answered yes" to the above, has the document been finalized by the State
❑ Yes X 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 Weiland
❑ Yes X 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 X No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
Teresa SiebertI / i % I % �
Ginger Cribb Applican at a ate
(Agent's signature is valid only if an authorization letter from the applicant u: provided.)
I\FTi1La
Send this completed form and accompanying documents to the following:
For government transportation projects sent
For government transportation projects sent
by First Class Mail via the US Postal Service:
by delivery service (UPS, FedEx, etc.):
NC DWR, Transportation Permitting Unit
OR NC DWR, Transportation Permitting Unit
1617 Mail Service Center
512 N. Salisbury Street
Raleigh, NC 27699 - 1617
Raleigh, NC 27604
For all otherprojects sent by First Class Mail
For all otherprojects sent by delivery service
via the US Postal Service
(UPS, FedEx, etc.):
Karen Higgins
OR Karen Higgins
NCDWR-401 & Buffer Permitting Unit
NCDWR-401 & Buffer Permitting Unit
1617 Mail Service Center
512 N. Salisbury Street
Raleigh, NC 27699 - 1617
Raleigh, NC 27604
FORM: BA 10-2013 Page 6 of 7

FORM: SSGP3080 8-13 Page 7 of 7

PROPOSED LANDSCAPE PLAN
TERESA SIEBERT
527 SAGAMORE DR
DRAWN BY:
NORBERTO MODESTO
LAWN HEALTH LLC
DEC. 16, 2015