20160614 Ver 1_Riparian Buffer Authorization_20160621

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D[vislon of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 026 .0233 (8)(b) and .0259 (8)(b) - Buffer Authorization
Riparian Buffer Authorization Form
FORM: BA 10-2015
A. Applicant information
1. Project Information
a. Name of project: Gage Addition
-1
1b. County: Wake
1c. Nearest municipality: Raleigh
2. Owner Information
2a. Name on Recorded Deed:
Shawn M. & Toni C. Gage
2b. Deed Book and Page No.
Deed Book 14838 Page 1480
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
Book of Maps 1991 Page 479
2d. Street address:
5508 Crossfield Dr.
2e. City, state, zip:
Raleigh, NC 27613
2f. Telephone no.:
919-452-4686
2g. Fax no.:
NIA
2h. Email address:
Shawn.m.gage@gmaiLcom
3. Agent/Consultant Information (if applicable)
3a. Name:
Richard A. Newton Jr.
3b. Business name
(if applicable):
R A Newton Custom Homes; LLC
3c. Street address:
8209 Last Oak Ct.
3d. City, state, zip:
Raleigh, NC 27163
3e. Telephone no.:
919-669-9607
3f. Fax no.:
NIA
3g. Email address:
[e-mail]
B.
Project Information
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
PIN 0779323517
1 b.
Site coordinates (in decimal degrees):
Latitude: 35.9275
Longitude: -78.75242
1c.
Property size:
.39 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
Falls Lake
2b.
River basin:
Neuse
3.
Project Description
Explain the purpose of the proposed project:
Kitchen and laundry addition to existing house
FORM: BA 10-2015 Page 1 of 2

C. Proposed Impacts
Buffer Impacts
Individually list all buffer impacts below.
Buffer impact number — Permanent (P) or Reason for impact
Temporary (T)
Zone 2 impact
sq ft)
B1 ZP DT Kitchen and laundry addition
128
62 C3 P EDT
B3 OP T
B4 [3 P F-1 T
Total buffer impacts =
128
Comments,
D. Impact Justification and Mitigation
Avoidance and Minimization
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Project was scaled back 4 ft. across the back to minimize buffer encroachment and still derive function from
addition
E. Diffuse Flow
All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment, Describe
how diffuse flow will be maintained:
Flow will remain the same with down spouts open at bottom of foundation and water flowing as a sheet flow
F. Violations
Is the site in violation of DWR Wetland Rules (15A NCAC 02H.0500), Isolated Wetland El Yes No
Rules (15,A NCAC 02H .1300). DWR Surface Water or Wetland Standards. or Riparian
Buffer Rules (15,A NCAC 028.0200)?
r7l lor<
Is this an after -the -fact permit application? Yes o
If you answered "yes' to one or both of the above questions, provide an explanation of the violation(s).
2W
Apel cant/Agent's Print Name
plkant/Ac
glent's Signature Ddle
alid only if an authonza6on tettertromr. rhe applicant is provided)
FORM� BA 10-2015 Page 2 of 2