20170028 Ver 1_Riparian Buffer Authorization_20170105

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D—WR 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 T �.
A.
1.
Applicant Information
Project Information
1a.
Name of project:
Bailey Middlesex Community Park Phase II
1 b.
County:
Nash County
1c.
Nearest municipality:
Town of Bailey
1 d.
Subdivision name:
N/A
1 e.
Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer if below.
El Yes ® No
1f.
Is the project located within a NC Division of Coastal
Management Area of Environmental Concern (AEC)?
El Yes ® No
2.
Owner Information
2a.
Name on Recorded Deed:
Town of Bailey and Town of Middlesex
2b.
Deed Book and Page No.
2500/533
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
36/369
2d. Responsible Party
(for Corporations):
Town of Bailey - Tim Johnson (Mayor), Lu Harvey Lewis
2e.
Street address:
6217 Main Street
2f.
City, state, zip:
Bailey, NC, 27807
2g.
Telephone no.:
252-235-4977
2h.
Fax no.:
252-235-5762
2i.
Email address:
[e-mail] ; [e-mail]
3.
Applicant Information (if different from owner)
3a.
Applicant is:
® Agent ❑ Other, specify:
3b.
Name:
Mark Hamlett, PE
3c.
Business name
(if applicable):
McGill Associates, P.A.
3d.
Street address:
1915 Evans Road
3e.
City, state, zip:
Cary, NC 27513
3f.
Telephone no.:
919-378-9111
3g.
Fax no.:
919-378-9127
3h.
Email address:
[e-mail]
FORM: BA 10-2013 Page 1 of 7

INTERNAL DRAFT- NOT FOR PUBLIC USE
Section A. Applicant Information, continued
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: 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):
27550030098
1 b. Site coordinates (in decimal degrees):
Latitude: 35.807 Longitude: 78.143
1 c. Property size:
65.46 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Big Branch (Johns Branch)
2b. Water Quality Classification of nearest receiving
Class C;Nutrient Sensitive Waters (NSW)
water:
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:
The existing site currently serves as a community park, which includes access roads, parking lots, sports fields
and playgrounds. Areas surrounding the project site are rural residential and agricultural.
3b. Attach an 8 Y2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8'/ 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:
1056 If.
3e. Explain the purpose of the proposed project:
The purpose of this project is the expansion of an existing park in Bailey, NC.
3f. Describe the overall project in detail, including the type of equipment to be used:
The proposed project (Phase II) is a continuation of Phase I and will include additional baseball fields, parking
lots, roads, and a natural walking trail. A bottomless culvert will be installed to reduce impacts at the proposed
road crossing of UT Big Branch (See Attached Stream Impact Plan).
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
❑ Yes ® No ❑ Unknown
Corps or State been requested or obtained for this property/
Comments:
project (including all prior phases) in the past?
4b. If yes, who delineated the jurisdictional areas?
Agency/ Consultant Company: McGill
Name (if known):
Associates, P.A.
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
® Yes ❑ No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain and detail according to "help file" instructions.
This is a phased project. Original permits were obtained for a total of three phases. Phase I included access roads,
parking lots, sports fields, playgrounds and a wet detention pond. Phase 11 included additional baseball fields,
parking lots and roads. Phase III included additional parking and tennis courts. After the permits were obtained, the
Town of Bailey constructed only Phase I of this project. This permit is being submitted for the construction of Phase
II of this project.
FORM: BA 10-2013 Page 3 of 7

B. Project Information and Prior Project History
6. Future Project Plans
6a. Is this a phased project? ® Yes ❑ No
6b. If yes, explain.
Phase I of this project has previously been completed on the site. This permit application is for Phase II which
includes the expansion of the park with additional baseball fields, parking lots, roads, and a natural walking trail.
FORM: SSGP3080 8-13 Page 4 of 7

C. Proposed Impacts Inventory
1. Buffer Impacts
1a. Project is in which protected
® Neuse ❑ Tar -Pamlico ❑ Catawba
basin?
❑ 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.
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/
re
required?
(sq ft)
(sq ft)
or Temporary
mitigation)
61 ®P ❑ T
Construction of
Allowable
UT — Brush
❑ Yes ® No
4048
2528
Access Road
Branch
and Bottomless
Culvert to allow
UT — Brushy
Branch to flow
under
Constructed
Road.
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 El El
El Yes ❑No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total
buffer Impacts
4048
2528
1c. Comments:
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.
This design calls for a bottomless culvert which will reduce the impacts to UT Big Branch from the proposed
road crossing. The road is also will have a perpendicular crossing through the buffer in order to minimize the
impacts.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. Footers for the bottomless culvert will be constructed far enough behind the stream bank to avoid
any impacts. Construction equipment will also be prohibited from entering the stream.
FORM: BA 10-2013 Page 5 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 ® 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 s uare 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❑Yes
mitigation bank or NC EEP proposed?
ElNo
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 6 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
❑ 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 S 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
la. Does the project involve an expenditure of public (federal/state/local) funds or the use
® Yes ❑ No
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 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 ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
MARK la>aMLllarr tzltz/it,
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only 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 all 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, etc.):
OR NC DWR, Transportation Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
For all otherprojects sent by delivery service
(UPS, FedEx, etc.):
OR Karen Higgins
NCDWR — 401 & Buffer Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
FORM: BA 10-2013 Page 7 of 7

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Custom Soil Resource Report
Soil Map
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Custom Soil Resource Report
MAP LEGEND
MAP INFORMATION
Area of Interest (AOI)
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Spoil Area
The soil surveys that comprise your AOI were mapped at 1:24,000.
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Area of Interest (AOI)
Stony Spot
Soils
Very Stony Spot
Warning: Soil Map may not be valid at this scale.
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Soil Map Unit Polygons
Wet Spot
Enlargement of maps beyond the scale of mapping can cause
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Soil Map Unit Lines
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Other
misunderstanding of the detail of mapping and accuracy of soil line
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Soil Map Unit Points
placement. The maps do not show the small areas of contrasting
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soils that could have been shown at a more detailed scale.
Special
Point Features
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Blowout
Water Features
Streams and Canals
Please rely on the bar scale on each map sheet for map
19
Borrow Pit
measurements.
Transportation
Clay Spot
444
Rails
Closed Depression
Source of Map: Natural Resources Conservation Service
Interstate Highways
Web Soil Survey URL: hftp://websoilsurvey.nres.usda.gov
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Gravel Pit
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US Routes
Coordinate System: Web Mercator (EPSG:3857)
Gravelly Spot
Major Roads
Maps from the Web Soil Survey are based on the Web Mercator
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distance and area. A projection that preserves area, such as the
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Aerial Photography
calculations of distance or area are required.
Mine or Quarry
This product is generated from the USDA-NRCS certified data as of
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the version date(s) listed below.
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Soil Survey Area: Nash County, North Carolina
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Custom Soil Resource Report
Map Unit Legend
Nash County, North Carolina (NC127)
Map Unit Symbol
Map Unit Name
Acres In AOI
Percent of AOI
Bb
Bibb loam, 0 to 2 percent slopes,
1.5
2.4%
frequently flooded
GeB
Georgeville loam, 2 to 6 percent
31.6
52.2%
slopes
GeC
Georgeville loam, 6 to 10 percent
17.0
28.2%
slopes
NrB
Norfolk, Georgeville, and
0.0
0.1%
Faceville soils, 2 to 8 percent
slopes
RaA
Rains fine sandy loam, 0 to 2
6.2
10.3%
percent slopes, Southern
Coastal Plain
W
Water
2.2
3.7%
Wh
Wehadkee loam, 0 to 2 percent
1.9
3.2%
slopes, frequently flooded
Totals for Area of Interest
60.5
100.0%
Map Unit Descriptions
The map units delineated on the detailed soil maps in a soil survey represent the soils
or miscellaneous areas in the survey area. The map unit descriptions, along with the
maps, can be used to determine the composition and properties of a unit.
A map unit delineation on a soil map represents an area dominated by one or more
major kinds of soil or miscellaneous areas. A map unit is identified and named
according to the taxonomic classification of the dominant soils. Within a taxonomic
class there are precisely defined limits for the properties of the soils. On the landscape,
however, the soils are natural phenomena, and they have the characteristic variability
of all natural phenomena. Thus, the range of some observed properties may extend
beyond the limits defined for a taxonomic class. Areas of soils of a single taxonomic
class rarely, if ever, can be mapped without including areas of other taxonomic
classes. Consequently, every map unit is made up of the soils or miscellaneous areas
for which it is named and some minor components that belong to taxonomic classes
other than those of the major soils.
Most minor soils have properties similar to those of the dominant soil or soils in the
map unit, and thus they do not affect use and management. These are called
noncontrasting, or similar, components. They may or may not be mentioned in a
particular map unit description. Other minor components, however, have properties
and behavioral characteristics divergent enough to affect use or to require different
management. These are called contrasting, or dissimilar, components. They generally
are in small areas and could not be mapped separately because of the scale used.
Some small areas of strongly contrasting soils or miscellaneous areas are identified
by a special symbol on the maps. If included in the database for a given area, the
8

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Joe NO.: 15.0191+. BAILEY COMMUNITY PARK ��
DATE: 12/152616
BAILEY COMMUNITY PARK DESIGNED BY: MAH PHASE II
CADD ONST. :EI, MM TOWN OF BAILEY
171 PHASE II DESIONREVIEW:_
m STREAM IMPACT PLAN �°" RIE" — ASSOCIATES
—I FILENAME: ENGINEERING•PLANNING•FINANCE
NASH COUNTY, NORTH CAROLINA "saenoslamT MHEM= wm� Mdalli 5 raa1�,can,

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 109623
STREET ADDRESS: 8104 Stoney Hill Church Rd
Bailey, NC, 27807
Please print:
Property Owner: Town of Bailey & Town of Middlesex
Property Owner: Tim Johnson, Mayor of Bailey (or)
Luther Harvey Lewis, Former Mayor of Middlesex
The undersigned, registered property owners of the above noted property, do hereby authorize
Mark Hamlett, PE , of McGill Associates, P.A.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
6217 Main Street, Bailey, NC, 27807
Telephone: Mayor Johnson (252-235-4977), Lu Harvey (252-235-5762)
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: Date: