20170670 Ver 1_Riparian Buffer Authorization_20170531

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02B .0233 (8)(b) and .0259 (8)(b) - Buffer Authorization
FORM: BA 10-2015
Riparian Buffer Authorization Form
A. Applicant Information
1. Project Information
1a. Name of project:
109 Fox Den Court
1b. County:
Wake
1c. Nearest municipality:
Cary
2. Owner Information
2a. Name on Recorded Deed:
Hinson, William Garrett and Caroline
2b. Deed Book and Page No.
16452 0728
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
0753 06
2d. Street address:
109 Fox Den Court
1U) LPM �0 LE U W L9
2e. City, state, zip:
Cary NC 27513
2f. Telephone no.:
919-604-7875
2g. Fax no.:
DEO-WATER E OU S
2h. Email address: [e-mail]
3. Agent/Consultant Information (if applicable)
3a. Name:
3b. Business name
(if applicable):
3c. Street address:
3d. City, state, zip:
3e. Telephone no.:
3f. Fax no.:
3g. Email address:
B. Project Information
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 10753385434
1b. Site coordinates (in decimal degrees): Latitude: Longitude:
1c. Property size: 1.21 acres
2. Surface Waters
FORM: BA 10-2015 Page 1 of 2

INTERNAL DRAFT- NOT FOR PUBLIC USE
Section A. Applicant Information, continued
2a. Name of nearest body of water to proposed project:
2b. River basin:
3. Project Descriation
Explain the purpose of the proposed project:
Add on a screened in porch
Crabtree Creek
Neuse
FORM: SSGP3080 8-13 Page 2 of 3

r
IPWRNTERNAL DRAFT- NOT FOR PUBLIC USE
S 9%?f fFc%fr't911Tb%ation, continued
C. Proposed Impacts
Buffer Impacts
Individually list all buffer impacts below.
Buffer impact number — Permanent (P) or
Temporary (T)
131 P xT
62 P T
B3 P T
B4 P T
impacts
Reason for impact Zone 2 impact
(sq ft)
Screened porch 276
Total buffer276
Comments:
D. Impact Justification and Mitigation
Avoidance and Minimization
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
NA
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:
All diffuse requirements will be met.
F. Violations
Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated Yes No
Wetland Rules (15A NCAC 02H .1300), DWR Surface Water or Wetland Standards, or
Riparian Buffer Rules (15A NCAC 02B .0200)?
Is this an after -the -fact permit application?
Yes No
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
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Applicant/Agent's Printed Name
9tt'- % ����� 05/30/17
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
FORM: SSGP3080 8-13 Page 3 of