20180131 Ver 1_Riparian Buffer Authorization_20180125

Division of Water Resources
15A NCAC 0213 .0233 (8)(b),.0243 (8)(b), .
State of North Carolina
Department of Environmental Quality
Division of Water Resources
1)(c), .0607 (e)(2) - Buffer Authorization
Riparian Buffer Authorization Form
FORM: BA 10-2013
A.
Applicant Information
1.
Project Information
2 0 1 8 0 1 3 1
la. Name of project: NEW HOME, DECK AND STEPS
1b. County: BEAUFORT
1 c. Nearest municipality: BELHAVEN
1 d. Subdivision name: SOUTH BAY POINTE NORTH LOT 72
1 e. Is the project located in any of North Carolina's twenty coastal counties?
If yes, answer 1f 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:
EDWIN O. & CAROLYN C. DANFORD
2b. Deed Book and Page No.
1903/00052
2c, Map Book and Page No.
(include a copy of the i
recorded map that indicates
when the tot was created):
Danford's Deed Book 1903 page 053
South Bay Pointe II Book 1866 page 596 map
Plat Cab. I silde 50-1
2d. Responsible Party
(for Corporations):
2e. Street address:
NA
3230 UNION SCHOOL ROAD
2f. City, state, zip:
CLINTON
2g. Telephone no.:
910-990-0199
2h. Fax no.:
2i. Email address:
[e-mail]
3.
Applicant Information (if different from owner)
3a. Applicant is: X Agent ❑ Other, specify:
3b. Name: JIMMIE WHICHARD
3c. Business name RIVERSIDE BUILDERS LLC
(if applicable):
3d. Street address: 513 BAY LAKE STREET
3e. City, state, zip: CHOCOWINITY
3f. Telephone no.: 252-945-5094
3g. Fax no.:
3h. Email address: [e-mail]
4.
AgenUConsultant Information (if applicable)
4a. Name:
4b. Business name
if applicable):
i
I
4c. Street address:
4d. City, state, zip:
4e. Telephone no.: j
4f. Fax no.:
4g. Email address: j
FORM: BA 10-2013 Page 1 of 4

B.
Project Information and Prior Project History
1.
Property Identification
1a. Property identification no. (tax PIN or parcel ID): 6694-38-2931
1b. Site coordinates (in decimal degrees): Latitude: 35.510003N Longitud?:76.671333W-
:76.671333W1c.
1c.Property size: .4 acres
2.
Surface Waters
2a. Name of nearest body of water to proposed project: Ut TO SCOTT CREEK
2b. Water Quality Classification of nearest receiving water: SC,NSW
2c. River basin: TAR-PAMILCO
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:
New subdivision almost 100 lots, lot cleared/old farm land, bulkhead installed on 25 ft. manmade canal
3b. Attach an 8 '/ 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:
100 FEET ON MANMADE CANAL FROM SCOTT CREEK
3e. Explain the purpose of the proposed project:
Build new modular home with open slat wood deck and steps elevated 8 feet plus
3f. Describe the overall project in detail, including the type of equipment to be used:
Pilin 8"x8" driven with excavator wooden PT deck& rails with 6" X 6" post home 1436 sq. ft.
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 priorphases) in thepast?
❑ 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 priorphases) in the 1ast?
❑ Yes ® No U Unknown
5b. If yes, explain and detail according to "help file" instructions.
6.
Future Project Plans
6a. Is this a phased project? Yes No
6b. If yes, explain.
FORM: BA 10-2013 Page 2 of 4

C. Proposed Impacts Inventory
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1. Buffer Impacts
1 a. Project is in which protected basin? ❑ Neuse
x Tar -Pamlico
❑ Catawba
❑ Randleman
❑ Jordan
❑ Goose Creek
1 b. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST 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,
allowable w/
mitigation
required?
impact impact
(sq ft) (sq ft)
Permanent (P) mitigation)
Total buffer mitigation required:
or Temporary
2c. If buffer mitigation is required, is payment to a mitigation bank or NC DMS
proposed?
El Yes No
T
2e. if no, then discuss what type of mitigation is proposed.
2f. Comments:
61 ® P [-] T
BUILD NEW ALLOWABLE Scott Ck
❑ Yes ® No
170
HOME Tar -Pam
62 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
65 ❑ P ❑ T
❑ Yes ❑ No
66 ❑ P ❑ T
❑ Yes LJ No
Total buffer Impacts
170
—71
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.
1 b. 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 Reason for impact Total impact
(square feet
Multiplier
Required mitigation
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 DMS
proposed?
El Yes No
2d. If yes, attach the acceptance letter from the mitigation bank or NC DMS.
2e. if no, then discuss what type of mitigation is proposed.
2f. 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.
Run off fence
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
Carolina) Environmental Policy Act NEPA/SEPA ?
1c. If you answered "yes" to the above, has the document been finalized by the State
plan for stormwater treatment as outlined in Chapter 8 of the IVC Stormwater BMS'
Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter.)
Manual and attach a BMP Supplement Form.
Comments:
F. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the —EJ
Yes ®No
use 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
❑ Yes ® No
Wetland Rules (15A NCAC 02H .1300), DWR Surface Water or Wetland Standards,
or Riparian Buffer Rules 15A NCAC 02B .0200)?
❑ Yes ® No
2b. Is this an after -the -fact permit application?
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
Applicant/Agent's Printed Name ; Applicant/Agent's Signature Date
,i (Agent's signature is valid only if an authorization letter from the applicant is provided.)
Send 3 complete sets of this form and accompanying documents to the following:
For government transportation projects sent by For government transportation projects sent by
First Class Mail via the US Postal Service: 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 al/ other projects sent by First Class Mail via
the US Postal Service
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 - 1617
For all other projects sent by delivery service
(UPS, FedEx, etc.):
OR Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:a ty%�✓ r-��+���
Mailing Address:
Phone Number: ��� 94
Email Address:°
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at Svti
in�.r9 ��' / County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
'1
Signature j
Print or Type Name
DWA) F-
Title
0/ 1 IQ / vI
Date
This certification is valid through l�_I - �'-'