20180491 Ver 1_Riparian Buffer Authorization_20180405

DWRState of North Carolina
2 0 1 8 4 D�epa1 tment of Environmental Quality
Divislon of Water Resources Division of Water Resources
15A NCAC 0213.0233 (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
A.
Applicant Information
1.
Project Information
1 a. Name of project: Jones Farm Rd Culvert Repair
1 b. County: Wake
1c. Nearest municipality: Wake Forest
1 d. Subdivision name: North Hampton
1e. Is the project located in any of North Carolina's twenty coastal counties?
If yes, answer 1f below.
❑ Yes x❑ No
1f. Is the project located within a NC Division of Coastal Management Area of
Environmental Concern (AEC)?
❑ Yes x❑ No
2.
Owner Information
2a. Name on Recorded Deed:
North Hampton HOA
2b. Deed Book and Page No.
11797 1386
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
2005 01247
2d. Responsible Party
for Corporations):
Scott Miles, PE, Assistant Town Engineer
2e. Street address:
0 Jones Farm Rd
2f. City, state, zip:
Wake Forest, NC 27587
2g. Telephone no.:
919-435-9442
2h. Fax no.:
919-435-9539
2i. Email address:
[e-mail]
3.
Applicant Information (if different from owner)
3a. Applicant is: ❑ Agent x❑ Other, specify: Town of Wake Forest
3b. Name: Scott Miles
3c. Business name Town of Wake Forest
if applicable):
3d. Street address: 301 S Brooks St
3e. City, state, zip: Wake Forest, NC 27587
3f. Telephone no.: 919-435-9442
3g. Fax no.: 919-435-9539
3h. Email address: SMiles(a)-wakeforestnc.gov
4.
Agent/Consultant Information (if applicable)
,A1
APR 05 241g
4a. Name:
4b. Business name
if applicable):
'
4c. Street address:
4d. City, state, zip:
4e. Telephone no.:
4f. Fax no.:
4g. Email address:
FORM: BA 10-2013 Page 1 of 4
C ���oL

B.
Project Information and Prior Project History
1.
Property Identification
1 a. Property identification no. (tax PIN or parcel ID): 1850420293
1 b. Site coordinates (in decimal degrees): Latitude: 35.952885 Longitude: -78.478842
1c. Property size: 0.1 acres
2.
Surface Waters
2a. Name of nearest body of water to proposed project: Smith Creek
2b. Water Quality Classification of nearest receiving water: Smith Creek
2c. River basin: Neuse
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:
Residential Subdivision
3b. Attach an 8 Y 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:
100 feet
3e. Explain the purpose of the proposed project:
Repair stormwater culvert and stabilize bank along edge of easement
3f. Describe the overall project in detail, including the type of equipment to be used:
Heavy equipment will be used due to the large size of pipe to be repaired 42" RCP
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 x❑ 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 thepast?
I ❑ Yes ❑ No x❑ Unknown
5b. If yes, explain and detail according to "help file" instructions.
6.
Future Project Plans
6a. Is this a phased project? ❑ Yes x❑ 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.
Designing roject to stay within drainage easement.
1. Buffer Impacts
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that
requires buffer mitigation?
1a. Project is in which protected basin?
x❑ Neuse
❑ Tar -Pamlico
❑ Catawba
Zone 1 3 (2 for 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.
2c. If buffer mitigation is required, is payment to a mitigation bank or NC DMS
proposed?
❑ Yes ❑ No
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 ❑ P x❑ T Repair of culvert
allowable
❑ Yeso x❑
0
150
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
B4 ❑ P ❑ T
❑ Yes ❑ No
B5 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total buffer impacts
1 c. Comments: work will occur within a drainage easement with small impact to the buffer area to ensure proper
stabilization
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.
Designing roject to stay within drainage easement.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. Will make every effort to stay within drainage easement
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
(square feet
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?
❑ 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.
Buffer will be restored to stable condition
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
x❑ 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 8 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
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
x❑ Yes ❑
use of public (federal/state) land?
No
1 b. If you answered "yes" to the above, does the project require preparation of an
❑ Yes x❑ 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 x❑ No
Wetland 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):
Applicant/Agent's Printed Name
fig
Applicant/Agent's Signature
ire is valid only if an authorization letter from the
Send 3 complete sets of this 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
3 06
Date
is
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 other projects sent by delivery service
(UPS, FedEx, etc.):
Karen Higgins Karen Higgins
NCDWR — 401 & Buffer Permitting Branch OR NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699 - 1617 Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4

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