20180811 Ver 1_Riparian Buffer Authorization_20180611

LJ� \ C�—
OMd" Of Water Resources
')0180811
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 020 .0233 (8)(b) and .0259 (B)(b)— Buffer Authorization
FORM: BA 10-2015
Riparian Buffer Authorization Form
A. Applicant Inforrnation
1. Project Information
1 a, Name of project
1 b. County:
1c. Nearest municipality
2. Owner Information

C. Proposed impacts
Buffer Impacts
Individually tial all txdter i below.
Buffer Impactember- Permanent (P) or Reason for impact Zone 2 impact
Si P T s ft
B2 T
B3 P T
B4 P T
Total buffer impacts
Comments;
D. Impact Justification and Mitigation
Avoidance and Minimization USIN I (-,I ti erg c k
SpeatflcaNy describe measures taken to avoid or minimize the proposed impacts in designing project.
L Dftse Flow
AN buffer impacts and high ground impacts require diffuse flow or other form of stomrwater treatment. Describe
how diffuse flow will be maintained:
Cf�A Nov G 14A -1) o.0 ie -'(GC, IVCD / pcCv2 11� J'i lac
F. Violations
laths site In violation of DWR Wetland Rules (15A NCAC 021-1,06M), Isolated Welland
Rules 15A NCAC 021-1.1300), DWR Surface Water or Wetland Standards,
❑ Yes j5kNo
or Riparian
Buffer Rules (15A NCAC 028.0200)?
Is this an after4he-fact permit application?
❑ Yes KNo
If you anwmred *Yes' to one or both of the above questions, provide an explanation of the violation(s):
all A01-1 Snrel Er
AppilcanOnrs Printed Name ApplicantlAgent's Signature Date
(mss souU ro is vaM only 11 an niYa WOW Z k0M Ns apPRnnl is provWad.)
FORM' SSGP3080 8-13 Page 2 of S

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