20180829 Ver 1_Riparian Buffer Authorization_20180615

2 0 1 8082[YW, 8
a \ State of North Carolina
Department of Environmental Quality
Division of Water Resources Division of Water Resources
15A NCAC 028 .0233 (8)(b) and .0259 (8)(b) - Buffer Authorization
FORM: EEA 10.201.5
Riparian Buffer Authorization Form
A. Applicant Information
1. Project Information
1. Property Identification '— •-"""_:.•__.-.__.-.__.__,
1a. Name of project:
13 r, Sa.., Re Jt r
1b. County: ____
Gari:¢. ) i0 - L7 51
1c. Nearest municipality:jt1
1b. Site coordinates (in decimal degrees):
2. Owner information
Longitude: _
2a. Name on Recorded Deed:
2b, Geed Book and Page No.
ke,41Yh 131,bSa, J 77�(I-,,:cy t ,AVoel
c 1700 1S-_-_
2c. Map Book and Page No.
(include a copy of the recorded
rnap that indicates when the lot
was created):
i
2d. Street address:
2e. City, state, zip:
i`�t,lti�1�, tJC- 2?601)
_
2f. Telephone no.:
c)1 q • ?.? - 'i 551a -_-
2g. Fax no.:
_
2h. Email address:
__....___.-
3. Agent/Consultant information
(if applicable)
3a. Name:
3b Business name ------._
(if applicable)
—
3c- Street address:
3d. state, zip:
_City,
3e. Telephone no.: -
—
3f. Fax no.:
3g. Email address:
B. Project Information
1. Property Identification '— •-"""_:.•__.-.__.-.__.__,
.___,-� �_
1a. Property identification no, (tax PIN or parcel ID):
Gari:¢. ) i0 - L7 51
t'70G3p6'5
1b. Site coordinates (in decimal degrees):
Latitude:
Longitude: _
1c. Property size: -
A.L115acres �-�`�_
2. Surface Waters
2a. Name of nearest body of water to proposed project:
,A (U, C f 2 rr k. C' e lsvr -1
ko V C A, rlaitm e
2b. River basin: Meose
3. Project Description
Explain the purpose of the proposed project: 'To AliavJ dor C-OnOrucf a., ra k
on40 t�c ID4cle orr O z.,Z G, C)" a
a„
:+k e,--
GfinGrt �o- pt k;o - 'i kee4 {-ort, batit-1 a,% 4e �:r eye w w%a 1- b' ,. 6 +k 17--p-K,-4h i3v4r,
FORM: BA 10-2015 Page 1 of 2

C. Proposed Impacts
Avoidance and Minimization
_ ~^
Buffer Impacts
E, Diffuse Flow
_Individually list all buffer impacts below.
how diffuse flow will be maintained:
1 W�l� �qe Ctrrr\e. —>A\? .,tit7 CYeviC
Buffer impact number — Permanent (P) or
Temporary (T)_
Reason for Impact
Zone 2 impact
s fl
81 _[P ❑T
B2 5? P ❑ T
_ _
Buffer Rules (15A NCAC 028,0200)?
B3 El T
Is this an after -the -fact permit application?
❑ Yes KNo
B4 ❑ P ❑ T
Total buffer impac#s
w ��
1-12 5
__..-_.._Comments: The i�.o(ci, ;s it,` 60 & ty G' ;s 'l .c ?.N
Lane, Pgre-1, AA ml
-'1 - _.1 1 !' 11. 11. 1 _ 1 r`i_ III11 !'f LI 1 � - t r 1 ,
D. Impact Justification and Mitigation
Avoidance and Minimization
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
EIN.-W ►. �'� ll� +t f%+e 1 �t (� "xG" �'�,�•krs, i1e t' 1�evvu;u��t U
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:
1 W�l� �qe Ctrrr\e. —>A\? .,tit7 CYeviC
F. Violations
Is the site in violation of DWR Wetland Rules (15A NCAC 1321-1.0500), Isolated Wetland
❑ Yes M No
Rules (15A NCAC 02H .1300), DWR Surface Water or Wetland Standards, or Riparian
Buffer Rules (15A NCAC 028,0200)?
Is this an after -the -fact permit application?
❑ Yes KNo
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
each �.r D. 3c ►as an _ _ _/�•--y /J . J �-- �o ! 5 ' Is
Applica t/Agent's Printed Name Ap cant/Agent's Signature Date
(Agent's signature Is valid only If an authorization letter from the applicant is provided.)
FORM: SSGP3080 8-13 Page 2 off

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