20181575 Ver 1_Riparian Buffer Authorization_20181114

State of North Carolina
Department of Environmental Quality
Division of Water Resources Division of Water Resources
15A NCAC 02B .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 2 0 1 8 1 5 7 5
la. Name of project: Iverson walkway
1 b. County: Lincoln
1c. Nearest municipality: Lincolnton
1 d. Subdivision name: Sailview
1 e. Is the project located in any of North Carolina's twenty coastal counties?
If yes, answer 1f below.
❑ Yes 940
1f. Is the project located within a NC Division of Coastal Management Area of
Environmental Concern (AEC)?
❑ Yes o
2.
Owner Information
2a. Name on Recorded Deed:
Jeffrey David Iverson
2b. Deed Book and Page No.
2694-26
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
9-208
2d. Responsible Party
for Corporations):
2e. Street address:
4676 Sierra View Dr
2f. City, state, zip:
Denver, NC, 28037
2g. Telephone no.:
80-589-8801
2h. Fax no.:
2i. Email address:
Jeff [e-mail]
3.
Applicant Information (if different from owner)
3a. Applicant is: El Agent E4,Other, specify: Property Owner
3b. Name:
3c. Business name
if a 11(:aLlc
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
4.
Agent/Consultant Information (if applicable)
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

B.
Project Information and Prior Project History
1.
Property Identification
1 a. Property identification no. (tax PIN or parcel ID): 74452
1 b. Site coordinates (in decimal degrees): Latitude: 35.5277N Longitude: 80.9633W
1c. Property size: .556 acres
2.
Surface Waters
2a. Name of nearest body of water to proposed project: Lake Norman
2b. Water Quality Classification of nearest receiving water:
2c. River basin: Catawba
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:
Gravel walkway surrounded by dirt and mulch
3b. Attach an 8'/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8 1/2 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:
3e. Explain the purpose of the proposed project:
To make the dock handicap accessible.
3f. Describe the overall project in detail, including the type of equipment to be used:
Prep existing ravel for proper base. Possible small excavator to help and move concrete to location.
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?
D Yes El No Q4Jnknown
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.
G.
r l Vicat Wiatory
5a. Have permits or certifications been requested or obtained
for this project(including all priorphases) in thepast?
El Yes No nknown
5b. If yes, explain and detail according to "help file" instructions.
6.
Future Project Plans
6a. Is this a phased project? El Yes QA0
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.
It will be a straight walkway to help minimize the area.
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?
❑ Neuse 0 Tar -Pamlico
❑ Randleman ❑ Jordan
EYCatawba
❑ 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
number —
Permanent (P)
or Temporary
T
Reason for
impact
Type of impact
(exempt, allowable,
allowable w/
mitigation)
Stream name
Buffer
mitigation
required?
Zone 1 Zone 2
impact impact
(sq ft) (sq ft)
B1 ❑ P ❑ T
Handicap
accessible
Catawba
❑ Yes ❑ No
B2 P T
Yes El No
B3 P T
LJ Yes Ll No.
B4 P T
Yes E3 No
B5 LJ P T
Yes No
B6 Er P LJ T
LJ Yes LJ No
Total buffer impacts
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.
It will be a straight walkway to help minimize the area.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. It is a small project that will minimally disturb the area.
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that
requires buffer mitigation?
El Yes VNo
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 Required mitigation
(square feet 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 El Yes El No
proposed?
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
EI 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.
1 c. 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
El Yes E344o
use of public federal/state land?
1 b. If you answered "yes" to the above, does the project require preparation of an
D Yes No
environmental document pursuant to the requirements of the National or State (North
Carolina) Environmental Policy Act NEPA/SEPA ?
1 c. If you answered `yes" to the above, has the document been finalized by the State
0 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
El Yes 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 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 Applicant/Agent's Signature Date
(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
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
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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GRAPHIC SCALE
OWNER'S ADDRESS
CATAWBA SPRINGS TWSP., LINCOLN CO., N.C.
178e
q. LAKE NORMAN 400 S. 1RYON ST. /1000
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CHARLOTTE. N.C. 75202
TEL 1(704) ]52-1259
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SEE MAP 3 OF 3 FOR LINE TABLE, CURVE TABLE AND NOTES

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