20181636 Ver 1_Riparian Buffer Authorization_20181129

DWR
�F`� �,\ State of North Carolina
�X, 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
la. Name of project:
AUA,014Y
1b. County:
Gcs A lc -c'
1 c. Nearest municipality:
C
1d. Subdivision name:
P26S-0 G�ct L/�1SrZ;�/�s
1e. Is the project located in any of North Carolina's twenty coastal counties?
If yes, answer 1f below.
F1 Yes 13'No
1f. Is the project located within a NC Division of Coastal Management Area of
Environmental Concern (AEC)?
1:1 Yes No
2.
Owner Information
2a. Name on Recorded Deed:
u?Fif ,qtr J /3 CST
2b. Deed Book and Page No.
•7 -ZS-
2c. Map Book and Page No.
2c.
(include a copy of the
recorded map that indicates
when the lot was created):
2d. Responsible Party
for Corporations):
I�
2e. Street address:
/GS-
2f. City, state, zip:
y Al C 1 -
2g. Telephone no.:
'r _ -- 1y35_
2h. Fax no.:
2i. Email address:
a a6 1 C-
3.
3.
Applicant Information (if different from owner)
3a. Applicant is:
Agent ❑ Other, specify:
3b. Name:
6 1-9� �
3c. Business name
if applicable):
�
C G%/?I PC, Eli , �i C c!
3d. Street address:
3�� tQ;,� E Z,41<,- t tlF
3e. City, state, zip:
✓oma C Z -7 J--3
3f. Telephone no.:
2 _ / 3
3g. Fax no.:
c 6 _ -7
3h. Email address:
, Cc -N 0 f-/ ^J C,^C .
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 b. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of
this form.
1a. Property identification no. (tax PIN or parcel ID): 07 8'7 2�f
Reason for
1b. Site coordinates (in decimal degrees): Latitude: --s'gp3 Longitude:—ZS,. 3s3
Stream name
1c. Property size: acres _ y3
2.
Surface Waters
2a. Name of nearest body of water to proposed project:
2b. Water Quality Classification of nearest receiving water: S U.
3.
2c. River basin: Ai F us
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:
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'/ 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:
&2w ,--1K W 7-O P
3f. Describe the overall p o'ect in detail, inc14ding the type of equipment to be used:
Ij
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?
ZYes No Unknown
Comments:
4b. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/ Consultant Company:
Other: S�W4-+,lc ass
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?
El Yes LTNo Unknown
5b. If yes, explain and detail according to "help file" instructions.
s•
Future Project Plans
6a. Is this a phased project? ❑ Yes No
6b. If yes, explain.
C. Proposed Impacts Inventory
1. Buffer Impacts
1 a. Project is in which protected basin?
euse ❑ 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
FORM: BA 10-2013 Page 2 of 4

number — impact (exempt, allowable,
Permanent (P) allowable w/
or Temporary mitigation)
T
mitigation impact impact
required? (sq ft) (sq ft)
1311 P T j3i�; Ca U 7
Yes o 376-
132 ❑ P ❑ T
❑ Yes ❑ No
133 P T
El Yes ❑ No
134 P T
❑ Yes ❑ No
135 ❑ P ❑ T
❑ Yes ❑ No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total buffer impacts
1 c. Comments:
D. Impact Justification and Mitigation
Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1� cte or 14&e. J�7—G1vc Z
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 o
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
s uare 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.
2f. Comments:
E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of
9tiffuse 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.
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
F. Supplementary Information
FORM: BA 10-2013 Page 3 of 4

1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
El 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 ?
1 c. 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)?
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):
0 U u Nox,a
Applicant/Agent's Printed Name Applicant/Age is Signature _
(Agent's signature is valid only if an au nzation letter from the applicant is provided.) Date
Send 3 complete sets of this form and accompanying documents to the following:
For government transportation projects sent For government transportation projects sent by
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 all other projects sent by First Class Mail via For ail other projects sent by delivery service
the US Postal 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

I but this map was drawn under my supervision from an actuM survey made
�`�•`Q��N CARp�.,,� sITE
under my supervisbn (deed descrlpdon recorded In Book -IE!-. Paps R— — +.` Q Ot SSS/p / ��' C� ' Dedair Ct.
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and that this OW meets the raquirenmw is of Tho Stwxkw r. P L-3218 —
surveying in Nodh C mNna (21 NCAC 36,1600).
2018 xri `� �►�'��
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11111iIN++` VICINITY MAP
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SERVICE EASEMENT
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CHORD
NOTES ' N 77°31'23" E
35.75
• COMPUTED BY COOR[„NATE COMPUTATIONS
COMPASS RULE ADJUSTMENT RIGHT W WAY
x NO ADJUSTMENT A'_ �
ALL DISTANCES ARE HORIZONTAL GROUND \ G4-0
- THIS IS TO CERTIFY TMS SURVEY IS OF AN / "IMPERVIOUS SURVEY AND/OR
EXISTING PARCEL OR PARCELS OF LAND \ WATER QUALITY STRUCTURES
Q' MAY BE REQUIRED TO OBTAIN
• IMPERVIOUS AREAS, WETLANDS, RIPARIAN �� / A BUILDING PERMIT.
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- THIS PLAT HAS NOT BEEN REVIEWED BY ANY 2' FRONT
GOVERNMENT AGENCY FOR COMPLIANCE 20' REAR

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e Oct �. `
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NAIL
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CHORD
NOTES ' N 72'91"23" E
95.75
COMPUTED BY COORDINATE COMPUTATIONS
_ RIGHT WAY
COMPASS RULE ADJUSTMENT / ?W
x NO ADJU8TMENT
ALL DISTANCES ARE HORIZONTAL GROUND
THIS is TO CERTWY THIS SURVEY IB OF AN \ / IMPERVIOUS SURVEY ANDIOR
EXISTING PARCEL OR PARCELS of LAND \ • WATER QUALITY STRUCTURES
EXISTING
MAY BE REQUIRED TO OBTAIN
IMPERVIOUS MEAS. WETLAND$. RIPARIAN �(/ / A BUILDING PERMIT.
- BUFFERS. UNDER GROUND UTILITIES, BURIAL V
GROUNDS. SEPTIC AND SPRINKER LINES
KAREN MURPHY AND ROBERT MURPHY
NOT DETERMINED
SETBACKS
BOM 1893 PG. 210
- THIS PLAT HAS NOT BEEN REVIEWED BY ANY
'"9D..
GOVERNMENT AGENCY FOR COMPLIANCE
20' REAR
APPROXIMATE
100 YEAR FLOOD
/ 5b 4
`
• SUBJECT TO RECORDED IL UNRECORDED
SCALED FROM
WAKE CO. IMAPS
/'
NISI
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THIS PLAT NOT FOR RECORDING
`. \
BRICK
PROTECTTVF COVENANTS ANO= ZONING
DB 9099 PG. 305
SETBACKS MAY DIFFER.
PIN 0744 M 9225
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\ \\
DB 15520 PG, 244
\
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\
DB 5566 PG. 2255 \
V WATER A SEWER
\
SERVICE EASEMENT
NAIL
\ � C0IFJP
RAO. 42.W BET
' AM 3B' ST
CHORD
NOTES ' N 72'91"23" E
95.75
COMPUTED BY COORDINATE COMPUTATIONS
_ RIGHT WAY
COMPASS RULE ADJUSTMENT / ?W
x NO ADJU8TMENT
ALL DISTANCES ARE HORIZONTAL GROUND
THIS is TO CERTWY THIS SURVEY IB OF AN \ / IMPERVIOUS SURVEY ANDIOR
EXISTING PARCEL OR PARCELS of LAND \ • WATER QUALITY STRUCTURES
EXISTING
MAY BE REQUIRED TO OBTAIN
IMPERVIOUS MEAS. WETLAND$. RIPARIAN �(/ / A BUILDING PERMIT.
- BUFFERS. UNDER GROUND UTILITIES, BURIAL V
GROUNDS. SEPTIC AND SPRINKER LINES
KAREN MURPHY AND ROBERT MURPHY
NOT DETERMINED
SETBACKS
BOM 1893 PG. 210
- THIS PLAT HAS NOT BEEN REVIEWED BY ANY
20- FRONT
GOVERNMENT AGENCY FOR COMPLIANCE
20' REAR
MTN ANY SUBDIVISION REGULATIONS
F $N7E
1T SIDE
• SUBJECT TO RECORDED IL UNRECORDED
AGGREGATE
EASEMENTS. AND RESTRICTIONS
15' CORNIER
THIS PLAT NOT FOR RECORDING
of _ %M,% FOR CERTIFICATES
REFERENCES
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SURVEYED BY LEGEND
DANIEL V. PARTIN, PLS OF - EXIST. IRON PIPE
200 WENDY COURT EIS - EXIST. IRON STAKE
IPE
CARY NC 27511 NNIS - NEW IR STAKE
919 46"683ECM - EX- CONI. MON.
( ) CP - COMPUTED PONT
p 40- w
SURVEY OF
LOT 563, PRESTON LAKESTONE
PRESTON PUD. PARCEL PS - 2A
CEDAR FORK TWSP., WAKE CO. NC
105 DECLAIR COURT, CARY NC 27513
SIIALFY MA
KAREN MURPHY AND ROBERT MURPHY
WALE
DRAWN BY
1. c D
OCT. 8.2015
DVP
OCT. 9, 2018
JOB
FIELD BOOK
SURVEYED BY
10761-1S
2018.988
DYP

-DWR State of North Carolina
1W 1W 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
�•
Project Information
1a. Name of project:
�o
1 b. County:
6L,
1 c. Nearest municipality:
CAYe
1 d. Subdivision name:
P/Z &�S-cj
le. Is the project located in any of North Carolina's twenty coastal counties?
If es, answer 1f below.
-0 Yes No
If. Is the project located within a NC Division of Coastal Management Area ofYes
Environmental Concern (AEC)?
No
2.
Owner Information
2a. Name on Recorded Deed:,OV
A a rC-- -r-
2b.
2b. Deed Book and Page No.
? 2 9 7 ZS -
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
y �� ZJ U
2d. Responsible Party
for Corporations):
tZ &..3 027- Gz.,e Py j,'
2e. Street address:
Dece,4-1,-, e, ,,AE
2f. City, state, zip:
C
2g. Telephone no.:
2h. Fax no.:
2i. Email address:
8 c 6 J W Yc,, 4 1f.,4 , C a
,41
3.
Applicant Information (if different from owner)
3a. Applicant is:
Agent Other, specify:
3b. Name:
3c. Business name
if applicable):
/?I PL cl"e
3d. Street address:
3&6
3e. City, state, zip:
p� r C Z 7 3 c
3f. Telephone no.:
�C�_ L Z _ / 3 3_3
3g. Fax no.:
h 7
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
1a. Property identification no. (tax PIN or parcel ID): Q-7 7 &2L,i!
1 b. Site coordinates (in decimal degrees): Latitude: 3gs`S�p,, ' Longitude:. -3s3
1 c. Property size: acres _ y,•3
2. Surface Waters
2a. Name of nearest body of water to proposed project:�'rq �r . (��
2b. Water Quality Classification of nearest receiving water: C S C.A.
2c. River basin: Ai F us 65,
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:
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 % 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:
TC n 10 a .�1
3f. Describe the overall p o'ect in detail, ingl�ding the type of equipment to be used:
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?
EaYes No El Unknown
Comments:
4b. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/ Consultant Company:
Other: �76� �;iL� , C.sS
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?
Yes No 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.
C. Proposed Impacts Inventory
1. Buffer Impacts
1 a. Project is in which protected basin?
euse ❑ Tar -Pamlico E] 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
FORM: BA 10-2013 Page 2 of 4

number —
Permanent (P)
or Temporary
T
impact (exempt, allowable,
allowable w/
mitigation)
mitigation impact impact
required? (sq ft) (sq ft)
B1 P T
4a cs U7 nc
Yes o 370
B2 P ❑ T
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.
El Yes ❑ No
B3 P T
Total impact
(square feet
Yes No
B4 P 0 T
Zone
1
El Yes No
B5 P ❑ T
3 (2 for
Catawba)
El Yes No
136 P T
Yes No
Total
buffer impacts
1 c. Comments:
D. Impact Justification and Mitigation
�• Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
3f 6-1 — c7�. F I Z61V6- Z
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 ErNo
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
s uare 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.
2f. Comments:
E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of
iffuse 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.
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
F. Supplementary Information
FORM: BA 10-2013 Page 3 of 4

1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federaUstate/local) funds or the
El Yes 7No
use of public(federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
El 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
❑ 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 LTNo
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?
El Yes No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
rd eE (VI [A/iu(
Applicant/Agent's Printed Name Applicant/Age is Signature _
(Agent's signature is valid only if an au nation letter from the applicant is provided.) Date
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
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 - 1617
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.):
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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NOTES AND STATEMENTS
REFERENCES
PROTECTIVE COVENANTS ANDIOR ZONNG
OB am PG. 305
SETBACKS MAY DIFFER.
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1 CHORD
NOTES ' N 71'31'23"E
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_ RIGHT OF WAY
COMPASS RULE ADJUSTMENT
x ND AQIuSTMENT �Q, /
ALL DISTANCES ARE HORIZONTAL GROUND \ G�
TINS IS TO CERTIFY THIS SURVEY IS OF AN / P IMPERVIOUS SURVEY ANUIOR
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BE REQUIRED
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BUFFERS. UNDER GROUND UTILITIES. BURIAL Q
GROUNDS, SEPTIC AND SPRI NKER LINES
NOT DETERMINED
SETBACKS
BOM 1895 PG. 210
- THIS PLAT FNS NOT BEEN REVIEWED BY ANY
20r FRONT
GOVERNMENT AGENCY FOR COMPLIANCE
20' REAR
WITH ANY SUBDIVISION REGULATIONS
WSW
• SUBJECT TO RECORDED B UNRECORDED
iS AWv
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15 CORNER
THIS PLAT NOT FOR RECORDING
SEE JM.2Ii �.'S1=2U% FOR CERTIFICATES
NOTES AND STATEMENTS
REFERENCES
PROTECTIVE COVENANTS ANDIOR ZONNG
OB am PG. 305
SETBACKS MAY DIFFER.
PIN 0744 B7 am
BOM INGPG. 210
SURVEYED BY LEGEND
DANIEL V. PARTIN, PLS EIP - EXIST. IRON PIPE
200 WENDY COURT EPS - EMST. RION STAKE
PIPE
CARY NC 27511 NIBS -NNW RN STAKE
[phone] ECM - EX CONIC. MON.
CP - COMPUTED POINT
0 40' w
SURVEY OF
LOT 563, PRESTON LAKESTONE
PRESTON PUD. PARCEL PS - 2A
CEDAR FORK TWSP_. WAKE CO. NC
105 DECLAIR COURT. CARY NO 27519
SURVEY FOR
KAREN MURPHY AND ROBERT MURPHY
ME DATE DRAWN OCT. 8.2018 BY
1- _ OCT. 9.2018 DVP
I FIELD BOOK suRVEYED BY
10781-18 2918-368 DVP

DWR
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 30-2013
Riparian Buffer Authorization Form
A.
Applicant Information
•
Project Information
1a. Name of project:
AaAeml
1 b. County:
Gt; 1c r
1 c. Nearest municipality:
C
1 d. Subdivision name:
PIZ e6n)IJ
le. Is the project located in any of North Carolina's twenty coastal counties?
If yes, answer 1f below.
OYes No
1f. Is the project located within a NC Division of Coastal Management Area ofYes
Environmental Concern (AEC)?
No
2•
Owner Information
2a. Name on Recorded Deed:��
2b. Deed Book and Page No.
7 2cl7 ZS -
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was created):
% j} 3 i Zl (i
2d. Responsible Party
for Corporation :
lzG'3 027-
2e. Street address:
j�;. e' ,-z-
A City, state, zip:
C74,19W Alc ;
2g. Telephone no.:
_ � -_ 1.135-
2h. Fax no.:
2i. Email address:
6 J mm, P14
3.
Applicant Information (if different from owner)
3a. Applicant is:
Agent Ll Other, specify:
3b. Name:
C-7
3c. Business name
if applicable):
�+
3d. Street address:
2&6 9,0 E L,¢ l vE
3e. City, state, zip:
App Ar C Z 7
3f. Telephone no.:
jCj- Z 2 - / 3 3.3
3g. Fax no.:
. - 7
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
1b. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of
this form.
1 a. Property identification no. (tax PIN or parcel ID): p i -7 :R 2L�Sl
Zone 2
1 b. Site coordinates (in decimal degrees): Latitude:3s k6.; ' Longitude:-- Z� 3.s3
1 c. Property size: acres z 3
2.
Surface Waters
2a. Name of nearest body of water to proposed project: ��,q,� ��. ���
2b. Water Quality Classification of nearest receiving water: s W
2c. River basin: Ai 45:7 us
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:
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 '/ 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:p
% zz c
3f. Describe the overall p o'ect in detail, in ding the type of equipment to be used:
11 61U 1-2-1-76 3-7.5_ .S,!2 iT
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?
0Yes No 0 Unknown
Comments:
4b. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/ Consultant Company:
Other: S2Af4,+- 1C r-7 asS
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?
Yes No 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.
C. Proposed Impacts Inventory
1. Buffer Impacts
1 a. Project is in which protected basin?
euse ❑ Tar -Pamlico ❑ Catawba
❑ Randleman ❑ Jordan ❑ Goose Creek
1b. 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
FORM: BA 10-2013 Page 2 of

number — impact
Permanent (P)
or Temporary
T
(exempt, allowable,
allowable w/
mitigation)
mitigation impact impact
required? (sq ft) (sq ft)
B1 ErP T
Lco C� OT
i Yes o 376
B2 P ❑ T
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.
❑ Yes ❑ No
B3 P T
Total impact
(square feet
Yes F1 No
B4 P T
Zone
1
❑ Yes No
B5 P ❑ T
3 (2 for
Catawba)
Yes No
B6 P T
FM Yes ❑ No
1.5
Total buffer impacts
1 c. Comments:
2c. If buffer mitigation is required, is payment to a mitigation bank or NC DMS
proposed?
D. Impact Justification and Mitigation
�• Avoidance and Minimization
l J wla Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
ej &.e, F � L 61U C 2-
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 DNO
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
s uare feet
Zone
1
3 (2 for
Catawba)
Zone
1.5
F
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.
2f. Comments:
E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of
iffuse 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.
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
F. Supplementary Information
FORM: BA 10-2013 Page 3 of 4

1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
El Yes 7No
use of public federallstate land?
1 b. If you answered "yes" to the above, does the project require preparation of an
El Yes 0 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
❑ 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 LTNo
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?
El Yes No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
U cc I I I
Rd 'U(d Applicant/Agent's Printed Name Applicant/Age is Signature _
(Agent's signature is valid only if an au nzation letter from the applicant is provided.) Date
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
Karen Higgins
NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 -1617
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.):
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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/CONTROLNAIL
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NOTES ' N 72°31`23" E ..._
35.76
COMPUTED BY COORDINATE COMPUTATIONS
COMPASS RULE ADJUSTMENT RIGHT (RJNtW) WAY
x NO ADJUSTMENT 4c�'
ALL DISTANCES ARE HORIZONTAL GROUND GQ'
- THIS IS TO CERTIFY THIS SURVEY Is OF AN \ P • IMPERVIOUS SURVEY AND/OR
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GROUNDS. SEPTIC AND SPRMIKER LINES SETBACKS
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!•
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NOTES ' N 72'$1'23`F �T —
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/ RIGHT OF WAY
_COMPASS RULE ADJUSTMENT (RNV)
x NO ADJUSTMENT e4:,
ALL DISTANCES ARE HORIZONTAL GROUND
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NOTES
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REFERENCES
PROTECTIVE COVENANTS AND/OR ZONING
DOB 8006 PG. 305
SETBACKS MAY DIFFER.
/
BOM 1993 PG. 218
/
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NOTES ' N 72'$1'23`F �T —
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COMPUTED BY COORDINATE COMPUTATIONS
/ RIGHT OF WAY
_COMPASS RULE ADJUSTMENT (RNV)
x NO ADJUSTMENT e4:,
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REQ ERMI T.
TO OBTAIN
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GROUNDS. SEPTIC AND SPRIVNER LINES
NOT DETERMINED
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BOM 1091 PG. 210
- THIS PLAT HAS NOT BEEN REVIEWED BY ANY
2W FRONT
GOVERNMENT AGENCY FOR COMPLIANCE
20' REQ
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WSW
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NOTES
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REFERENCES
PROTECTIVE COVENANTS AND/OR ZONING
DOB 8006 PG. 305
SETBACKS MAY DIFFER.
PIN 0744 87 SM
BOM 1993 PG. 218
SURVEYED By
DANIEL V. PARTIN, PLS
2w WENDY COURT
CARY NC 27511
[phone]
leale>• �
SURVEY OF
LOT 563, PRESTON LAKESTONE
PRESTON PUD. PARCEL PS - 2A
CEDAR FORK TWSP.. WAKE CO. NC
105 OeCLAIR COURT. CARY NO 2791,
LEGEND SURVEY FOR — ---
EIP - EXIST. IRON PIPE KAREN MURPHY AND ROBERT MURPHY
EIS - EXIST. IRON STAKE
NIP - NEW IRON PIPE SCALE OCT. 8. 2018 DRAWN BY
NIS - NEW IRN STAKE 1-= 40 OCT. 9.2018 DVP
ECM -EX. CONC. MON. JOB FIELD BOO( SURVEYED
CP - COMPUTED POINT 10781 -IS
2018.368 Ow