20181734 Ver 1_Riparian Buffer Authorization Application_20181221

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/21/2018 10:49:20 AM (Start)
Approve by Montalvo, Sheri A 12/28/2018 8:56:54 AM (NON DOT - Initial Review)
• The task was assigned to Montalvo, Sheri A 12/21/2018 10:50 AM

Original Submittal 12/21/2018
A. Owner/Applicant Information
General Information
Primary Contact Email: * [e-mail]
Reese list the contact person's errail for questions or payrrent on this project if needed.
Who is submitting the application?* r1 Owner
r- Applicant other than Owner
F- Agent
Is there an agent working on this application r Yes
but not submitting it?* r No
1. Property Owner Information:
1a. Name on Recorded Deed:*
Daniel R. Forman
1b. Responsible Party:
Daniel R. Forman
(for Corporations)
1c. Mailing Address:*
Street Address
1412 Seafarer Dr.
Address Line 2
City
Oriental
Postal / Zip Code
28571
1d.Telephone: * 2522490193
B. Project Information and Prior Project History
1. Project Information
State / Province / F;bgion
NC
Country
United States
1e. Email Address:* [e-mail]
1a. Name of Project:* Forman
(Subdivision, facility, or establishment narre)
1b. Is this a publicly -funded transportation project?*
r Yes
r No
1d. Subdivision Name: Sea Vista
1e. Nearest Oriental
Municipality:
1f. Property Size: 0.41
acres
ErvvWater Resources
iaonmEx,n� ouw�i,r
n

1g. County (or Counties) where the project is located:*
Pamlico
1h. Property ID# Date of Purchase
jo82-320-6 12/10/2018
Tax AN or Parcel id
1 i. Deed Information
Type of Book Book#11 Page#
Deed 643 579
1j. Attach a copy of the recorded map that indicates when the lot was last platted.
Click the upload button or drag and drop files here to attach docurrent
Cama deed and map.pdf 3.39MB
FDF only
1k. How would you like to provide the Latitude and Longitude information?*
r Address Lookup
M Manually
Latitude * 35 01 78N Longitude * 76 41 14W
11. Is the project located in any of North Carolina's twenty coastal counties?*
r Yes
r No
1m. Is the project located within a NC Division of Coastal Management Area of Environmental Concern (AEC)?
r Yes
r No
2. Surface Waters
2a. Name of the nearest body of water to proposed project:*
Tarpon Channel/ Neuse R.
2b. Water Quality Classification of nearest receiving water:*
SA; HQW, NSW
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:*
160
(linear feet only)
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:
originally a spoil site for the digging of the creeks. It is a cleared lot with grass on it
in a residential neighborhood
3b. Attach an 8 % x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
click the upload button or drag and drop files here to attach docurrent
cama top map.pdf 10.26MB
FDF only
A

3c. Attach an 8 %x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the
project site.
Click the upload button or drag and drop files here to attach docurrent
FDF only
4. Proposed Activity
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used:*
To build our dream home of 1879 sq. ft. Normal equipment to build a residential
house.
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach docurrent
plot map for cama w house. pdf 825.06KB
FDF only
5. Jurisdictional Determinations
5a. Have jurisdictional wetlands or stream determinations by the Corps or State been requested or obtained for this
property/project (including all prior phases) in the past?*
r Yes
t: No
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes
r No
7. Future Project Plans
7a. Is this project a phased project?* r Yes
r No
C. Proposed Impacts Inventory
Buffer Impacts
Project is in which protected Basin?*
r Neuse River Basin (15A NCAC 02B.0233)
r Catawba River Basin (15A NCAC 02B.0243)
f Randleman Lake Watershed (15A NCAC 0213.0250)
r Tar -Pamlico River Basin (15A NCAC 026.0259)
f Jordan Lake Watershed (15A NCAC 02B.0267)
r Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 02B.0607)
Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of this form.
Site# - Reason Stream Name Buffer Impact* Impact Type * Zone 1 Zone 2
Total Zone 1 Impacts: 0.00
Total Zone 2 Impacts: 220.00
residential house
Tarpon
Permanent
Allowable
0.00
220.00
K/hp label (e.g. Fbad
Ch./Neuse
(P)
Square
Square
Grossing 1)
R.
Ft:rmorTerrp
Feet
Feet
Total Zone 1 Impacts: 0.00
Total Zone 2 Impacts: 220.00

Total Buffer Impacts: 220.00
Comments:
The lot was platted in 1969 and is a narrow at the street and wide at the water's
edge. Because the lot tapers so much it is impossible to fit the house on the let
without the corners of the house going into zone 2.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project.*
Only 2 corners of the house will be in Zone 2 and all gutters will be draining to the
front of the house towards the street.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.`
Gutters will be draining towards the front of the house away from the creek.
E. Diffuse Flow Plan
1a. What type of SCM are you providing?*
r Level Spreader
r Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
W Proposed project will not create concentrated stormwater flow through the
buffer
r Other SCM that removed minimum of 30% nitrogen
1 c. Diffuse Flow Documentation * Click the upload button or drag and drop files here to attach docurrent
cama diffuse water plan.pdf 838.59KB
FDF only
F. Supplementary Information
Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
r Yes
r No
Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H.0500), Isolated Wetland Rules (15A NCAC 02H.1300), DWR
Surface Water or Wetland Standards, or Riparian Buffer Rules (15A NCAC 02B.0200)?
r Yes
r No
2b. Is this an after -the -fact buffer authorization application?
r Yes
r No
G. Additional Information
Please upload any additional information you would like the Division to consider during application review.
Additional Attachments: Click the upload button or drag and drop files here to attach docurrent
FDF only

Additional Comments:
With the house gutters draining away from the water I believe there will be very little
impact. I could not get the soil map to download as it kept coming up blank. I am
hoping that you can or will provide this information if needed. Thank you for your
consideration with this matter.
H. Sign and Submit
By digitally signing below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act)
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
o I intend to electronically sign and submit the application form."
Print Name:* Daniel R. Forman
Signature *
019M�115eO ldfG
Submission Date: (Auto populated field)

Initial Review
Is this accepted into the review process?
Is this a public -funded transportation
project?*
ID#*
Version:
Select Reviewer:
Select Reviewing Office*
Has payment been received?*
O Yes b No
a Yes
r No
20181734
1
David May:eads\dlmay
Washington Regional Office - [phone]
F No Payment Needed
r Fee Received
r Need Fee - send electronic notification