20191003 Ver 1_Buffer authorization application_20190719

DWR �k <<Q k
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources Division of Water Resources
SSA NCAC 026 .0233 (8)(b),.0243 (8)(b),.0250 (11)(b),.0259 (8)(b),.0267 (11)(c), .0607 (e)(2) - Buffer Authorization
FORM: BA 10-2013
A. Applicant Riparian Buffer Authorization Form information
1. Pro)ect Information
1 a. Name of project: Gh 0 G1fhcr,L
1b. County: i�C�
1c. Nearest municipality: r'GL C 11
1d. Subdivision name:
1e. Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer 1f below.
Yes ❑ No
1f. Is the project located within a NC Division of Coastal
Management Area of Environmental Concern (AEC)?
Yes ❑ No
2. Owner Information
2a. Name on Recorded Deed:
'S P G 0-eA�
2b. Deed Book and Page No.
p -b lt
2c. Map Book and Page No.
(include a copy of the recorded
map that indicates when the lot
was created):
2d. Responsible Party
(for Corporations):
�;mbf✓1 L. SL ULr1
2e. Street address:
2 i ey 2
2f. City, state, zip:
(a rc� S ) O
2g. Telephone no.:
2h. Fax no.:
2i. Email address:
CC. b i •L m bet rg Eli I,
3. Applicant Information (if different from owner)
3a. Applicant is: [I Agent ❑ Other, specify:
P fY
3b. Name: ti m -
3c. Business name
(if applicable):
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 5

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
— /L9 I —
1b.
Site coordinates (in decimal degrees):
Latitude: Longitude:
1c.
Property size:
acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
ac s -t
2b.
Water Quality Classification of nearest receiving
water.
_ �v�Vv
S/� —
2c.
River basin:
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: c { v-r(A h v r rl`C a v..0 friG� ylC �( f Pte✓
-.frC.rv- on I s ho ikc e 4::�IiY.tnGL n 62rae-
3b.
Attach an 8 Y2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c.
Attach an 8 Y2 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:
I�5 -pt
3e.
Explain the purpose of the proposed project:
r e-hw; (d h0",y—
3f.
Describe the overall project in detail, including the type of equipment to be used:
Mu d u -.(a -r ho iu.e_ V-� i l; n 5# (ni nuv Cu nsdyttic1`,3k- -2
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 prior phases) in the past?
16es 'N"o ❑ Unknown
Comments:
4b.
If yes, who delineated the jurisdictional areas?
Name (if known): Y AGi % A nk l I
Agency/ Consultant Company:
Other: b G 1't'1
4c.
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach
documentation. �/i�
0 3 d- l /3 £.r)e ra.( pt,rm ,, t f vy n@,- V ,i I wa ! (
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
Yes ❑ No &6nknown
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.
FORM: BA 10-2013 Page 2 of 5

C. Proposed Impacts Inventory
1. Buffer Impacts
1a. Project is in which protected
basin?
euse ❑ Tar -Pamlico ❑
❑ Randleman ❑ Jordan ❑
Catawba
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
number-
Permanent(P)allowable
or Temporary
Reason for
impact
Type of impact
(exempt, allowable,
w/
mitigation)
Stream name
Buffer
mitigation
required.
Zone 1
impact
(sq ft)
Zone 2
impact
(sq ft)
B1 P ❑T
l0
DD
�Nt-LRj
E] Yes 7No
qq
1 140
B2 P ❑T
f„rr,h--Sk s
jowa bk-
JVLwsL Aivt,❑Yes[�No
).i+ I
B3 ❑P ❑T
❑Yes ❑No
Iv
B4 ❑P ❑T
Yes No
B5 ❑P El
Yes No
B6 ❑ P ❑ T
❑ Yes ❑ No
Total buffer Impacts
I I '3W
1 1
1c. Comments: 45`s �n
i VictAS
5-v 4 - 2orte- I I J
-
zu
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
m Q fc i Sig ^� ✓1. u �1�[u� P.�� s{t h
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques. M o Gi (h_( (A, e- h u tik.t__ I,�;+ ' (,U"L, CxI, C uLw road
FORM: BA 10-2013 Page 3 of 5
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C. Impact Justification and Mitigation, continued
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
(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 aYes
mitigation bank or NC EEP proposed?
❑ No
2d.
If yes, attach the acceptance letter from the mitigation bank or NC EEP.
2e.
If no, then discuss what type of mitigation is proposed.
2f.
Comments:
FORM: SSGP3080 8-13 Page 4 of 5

E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of
Diffuse flow
stormwater treatment. Include a plan that fully documents how diffuse flow will be
Environmental Documentation
maintained. If a Level Spreader is proposed, attach a Level Spreader Supplement Form.
❑ Other BMP
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
140,,,4W I j l
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
rc 6L alt {5j
Vy�,�
Manual and attach a BMP Supplement Form.
t
F.
Supplementary Information
by First Class Mail via the US Postal Service:
1.
Environmental Documentation
OR NC DWR, Transportation Permitting Unit
la.
Does the project involve an expenditure of public (federal/state/local) funds or the use
❑ Yes o
Raleigh, NC 27604
of public (federal/state) land?
For all other projects sent by delivery service
1b.
If you answered "yes" to the above, does the project require preparation of an
❑ Yes ❑ No
Karen Higgins
OR
environmental document pursuant to the requirements of the National or State (North
NCDWR —401 & Buffer Permitting Branch
1617 Mail Service Center
Carolina) Environmental Policy Act (NEPA/SEPA)?
Raleigh, NC 27699 - 1617
1c.
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 Wetland
❑ Yes o
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 E� o
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
vr>(r5 �S
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agents 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
For government transportation projects sent by
by First Class Mail via the US Postal Service:
delivery service (TIPS, 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
For all other projects sent by delivery service
via the US Postal Service
(UPS, FedEx, etc.):
Karen Higgins
Karen Higgins
OR
NCDWR —401 & Buffer Permitting Branch
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 5 of 5
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➢C�F�85C—
CAMA /DREDGE & FILL
GENERAL PERMIT Previous permit New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC '' ,(�T u es attached.
Applicant Name Project Location: County! raw
�
/JO -^. A Street Address/ State Road/ Lot #(s)
Phone # 4W��� Fax # (_^)
Authorized Agent
0 CW �MW p ES ❑ PTS
Affected o ciEA f- HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): El FC:
El PWS:
ORW: yes / el- PNA yes Un Crit.Hab. yes
Type of Project/ Activity pl
Subdivision
jn r
City IC CIpiXV1(9F_.___�—. ZIP
r.
Phone # ( ),AMa River Basin
Adj. Wtr. Body 5 ` nat man unkn
Closest Maj. W... Body
Pier (dock) length–
Plat(orm(s)
Finger pier(s) - - -
Groin length '!..
7
ber ___ , -
Bulkhead .Uptaplength 1
avg distance offshore
max distance offshore
Basin, channel
cubic yards
a
Shoreline Length _
SAV: not sure yes o
Sandbags: not sure yes
Moratorium: n/a yes no
Photos: yes
Waiver Attached: Oy no - – - " - - --
v 1 '
A building permit may be required by:
Notes/ Special Conditions
Signature
Fee(s)
S
Check#
XSee note on back regarding River Basin
r File Name

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CAMA / KDREDGE & FILL
GENERAL PERMIT`�2���G
New ❑Modification Complete Reissue ❑Partial Reissue Previous permit #
As authorized by the State of North Carolina, Department of Environment and Natural Resources Date previous permit issued
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Applicant Name 4-7
V $Rules attached.
Address
Project Location: County
Street Address/ State Road/ Lot #(s) - - e
City State ZIP D
Phone # (oFax # (�
Authorized Agent �&X 6,,1 „Ei f C� f �� /+
Affected 0 C —Ft W "Jr'A .eS ❑PTTs �(
AEC(s): L1 OBA 13 HHF ❑ IH ❑ UBA ❑ WA
❑ PWS: ❑FC:
ORW: yes /(9 PNA yes /� Crit.Hab. yes /0
Type of Project/ Activity (_ t'[3 P()
Subdivision
City ZIPS_
Phone # ( River Basin
Adj. Wtr. Body ✓ I 1/Px
(n 1man
t� /unknl
Closest Maj. Wtr. Body Al" nF7 Q ( 1/pr
'id /if?t0 r, I L / _
Pier (dock) length x
++/ \ (Scale: :� %
Platform(s) X (i��fljl(V Cr'V(A)
_(
Finger �
i
Groin length ----
1
number_
khea Riprap
avg distance offshore�-L.
max distance offshore
Basin, channel I I -
cubic yards
Boat ramp
Boathouse/ Boadift s i
-
Beach Bulldozing
Cs ,
Other
4.
Shoreline Length i -
SAV: notsureyes
lll �
no
_.
Sandbags: not sure yes n -
Moratorium: n/a
j
res n
Photos: yes o
Waiver Attached: V
\Jit
_
i
A building permit may be required by: (, Q - - — -
f�l See note on back regarding Riv r Basin rules.
Notes/ Special Conditions t^
., 1_I _ a �� to �� �w ri !n, _,_ lG`� �.;>i-7 G._
■�€ratir�Fi�.����3r
Check #

how QMugRymy
15.560 Sa Ft
raw OR eD
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Rev ER A AC .
State of North Caroline ho,
County of Pamlico
I• ; �•`T a Review Officer of
unlco County, certify that the
or Plat to which
.cation Is affixed meets all
y require for recording.
Review Off�FCAP
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