20072214 Ver 2_Riparian Buffer Authorization Request_20210820

Buffer Authorization Application Form
15ANCAC 02B .0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2) Buffer Authorization Online Fo
Update 10/23/2018
Original Submittal 8/20/2021
A. Owner/Applicant Information
General Information
Primary Contact Email: *
Who is submitting the application?*
1. Property Owner Information:
la. Name on Recorded Deed:*
1b. Responsible Party:
1c. Mailing Address:*
1d. Telephone:* 252-946-0492
3. Agent Information:
3a. Name:
3b. Company Affiliation:
3c. Mailing Address:
[e-mail]
Rease list the contact person's en -ail for questions or payrrent on this project if needed.
r- Owner
r- Applicant other than Owner
W Agent
Girl Scout Council of Coastal Carolina
(for Corporations)
Street Address
752 Camp Hardee Road
Address Line 2
aty State / Province / Region
Blounts Creek NC
Rzstal / Zip Code Country
27814 United States
le. Email Address:* [e-mail]
Street Address
Address Line 2
aty State / Province / Region
Postal / Zip Code Country
3d. Telephone: 3e. Email Address:
3f. Attach a signed and dated copy of the agent Click the upload button or drag and drop files hereto attach docurrent
authorization form. R7FOnly
B. Project Information and Prior Project History
.... ...... ..... ...... ...... ...... ............
1. Project Information
..................................................................................................................................................................................................................................................................................................................................

la. Name of Project:* Camp Hardee
(Subdivision, facility, or establishrrent narre)
1b. Is this a publicly -funded transportation project?*
r Yes
r No
1d. Subdivision Name:
le. Nearest
Municipality:
1f. Property Size: acres
1g. County (or Counties) where the project is located:*
Beaufort
1h. Property ID# Date of Purchase
Tax RN or Rarcel id
1 i. Deed Information
Type of Book Book#11 Page#
Deed
1j. Attach a copy of the recorded map that indicates when the lot was last platted.
nick the upload button or drag and drop files here to attach docurrent
FDF only
1k. How would you like to provide the Latitude and Longitude information?*
r Address Lookup
f Manually
Address Lookup
Latitude * 35.474537
Street Address
752 Camp Hardee Rd
Address Line 2
City State / F rovince / Fbgion
ChocoW n ity NC
Fbstal / Zip Code Country
27817 United States
Longitude * 76.995345
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:*
Pamlico River
2b. Water Quality Classification of nearest receiving water:*
SB, NSW
2c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:*
175
(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:
This property is a girl scout camp. The hill in front of cabins is eroding.
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
FDF only
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 docunent
R F only
4. Proposed Activity
.............................................................................................
Provide a detailed description of the proposed activity including its purpose and include the type of equipment to be used:
Fill in washed out area with fill and install a 10' Rip Rap wall in a 175' area. The area
will be matted for heavy equipment to be used to haul in fill and rock.
Attach a site plan as applicable to the project:
Click the upload button or drag and drop files here to attach docunent
R F 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?*
f Yes
r No
6. Project History
.......................................................................... _ ...
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
f 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)
r Randleman Lake Watershed (15A NCAC 02B.0250)
r Tar -Pamlico River Basin (15A NCAC 026.0259)
r Jordan Lake Watershed (15A NCAC 02B.0267)
r Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 026.0607)
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 111 Zone 2
Ivbp label (e.g. Road Permanent Allowable 0.00 0.00
Grossing 1) (p) Square Square
Perm orTenp Feet Feet
Total Zone 1 Impacts: 0.00
Total Zone 2 Impacts: 0.00
Total Buffer Impacts: 0.00
Comments:
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.*
No trees will be removed from the area.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The area will be matted for heavy equipment to be used in hauling rock and dirt.
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
1c. Diffuse Flow Documentation* aick the upload button or drag and drop files here to attach document
20210820124229359.pdf 40.78KB
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?
f 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 document
FDF only
Additional Comments:
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')
o 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
• I intend to electronically sign and submit the application form."
Print Name:* Lisa Beacham
Signature
Submission Date: 08/20/2021
(Auto populated field)

Initial Review
Is this accepted into the review process?*
Is this project a public transportation
project?*
ID#*
Version:*
Select Reviewer:*
Select Reviewing Office*
Has payment been received?*
G Yes O No
a Yes
r No
20072214
Chris Pullinger:eads\rcpullinger
Washington Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification

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