20150744 Ver 1_Buffer Determination Request_20150727

RECENED/NCN NCDENR
of Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCr 2120 Water Quality Programs John E. Skvarla, III
Governor Thomas A. Reeder Secretary
Water Ouallty Regional Director
Opetwons 3ectlon
yraehington Regional Office
DWQ Use Only: Project #
Stream Origin /Buffer Applicability Determination
Required Information
1. Owner Information (corporation /individual who is legally responsible for the property and its compliance)
1 a. Name(s) on Recorded Deed I YMCA of the Triangle Area, Inc.
1 b. Responsible Party (for LLC) I Tim Carr
1c. Mailing Address 801 Corporate Center Dr., Suite 200, Raleigh, NC 27607
1d. Telephone Number (919) 719 -9628 11e. Email Address I Tim.carr @ymcatdangle.org
2. Location of Project Site - please include the county, nearest named town and highway number:
Camp Sea Gull, 218 Sea Gull Landing, Arapahoe, Pamlico County, NC
3. Has anyone from DWQ visited the site? I No I Staff Name I I Date of Visit? I
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company Bob Zarzecki, Soil & Environmental Consultants, PA (S &EC)
4b. Mailing address 8412 Falls of Neuse Rd., Suite 104, Raleigh, NC 2761or 5'
4c. Telephone no. (919) 846 -5900 4d. Email address I bzarzecki @sandec.com
5. Project and Site Information
5a. Name of project Camp Sea Gull Aquatics Facility 5b. County I Pamlico
5c. Nearest Named Stream Neuse River, 27-(118 5d. River Basin Neuse
5e. Provide a brief description of this project (attach site plan if available):
New pool facility (pool, patio, fence, pool house, etc.) to be constructed adjacent to existing swim tank / swim lake.
Reconfigure swim tanks & decking within swim lake. Also, new amphitheater, fire pit and stage adjacent to swim lake.
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or NRCS Soil Survey.
If you are unable to locate either of these maps, please contact the Reqional Office for assistance.
DWQ Use Only Is this stream call for the purpose of: _ buffer mitigation _ nutrient offset credit
Please return form to: Anthony Scarbraugh
943 Washington Square Mall
Washington, NC 27889 Note: Submittals on Friday after 12:00 pm
will be stamped as received on the
Fax: [phone] next business day.
Email: anthonv.scarbrauahOncdenr.00v
Please contact Anthony Scarbraugh at (252) 946 -6481 if you have any questions.

Soil & Environmental Consultants, PA
9412 Fall. of N me Road. Sviw 104, 1Ldcigh, \IC: 27615 • P6o.m ()19) 846 -591M1 • Rm (919) 846 -9467
sandeacom
PROPERTY OWNER CERTIFICATION / AGENT AUTHORIZATION
Project Name /Description: YMCA Camn Seafarer — Aaaatics Facilities S &EC Project #12625
Date: July 2015
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
69 Darlington Avenue
Wihnington,NC 28403
Attn: Gary Beecher Field Office: Washington Reaulatory Field Office
I, the undersigned, a duly authorized owner of record of the property /properties identified herein, do
authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps) and Soil &
Environmental Consultants, PA (S &EC) staff (as my agent) to enter upon the property herein described
for the purpose of conducting on -site investigations and issuing a determination associated with Waters
of the U.S. subject to Federal jurisdiction under Section 404 of the Clean Water Act and /or Section 10 of
the Rivers and Harbors Act of 1899. This document also authorizes S &EC (as my agent) to act on my
behalf and take all actions necessary for the processing, issuance and acceptance of a permit or
certification and any and all associated standard and special conditions.This notification supersedes any
previous correspondence concerning the agent for this project.
I
NOTICE: This authorization, for liability and professional courtesy reasons, is valid only for government
officials to enter the property when accompanied by S &EC staff. You should call S &EC to arrange a site
meeting prior to visiting the site.
PARCEL INFORMATION:
Parcel Index Number(s) (PIN): 6446327429000
Site Address: 1 2744 Seafarer Road
City, County, State: Arapahoe. Pamlico Countv. NC
Lat/Long: 34.99641/- 076.85483
PROPERTY OWNER INFORMATION:
Name: YMCA'of the Triangle Area, Inc.
Address: 801 Corporate Center Drive, Suite 200, Raleigh, NC 27607
Phone No.: (919) 719 -9628 Fax No.:
Email: tim.carr @ymcatriangle.org
TlM CAr2('Z
Property Owner (please print)
Prol}erty Owner Signature
Mobile No.: (919) 345 -5596
l ? JU4 I r
Date
We hereby certify the above information submitted in this application is true and accurate to
the best of our know /edge.

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