20170575 Ver 1_Buffer Determination Request_20170511

Water Resources
I.nvironmental Quality
ROY COOPER
Govel nol-
MICHAEL S. REGAN
,s'ecrerary
S. JAY ZIMMERMAN
Oirecra-
DWR Use Only: Project #: I 105—IfS
Date Received: r
Buffer Applicability / Stream Origin Determination Request
Property Owner Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
la. Name(s) on Recorded Deed
First Congregational United Church of Christ
1b. Responsible Party (for LLC)
3e. Email address
1c. Mailing Address
PO Box 680
1d. Telephone Number
le. Email address
[e-mail]
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
215 Sleepy Creek Road
3. Agent/ Consultant Information
3a. Agent/ Consultant Name Len Henderson
3b. Company
3c. Mailing address
3d. Telephone no. 919-344-3560
3e. Email address
[e-mail]
4. Project / Site Information
First Congregational
4a. Name of project
Church of Christ —
4c. Nearest Named Stream
flooding issues
4b. County
Wayne
4d. River Basin
Neuse
5. Project Description (attach plan if available)
Received a forwarded concern from the Governor's office about long-term flooding issues at the church, potentially due to a tree on
the railroad right-of-way
6. Has anyone from DWQ visited the site? I Y / N I Staff Name: Date of Visit:
7. 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 DWR Washington Regional Office for assistance.
DWR Use Only: Is this determination for the purpose of Buffer mitigation? Nutrient offset credit?
8. 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
Email: [e-mail] Next business day
-' Nothinq Compares
State of North Carolina I Environmental Quality I Water Resources -Water Quality Regional Operations Section -Washington Regional Office
943 Washington Square Mall, Washington. North Carolina 27889
252-946-6481