20080247 Ver 1_Complete File_20080205

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FEB 0 5 2008
UWY-WA U
Alan W. Klimek, P.E. Director
Division of Water Quality
Stream Origin Determination 's a' "I
Applicant Name: As?d6cy 8. DA/0
Applicant Address: ko 7? SVKVIZS ZAA)01,1045" R-D • ALLRQR/? A)r_, C2 ? p
Applicant's phone number: Fax number: N
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Applicant's email address:
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Consultant Name (if applicable):
Consultant address (if applicable):
Consultant's phone number: _ ?IA Fax number:
Consultant's email address: JJ /
Project. YOB' 1 County:
Name of ?
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Nearest Named stream + River Basin (from USGS topo map): 1 v AA514)
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Please provide a brief description of this project (attach site plan if available):

Please attach a map of site location using USGS 1:24,000 map and county soil survey.
Location of project site - please include reference to the county, nearest name town and highway number:
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Has any s a visited the site? if yes, please provide DWQ staff name, and
date of visit:
This forth may be submitted via email (Chris.pullinger@ ncmail.netfaxed (252-946-9215), mailed or hand-delivered
to the 943 Washington Square Mall, Washington, NC 27817. (Note: Submittals of the review packages on Friday
after 12: 00 pm will be stamped as received on the next business day).
Please contact Chris Pullinger at 252-948-3920 if you have any questions regarding this form.
North Carolina Division of Water Quality Internet: h2o.enr.state.nc.us
943 Washington Square Mall Phone: [phone]. One
Washington, NC 27889 FAX [phone] NorthCarolina
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper Natuy?half
Michael F. Easley, Governor
William G. Ross Jr„ Secretary
North Carolina Department of Environment and Natural Resources
Checklist for Complete Stream call re nest/a lication
(Incomplete applications will be returned)
Copy of the soil survey AND USGS 1-24,000 topographic map
Z A map or plat of the property boundaries (can be overlaid on one of the above
maps)/
I/ A description stating what kind of project the stream determination is being
requested for. (can be as brief as a name of the development)
Some indication of authorization/permission to be on the property (if there's no
indication that the person or their agent wants to be present at the time of the field visit)
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Property Details:
PIN 15023755 GPIN 6588-924373
GPINLONG 6588-924373 NAME1 DANIELS ASHLEY B
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NAME2 ADDR1 1675 JARVIS LANDING RD ?
ADDR2 CITY AURORA li
STATE NC 21P 27806 I
PROP ROAD SR 1908 A 1907 ACRES 12.49
STAMPS
PROP DESC 111.69 AC PT LT 4 DENNIS L BROV M 11 MBL 1165880474 li
DISCLAIMER: These maps and information either in digital or hardoopy format are provided solely as a public sere oa and they do not meet surveying accuracy standards. This map
data is prepared from the inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats, and tithe; public records and data. Users of any maps
generated on this site are hereby notified that the aforementioned public primary information sources should be =iSLlited for verification of the information contained on any maps. The
county of Beaufort assumes no legat responsibility for the information contained on these maps.
http://www2.undersys.com/seriptsltestadv/usiwebbpd.dlllusinonnis?- map&MouseX=Q&... 2/2/2008
Page 1 of 1
Site: 11.69 AC PT LT 4 DENNIS L BROWN

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Pr®nerty Details:
RD
1908 & 1907
H DO PG t 102110003 t LAND VAL 110203 i
10203
1.59 AC PT LT 4 DENNM L BROWN
EXMPT
DISCLAIMER, These maps and information either in digital or hardcopy formal are provided soleiy as a public service and they do not meet surveying accuracy standards. This map
data is prepared from the Inventory of real property found within this jurisdiction and is compiled from recorded deeds. plats, and other public records and data, Users of any maps
generated on this site are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on any maps. The
county of Heaufcrt assumes no legal responsibii ty for the information contained on these maps.
http:llwww2.undeMs.cam/scripts/testadvlusiwebbpd.dillusi?formic=ptmap&MouseX=4&... 2/2/2008
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