20120920 Ver 1_Complete File_20121008

Beverly Eaves Perdue
Governor
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakid, P.E.
Director
Dee Freeman
Stream Origin /Buffer Applicability Determination
Applicant /Owner's Name (corporation/individual who is legally responsible for the pr op ty and its compliance:
Applicant /Owner Address:
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Applicant's phone number: 1-.o Gj (� --40 % Fax number:
Applicant's email address: Qq r At1f e�h dr1(t � co _Duo'7 c T — 3 2-012 D �0
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Consultant /Contact person Name (if applicable): IUADn
Consultant address (if applicable):
Consultant's phone number: Fax number:
Consultant's email address:
Name of Project: DI�-Lh lecvr,OvT County: ICGtUdId_
Nearest Named stream + River Basin (from USGS topographic map):
Please rovide a brief descriptio of this project (attach site rplan if available)-
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Please attach a map of site location indicating project boundaries using USGS 1:24,000 topo map and NRCS county soil survey.
Location of project site - please incly4e reference to the county, nearest named town and highway number:
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Has any DWQ staff visited the site? if yes, please provide DWQ staff name,
visit:
and date of
This form may be submitted via email (amy.adamska,ncmail.net), faxed (252- 946- 9215), mailed or hand - delivered to:
943 Washington Square Mall, Washington, NC 27889. (Note: Submittals of the review packages on Friday after 12:00 pm will
be stamped as received on the next business day).
Please contact Amy Adams at 252- 948 -3917 if you have any questions regarding this form.
North Carolina Division of Water Quality Internet: www wwateroualit .or
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] NorthCarohna
An Equal Opportunity/Affirmative Action Employer– 50% Recycled/10% Post Consumer Paper Naturally

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Name: HACKNEY Location: 035'25'27.67" N 077° 01' 56.32" W
Date: 10/8/2012 Caption: Philip Madre, 7981 Hwy. 33 East, Beaufort Co.
Scale: 1 inch equals 1000 feet
Copyright (C) 1998, Maptech, Inc
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Name: HACKNEY Location: 035'25'27.67" N 077° 01' 56.32" W
Date: 10/8/2012 Caption: Philip Madre, 7981 Hwy. 33 East, Beaufort Co.
Scale: 1 inch equals 1000 feet
Copyright (C) 1998, Maptech, Inc

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Name:
HACKNEY
Location: 035' 25'45.66" N 077' 02'06.59" W
Date:
10/8/2012
Caption: Philip Madre, 7981 Hwy. 33 East, Beaufort Co.
Scale:
1 inch equals 2000 feet
Copyright (C) 1998, Maptech, Inc