20130975 Ver 1_Stream Call Request_20130910 (2)

NCDENR
REC E` LZ0rla Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governn Acting Director Secretary
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D V V Q -WARD DWO 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)
1a. Name(s) on Recorded Deed
Weyerhaeuser Company
1b. Responsible Party (fox L-C)
5. Project and Site Information See attached maps
1c. Mailing Address
1785 Weyerhaeuser Road Vanceboro, NC 285856
1d. Telephone Number
252 - 2298328
1 1e. Email Address
I Cliff. [e-mail]
2. Location of Project Site - please include the county, nearest named town and highway number.
Martin off SR #1306
3. Has anyone from DWQ visited the site?
I N
I Staff Name
Access at 77 20.205 35 50.894 call at 77 16.641 35.51.901
Date of Visit?
If you are unable to locate either of these maps, please contact the Regional Office for assistance.
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
4b. Mailing address _
4c. Telephone no. 4d. Emai address
5. Project and Site Information See attached maps
5a. Name of project
580168 -2013
5b. County
Martin
5c. Nearest Named Stream
Ross Swamp
5d. Ri er Basin
Tar
5e. Provide a brief description of this project (attach site plan if available):
1" thin
Access at 77 20.205 35 50.894 call at 77 16.641 35.51.901
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 Regional Office for assistance.
DWQ Use Only: Is this stream rail for the purpose of: _X_ buffer mitigation _ nutrient offset credit
Please return form to: Anthony Scarbraugh
943 Washington Square Mail Note: Submittals on Friday after 12:00 pm
Washington, NC 27889 wi11 be stamped as received on the
Fax: [phone] next business day.
Email: anthonv.scarbrauch(o)ncdenr.gov
Please contact Anthony Scarbratgh at (252) 946-W1 if you have any questions.

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