20131011 Ver 1_Stream Call Request_20130911

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North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
RECEIVED.
Division of Water Quality
Thomas A. Reeder John E. Skvarla, III
Acting Director Secretary
DWQ Use Only: Project #
SFSWecQ Origin /Buffer Applicability Determination
DWQ-WARO Required Information
1. Owner Information (corporation /individual who is legally responsible for the property and its compliance)
la. Name(s) on Recorded Deed
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1 b. Responsible Party (for LLC)
1 c. Mailing Address
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1d. Telephone Number
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1e. Email Address
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2. Location of Project Site - please include the county, nearest named town and highway number:
3. Has anyone from DWQ visited the site?
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Staff Name
Date of Visit?
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Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
4b. Mailing address
4c. Telephone no.
4d. Email address
5. Project and Site Information
5a. Name of project
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5b. County
5c. Nearest Named Stream
5d. River Basin
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5e. Provide a brief description of this project (attach site plan if available):
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 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.scarbraugh(o)ncdenr.gov
Please contact Anthony Scarbraugh at (252) 946 -6481 if you have any questions.
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