20140206 Ver 1_Stream Call Request_20140312

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NC ENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Charles Wakild, P.E. John E. Skvada III
Pat McCrory Secretary
Governor Director ry
Stream Origin /Buffer Applicability Determination
Applicant/Owner's Name (corporation/individual who is legally responsible for the property and its compliance):
Applicant/OwnerAddress: 189, Wl.`tlo.V Chs..r�l� tkd IPf`�' -�to.� rVC 2'75b9
Applicant's phone number: `I 14 - 7 38 - 10 3,f Pax number: bf ¢A
Applicant's email address: �_y�1 I I k1 C� b r ) r- �cloare G, , c e
Consultant/Contact person Name (if applicable): C o x - E4,wa✓ -6 C.e V�,p a v, y 1' ✓`<
Consultant address (if applicable): I1.o5 Po.rll wo.y Or',v_�t 3 GoUSbora IV C L'7534-
Consultant's phone number. 9 I'R - '7 5 t - 51 O O Fax number: t g - -7 5 I - 17 44
Consultant's email address: __ e 6 e- c o x Q-A Q b , c 1, . w cL+
Name of Project: T6-, 8e k,4$9, - l o. te�y 9/apa/1'y GU of noi4 nCounty: Wow r-k
Nearest Named stream + River Basin (from USGS topographic map):
Please provide a brief description of this project (attach site plan if available):
Teat 9.E e4a� of u ✓r: G. 's �ons;IRe1,"4 tlr�.y v✓eV%", t-f 3.5 -4.o a.cre5 o'f tb.i
5.4-1 CIZ,"k\/ Oropvi'V t� 164 Ck r I, Act - lkwc4.tc. NC
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 include reference to the county, nearest named town and highway number:
West S ce,& of Wars Ca., yep �c lnnSf�� _Cb. /txdo.vv,i Co. I;v.d a.s4 def
US to ov. tall^)il�tt CI Kl� R�. <►�CSlZ 113E }le•ta ✓¢5f7ow.� is P ✓3v,c¢ibv,NC
Has any DWQ staff visited the site ? 1`J o , if yes, please provide DWQ staff name, and date of
visit: AI bs_
This form may be submitted via email (roberto.scheller @ncdenr.gov), 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 Roberto Scheller at 252- 948 -3940 if you have any questions regarding this form.
Water Quality Regional Program Internet: tr,,,v.novwerwmlitr.ora
943 Washington square Mall Phone: 252 - 946-6481
Washington, NC 27889 FAX [phone]
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