HL-0008K BufferDeterminationRequestForm_5Feb2020_RRO

DWR Use Only: Project #
Date Received___

Buffer Determination Request Form
Property Owner Information
1. Owner Information
1a. Name(s) on Recorded Deed NCDOT Transportation Project
1b. Responsible Party (for LLC) Chris Murray
1c. Mailing Address 2612 North Duke St- Durham, NC 27704
1d. Telephone Number 256159 1e. Email Address [e-mail]
Address of Property: 2042 NC-42, Willow Spring, NC 27592
Project Description (attach plan if available): ): NC 42 and Hilltop Road in Wake County

Consultant/Agent Information
4. Agent/Consultant Information
4a. Name, Company
4b. Mailing address
4c. Telephone no. 4d. Email address
5. Project and Site Information
5a. Name of project HL-0008K 5b. County Wake
5c. Nearest Named Stream Terrible Creek 5d. River Basin Neuse River

6. Has anyone from DWR visited the site? Y / N Staff Name Date of Visit?

Attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or NRCS Soil Survey.

Please return form Josh Brigham

to: 1628 Mail Service Center
Raleigh, NC 27699-1628
Email: [e-mail]

Please contact the Raleigh Regional Office at [phone] if you have any questions.