20140732 Ver 1_Stream Call Request_20140814

-E R
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvada, III
Governor Secretary
DWQ Use Only: Project #
Stream Origin /Buffer Applicability Determination
Additional Requested Information
Required Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance) s
1a. Ni on Recorded Deed
Rcxs6cri-V
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1 b. Responsible Party (for LLC)
4d. Email address
1c. Mailing Address
Narri&
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1d. Telephone Number
252 -
- 5-335"
1 le. Email Address
2. Location of Project Site - please include the county, nearest named town and highway number.
e. CZQ Yi 5n6 W 41 W 258 13 1"iJ
3. Has anyone from DWO visde6 the site?
I Y
N
I Staff Name
I
Dale of Visit?
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
4b. Mailing address
4c. Telephone no.
4d. Email address
II
5. Project and Site Information Pco, Ci A r-v ^Ad Dili:- i Ann k q,l 11
5a. Name of project
5b. County
So. Nearest Named Stream
"i5ijanp Cre_tk
I 5d. River Basin
Se. Provide a brief description of this project (attach site plab if available):
n Qf6,ri �ch cvdr� nk res,e «cis tshrr
Please attach a map of UN site indicating project boundaries on the USGS 1:211,000 Topo and /or NR CS So Survey.
If you are unable to locate either of these maps, please contact the Regional Office for assistance.
DWO Use Only. Is this stream call for the purpose of: buffer mitigation _ nutrient offset credit
Please return form to: Anthony Scarbrough
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.scarbraughrrDncdenr.eov
Please contact Anthony Scarbraugh at (252) 946 -6481 if you have any questions.
Division of Water Resources - Water Quality Regional Operations Section - Washington Regional office
943 Washington Square Mall, Washington, NC 27889
Phone: [phone] Fax: 252 - 97517161 Internal: vnvw.ncdenr.gov
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