20140890 Ver 1_Stream Call Request_20140818

RUG - 19-2014 10:51 From: 9197599697 To:12529469215
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AUG 18 2014 WDEE R
North Carolina Department of Environment and Natural Resources
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Page: 111
John E. Skvaria, III
Secretary
DWQ Use Only: Project q
Stream Origin/Buffer Applicability Determination
Required Information
1. Owner Information (corporationlndlvldual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded need
Sf h a
1 b. Responsible Party (for Lll
10. Mailing Address
/(Q 3 C K.h a� ou) % / NL 2.8 s8 6
id. Telephone Number
qt _ A'A 44-7(,5 1e. Email Address
StA f 4ums resk-lnbync,
2. Location of Project Site - please indude the County, nearest named town and highway number:
cene ogyphl, Slio % Hill /,y Z5' Cdch Aue.cA poi
1 Has anyone from DWQ visited the site?
1(-Y)o
Staff Name
5c. Nearest Named Stream
Date of Visit?
- _
Additional Requested Information
4. Agent/Consultant Information (d applicable)
4a. Name, Company
4b. Mailing address
4c. Telephone no.
4d. Email address
5. Project and Site Information ()/)*m rLV6. ° ry -',P,
5a. Name of project
5b. County
een C
5c. Nearest Named Stream
5d. River Begin
5e. Provide a brief des/c�ription of this project (attach site plan N available):
c%erb y
(P l l 0 t/Ses
Please attach a map of the site Indicating project boundaries on the USGS 1:24,000 Tope and/or NRCS Soil Survey.
If you are unable to locate either of these maps, lease contact the Regional Office far 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 Note: Submittals on Frfday after 12:00 pm
Washington, NC 27889 will be stamped as received on the
Fax: [phone] next business day.
Email: anthony.sWbrauahOucdenr,gov
Please contact Anthony Scarbraugh at [phone] 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: [phone] Internet:wmv.ncdenr.gov .
An Equid 0ppertunity 1 AftmaUm Acton Empleytx —Made in pat by recycled paper
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