20221097 Ver 1_500 Truitt Road - Express Buffer Applicability_20220815

DocuSign Envelope ID: Al DiB134-FFA6-4934-832C-EDEBC700ED59
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
FORTH CAROLINA
lrrrkrenmrttalQualify
Express Buffer Applicability / Stream Origin
Determination Request
Property Owner Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
la. Name(s) on Recorded Deed
Debra L. Weaver
1b. Responsible Party (for LLC)
George & Daniella Cerasani
lc. Mailing Address
1007 Spot Cir
ld. Telephone Number
951-595-0192
le. Email address
[e-mail]
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
500 Truitt Rd New Bern NC 28560
3. Agent / Consultant Information
3a. Agent/ Consultant Name
3b. Company
3c. Mailing address
3d. Telephone no.
3e. Email address
4. Project / Site Information
4a. Name of project
Survey 4d. River Basin
4b. County
Craven 4e. Lat/Long
4c. Nearest Named Stream
Upper Broad 4F. Number Stream
Creek Calls
5. Project Description (attach plan if available)
Looking to see if this blue line stream is needed for the property and if we can build within 50 feet of it. Also requesting to see if we
can build 2 driveways over the stream. One would be for vehicles and the other for animals.
6. Has anyone from DWQ visited the site?
NO
Staff Name:
Date of Visit:
7. Does DWR staff have permission to
access this property?
Yes
N
8. 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 DWR Washington Regional Office for assistance.
DWR Use Only: Is this determination for the purpose of Buffer mitigation? X Nutrient offset credit?
9. Please return form to:
Lyn Biles (Hardison)
943 Washington Square Mall
Washington, NC 27889
Email: [e-mail]
Please contact Chris Pullinger at the Washington Regional Office at [phone] if you have any
questions.
Note: Submittals on Friday after 12:00 pm
Will be stamped as received on the
Next business day
North Carolina Department of Environmental Quality 'Division of Water Resources - Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

DocuSign Envelope ID: Al D1 B134-FFA6-4934-832C-EDEBC700ED59
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
PROPERTY LEGAL DESCRIPTION:
LOT NO. 2
NORTH CAROLINA
Envinorkme.ritcri Qualify
SAMPLE AGENT AUTHORIZATION FORM
PLAN NO. PARCEL ID: 2-022-26000
STREET ADDRESS: 500 Truitt RD New Bern NC 28560
Please print:
Property Owner: Debra L. Weaver
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
, of
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
119 Leonard Drive, New Bern, NC 28560
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Debra L. Weaver
Authorized Print Name
2S.13 B4€S6,'_"S
Authorized Signature
rDocuSigned by:
8/15/2022 8/15/2022
Date: Date:
North Carolina Department of Environmental Quality (Division of Water Resources - Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

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