20141223 Ver 1_Stream Call Request_20141126

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Acting Director Secretary
DWQ Use.Only: Project #
Stream Origin /Buffer Applicability Determination
Required Information
1. Owner Information (corporation /individual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded Deed
CMA
1b. Responsible Party (for LLC)
1c. MailingAddress
1
1d. Telephone Number
5. Project and Site Information
1e. Email Address
2. Location of Project Site - please include the county, nearest named town and highway number:
3. Has anyone from DWQ visited the site?
Y(
Staff Name
Date of Visit?
5d. River Basin
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
4b. Mailingaddress
4c. Telephone no.
4d. Email address
5. Project and Site Information
5a. Name of project
5b. County
5c. Nearest Named Stream
5d. River Basin
5e. Provide a brief description of this project (attach site plan if available):
Please 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 Regional Office for 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
Wa shington, NC 27889 Note: Submittals on Friday after 12:00 pm willbe
Washington,
stamped as received on the
Fax: [phone] nextbusinessday.
Email: anthonv.scarbraugh(Dricdenr gov
Please contact Anthony Scarbraughat (252) 946 -6481 if you have any questions.

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