20150240 Ver 1_Buffer Determination Request_20150303

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North Carolina Department of Environment and Natural Resources
Pat McCrory MAR 32015 Donald R. van der Vaart
Governor wew Quaft Pagow Secretary
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DWR Use Only: Project# fS O ZHo
Stream Origin /Buffer Applicability Determination
Required Information
1. Owner Information (corporation /individual who is legally responsible for the property and its compliance)
la. Name(s) on Recorded Deed
Joy Bennett Mosley
1 b. Responsible Party (for LLC)
1c. Mailing Address
48 Norman Road, Blounts Creek, NC 27814
1d. Telephone Number
612 - 817 -8766
1e. Email Address
5a. Name of project 1
2. Location of Project Site - please include the county, nearest named town and highway number:
0.1 miles SW of 48 Norman Road near Blounts Creek
3. Has anyone from DWR visited the site?
Y IN
I Staff Name
I Anthony Scarbraugh
Date of Visit?
03/03/14
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
4b. Mailing address
4c. Telephone no.
4d. Email address
5. Project and Site Information
5a. Name of project 1
Jay and Joy Mosley Property
5b. County
Beaufort
5c. Nearest Named Stream
Blounts Creek
5d. River Basin
Tar - Pamlico
5e. Provide a brief description of this project (attach site plan if available):
A proposed stream crossil g to access a homesite.
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.
DWR Use Only: Is this stream call for the purpose of: — buffer mitigation _ nutrient offset credit
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Please return form to: Anthony Scarbraugh
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.scarbraughancdenr.gov
Please contact Anthony Scarbraugh at (252) 946 -6481 if you have any questions.
i
Division of Water Resources - Water Quality Regional Operations Section - Washington Regional Office
943 Washington Square Mall, Washington, NC 27889
Phone: 252 - 946 -64811 Fax: [phone] Internet: vnvw.nodenr.gov
An Equal Opportunity l Affirmative Action Employer— Made in part by recycled paper

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