20230264 Ver 1_Other_20230227

ROY COOPER
Governor
ELIZABETH S. SISER
Secretory
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
Date Received DWR Use Only: Project #
— II
Buffer Determination Request Form
Property Owner Information
1.Owner Information
Ia. Name(s) on Recorded Deed
Sallie Temple
lb. Responsible Party (for LLC)
le. Mailing Address
2375 Temples Point Road, Havelock, NC 28532
Id. Telephone Number
252-670-1096
le. Email Address
[e-mail]
Address of Property: 2365 Temples Point Road, Havelock, NC 28532
Project Description (attach plan if available): Two Culvert installations to provide farm tractor from having to drive on State Road to get
from one side to the other I see attached map
Consultant/Agent Information
4. Agent/Consultant Information
4a. Name, Company
Sean Jahr (Son -in -Law)
4b. Mailing address
2400 Temples Point Road, Havelock, NC 28532
4c. Telephone no.
252-723-2423
4d. Email address
Sean [e-mail]
5. Project and Site Information
5a. Name of project
Culvert(s) Installation
5b. County
Craven
5c. Nearest Named Stream
Neuse River
5d. River Basin
Neuse
6. Has anyone from DWR visited the site?
No
N I
Staff Name
Date of Visit?
Attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or NRCS Soil Survey.
Please return form Jim Westcott
to: 1628 Mail Service Center
Raleigh, NC 27699-1628
Email:
DEQ. RRO. Buffer. Req ucsts(a,ncden r. Rov
North Carolina Department of Environmental Quality I Division of Water Resources
D E Q 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
! 11
..10. urr919.707.9000
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