20150343 Ver 1_Stream Call Request_20150406

4
NCDEE R
Carolina Department of Environment and Natural Resources
7NCDENft" Division of Water Resources
Pat McCrory Water Quality Programs John E. Skvada, III
Governor APR g 2015 Thomas A. Reeder Secretary
Director
Eton ~��0" DWQ Use Only Project # Ij"�4)
Stream Origin /Buffer Applicability Determination
Required Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
1 a. Name(s) on Recorded Deed
1b. Responsible Party (for LLC)
1 c. Mailing Address
44.
11d. Telephone Number
t e. Email Address
5a. Name of project
2. Location of Project Site - please include the county, nearest named town and highway number:
3. Has anyone from DWQ visited the site?
Y'/ N
I Staff Name
Date of Visit?
Additional Requested Information
4. AgenUConsultant Information (if applicable)
4a. Name, Company
4b. Mailing address
4c. Telephone no.
4d. Email address
5. Project and Site Information
5a. Name of project
lio4 rhu6 fix^ c'
Sb. County
5c. Nearest Named Stream
5d. River Basin
be. Proivde as Drier description of this pr fect (attach site plan if available):
*as- /
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
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 scarbraughCcDncdenr gov
Please contact Anthony Scarbraugh at (252) 946 -6481 if you have any questions.
f

Beaufort County
Scale : 1 Inch = 318 Fee . Date : 0712005
boa -08 -0 `17_3
Land Records / GIS
++++ +....+..+ DISCLAIMER +++ + + + +......
THIS MAP IS PREPARED FOR THE INVENTORY OF REAL PROP-
ERTY IN ACCORDANCE WITH N.C. LAND RECORDS TECHNICAL
SPECIFICATIONS FOR BASE, CADASTRAL AND DIGITAL
MAPPING SYSTEMS. GRAPHIC ILLUSTRATIONS HEREON ARE
COMPILED FROM RECORDED DEEDS, PLATS AND OTHER
PUBLIC RECORD RESOURCES. PERSONS ARE HEREBY
NOTIFIED TO CONSULT ALL APPLICABLE PUBLIC RECORDS
FOR VERIFICATION. BEAUFORT COUNTY AND ITS AGENTS
ASSUME NO LEGAL RESPONSIBILITY FOR THE ACCURACY OF
INFORMATION DEPICTED ON THIS MAP.
Online Maps: www.co.beaufort.mus

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