20150776 Ver 1_Buffer Determination Request_20150803

NCDENR
North Carolina Department of Environment and N2410I Rfes
Division of Water Resources
Pat McCrory Water Quality Programs waterouelttyReglonalJohn E. Skvarla, III
Governor Thomas A. Reeder Operations Section Secretary
Director WaaOntReglo al
DWQ Use Only: Project #
Stream Origin /Buffer Applicability Determination
Required Information
1. Owner Information (corporationlndividual who is legally responsible for the property and its compliance)
1 a. Name(s) on Recorded Deed I Shelton H. and Donald D. Manley
1 b. Responsible Party (for LLC)
1 c. Mailing Address 1 131 Snug Harbor Road, Hertford, NC 27944
1d. Telephone Number 1 313 -204 -8349 11e. Email Address I Shelton manlev510icloud.com
2. Location of Project Site - please include the county, nearest named town and highway number:
131 Snug Harbor Road, Hertford, NC 27944
3. Has anyone from DWQ visited the site? I Y / N I Staff Name I I Date of Visit? I
Additional Requested Information
4. AgenUConsultant Information (if applicable)
4a. Name, Company I Jason Shepherd, Burns & McDonnell Consultants, Inc.
4b. Mailing address 3750 Mansell Road, Suite 300, Alpharetta, GA 30022
4c. Telephone no. 770 - 510 -4536 14d. Email address I jasonshepherd @burnsmcd.com
5. Project and Site Information
5a. Name of project NC13064- SolnPowerl0 5b. County Perquimans
5c. Nearest Named Stream Bethel Creek 5d. River Basin Pasquotank
5e. Provide a brief description of this project (attach site plan if available):
5 MWac Solar Photovoltaic Power Plant
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.scarbrauahOncdenr.aov
Please contact Anthony Scarbraugh at (252) 946 -6481 if you have any questions.

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