20150766 Ver 1_Buffer Determination Request_20150819

aO15- 0766
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Water Quality Programs John E. Skvada, III
Governor Thomas A. Reeder Secretary
Director
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)
1a. Name(s) on Recorded Deed Growes Drive, LLL a NL 11 nnAc3 It &-VxL; A y �ohni0q htl
1b. Responsible Party (for LLC) K�\P -T "Z' o �-h t
1c. Mailing Address S zao -TO, k \a r lee e . RaAe,i l' W L �1 "I W 13
1d. Telephone Number q 1q _ 3cl s - 04 (_L u 11e. Email Address 1ru { L k It hdj w a,l • C wt
2. Location of Project Site - please include the county, nearest named town and highway number.
a'1ao Grades Dtcve r-J C- a-1s3Z4 . Wct it CoLky,f -y
3. Has anyone from DWQ visited the site? I Y 0I Staff Name
I Date of Visit? I
Additional Requested Information \ is
4. Agent/Consultant Information (if applicable) r� �
4a. Name, Company dQiC/i/ (- °O.AUA(�IM AJ
4b. Mailing address
4c. Telephone no. 2q3 -G49 -944( I4d. Email addr I/uflcNllEL.CDARF/�/�IbHf�
5. Project and Site Information
5a. Name of project (mil. 96oRo - CARo1,tXI4 DEPTAL 15b. County I U39VAIE
5c. Nearest Named Stream ? 5d. River Basin 2
5e. Provide a brief description of this project (attach site plan if available):
WE ARi (tlAvT/sG To AVS P4(z1<t,JG SP8C65 /It)8461<OFS06.
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 Note: Submittals on Friday after 12:00 pm
Washington, NC 27889 will be stamped as received on the
Fax: [phone] next business day.
Email: anthonv.scarbrauahnnodenr.00v
Please contact Anthony Scarbraugh at (252) 946 -6481 if you have any questions.

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