20150897 Ver 1_Buffer Determination Request_20150827

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NCDENR
North Carolina Department of Environment and
Division of Water Resources
Water Quality Programs
Pat McCrory Charles Wakild, P.E.
Governor Director
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RECEIVED /NCDENR/DWR
AUG 2 7 2015
Natural ResQ"egality Regional
Operations Section
Washington Regional Office
Stream Origin /Buffer Applicability Determination
John E. Skvarla III
Secretary
Applicant/Owner's Name (corporation /individual who is legally responsible. for the property and its compliance):
Applicant/OwnerAddress: •V•(7. �V K in(ri_)
Applicant's phone number: 6&a 86a — 1071 7 F x number:
Applicant's email address:
Consultant/Contact person Name (if applicable): ,�1 e_k/ � arvies � 1—y< n' 4
Consultant address (if applicabble): C7 �cS� 1- Fj� 10 -t✓. _-_)793V
Consultant's phone number: aSa — Fax number: /
Consultant's email address: hodsaw MCCYI 10, Cl O 1. e,(Jrr-)
Name of Project: N e\i► iA n n f, l Y5t 1 r/`" County: t
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Nearest Named stream + River Basin (from USGS topographic map):
0EL45 E'— '71,1 Jr, RaS; n
Please provide a brief description of this project (attach site plan if available):
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Please attach a map of site location indicating project boundaries using USGS 1:24,000 topo map and NRCS county soil survey.
Location of project site - please include reference to the county, neareSI named town and highway number:
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Has any DWQ staff visited the site? if yes, please provide DWQ staff name,
visit:
and date of
This form may be submitted via email (roberto.scheller @ncdenr.gov), faxed (252 -946- 9215), mailed or hand - delivered to:
943 Washington Square Mall, Washington, NC 27889. (Note. Submittals of the review packages on Friday after 12:00 pm will
be stamped as received on the next business day).
Please contact Roberto Scheller at 252- 948 -3940 if you have any questions regarding this form.
Water Quality Regional Program
943 Washington Square Mall
Washington, NC 27889
Internet: wwwncwateroual¢v.ore
Phone: [phone]
FAX [phone]
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