6571B-BufferDetermReqForm-RRO-20230622 (1)

North Carolina Department of Environmental Quality Division of Water Resources
512 North Salisbury Street 1617 Mail Service Center Raleigh, North Carolina 27699-1617
919.707.9000

Date Received___ DWR Use Only: Project #

Buffer Determination Request Form
Property Owner Information
1. Owner Information: H & S Land, LLC
1a. Name(s) on Recorded Deed H & S Land, LLC
1b. Responsible Party (for LLC) Hunter Stone
1c. Mailing Address PO Box 8159
1d. Telephone Number 252-243-7285 1e. Email Address [e-mail]
Address of Property: 1746 Barnes Hill Church Road Nashville, NC 27856
Project Description (attach plan if available): Residential Subdivision

Consultant/Agent Information
4. Agent/Consultant Information : Ron Sutton, PE
4a. Name, Company Herring-Sutton & Associates, PA
4b. Mailing address 2201 Nash St NW Wilson, NC 27896
4c. Telephone no. 252-230-0709 4d. Email address [e-mail]
5. Project and Site Information
5a. Name of project Castle Berry Section III 5b. County Nash
5c. Nearest Named Stream Maple Creek 5d. River Basin Tar-Pamlico
6. Has anyone from DWR visited the site? N 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
to:

Joe Myers
1628 Mail Service Center
Raleigh, NC 27699-1628
Email:
[e-mail]

Please contact the Raleigh Regional Office at [phone] if you have any questions.