Trout Notification Form - Bandari Culvert and Driveway

RECEIVED
iz"CEIVED
Water Resources �W % Z mk
Environmental Quality
MAY Pop State of North Carolina
Department of Environmental Quality
Division of Water Resources
DEO-way RESOURCES
401 d. BUFFER PaMWMM2H .0506(b)(4) Water Quality Certification,
Notification of Work in Trout Watersheds
FORM: TroutWS 11-2017
Notification of Work in Trout Watersheds Form
A. Applicant Information
1. Processing
1 a. Specify Nationwide Permit (NWP) number:
1b. Has the NWP or GP number been verified by the Corps?
or General Permit (GP) number: L4 Zy (,a
es ❑ No
1 c. Does the project meet all the Conditions of the applicable Water Quality Yes ElNoCertification
Please note that your project may be subject to the Sediment and Erosion Control Program and/or Trout Buffers
implemented by the Division of Energy, Mineral, and Land Resources. Find more info at:
hftps:/Ideq.nc.goviabout/divisions/energy-minera I-land-resources/erosion-sed iment-control
2. Project Information
2a. Name of project: e UL-VI-r-►Zt- (2t Vk W r'-
2b. County: ;} A Ck sp v,
2c. Nearest municipality / town: l;/A 5H141?-el N L
3. Owner Information
3a. Name(s) on Recorded Deed:
Af4(11`WO , �>
3b. Responsible Party (for LLC if
applicable):
3c. Street address:
7 3 9 ,5 (o 'y7a j VIA R 3
3d. City, state, zip:
-1) 1F:� Cd{fi.J {L &-JA 30030
3e. Telephone no.:
-f 0'/ & y7 - 9Z,-7 f
3f. Email address:
Ai -A V aoWD► F-r Lc, .VkAW v0, [p y.t,-1
4. Agent/Consultant Information (if applicable)
4a. Name: [IT LA546 A-
4b. Business name f
(if applicable): f
4c. Telephone no.: qoV 229 3q3(
4d. Email address: f} r-T & A RTS WDPGCS . C-oro
B. Project Information
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): f !9'?2--- 5Y- � 7
Latitude: 35 122 7 It 0 Longitude: 93-05-32-rO
1b. Site coordinates (in decimal degrees): �
(DD.DDDDDD (-DD.DDDDDD)

From: Nan Bandari <[e-mail]>
Date: April 22, 2024 at 8:33:01 PM EDT
To: Art Lassek <[e-mail]>
Subject: Trout Watershed Authorization
I, Nandini Bandari, authorize, my agent, Art Lassek to sign the
Notification of Work in Trout Watershed form for the North
Carolina water resources division for parcel ID: 7572-5 4--6799
on my behalf.
If you have any questions, I can be reached at 404-643-9271.
Nan Bandari
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