20151006 Ver 1_Stream Call Request_20151104

Pat McCrory
Governor
��
J
�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Thomas A. Reeder
Acting Director
John E. Skvarla, III
Secretary
DWQ Use Only: Project #
Stream Origin/Buffer Applicability Determination
Required Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded Deed
Flintrock Farm #2 --Annette Bradsher
1 b. Responsible Party (for LLC)
1652 Mail Service Center, Raleigh NC 27699
1c. Mailing Address
221 Flint Rock Trail, Reidsville, NC 27320
1d. Telephone Number
336-349-4723
1e. Email Address
[e-mail]
2. Location of Project Site - please include the county, nearest named town and highway number:
221 Flint Rock Trail, Reidsville NC, site is on the right side of Flint Rock Trail 2.2 miles from turn off. 36.28208, -79.82494
3. Has anyone from DWQ visited the site?
Y / N
Staff Name
Troublesome Creek
Date of Visit?
Cape Fear
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
Melonie Allen NC DEQ DMS
4b. Mailing address
1652 Mail Service Center, Raleigh NC 27699
4c. Telephone no.
919-368-9352
4d. Email address
[e-mail]
5. Project and Site Information
5a. Name of project
(#92812) Flint Rock Farm 2
5b. County
Rockingham
5c. Nearest Named Stream
Troublesome Creek
5d. River Basin
Cape Fear
5e. Provide a brief description of this project (attach site plan if available): 555,893.95 square feet of buffer mitigation on
rural subject and non -subject streams ( please see attached project map and closeout report for site specifics).
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: anthony.scarbraugh(a)ncdenr.gov
Please contact Anthony Scarbraugh at [phone] if you have any questions.