20160210 Ver 1_Buffer Determination Request_20160302

Water Resources
ENVIRONMENTAL QUALITY
Stream Origin/Buffer Applicability Determination
Required Information
PAT MCCRORY
RECEIVED/NCDENR/DWR
Governor
1 b. Responsible Party (for LLC)
DONALD R. VAN DER VAART
MAR 2.2016
Secretary
1d. Telephone Number
S. JAY ZIMMERMAN
Water Quality Regional
lon
OperationsRegional
lOfflcg
DWR 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
Pitt County Soccer Association, Inc
1 b. Responsible Party (for LLC)
Vance Averette-Vice President
1c. Mailing Address
PO Box 3915 Greenville NC 27836
1d. Telephone Number
252-917-1090
le. Email Address
[e-mail]
2. Location of Project Site - please include the county, nearest named town and highway number:
Pitt County, Greenville NC, West of NC HWY 43 S and South of Worthington Road (Behind DH Conley High School)
3. Has anyone from DWR visited the site?
I N
I Staff Name
Indian Well Swamp
Date of Visit?
Tar -Pam
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
Kendall Gaskins, Gaskins Land Surveying, P.A.
4b. Mailing address
PO Box 354
4c. Telephone no.
252-714-0983
4d. Email address
[e-mail]
5. Project and Site Information
5a. Name of project
Pitt Greenville Soccer Association, Inc
5b. County
Pitt
5c. Nearest Named Stream
Indian Well Swamp
5d. River Basin
Tar -Pam
5e. Provide a brief description of this project (attach site plan if available):
Drainage improvements on existing ditches and proposed improvements
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.
DWR 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.scarbraugh(7ancdenr.gov
Please contact Anthony Scarbraugh at [phone] if you have any questions.
State of North Carolina I Environmental Quality I Water Resources —Water Quality Regional Operations Washington Regional Office
943 Washington Square Mail, Washington, NC 27889
252-946-6481

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