20160421 Ver 1_Buffer Determination Request_20160429

Pat McCrory
Governor
North Carolina Department of Environmental Quality
RECEIVED/NCDENRIDWR
APR 2 9 2016
Water Quality Regional
Operations Section
Washington Regional 011108
Donald R. van der Vaart
Secretary
DWR Use Only: Project #
Stream Origin/Buffer Applicability Determination
Required Information
1. Owner Information (corporationlndividual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded Deed
Weyerhaeuser NR
1 b. Responsible Party (for LLC)
1c. Mailing Address
1785 Weyerhaeuser Road Vanceboro , NC 28586
1d. Telephone Number
1 [phone]
1e. Email Address
[e-mail]
2. Location of Project Site - please include the county, nearest named town and highway number.
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3. Has anyone from DWR visited the site?
Y / N
I Staff Name
Date of Visit?
Additional Requested Information
4. AgentlConsultant Information (if applicable)
4a. Name, Company
4b. Mailing address
4c. Telephone no.
4d. Email address
5. Project and Site Information
5a. Name of project
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5b. County
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5c. Nearest Named Stream
5d. River Basin
5e. Provide a brief description of this project (attach site plan if availb6l;57.
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Call at:
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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: _X_ buffer mitigation _ nutrient offset credit
Please return form to: Anthony Scarbraugh
943 Washington Square Mall Note: Submittals on Friday alter 12:00 pm
Washington, NC 27889 will be stamped as received on the
Fax: [phone] next business day.
Email: anthonv.scarbraugh0nodenr.gov
Division of Water Resources - Water Quality Regional Operations Section - Washington Regional Office
943 Washington Square Mall, Washington, NC 27889
Phone: [phone] Fax: [phone]M Internet: www.ncdenroov
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