20160468 Ver 1_Stream Call Request_20160506 (2)

RECENEDMCDENWWR
MAY 0 6 2016
Water Quality Regional
Operations Section
ashington Regional Office
Stream Origin
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Beverly Perdue, Governor
Dee Freeman., Secretary
Norah Carolina Department of Environment and Natural Resources
Colleen Sullins, Director
Division of Water Qualit}'
Applicant/Owner's Name (corporation/individual who is legally responsible for the property and its compliance
Outlaw Mobile Homes Inc.
Applicant/Owner Address: P.O. Box 772 City: Mt. Olive State: NC Zip: 28365
Applicant's phone number: [phone] Fax number:
Applicant's email address: outlawmh(a�att net Mobile Number: [phone]
Consultant/Contact person Name (if applicable): Jeffrey L Kornegav, PE PLS / B R Korneeay Inc
Consultant address (if applicable): 300 E. Walnut St., Goldsboro NC 27530
Consultant's phone number: j919) 735-5886 Fax number: (9i9) 580-9053
Consultant's email address: ieffrevni korneeaysep com Mobile Number: [phone]
Name of Project:. Bonnie Farms County: Wayne
Please specify the number to stream origin determinations) requesting for this project: 1 # of stream calls
Nearest Named stream + River Basin (front USGS topographic map):
Carrowa Creek +Neuse River
Please provide a brief description of this project (attach site plan if available):
Please attach a map of site location indicating project boundaries using USGS 1:24,000 topo map and NRCS county soil
survey (depicting the streams in question).
Location of project site - please include reference to the county, nearest named town and highway number/ NCSR, etc.
The property is located on the southwest intersection of Genoa Road (1927) and Pecan Road ( 1918) in Wayne County NC
Has any DWQ staff visited the site? No if yes, please provide DWQ staff name.
visit:
and date of
Does DWQ representative have permission to go on location to conduct the stream determination without the owner present?
Yes_ or No N (Please check one). If No please specify
This form may be submitted via email to lyra hardisonnnctlenr.gov (252-948-3842) or roberto.scheller«,ncdenr.kov (252-948-
3940) mailed or hand -delivered to: 943 Washington Square Mal],Wash ington, NC 27889. (A' ore: Submittals a(the revietr packages
on Pi4day after 12:00 pm trill be stmnpecias receiver/ on the nest business dao).
Please contact Chris Pullinger at 252-948-3920, if you have any questions regarding this form.
North Carolina Division of Water Quality Internet: h2o.enrstate.rices One
943 Washington Square Mall Phone. [phone]
Washington, NC 27889 FAX [phone]V�n/l7rt')C�[y)..Ii)�/(f�[),
An Equal CpportunitylAffrmative Action Employer -50% Recycletll10% Post Consumer Paper Q t'atimal`if