20160538 Ver 1_Stream Call Request_20160525

Beverly Perdue, Governor
RECEIVED/NCDENR/DWR Dee Freeman.. Secretary
North Carolina Department of Environment and Natural Resources
EX f °-� Colleen Sullins, Director
MAY 2 5 2016 zr4% b531? Division of Water Quality
wasnington Regional Office
Applicant/Owner's Name (corporation/individual who is legally responsible for the property and its compliance
Applicant/Owner Address: 809 Mill Road City: Goldsboro State: NC Gip: 27534
Applicant's phone number: [phone] Fax number:
Applicant's email address: iackbestnbestcdev.coin Mobile Number:
Consultant/Contact person Name (if applicable): Jeffrey L. Kornegav, PE PLS / B.R. Kornesay, Inc.
Consultant address (if applicable): 300 E. Walnut St., Goldsboro, NC 27530
Consultant's phone number: [phone] Fax number: [phone]
Consultant's email address:efi free n korneeaysep.com Mobile Number: [phone]
Name of Project:
County:
Please specify the number to stream origin determination(s) requesting for this project: I # of stream calls
Nearest Named stream + River Basin (from USGS topographic map):
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 MRCS 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 east side of NC Hwv. 11 I North hi Meares Bluff subdivision Aproximately 2420 feet
north of the intersection with NC Hwv. I I I North and Tommy's Road (SR 1523).
Has any DWQ staff visited the site? Yes , if yes, please provide DWQ staff name, Kyle Barnes and date of
visit: 9-14-2005 (KB -05-0060)
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 hrn.hardisonnncdem.,,ov (252-948-3842) or ioberto.scheller((Dncdeni.-,,ov (252-948-
3940) mailed or hand -delivered to: 943 Washington Square Mall, Washington, NC 27889. (Note: Submittals of the review
packages on Friday after 12: 00 pm will be stomped as received on the nest business da,i).
Please contact Chris Pullinger at 252-948-3920, if you have any questions regarding this form.
North Carolina Division of Watcr Quality Internet h2o.enr.state.nc.us
943 Washington Square Mall Phone: [phone] One
Washington, -NC 27889 FAX [phone] NorthiCaNr�7oll/ina
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