20160811 Ver 1_Buffer Determination Request_20160822

cpENRI®WR
Nor Nepartment of Environmental Quality
Pat McCrory AUG 2 2.2016
Governor
tNater Cluat'�% Reg ions
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�ashin9ton
Donald R. van der Vaart
Secretary
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
Weyerhaeuser NR
1b. 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:
3. Has anyone from DWR visited the site?
Y /_N
I Staff Name I
Date of Visit?
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Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
4b. Mailing address
4c. Telephone no.
_
4d. Email address _
5. Project and Site Information
5a. Name of project,
C p $ _ 2 01
5b. County
g;
5c. Nearest Named Stream
5d. River Basin
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ye. Provide a brief description of this project (attachite pia if available):
Access at: I- �- I Z - `I (Z_
Call at: S` L,
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or MRCS Soil Survey.
If you are unable to locate either of these maps, please contact the Regional Office for assistance.
I 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 Niall
Washington, NC 27889
Fax: [phone]
Email: anthony scarbraugh ncdenr gov
/Vote: Submittals on Friday after 12:00 pm
will be stamped as received on the
next business day.
Division of Water Resources - Water Quality Regional Operations Section - Washington Regional Office
943 Washington Square Mall, Washington, NC 27889
Phone. [phone] Fax: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 't. Affiemative Action Employer - Made in part by eeoycled paper

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