20161219 Ver 1_Buffer and/or Stream Determination_20161213

3
WEIVEDMIDDENRIDWR
PAT M C C R O R Y
3a. Agent/ Consultant Name
Governor
DEC 13 2016
DONALD R. VAN DER VAART
M
Secretary
Water Resources Water lona)
ENVIRONMENTAL QUALITY Quality Regional
S. JAY ZIMMERMAN
Operations Section
Washington Regional Office
DWR Use Only: Project #:
Date Received:
Buffer Applicability / Stream Origin Determination Request
Property Owner Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded Deed J Isaac Gurley Farms Inc
lb. Responsible Party (for LLC) Brad Gurley
1c. Mailing Address P.O. Box 1661, Goldsboro, NC 27533
1d. Telephone Number 919-920-1333 1e. Email address [e-mail]
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
Northeast quadrant of the intersection of US HWY 13 and Hood Swamp Road Northeast of Goldsboro, Wayne County, NC
3.
Agent / Consultant Information
3a. Agent/ Consultant Name
D.E. "Trey" Gurley, III, PE
3b. Company
McDavid Associates, Inc.
3c. Mailing address
P.O. Box 1776, Goldsboro, NC 27533
3d. Telephone no.
919-736-7630 3e. Email address [e-mail]
4. Project / Site Information
4a. Name of project Handy Mart
4c. Nearest Named Stream
Bear Creek
4b. County Wayne
4d. River Basin
Neuse
5. Project Description (attach plan if available)
Proposed convenience store with mixed used following.
6. Has anyone from DWQ visited the site? INo IStaff Name: Date of Visit:
7. 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 DWR Washington Regional Office for assistance.
DWR Use Only: Is this determination for the purpose of Buffer mitigation? Nutrient offset credit?
8. 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
Email: [e-mail] Next business day
Please contact Anthony Scarbraugh at the Washington Regional Office at [phone] if you have any
questions.
State of North Carolina I Environmental Quality I Water Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252 946 6481

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PIN Number:
Owner/Address 1;
City:
Zip Code:
Property Address:
Acreage:
Sale Price:
Building Value:
Deferred Value:
Detailed Property Card
Tuesday, December 13, 2016
3620848574
Owner Name:
J ISAAC GURLEY FARMS INC
PO BOX 1661
Owner/Address 2:
GOLDSBORO
State:
NC
27533
Neighborhood:
05906
HOOD SWAMP RD
Deed Book -Page:
0822-430
11.550
Sale Year:
73
$0.00
Land Value:
$88,420.00
$0.00
OBXF Value:
$0.00
$60,290.00
Total Value:
$28,130.00
DISCLAIMER: THIS MAP IS PREPARED FOR THE INVENTORY OF REAL PROPERTY FOUND WITHIN THIS JURISDICTION AND IS COMPILED FROM
RECORDED DEEDS, PLATS, AND OTHER PUBLIC RECORDS AND DATA. USERS OF THIS MAP ARE HEREBY NOTIFIED THAT THE AFOREMENTIONED
PUBLIC PRIMARY INFORMATION SOURCES SHOULD BE CONSULTED FOR VERIFICATION OF THE INFORMATION CONTAINED ON THIS MAP. THE
COUNTY AND THE MAPPING COMPANIES ASSUME NO LEGAL RESPONSIBILITIES FOR THE INFORMATION CONTAINED ON THIS MAP.

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