20171123 Ver 1_Buffer and/or Stream Determination_20170906

Water Resources N
Environmental Quality
RECEIVEDINCDF-NP40WR
ROY COOPER
Governor
SEP 6 2017 MICHAEL S. REGAN
Secretary
Water Quality Regional S. JAY ZIMMERMAN
Operations Section Director
Washington Regional Office
DWR Use Only: Project #: SLOt;t 1 l a3
Date Received: 'i0 /C!
Buffer Applicability / Stream Origin Determination Request
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3. Agent / Consultant Information
3a. Agent/ Consultant Name
3b, Company
3c. Mailing address
3d. Telephone no. 3e. Email address
4. Project / Site Information
Property Owner Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
la. Name(s) on Recorded Deed
9 en n e e+ - *V W
1b. Responsible Party (for LLC)
6. Has anyone from DWQ visited the site? I Y N Staff Name: I Date of visit:
lc. Mailing Address
.3 gvertkwood Dr'1Nt bta N C, ZT333
1d. Telephone Number
Ql 298aS le. Email address I tq ) r
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
32b, 32$, 33©, 332, 33 LA '+3renA-W O(Dd '%c,ve, ­bud),e� j A)C 29,333
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3. Agent / Consultant Information
3a. Agent/ Consultant Name
3b, Company
3c. Mailing address
3d. Telephone no. 3e. Email address
4. Project / Site Information
4a. Name of project &P_n�W oo6 hrq;hp ffiq,1nieA4M44c.
Nearest Named Stream I Yewou0 1(Y ocsk smncil
4b. County I ryp
4d. River Basin u eU
S. Project Description (attach plan if available)
--eas; c, d,4 kc.h Q_nsu re pro per Ck'a i n a9l,-,
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6. Has anyone from DWQ visited the site? I Y N Staff Name: I 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?
B. 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.
--- `Nothing Compares`-
State of North Carolina I Environmental Quality I Water Resources -Water Qualit) Regional Operations Section -Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

Scarbraugh, Anthony
From: Ashley Smith <[e-mail]>
Sent: Tuesday, September 05, 2017 4:53 PM
To: Scarbraugh, Anthony
Cc: Ashley Smith
Subject: Mr. Renny Petty site visit information for Sept. 14th
Attachments: Renner Petty doc.pdf
Importance: High
Good Afternoon,
My name is Ashley Smith with the Wayne Soil & Water Conservation District. Our office has
assisted Mr. Renny Petty with the paperwork you requested. Mr. Petty does not have access
to email so I am forwarding this along. Mr. Petty's cell phone is listed on your form. If you
have any questions please feel free to contact me if needed. I will be glad to help any way I
can.
Ashley Smith
Soil Conservation Coordinator/Director
919-734-5281 Ext 3
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Iniacery Date: 5!14.2016 lot 35.291037° Ion -78.027933° .

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