20180371 Ver 1_Agent Authorization_20180130

ROY COOPER
K.
Governor
MICHAEL S. REGAN
Secretary
Water Resources r.p
LINDA CULPEPPER
Environmental Quality Interim Director
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 Alpha Media LLC
1b. Responsible Party (for LLC) Larry Wilson
1c. Mailing Address 1211 SW 5' Ave Suite 750 Portland OR 97204
1d. Telephone Number na 1e. Email address na
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
3.
Agent / Consultant Information
3a. Agent/ Consultant Name
J. Stephen Janowski PE
3b. Company
Rivers and Associates Inc
3c. Mailing address
107 East 2nd Street Greenville NC 27858
3d. Telephone no.
252-752-4135 3e. Email address [e-mail]
4. Project / Site Information
4a. Name of project
Tract 2 Craven Co
Ind Dev
4c. Nearest Named Stream
Bachelor Creek
4b. County
Craven
4d. River Basin
Neuse
5. Project Description (attach plan if available) undeveloped
6. Has anyone from DWQvisited the site? Y / N Staff Name: Chris Pullinger Date of Visit: 1-30-18
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.
5�11'NothIng Compares _.
State of North Carolina I Environmental Quality I Water Resources -Water Quality Regional Operations Section -Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481