20150524 Ver 2_Determination Request_20220706

Stream Origin/Buffer Applicability Determination
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Name: * Meadowbrook
Is this a transportation project?* Yes • No
Is this request for a mitigation site?* Yes • No
What type of request is this?* Buffer
Isolated Wetland
Check all that apply.
Owner Information
Name on the Recorded Deed: *
Responsible Party :
Town of Grifton
Mark Warren
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 252-524-3168
How would you like to received your determination?*
USPS Email
Email Address:*
[e-mail]
Is there an agent or consultant responsible for the request?*
Yes
No
IP Stream Determination
Stream
Attach agent authorization letter:* 20220630 ToG Signed.pdf 70.45KB
PDF only
Agent/Consultant Information
How would you like to receive your
determination letter?*
Name of Agent: *
Company Name:*
Email Address:*
Project Information
USPS
Email
Kim Williams
DRG
[e-mail]
Has anyone form DWR done a previous site visit?*
Yes
• No
Other

Date of Visit:
Site Information
Nearest Highway/Street: *
Nearest Town: *
Nearest Named Stream: *
River Basin: *
County: *
Pitt
Casey Drive
Grifton
Contentnea Creek
Neuse
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
Click the upload button or drag and drop files here to attach document
Meadowbrook_Fig.2_TopographicMap.pdf 1.68MB
Pdf file type only
TOPO map look up: https://viewer.nationalmap.gov/basic/
Please attach a map of the site indicating project boundaries on the NRCS Soil Survey.
Click the upload button or drag and drop files here to attach document
NRCS.pdf
Pdf file type only
387.43KB
Soil Survey Link: https://www.nres.usda.gov/wps/portal/nres/surveylist/soils/survey/state/?stateld=NC
Latitude and Longitude
Please provide the Latitude and Longitude for physical location for the determination that. If you have a physical
address you can look up the Latitude and Longitude by typing in an address or filling out the information
manually.
Choose below how you would like to provide this information.
Address Lookup
Manually
Latitude:
Longitude:
Misc attachments:
35.376756
-77.424727
By digitally signing below, I certify that:
Meadowbrook_PreliminaryDelineationS...
21-22.pdf
pdf or kmz file types only
1.45MB
o I have given true, accurate, and complete information on this form;
o I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions Act")
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the "Determination Request" form."

Signature
Date Submitted: 7/6/2022
Initial Review
ID#* 20150524
Version* 2
Do you want to send for review? * • Yes No
Select Reviewer: * Robert Tankard:eads\rbtankard
Select Regional Office: * Washington Regional Office - [phone]

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Meadowbrook
Pitt County, NC DAVEY • ® Figure 2
Resource Group Topographic Map
March, 2022 3805 Wrightsville Avenue
DRGNCW22.077 Wlmington, NC 28403
[phone]

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Map Source: 2020 NC OneMap Scale applies to 11X17" print.
Meadowbrook
Pitt County, NC DAVEY ® Section 404/401 Delineation
Resource Group Preliminary Sketch
3/21/22 3805 Wrightsville Avenue
DRGNCW22.077 Wilmington, NC 28403
[phone]

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DAVEY
Resource Group
AGENT AUTHORIZATION FORM
TO WHOM IT MAY CONCERN:
I/we,the undersigned, hereby authorize Davey Resource Group to act as our agent in the
determination of jurisdictional wetland boundaries on the subject property, Meadowbrook By
way of this form, I/we additionally authorize access to the site by representatives of the US
Army Corps of Engineers and/or the NC Division of Coastal Management for the purpose of
reviewing the flagged wetland boundary and providing a final jurisdictional determination. Any
questions regarding the jurisdictional wetland determination should be directed to Davey
Resource Group.
Please provide the following information:
Property Address and Parcel ID Number: 0 Casey Drive; Grifton,NC
Parcel ID #82267
Current Property Owner Name: Town of Grifton
Owner Address,Phone Number, & Email Address:
Address: PO Box 579; Grifton, NC 28530i�
Email: 740 a./n moisic q�� ���-1'"�o, G0"-.
Phone: 2 2 -- S'2 ' - �I
Notice:This authorization,for liability& professional courtesy reasons,is valid only for government officials
to enter the property when accompanied by Davey Resource Group staff. Please call DRG to arrange a site
meeting prior to visiting the site.
MP (&K R. Li RCN, Tvwri rc4"' r—'TtY,
Print Owner's Name
77/____
Owner's Signature
C / h
Date
Phone:[phone]
3805 Wrightsville Ave.,Suite 15,Wilmington,NC 28403
daveyresourcegroup.comlcarolinas

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION"
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps)to enter upon the property herein described for the purpose of conducting on-
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I,the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
M R.V Vs . IA)PrClQ EA) , ThJn/ vr-- &P. tEiUPo
Print Name
Capacity: E Owner A.Authorized Agents
3 O -2`ti.-
Date
A4......" 1/4,..,
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
nI intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
nI intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
I7 ( I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
I intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
ElI intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
HA Corps JD is required in order obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
I believe that the site may be comprised entirely of dry land.
nOther:
3 For NCDOT requests following the current NCDOT/USACE protocols,skip to Part E.
4 If there are multiple parcels owned by different parties,please provide the following for each additional parcel on a
continuation sheet.
5 Must provide agent authorization form/letter signed by owner(s).
Version:May 2017 Page 3