20200573 Ver 1_Determination Request_20200417

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:* Grifton PV2 Solar
Is this a transportation project?* f Yes r No
What type of request is this?* PF Buffer r IP Stream Determination
r Isolated Wetland r Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* Thomas A Tyson
Responsible Party: (for LLC, Corporations, businness, agency, etc.)
Telephone Number:
How would you like to received your determination?*
r USPS PF Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
C
Attach agent authorization letter:* Agent Authorization for JD_NC_Grifton
513.66KB
PV2. pdf
PDF only
Agent/Consultant Information
How would you like to receive your f USPS
determination letter?* r Email
Name of Agent:* Seren Homer
Company Name:* Pilot Environmental, Inc.
Email Address:* [e-mail]
riuject Intormation
Has anyone form DWR done a previous site visit?*
Yes
C No
(-- Other

Date of Visit:
Site Information
Nearest Highway/Street:*
Brown Hodges Road
Nearest Town:*
Grifton
Nearest Named Stream:*
Buckleberry Canal
River Basin:*
Neuse
County:*
Pitt
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
aick the upload button or drag and drop files here to attach docurrent
Grifton PV2 USGS Topo_24000.pdf 379.9KB
RiF 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.
nick the upload button or drag and drop files here to attach docurrent
Grifton PV2 Pub Soil Map.pdf 577.71KB
RiF file type only
Soil Survey Link: https://wwvv.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.
f Address Lookup
r Manually
Latitude: 35.377453'
Longitude:-77.386241 °
M isc attachments: pdt or krre file types only
By digitally signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• 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');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit the "Determination Request' form."

Signature
Date Submitted:
Initial Review
ID#*
Version*
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
4/17/2020
20200573
F Yes r No
David May:eads\dlmay
Washington Regional Office - [phone]

AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
es
Property Address: s
Owner Information: y ��
Address:
r
Telephone Number:
Fax Number:
E-mail Address:
e- 1W, COM
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 Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. !o
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.
�&' _74- 1 1 11he ".5
Print Name /�
Capacity: _ py caner Authorized aoo.,.

USGS Topographic Map
Grifton PV2 Solar
Approximate 377-Acre Tract
Grifton, Pitt County, NC
Pilot Project 3225.1
Drawing 1
USGS Topographic Map
Ayden, Gardnerville, Grifton,
and Fort Barnwell, NC Quadrangles
Scale: 1” = 2,000’
LEGEND
Site Boundary
Drawing 2A
NRCS USDA Published Soil Survey
of Pitt County, NC
Published 1974, Sheet 78
Not to Scale
LEGEND
Site Boundary
Published Soil Map
Grifton PV2 Solar
Approximate 377-Acre Tract
Grifton, Pitt County, NC
Pilot Project 3225.1