20061223 Ver 1_Application_20060809

MaJpass 8 Associates
Engineering and Planning
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Letter of Transmittal
gate: 7272006
Attention: LAURIE DENNISON
Re: BROOKSTONE SUBDIVISION
.lob No. P-776
2.0051 223
To: NCDENR ~ ~~
303'
NCDWQ-401 DIVISION ~ ~~~ ~i ! ~ (~ ~ ~ ~~ ~~~
2321 CRABTREE BLVD ~ (Ijpv'" L-- ~--z ~fd
RALEIGH, NC 27604 ~ {,~. ~ ~~~~ u~ ~~~~ ~ ~il~~
~ 2006
~ DENF~~ - 1~47E!? Q'
WE ARE SENDING YOU: ^ Attached ^ Under separate cover via DlriVk - 17.,,
~~~tC~t ~YETI.ANDS Akita 5 fc Q Awtj ER SRAfdCH
^ Shop Drawings ^ Prints ^ Plans ^ Samples ^ Specfications
^ Copy of Letter ^ Change Order ^
Co ies Date No. Descri '
1 7262006 COVER LETTER
1 7272006 PCN
1 7272006 AGENT AUTHORIZATION
2 7262006 Stormwater Calculations for Subdivision incl Construction Plans for Phase One

THESE ARE TRANSMITTED As Checked Below:
^ For Approval ^ Approved As Submitted
^ For Your Use ^ Approved As Noted
^ As requested ^ Returned for corrections
^ For review and comment ^
^ FOR BIDS DUE
^ Resubmit copies for approval
^ Submit copies fa distribution
^ Return corrected prints
^ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO: FIIe
SIGNED:
If enclosures are not as noted, kindly notify us at once.

Malpass & Associates
Engineering & Planning
1645 E. Arlington Blvd Suite D
Greenville, NC 27858
Priono: ("252j 756-1780
Fax: [phone]
Wednesday, July 26, 2006
North Carolina Division of Water Quality
Surface Water Protection Section - 401 Oversight
2321 Crabtree Blvd
Raleigh, NC 27604
RE: Brookstone Subdivision Phase One PCN- BUFFER RULES ONLY
To Whom It May Concem:
Brookstone Subdivision is located near Winterville Township in Pitt County, North Carolina. The entire
subdivision has been designed. Enclosed with this transmittal are stormwater control calculations for
the entire site. The subdivision construction plan is in iwo phases corresponding to two parcels
separated by a buffered stream. The first phase will be development of frontage along NCSR 1714
(Church Street Extension) this is the first parcel of land under development. The second phase of
construction will involve the second parcel which is only accessible by crossing the buffered stream.
This PCN is for the first phase of construction only and does not Concem the stream crossing and
related permitting. Therefore, no USACE permit is associated with this phase. We are only proposing
to introduce a stormwater outfall to the buffered stream at this time. Due to the existing topography, it is
not possible to achieve diffuse flow through the buffer. The local government is requesting written
approval of this non-diffuse discharge. Please review the calculations for Pond 1 at this time. Once your
review staff is satisfied that the stormwater control plan is adequate, please send written confirmation
to:
Pitt County Planning
ATTN: Mr. Jonas Hill
1717 West Fifth Street
Greenville, NC 27834
A second PCN, for the stream crossing, will be submitted when the US Army Corps of Engineers has
visited the site, made the jurisdictional determination and provided the corresponding permit number.
This PCN will include the stream crossing as well as an additional stormwater outfall for phase two
(Pond 2). The full calculations are being submitted with this PCN for phase 1, please retain these for
future reference, if possible.
If you have any questions, comments or concerns do not hesitate to contact me at [phone] at
the business address above or via a-mail at [e-mail].
Sincerely,
Jamie Midgette, EI
~+
~ ~ ~,~

303dF1~~ ~ ~ Y
Office Use Only' Form Version March OS
2006223
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter °NOt Appnca~ie~~ or ~ruP--.~
I. Processing
1. Check all of the approval(s) requested for this project:
^ Section 404 Permit ® Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
^ 401 Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N/A
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ^
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ^
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ^
II. Applicant Information D ~~
1. Owner/Applicant Information ,JL)~ Z ~; 2006 _.,
Name: Kenneth Smith Properties Inc
Mailing Address: 1588 NC HWY 102 East eENk - wn,r~k cw~.~r~ r
Ayden NC 28513
Telephone Number:~252) 746-7628 Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: JAMIE MIDGETTE
Company Affiliation: MALPASS & ASSOCIATES
Mailing Address: 1645 E. ARLINGTON BOULEVARD
SUTIE D
GREENVILLE NC 27858
Telephone Number: 252-756-1780 Fax Number: 252-756-2098
E-mail Address: JAMIE~a M~LPASSANDASSOCIATES.COM
Page 5 of 13

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north azrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is cleazly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no lazger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans aze
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Brookstone Subdivision Phase One
2. T.LP. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): 10508
4. Location
County: PITT Neazest Town: Winterville
Subdivision name (include phase/lot number): Brookstone Subdivision Phase One
Directions to site (include road numbers/names, landmarks, etc.): TAKE NC HWY 11
SOUTH FROM GREENVILLE TO NCSR 1131 (REEDY BRANCH ROAD) HEAD EAST
ON REEDY BRANCH TO NCSR 1714 (CHURCH STREET EXTENSION) THE SITE IS
LOCATED APPROXIMATELY 2 000 FEET NORTH OF THIS INTERSECTION.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 35.504751 °N -77.406712 °W
6. Property size (acres): +/- 21
7. Name of nearest receiving body of water: Swift Creek
8. River Basin: NEUSE
(Note -this must be one of North Cazolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mapsl.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: SITE IS CURRENTLY AGRICULTURAL
ALL ADJACENT PROPERTIES ARE EITHER CURRENTLY WOODED OR
AGRICULTURAL
Page 6 of 13

10. Describe the overall project in detail, including the type of equipment to be used:
THE PROJECT INVOLVES THE ROUGH AND FINE GRADING ASSOCIATED WITH
INSTALLATION OF APPROXIMATELY 1800 LF OF ROAD, AND VARIOUS
UTILITY INSTALLATIONS GRADING WILL INVOLVE: MOTOR GRADERS,
TRACTORS BULLDOZERS LOADERS ROLLERS POWER SHOVELS, ETC. ___
11. Explain the purpose of the proposed work:
THIS PHASE OF THE PROJECT IS CREATING A RESIDENTIAL SUBDIVISION OF
33 LOTS ON APPROXIMATELY 21 ACRES.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
DWQ will be visiting the site Monday July 31. A site visit by USACE is being scheduled.__
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
The next~hase of the subdivision will require a stream crossing and permitting from USACE
and DWQ Due to time constraints the USACE has not issued a permit and thusly, we have
omitted the stream crossing from this phase. Once USACE has visited the site and issued a
pernut• a PCN for the crossing will be submitted to DWQ for review.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
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wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Introduction of a stormwater
discharge RCMP) into buffered stream. The use of a level spreader is not possible given
existing_topography No impacts will be made to wetlands or alon eg xisting stream beds.
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)

Total Wetland Impact (acres) 0.00
3. List the total acreage (estimated) of all existing wetlands on the property: 0.00 ACRES
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact
Perennial or
Intermittent? Average
Stream Width
Before Im act Impact
Length
(linear feet) Area of
Impact
(acres)

Total Stream Impact (by length and acreage) 0 0.0
Page 8 of 13

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact

Site Number
(indicate on ma)
Name of Waterbody
(if applicable)

Type of Impact Type of Waterbody

(lake, pond, estuary, sound, bay,
ocean, etc.) Area of

Impact
(acres

Total Open Water Impact (acres) 0.00
6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres): 0.0
Wetland Impact (acres): 0.000
Open Water Impact (acres): 0.000
Total Impact to Waters of the U.S. (acres) 0.0
Total Stream Impact (linear feet): 0
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes ®No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
The USACE has made no determinations on site.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ®uplands ^ stream ^ wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): EXCAVATION
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): STORMWATER MANAGEMENT
Current land use in the vicinity of the pond: AGRICULTURAL
Size of watershed draining to pond: +/-21 AC Expected pond surface area: 0.22 AC
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
Page 9 of 13

were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The site's lot sizes as well as road and ri t of way widths are in accordance with local
ordinances and provide a design that is cost effective and development that is financially viable
to the owner The proposed impact is necessary for stormwater release from the site. Stormwater
BMPs have been utilized and are desi ng ed by NCDENR standards.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minirnal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/sti•m~ide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
Page 10 of 13

[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): 0
Amount of buffer mitigation requested (square feet): 0
Amount of Riparian wetland mitigation requested (acres): 0
Amount ofNon-riparian wetland mitigation requested (acres): 0
Amount of Coastal wetland mitigation requested (acres): 0
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federaUstate/local) funds or the use of
public (federal/state) land? Yes ^ No
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ^ No ^
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ^ No ^
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ® No ^
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Page 11 of 13

D~ -
Zone* Impact
(s uare feet) Multiplier Required
Miti ation
1 450 3 (2 for Catawba)
2 300 1.5

AUG ~ [i~~so
Total DENR • WATER QUALITY
1'1rETLANDS AND STORMWgTER BRANCH
* Zone 1 extends out 30 feet perpendicular from the top of the neaz bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement,- or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. This is a temporary disturbance necessary to
install the outlet nine. The area will be_ restored after the installation is complete. Erosion
control measures will be in place to protect the adjacent buffer.
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level.
THE EXISTING IMPERVIOUS AREA IS «1% THE PROPOSED IMPERVIOUS AREA IS
24%. A STORMWATER CONTROL PLAN IS PROVIDED WITH THIS SUBMITTAL.
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
ALL WASTEWATER WILL BE TREATED BY CONTENTNEA METROPOLITAN
SEWERAGE DISTRICT. NCDENR WWTF PERMIT NO. NC0032077. THE FAST TRACK
APPLICATION PROCESS IS CURRENTLY UNDERWAY.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Isthis anafter-the-fact permit application? Yes ^ No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ® No ^
223
D
Page 12 of 13

Zone* Impact
(s uare feet) Multiplier Required
Miti ation
1 3 (2 for Catawba)
2 1.5
Total
* Zone i extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additiona120 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
Stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level.
THE EXISTING IMPERVIOUS AREA IS «1% THE PROPOSED IMPERVIOUS AREA IS
24%. A STORMWATER CONTROL PLAN IS PROVIDED WITH THIS SUBMITTAL.
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
ALL WASTEWATER WILL BE TREATED BY CONTENTNEA METROPOLITAN
SEWERAGE DISTRICT. NCDENR WWTF PERMIT NO. NC0032077. THE FAST TRACK
APPLICATION PROCESS IS CURRENTLY UNDERWAY.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Is this anafter-the-fact permit application? Yes ^ No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ® No ^
Page 12 of 13

If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
This project is the first phase of a two phase subdivision upon completion the development will
consist of 74 lots on 49 acres. Further residential developments on adiacent property is a
possibilitybut not planned in the near future. Existing Neuse river buffer regulations address
stormwater quality for developments located in this region.
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
' ~2~-~
Applies t/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13

AGENT AUTHORIZATION FORM
RE: WETLANDS/STREAMIWATER BODIES
PROJECT: Brookstone Subdivision
OWNER: Kenneth Smith Properties, Inc.
DATE: July 26, 2006
[phone]
To Whom It May Concern:
I, the current rop~rty owner, hereby authorize Malnass & Associates Engineering and Planning to act
on my behalf as agent in processing of permit applications and all supplemental information required
for approval of said permit applications pertaining to property described as Parcel Numbers 10508 8~
70650.
Properly Owner
Kenneth Smith Prooerties. Inc.
Owner
1588 NC HWY 102 East: Ayden. NC 28513
Address
Phone
KENNET SMITH
Own
27r o ~
Signatu Date
Authorized Agent
Malpass & Associates Engineering and Planning
Owner
1645 E Arlington Boulevard. Suite D; Greenville. NC 27858
Address
[phone]
Phone
' nature
. ~~~~o~
Date