20200753 Ver 1_Determination Request_20200605

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:* Dickinson Avenue Extension Properties - Pitt County Tax Parcel
Nos. 07914 and 22777
Is this a transportation project?* f Yes r No
What type of request is this?* V Buffer IP Stream Determination
F Isolated Wetland rJ Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* 4 Life Properties LLC
Responsible Party: (for LLC, Corporations, businness, agency, etc.)
Telephone Number:
How would you like to received your determination?*
F V -11
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
c:
r
Attach agent authorization letter:* Parcel 07914 Agent Executed.pdf 91.31KB
Parcel 22777 Agent Executed.pdf 25.27KB
FDF only
Agent/Consultant Information
How would you like to receive your r IJSPS
determination letter?* r Email
Name of Agent:* Stuart Bryan
Company Name: * ESI Terracon
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
r
r
r

Date of Visit:
I
Nearest Highway/Street:*
Dickinson Avenue EXT
Nearest Town:*
Greenville
Nearest Named Stream:*
Greens Mill Run
River Basin:*
Tar -Pamlico
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
Topo.pdf 4.36MB
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
Soils.pdf 7.67MB
1974 Pitt County Soil Survey Sheets.pdf 5.79MB
Rif file type only
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.
r Address Lookup
r Manually
Latitude: 35.5855
Longitude: 77.4218
Misc attachments: Aerial.pdf 7.61MB
pdf 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:*
6/5/2020
20200753
F Yes r No
Robert Tan kard:eads\rbtan kard
Washington Regional Office - [phone]

USACE/NCDWR Agent Authorization Form
Property/Site: Dickinson Avenue Subdivision
Address of Site: Dickinson Avenue
Parcel Identification Number (PIN): 07914
Owner Information:
Name:
Address:
Telephone Number:
Fax Number:
E-mail Address:
4 Life Properties LLC
1698-E Arlington Boulevard
Greenville. NC 27858
1rerracon
Property Owner Certification:
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
and/ or the North Carolina Division of Water Resources (NCDWR) to enter upon the property
herein described for the purpose of conducting on -site investigations and issuing a determination
associated with Waters of the U.S (WOTUS) subject to Federal/State jurisdiction under Section
404 and 401 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899.
Terracon, as designated by the current property owner, is the authorized consultant to coordinate,
schedule, and provide supplemental information to both agencies in support of this verification
and/or permit application. A /_�T1
Property Owner Signature:
Date:�-
Terracon Consultants inc. 2401 Brentwood Roan; Su;te 107, Raleigh, NC 28208-3608
P:919-873-2211 F:919-873-9555 terracon.com

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 07914
STREET ADDRESS: North of Dickinson Ave near intersection with
Williams Rd.
Please print:
Property Owner: '� ��,>e �an''i- / C
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Stuart Bryan (912-220-1893) ESI Terracon
(Contractor / Agent)
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
894 Darrel Drive, Greenville, NC 27834
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
A iz Signature
Date:f��/
Authorized Signature
Date:

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS:
22777
North of Dickinson Ave near intersection with
Williams Rd.
Please print: Roman Catholic Diocese of Raleigh
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Stuart Bryan (912-220-1893)
bf
(Contractor / Agent)
ESI Terracon
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
7200 Stonehenge Drive, Raleigh, NC 27613
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorize Signature
Date: I q G V
Authorized Signature
Date:

SMemorialDrCr e stl i n eBlvd
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Cl ub P inesDrAllen RdE lls w orthDrAllendaleDrCoun tryClubDrSpringForestRd
Johns H opkinsDrD ickinson A ve EXTThomas Langston Rd
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Te a kw o o d D r
Copyright:© 2013 National Geographic Society, i-cubed
Project Location
Pitt County, North Carolina
Dickinson Avenue
E
0 20001000
Feet
Project Study Area
HL207069
May 2020
CW/JH
Figure:
Project:
Date:
Drwn/Chkd:
1
D:\GIS\2020\HL207068_DickinsonAvenue\Maps\Topo.mxd Date: 4/16/2020 9:07:22 AM
Source: 2011 National GeographicSociety/ESRI, i-cubed seamless USGSquadrangles (Greenville SW, NC); ProjectStudy Area approximated by ESI based onPitt County Parcel Data.
Location and extent is approximate.
Pamlico River Basin
Disclaimer: The information depicted in this file is forinformational purposes only and was not preparedfor and is not suitable for legal or engineeringpurposes. This information presented is not forregulatory review and is intended for use only by aProfessional Land Surveyor prior to regulatoryreview.
El l s w o r th D r
WilliamsRdDickinsonAveEXTSWA
SWB
TAa
TAb
WA
WB
WC
WD
Greens Mill Run
SBAd
SBAa
SBAe
SBB
SBAb SBAc
Potential Wetlands and Waters of the US
Pitt County, North Carolina
Dickinson Avenue
E
0 500250
Feet
Project Study Area
Potential Wetlands and Waters of the US
Potential Non-Wetland Waters of the US (Pond)
Potential Non-Wetland Waters of the US (Stream)
Potential Non-Wetland Waters of the US (Tributary)
HL207069
May 2020
CW/JH
Figure:
Project:
Date:
Drwn/Chkd:
3
D:\GIS\2020\HL207068_DickinsonAvenue\Maps\Aerial.mxd Date: 5/2/2020 9:30:44 AM
Source: Latest High-Resolution NC Statewide Orthoimagery, NC OneMap Server;Project Study Area approximated by ESI based on Pitt County Parcel Data.
Note: Vegetation removal or alteration of soils or hydrology after initial site evaluation canaffect jurisdictional status and may require re-evaluation of wetland boundaries.
Location and extent is approximate.
Pamlico River Basin
Disclaimer: The information depicted in this file is for informational purposes only and was notprepared for and is not suitable for legal or engineering purposes. This information presented is notfor regulatory review and is intended for use only by a Professional Land Surveyor prior to regulatoryreview.
Bb
Bb
Ra
ExB
ExA
ExA
OcB
CrB2
CrB2
ExB
Ra
CrB2
CrB2
NrB
WaB
AyB Ly
ExA
WaB
Ly
NrB
NrB
ExA
GoA
NrA
Ra
Ra
ExA
WaBGoAGoA
NrB
Ly
NrA
WaB ExB
OcB LyWaBExB
NRCS Soils
Pitt County, North Carolina
Dickinson Avenue
E
0 500250
Feet
Project Study Area
Soil Boundaries
HL207069
May 2020
CW/JH
Figure:
Project:
Date:
Drwn/Chkd:
2
D:\GIS\2020\HL207068_DickinsonAvenue\Maps\Soils.mxd Date: 4/16/2020 11:39:44 AM
Source: Latest High-Resolution NC StatewideOrthoimagery, NC OneMap Server; NRCSdigital Soil Survey of Pitt County, 2009;Project Study Area approximated by ESIbased on Pitt County Parcel Data.
Location and extent is approximate.
Pamlico River Basin
Disclaimer: The information depicted in this file is forinformational purposes only and was not preparedfor and is not suitable for legal or engineeringpurposes. This information presented is not forregulatory review and is intended for use only by aProfessional Land Surveyor prior to regulatoryreview.
BbGoALyNrANrBRaWaB
Byars loamGoldsboro sandy loam, 0-1% slopesLynchburg fine sandy loamNorfolk sandy loam, 0-1% slopesNorfolk sandy loam, 1-6% slopesRains fine sandy loamWagram loamy sand, 0-6% slopes
Soil Mapping Units
Dickin son Avenue
Exten sion Properties -
Pitt County Tax Parcel
Nos. 07914 and 22777
1974 NRCS Soil Survey of Pitt County
Sheets 40, 41, 48 and 49
Legend
Pitt County Tax Parcels
1000 ft
N➤➤N
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