20201150 Ver 1_Determination Request_20200709

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:*
Is this a transportation project?*
What type of request is this?*
Owner Information
Name on the Recorded Deed:*
Responsible Party:
Telephone Number:
Pungo Nutrient Offset Mitigation Bank
f Yes r No
r% Buffer rJ IF Stream Determination
r Isolated Wetland r Stream
Check all that apply.
Engel Farms Inc.
Kevin Engel
(for LLC, Corporations, businness, agency, etc.)
919-604-9314
How would you like to received your determination?*
1— 141
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
Yes
c'
Attach agent authorization letter:* Sig ned_Landowner_Authorization_Form... 284.88KB
FDF only
Agent/Consultant Information
How would you like to receive your r IJSPS
determination letter?* r Email
Name of Agent:* Raymond Holz
Company Name:* Restoration Systems, LLC
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
r
r
r
Date of Visit:

Site Information
Nearest Highway/Street:*
Free Union Chruch Rd.
Nearest Town:*
Pinetown, NC
Nearest Named Stream:*
Pungo Creek
River Basin:*
Tar -Pamlico
County: *
Beaufort
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 document
Pungo—Viability Request —Figure 03 -
2.27MB
2019 USGS Quad_.pdf
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.
dick the upload button or drag and drop files here to attach documnt
Pungo Viability Request Figure 04 -
2.25MB
1995 NRCS Soil Manuscript_ pdf
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: 35.551670
Longitude:-76.781149
Misc attachments: Pungo - VIABILITY-ASSESSMENT-
8.55M6
REQUEST-FORM_07-01-2020_ pdf
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');
o 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:
Initial Review
ID#*
Version*
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
0
7/9/2020
20201150
r Yes r No
Chris Pullinger:eads\rcpullinger
Washington Regional Office - [phone]

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book: _ 1641 Page: 00625 County: Beaufort
Parcel ID Number: GPIN - 6666-06-5494
Street Address: No Physical Address, Beaufort Co. GIS - 4717 Free Union Church Rd. Pinetown NC 27865
Site Specific Coordinates 35.551670,-76.781149
Property Owner (please print: Kevin Engel, President Engel Farms Inc.
Property Owner (please print):
The undersigned, registered property owner(s) of the above property, do hereby authorize
Raymond Holz of Restoration Systems, LLC
(Contractor/Agent/Project Manager); (Name of Contractor/Agent Firm/Agency)Z
to take all actions necessary for the evaluation of the property as a potential stream, wetland and/or
riparian buffer mitigation project, including conducting stream and/or wetland determinations and
delineations, as well as issuance and acceptance of any required permit(s) or certification(s). I
agree to allow regulatory agencies, including the NC Division of Water Resources, to visit the
property as part of these environmental reviews.
Property Owners(s) Address:
(if different from above)
7423 Cabin Hill Faun Lane
Hanover VA 23069
Property Owner Telephone Number: [phone]
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
(Property Owner Authorized Signature)
6--,Zl i O rq 0
(Date)
(Date)
'Name of full delivery staff member (full -deliveries) or DMS project manager (design -bid -build).
ZName of company (full -deliveries) or DMS (design -bid -build),

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Q Site Parcel (NC PIN 6666-06-5494): +/- 470 Acres
750 ft 1 in = N
RESTORATION SYSTEMS, LLC SCALE. � Pungo Nutrient Offset Site
1101 HAYNESST, SUITE211 DATE: 06-2020 Figure 3 - 2019 USGS Topo Quad (Pinetown)
RALEIGH, NC 27604
PHONE. [phone] SITE:PUNGO Beaufort County, NC
FAX : [phone]
This map and all data-,ttainetl within are supplied as is wen n—.,tty. Restnratiwn systems, I1c expressly Aerial Imagery: (C) ESRI
tlisd.ims resp-sibilityfor tlamages or liability from any claims that may arise out oft he use or misuse of this map. It is
the sde responsibility of the user to dd—ine if the tlata - this map is compatible with the user's neetls. This map Feet Coordinate S stem:
not createtl as survey tlata, nor shoultl it be usetl � such. It is the user's responsibility to obt ain proper survey y
tlalapreparetl byali-nsetl surveyor, whererequiretl by law. 0 187.5 375 750 1,125 1,500 NAD_1983_SP_NC_RIPS _3200_Ft.
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Site Parcel (NC PIN 6666-06-5494): +/- 470 Acres
750 ft 1 in =
RESTORATION SYSTEMS, LLC SCALE. Pungo Nutrient Offset Site
1101 HAYNESST, SUITE211 DATE: 06-2020 Figure 4 - 1995 NRCS Soil Manuscript
RALEIGH, NC 27604
PHONE. [phone] SITE:PUNGO ( Map 8 - Pineville, Beaufort County, NC
FAX : [phone]
This map and all data-nfidnetl within are supplied as is wen n warranty. Restnratiwn systems, ITC expressly Aerial Imagery: (C) ESRI
tlisd.ints resp-sibilityfor tlamages or liability from any claims that may arise out oft he use or misuse of this map. It is
the sde responsibility of the user to tletermine if the tlata on this map is compatible with the user's needs. This map Feet Coordinate S stem:
not createtl as survey tlata, nor sh-Id ft be usetl m such. It is the user's responsibility to obt in proper survey y
tlalapreparetl bya li-nsetl surveyor, whererequiretl by law. 0 187.5 375 750 1,125 1,500 NAD-1983_SP—NC_RIPS _3200_Ft.
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