20210207 Ver 1_Express Stream Determination Request_20210201

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
NDRTH CAPOLIP4A
F�vPrenr��iit�f �r�aNl~y
Express Buffer Applicability / Stream Origin
Determination Request
Property Owner Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded Deed
Magnolian Run, LP
1b. Responsible Party (for LLC)
Frankie Pendergraph
1c. Mailing Address
3924 Browning Place, Raleigh, NC 27609
1d. Telephone Number
919-861-6092
1e. Email address
[e-mail]
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
The property is located in Goldsboro, NC, Wayne County. It is on the south side of Arrington Bridge Road (SR 1915) approximately 860
feet southeast of the intersection of Arrington Bridge Road and South John Street.
3. Agent / Consultant Information
3a. Agent/ Consultant Name
Jeffrey L. Kornegay, PE, PLS
3b. Company
B. R. Kornegay, Inc.
3c. Mailing address
300 E. Walnut St., Goldsboro, NC 27530
3d. Telephone no.
919-735-5886
3e. Email address
[e-mail]
4. Project / Site Information
4a. Name of project
Magnolia Run 4d. River Basin
Neuse
4b. County
Lenoir 4e. Lat/Long
35.3147 /-77.7838
4c. Nearest Named Stream
Moseley Creek 4F. Number Stream
Calls
1
5. Project Description (attach plan if available)
Proposed apartment complex.
6. Has anyone from DWC. visited the site?
y
N X
Staff Name:
Date of Visit:
7. Does DWR staff have permission to
access this property?
y X
N
8. Attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or NRCS Soil Survey
If you are unable to locate either of these maps, please contact the DWR Washington Regional Office for assistance.
DWR Use Only: Is this determination for the purpose of Buffer mitigation? Nutrient offset credit?
9. Please return form to: Chris Pullinger
943 Washington Square Mall Note: Submittals on Friday after 12:00 pm
Washington, NC 27889 Will be stamped as received on the
Email: [e-mail] Next business day
Please contact Chris Pullinger at the Washington Regional Office at [phone] if you have any
questions.
North Carolina Department of Environmental Quality IDivision of Water Resources - Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

NORTH CAROLINA
Envirownewa! Quulif y
ROY COOPER
MIC14AEL S. REGAN
LINDA CULPEPPER SAMPLE AGENT AUTHORIZATION FORM
nr, ,t,
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 34959through 34986
STREET ADDRESS: Sweetbay Lane, La Grange NC 28S51
Please print:
Property Owner: Magnolia Run, LP
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Jeffrey L. Kornegav, PE, PLS of B. R. Kornegav, Inc.
(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):
3924 Browning Place, Raleigh, NC 27609
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Frankie Pendergraph, registered agent
Authorized Print Name
North Carolina Department of Environmental Quality IlXvision or Water Resources - Washington Regional Office
943 Washington Square Mall, Washington. North Carolina 27889
252-946-6481

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