20210948 Ver 1_Buffer and/or Stream Determination Request_20210514

ROY COOPER
GOVCIllOr
MICHAEL S. REGAN
secretary
LINDA CULPEPPER
Director
NORTH CAROLINA
Environmental Quality
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)
la. Name(s) on Recorded Deed
Karl Brown Manning, Pamela J. Manning
ib. Responsible Party (for LLC)
N/A
lc. Mailing Address
3731 Dickinson Avenue, Greenville, NC 27834
ld. Telephone Number
252-229-2276
le. Email address
[e-mail]
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
3731 Dickinson Avenue, Greenville, NC 27834
3. Agent / Consultant Information
3a. Agent/ Consultant Name
Igor Palyvoda
3b. Company
Baldwin Design Consultants, PA
3c. Mailing address
1700-D East Arlington Boulevard, Greenville, NC 27858
3d. Telephone no.
252-756-1390
3e. Email address
[e-mail]
4. Project / Site information
4a. Name of project
The Dickinson
4d. River Basin
Tar -Pamlico
4b. County
Pitt
4e. Lat/Long
35.578893,-77.424576
4c. Nearest Named Stream
Greens Mill
Run
4F. Number
, Stream Calls
1
5. Project Description (attach plan if available)
A developer is interested in purchasing the land (Pitt County parcel #14234) with potential blue line stream in order to construct multi-
family type of development with multiple buildings, amenities, etc. and the required utilities to serve those buildings.
6. Has anyone from DWQ visited the
site?
y
X
N
Staff Name: Unknown
Date of Visit:
Approximately 8 years
ago
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
Washington, NC 27889
Email: [e-mail]
Please contact Chris Pullinger at the Washington Regional Office at [phone] if you have any
questions.
Note: Submittals on Friday after 12:00 pm
Will be stamped as received on the
Next business day
D_EQ*5
North Carolina Department of Environmental Quality 'Division of Water Resources - Washington Regional Office
943 Washington Square Mall. Washington, North Carolina 27889
252-946-648 1

DocuSign Envelope ID: BB36B758-811F-4DB2-82CD-743B8E00A34B
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 14234
STREET ADDRESS: 3731 Dickinson Avenue, Greenville, NC 27834
Please print: Karl Brown Manning
Property Owner:
Property Owner: Pamela J. Manning
The undersigned, registered property owners of the above noted property, do hereby authorize
Igor Palyvoda of Baldwin Design Consultants, PA
(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):
Telephone: XXX-XXX-XXXX
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
DocuSigned by: DocuSigned by:
Gov. P Z3,ok , it,--)� ,�
Authorize Signature Authorized Signature
5/10/2021 5/10/2021
Date: Date:

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