20211156 Ver 1_4806_WaRO-DWR Stream Det_express_20211025

ROY COOPER
Governor
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
Casey and Traci Jones
lb. Responsible Party (for LLC)
lc. Mailing Address
3752 Woodman Rd., Greenville, NC 27858
ld. Telephone Number
252-493-2721
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):
Pitt County, NC. Hwy 43 s of Greenville at Intersection of Hwy 43 S. and Woodman Rd
3. Agent / Consultant Information
3a. Agent/ Consultant Name
Scott Stone
3b. Company
Environmental and Soil Service Inc
3c. Mailing address
P.O. Box 82, Pinetops, NC 27864
3d. Telephone no.
252-531-3471
3e. Email address
[e-mail]
4. Project / Site Information
4a. Name of project
Jones Site
4d. River Basin
Neuse
4b. County
Pitt
4e. Lat/Long
35.446866, -77.264071
4c. Nearest Named Stream
Clayroot
Swamp
4F. Number Stream
Calls
1
5. Project Description (attach plan if available)
Previously submitted
6. Has anyone from DWQ visited the site?
Y
NTMK
Staff Name:
Date of Visit:
7. Does DWR staff have permission to
access this property?
Y Yes
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]
Note: Submittals on Friday after 12:00 pm
Will be stamped as received on the
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 Division of Water Resources - Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
PROPERTY LEGAL DESCRIPTION:
LOT NO.
STREET ADDRESS:
NTH CARCSLINA
£z v tortmentaf Quality
SAMPLE AGENT AUTHORIZATION FORM
PLAN NO. PARCEL ID:
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
, of
(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:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Print Name Authorized Signature
Date: Date:
North Carolina Department of Environmental Quality (Division of Water Resources - Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

Relative Elevations
Bottom of Trench
L1 Beginning (42.71')
End (42.88')
(41.71')
L2 Beginning (42.34')
End (42.59')
(41.34')
L3 Beginning (42.30)
End (42.38')
(41.30')
L4 Beginning (42.05')
End (42.15')
(41.05, )
TMB (44.00')
Top of Telephone
Pedestal
jiO <f
'
-3\
1
- ^
n
Proposed Septic System Layout
Number of Bedrooms: 2
Design Waste Water Flow: 240 GPD
Proposed Primary Septic System
Conventional LTAR: 0.3 GPD/sqft
Septic System Type: Conventional
(Rock) 6" Cap
Number of Drain Lines: 4
Length of Drain Lines: 67'
Proposed Repair Area
Conventional LTAR: 0.3 GPD
Septic System Type: Conventional
(Rock) 6" Cap
Number of Drain Lines: 3
Length of Drain Lines: 89'
/ "df
S
Environmental and Soil Service Inc
P.0 Box 82
Pinetops, NC 27864
IAIIII fl
TBM
Assigned 43
Elevation
, (44.00')
• Soil Boring Locations
Proposed Supply Line
- 25' Septic System Setback From Ditch
Ditch
— Proposed Drain Line
Proposed Septic Tank and D-box
Proposed House Location
. • •::1 Proposed Trench
Pro osed Re air Area
Parcel: 81056 Pitt County, NC
Client: Traci Jones
Esri Community Maps Contributors, State of North Carolina DOT,
OpenStreetMap, Microsoft, Esri, HERE, Garmin, SafeGraph, INCREMENT
P, METI/NASA, USGS, EPA, NPS, US Census Bureau, USDA, NC CGIA,
Maxar, Microsoft
10/19/2021
Proposed Driveway
Q Approximate Property Lines
r 10' Septic System Setback
1' Contour
Contours
— Index Contour
— Contour
A
Feet
0 30 60
Figure 1

Parcel: 81056 Pitt County, NC
Client: Traci Jones
Copyright:© 2013 National Geographic Society, i-cubed, USGS, ESRI,
ArcGIS
Environmental and Soil Service Inc
P.0 Box 82
Pinetops, NC 27864
10/20/2021
Feet
0 750 1,500

PITT COUNTY, NORTH CAROLINA — SHEET NUMBER 70
(Joins sheet 65)
Bd
(Joins sheet 75) 2 510000 FEET
LoA LoA 2 525 000 FEET
This map is one
NORTH CAROLMA
PITT COUNTY,

North Carolina Department of Environmental Quality
Request for Express Permit Review
For DEQ Use ONLY
Reviewer:
Submit:
Time:
Confirm:
FILL-IN all the information below and CHECK the Permit(s) you are requesting for express review. CaII and Email the completed form to the
Permit Coordinator along with a completed DETAILED narrative, site plan (PDF file) and vicinity map (same items expected in the application
package of the project location. Please include this form in the application package.
• Asheville Region -Alison Davidson 828-296-4698;alison.davidson(c.ncdenr.gov
• Fayetteville and Raleigh Regions -David Lee 919-791-4204; david.lee(a,ncdenr.gov
• Mooresville and Winston-Salem Regions -Paul Williams 336-776-9631; paul.e.williams(a)ncdenr.gov
• Washington Region -Lyn Hardison 252-948-3842 or lyn.hardison(cncdenr.gov
• Wilmington Region -Cameron Weaver 910-796-7265 or cameron.weaverRncdenr.gov
NOTE: Project application received after 12 noon will be stamped in the following work day.
Project Name: JONES SITE County: PITT
Applicant: CASEY & TRACI JONES Company:
Address: 3752 WOODMAN RD City: GREENVILLE, State: NC Zip: 27858-
Phone: [phone], Fax: --, Email: [e-mail]
Physical Location:INTERSECTION OF HWY 43 S. AND WOODMAN RD.
Project Drains into CLAYROOT SWAMP waters — Water classification C;Sw,NSW (DWR Surface Water Classifications Map)
Project Located in NEUSE River Basin. Is project draining to class ORW waters? N, within''/2 mile and draining to class SA waters N or within 1 mile and
draining to class HQW waters? N
Engineer/Consultant: SCOTT STONE Company: ENVIRONMENTAL AND SOIL SERVICE INC
Address: P.O. BOX 82 City: PINETOPS, State: NC Zip: 27864-
Phone: [phone], Fax: _ _ Email: [e-mail]
PLEASE PROVIDE ESTIMATED INVESTMENT AND EXPECTED EMPLOYMENT, IF AVAILABLE
$ # JOBS
SECTION ONE: REQUESTING A SCOPING MEETING ONLY
❑ Scoping Meeting ONLY ❑ DWR, ❑ DCM, ❑ DEMLR, ['OTHER:
SECTION TWO: CHECK ONLY THE PROGRAM (S) YOU ARE REQUESTING FOR EXPRESS PERMITTING
❑ 401 Unit ❑ Stream Origin Determination: _ # of stream calls — Please attach TOPO map marking the areas in questions
❑ Intermittent/Perennial Determination: 1 # of stream calls — Please attach TOPO map marking the areas in questions
❑ 401 Water Quality Certification ❑ Isolated Wetland ( linear ft or acres)
❑ Riparian Buffer Authorization ❑ Minor Variance ❑ Major General Variance
Provided Existing Permits
related to this Project
SW
SW
SW
NPDES
NPDES
WQ
WQ E&S
E&S
Other
❑ State Stormwater ❑ General ❑ SFR, ❑ SFR < 1 ac. ❑ Bkhd & Bt Rmp, ['Clear & Grub, ❑ Utility ['Other
❑ Low Density ❑ Low Density -Curb & Gutter # Curb Outlet Swales ❑ Off -site [SW (Provide permit #)]
❑ High Density -Detention Pond _ # Treatment Systems ❑ High Density -Infiltration _ #Treatment Systems
❑ High Density -Bio-Retention _ # Treatment Systems ❑ High Density —SW Wetlands _ # Treatment Systems
❑ High Density -Other _ # Treatment Systems / ❑ MOD:❑ Major ❑ Minor ❑ Plan Revision ❑ Redev. Exclusion SW (Provide permit #)
❑ Coastal Management
❑ Excavation & Fill ❑ Bridges & Culverts
❑ Upland Development ❑ Marina Development ❑ Urban Waterfront
❑ Structures Information
❑ Land Quality ❑ Erosion and Sedimentation Control Plan with acres to be disturbed. (CK # & Amt.
(for DEQ use))
SECTION THREE — PLEASE CHECK ALL THAT IS APPLICABLE TO YOUR PROJECT (for both scoping and express meeting request)
Wetlands on Site ❑ Yes ® No
Wetlands Delineation has been completed: ❑ Yes ❑ No
US ACOE Approval of Delineation completed: ['Yes ❑ No
Received from US ACOE ['Yes ❑ No
Fee Split for multiple permits: (Check#
Buffer Impacts: ❑ No ❑ YES: _acre(s)
Isolated wetland on Property ['Yes ® No
404 Application in Process w/ US ACOE: ❑ Yes ® No Permit
For DEQ use only
Total Fee Amount $
SUBMITTAL DATES
Fee
SUBMITTAL DATES
Fee
CAMA
$
Variance (•
Maj;
•
Min)
$
SW (■
HD,
•
LD,
•
Gen)
$
401:
$
LQS
$
Stream Deter,
$
NCDEQ EXPRESS June 2019

•
i
argaiSak
Environmental and Soil
Service, Inc.
PROPERTY DESCRIPTION:
P.O. Box 82
Pinetops, N.0 27864
[phone] Office
[phone] Cell
E-mail: [e-mail]
Agent Authorization Form
+y.. _ • r
-1424
ESS
Site: Casey & Traci Jones Site Size: 0.99 acres (By Pitt County OPIS)
Tax Parcel:.8)056 County: Pitt
Site Address: NA
Location: Pitt County — Hwy 43 S. at intersection of Hwy 43 and Woodman Rd.
Property Owner: Casey and Traci Jones
The undersigned, registered property owners of the above noted property, do hereby authorize
Scott Stone of Environmental and Soil Service, Inc. (Contractor / Agent) (Name of consulting firm) to act
on my behalf and take all actions necessary to determine if a regulated stream exist on the property
described above. The final determination will be made by NCDWR or persons or agencies authorized by
NCDWR.
Consultant Address: P.O. Box 82, Pinetops, NC 27864
Consultant Telephone: [phone] Consultant E-Mail: [e-mail]
Property Owner's Address (if different than property above): 3752 Woodman Rd., Greenville, NC 27858
Telephone: [phone] E-mail: [e-mail]
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge.
Print Name:
C\c_ \ t-'c- S
Authorized Signature:
Title:
Date: