20210020 Ver 3_Musselshell NOB WaRO-DWR Stream Det_express_20220106

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
NORTH CAROLINA
Environmental Qualify
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
James Clifton Pollock, Gloria H Thomas, Charles C Mitchell, Elvin Lee Jr., Elvin James III
1b. Responsible Party (for LLC)
Same as above
lc. Mailing Address
James Pollock Gloria Thomas Charles Mitchel Elvin Lee Jr.
2307 HWY 11 S 296 Hughes Plantation Rd 11530 Old US 70 PO Box 213
Kinston, NC 28504 Pollocksville NC 28573 Cove City NC 28523 Trenton NC 28585
252-560-1948 252-637-0211 252-671-3684
ld. Telephone Number
See above
le. NA
See above
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
Either side of Highway 41 between Cove City and Trenton in Craven County NC.
3. Agent / Consultant Information
3a. Agent/ Consultant Name
Barrett Jenkins
3b. Company
Restoration Systems, LLC
3c. Mailing address
1101 Haynes Street, Suite 211 Raleigh NC 27609
3d. Telephone no.
512.230.0424
3e. Email address
[e-mail]
4. Project / Site Information
4a. Name of project
Musselshell
Nutrient Offset
Bank
4d. River Basin
Neuse 04
4b. County
Jones
4e. Lat/Long
35.116225, -77.338622
4c. Nearest Named Stream
Musselshell
Creek
4F. Number Stream
Calls
1
5. Project Description (attach plan if available) Permanently restore 200 foot buffer on either side of the features shown on the attached
map. This project may overlap with the Kingsfield Buffer Mitigation Site (Ecoterra/NCDMS).
6. Has anyone from DWQvisited the
site?
Y
X
N
Staff Name: Allen Stewart
Date of Visit:
February 22, 2021
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 a
Note: Submittals on Friday after 12:00 pm
Will be stamped as received on the
Next business day
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

LANDOWNER AUTHORIZATION FORM
PROPERTY LEG DESCRITION: /q 3 © 11.2. j 1.
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Deed Rook:
Parcel ID Number: (3) yLigCM9 (87 l0o g ctio90q 4La/oo
Street Address:0 1 1)S 1 K-‘'► C-i ILS a I I'2 jr. C 9
/6q eiviA Jee t
() 111.E k r e ld ZA 1140 Elul,, Lee
Property Owner (please print: EIV r 5. Lee , �.
Property Owner (please print):
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The undersigned, registered property owner(s) of the above property, do hereby authorize
AIe con
(Contractor/Agent/Project Manager)
of Pesk-orak:kor\ �i ��v►S / L-C-
(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)
-Po T c x, 13
1rert7A NC_ a23f�S
Property Owner Telephone Number:
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
(:) �-�1- � L�
(Property Ownetuthorized Siture)
7//�� /
(Date)
(Property Owner Authorized Signature) (Date)
'Name of full delivery staff member (full -deliveries) or DMS project manager (design -bid -build).
2Name of company (full -deliveries) or DMS (design -bid -build).

LANDOWNER AUTHORIZATION FORM
PROPERTYxLE La
(�
AL DESCRITION: q
Deed Book: (4 LEI Page: / Y
Parcel ID Number: 41-1 I6171 7Y//oo
Street Address:
County:
Property Owner (please print:
Property Owner (please print):
eie'77-1z1 / ,'/cc XQ//
The undersigned, registered property owner(s) of the above property, do hereby authorize
(Contractor/Agent/Project Manager)'
of�I�l�'G^ ) '� S
(Name of Contractor/Agent F rm/Agency)2
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)
II c`_?D ( l2 S 7 a 0
Property Owner Telephone Number:
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
a;,4
(Property Owner Authorized Signature)
(Date)
(Property Owner Authorized Signature) (Date)
Name of full delivery staff member (Full -deliveries) or DMS project manager (design -bid -build).
'Name of company (full -deliveries) or DMS (design -bid -build).

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION: �
Deed Book: �5L)c j Page: { O County: �Q' eS
Parcel ID Number: ltL 13 r gl€Q
S. foal
Street Address:
Property Owner (please print:
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Property Owner (please print):
The undersigned, registered property owner(s) of the above property, do hereby authorize
(Contractor/Agent/Project Manager)'
of e s-c,--�oA si.es �L1
(Name of Contractor/Agent Firm/Agency)'
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)
2 07- lq;604,„,,,, ))
/K 7 n I NC- r 5-6 l
Property Owner Telephone Number: foL) 5 c - I Ll U
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
/X.-A(2_ cc-12/A)
Signature)
Authorized
(l'rc crt, Owner Signature) (Date)
(Property Owner Authorized Signature)
(Date)
'Name of full delivery staff member (full -deliveries) or DMS project manager (design -bid -build).
Name of company (full -deliveries) or DMS (design -bid -build).

Property Owners(s) Address:
(if different from above)
LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book: j o c
Parcel ID Number:
Page: a-
I-119 0 4o (7qV /60
Street Address: ) ` 100) g S p
County: -flPS
Property Owner (please print: C for )1. 1 kM e tS
Property Owner (please print):
The undersigned, registered property owner(s) of the above property, do hereby authorize
J-1 f �� c1 ldw
(Contractor/Agent/Project Manager)'
of510 r ������ ��,-��rtis, L�L
(Name of Contractor/Agent Firrii/Agency)2
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.
aoi( 1-\ L s
701l oc k v'llie 7 I�1C ? 7 3
Property Owner Telephone Number:
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) (Date)
(Property Owner Authorized Signature) (Date)
'Name of full delivery staff member (full -deliveries) or DMS project manager (design -bid -build).
2Name of company (full -deliveries) or DMS (design -bid -build).

TITRE
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