20220357 Ver 1_Determination Request_20220210

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: *
Mann Farm Road Tract
Is this a transportation project?*
Yes No
Is this request for a mitigation site?*
Yes No
What type of request is this?*
Buffer
Isolated Wetland
Check all that apply.
Owner Information
Name on the Recorded Deed:* Mann Farm Partners LLC
IP Stream Determination
Stream
Responsible Party : Thomas Rawl - Mann Farm Partners LLC
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: [phone]
How would you like to received your determination?*
USPS Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * SIGNED_Agent-Owner
Authorization Mann Farm Partners
LLC.pdf
PDF only
Agent/Consultant Information
.................................................................................................................................................................
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Alyssa Ricci
Company Name:* WithersRavenel
Email Address:* [e-mail]
Project Information
873.66KB

Has anyone form DWR done a previous site visit?*
Yes
• No
Other
Date of Visit:
Site Information
Nearest Highway/Street:
Nearest Town: *
Nearest Named Stream:*
River Basin: *
County: *
Mann Farm Road
Greenville
Hardee Creek 28-97
Tar -Pamlico
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
Click the upload button or drag and drop files here to attach document
USGS.pdf 355.83KB
USGS Location.pdf 583.67KB
Pdf file type only
TOPO map look up: https:Hviewer.nationalmap.gov/basic/
Please attach a map of the site indicating project boundaries on the NRCS Soil Survey.
Click the upload button or drag and drop files here to attach document
Pitt Co Soil Survey.pdf 3.04MB
Pdf 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.
Address Lookup
Manually
Latitude: 35.586545
Longitude:-77.317022
Misc attachments: Aerial.pdf 551.38KB
Buffer Determination Exhibit.pdf 556.06KB
pdf or kmz file types only
By digitally signing below, I certify that:
o I have given true, accurate, and complete information on this form;

a 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)
a 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');
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a 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:*
r -Y,4r + r4141 cf
2/10/2022
20220357
• Yes No
Robert Tan kard:eads\rbtan kard
Washington Regional Office - [phone]

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People. 'Your success.
The undersigned contract purchaser, Bann Farm Partners. LLC (Client) does hereby appoint
WithersRavenel, Inc. as his, her, or it's agent for the purpose of petitioning the appropriate
local, state and federal environmental regulatory agencies (US Army Corps of Engineers, NC
Division of Water Quality, NC Division of Coastal Management, local municipalities, etc.) for:
a) review and approval of the jurisdictional boundaries of onsite jurisdictional areas
(wetlands, streams, riparian buffers, etc.) and/or; b) preparation and submittal of appropriate
environmental permit applications/requests for the following two parcels located in
Greenville, Pitt County, NC:
® NC PIN: 4697926673 +62 51-acre parcel located at 1130 Mann Farm Road
® NC PIN: 5607021497 +2 0-acre parcel located near 1130 Mann Farm Road
The Client does hereby authorize that said agent has the authority to do the following acts
on behalf of the owner:
(1) To submit appropriate requests/applications and the required
supplemental materials;
(2) To attend meetings to give representation on behalf of the Client.
(3) To authorize access to subject property for the purpose of
environmental review by appropriate regulatory agencies.
This authorization shall continue in effect until completion of the contracted task or
termination by the Client.
Agent's Name, Address & Telephone:
WithersRavenel Inc.
115 MacKenan Drive
Cart/ NC 27511
Tel [phone]
Date: I 12- &- -Z
Signature of Client:
(Name - Print) (Title)
(Signature)
1�
Mailing Address
City Stbit Zip
Phone:
C\
Email:
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