20220694 Ver 1_Buffer and/or Stream Determination Request_20220517

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
DANNY SMITH
Director
NORTH CARCLINA
Errrirorrrrierrtat 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
Kate Vincent Kittrell
1 b. Responsible Party (for LLC)
1c. Mailing Address
2771 Dickinson Ave. Ex, Greenville, NC 27834
1d. Telephone Number
919-247-5599
1e. Email address
2. Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
2719 Dickinson Ave. Ex., Greenville, NC
3. Agent / Consultant Information
3a. Agent/ Consultant Name
Kevin C Martin
3b. Company
Soil & Environmental Consultants, PA
3c. Mailing address
8412 Falls of Neuse Rd., Ste. 204, Raleigh, NC 27615
3d. Telephone no.
919-270-7941
3e. Email address
[e-mail]
4. Project / Site Information
4a. Name of project
NA
4d. River Basin
TAR
4b. County
Pitt
4e. Lat/Long
35.593/-77.403
4c. Nearest Named Stream
Greens Mill
Run
4F. Number
Stream Calls
1
5. Project Description (attach plan if available)
6. Has anyone from DWQ visited the
site?
N
Staff Name:
Date of Visit:
7. Does DWR staff have permission to
access this property?
y
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
North Carolina Department of Environmental Quality (Division of Water Resources - Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: Please see attached legal description
LOT NO. as labelled in plan PLAN NO. any other identifier PARCEL ID: 13111 PIN 4677445372
STREET ADDRESS: 2721 US 13 Greenville, NC 27834
Please print:
Property Owner: Kate Vincent Kittrell
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Kevin C. Martin, of Soil & Environmental 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):
2719 Dickinson Avenue, Greenville NC 27835
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Kate Vincent Kittrell
Authorized Print Name Authorized Signature
Date: 5-16-2022 Date: 5-16-2022

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Project Number: Map Title: N
15281.W1 Figure 2 - Soil Survey 0 1,000 2,000
Project Manager: 1 1 1 1 1 1 1 1 1
KM 2719 Dickenson Ave Feet
Scale: Pitt County, NC
1" = 1000' S&
Source:Pitt County Soil S
Date: Survey
F Soil& Environmental Consultants, PA
0 5/17/2 0 2 2 Sheet 41 E C 8412 Falls of Neuse Road,Suite 104,Raleigh,NC 27615•Phone[phone]•Fax[phone]

Project Number:
15281.W1
Project Manager:
KM
Scale: 1 1000
Date:
05/17/2022
Map Title:
Figure 1 - USGS
2719 Dickenson Ave
Pitt County, NC
Source: 2019 USGS Greenville
Southwest Quad
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EC
C I'Center for Geographic In
1,000 2,000
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Soil & Environmental Consultants, PA
8412 Falls of Neuse Road, Suite 104, Raleigh, NC 27615 • Phone: [phone] • Fax: [phone]
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2771 DICKINSON A
OwnerAddressl:
OwnerAddress2:
OwnerAddress3:
GREENVILLE NC 27834
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