20231415 Ver 1_Determination Request_20231106

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:*
Is this a transportation project?*
Is this request for a mitigation site?
What type of request is this?*
Owner Information
Greenville Self Storage Site
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
IP Stream Determination
Stream
Name on the Recorded Deed: * Larkspur Acquisitions, LLC (under option to purchase)
Responsible Party : Mr. David Bernstein
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 786-540-4001
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * 02_SIGNED_AgentAuthorizationForm. pdf 324.24KB
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Brandon Wyatt
Company Name:* Kimley-Horn
Email Address: * [e-mail]
Project Information
.........
Has anyone form DWR done a previous site visit?*
Yes
No
Other

Date of Visit:
Site Information
Nearest Highway/Street: * NC Route 264
Nearest Town: * Greenville
Nearest Named Stream:* Swift Creek
River Basin: * Tar -Pamlico
County: *
Pitt
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
Fig2_GreenvilleSelfStorage_USGS.pdf 866.86KB
Pdf file type only
TOPO map look up: https://viewer.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
Fig4_GreenvilleSelfStorage_NRCS.pdf 767.13KB
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: 35.571977
Longitude:-77.412118
Misc attachments:_GreenvilleSelfStorage_BufferDetermin... 5.84MB
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;
o 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)
o 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');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the "Determination Request' form."

Signature
Date Submitted: 11/6/2023
Initial Review
.................................................
ID#* 20231415
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Paul Nyarko:Paul. Nyarko
Select Regional Office: * Washington Regional Office - [phone]