20171286 Ver 1_Buffer and/or Stream Determination Request_20171006

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tNVIKUNMeN I AL QV ALIT
PAT MCCRORY
1 11
DONALD R. VAN DER VAART
5_ JAY ZIMMERMAN
DWR Use Only: Project #
Stream Origin/Buffer Applicability Determination
Required Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
1 a. Name(s) on Recorded Deed
Happy Trail Farms, LLC
1b. Responsible Party (for LLC)
H. E. Whichard, Jr
1c. Mailing Address
P.O. Box 1863 Greenville, NC 27835
1d. Telephone Number
252-916-9028
ie. Email Address
[e-mail]
2. Location of Project Site - please include the county, nearest named town and highway number: This project is located at the
intersection of NCSR 1120 — Jolly Road and NC -11 S in Ayden Township, Pitt County, North Carolina.
3. Has anyone from DWR visited the site?
No
Staff Name
N/A
Date of Visit?
N/A
Additional Requested Information
4. Agent/Consultant Information (if applicable)
4a. Name, Company
Igor Palyvoda, Baldwin Design Consultants, PA
4b. Mailing address
1700-D East Arlington Boulevard
4c. Telephone no.
252-756-1390 Ext. 205
4d. Email address
ipalyvoda@baldwindesignconsultants.
com
5. Project and Site Information
5a. Name of project
Jolly Road (Happy Trail Farms, LLC)
5b. County
Pitt
5c. Nearest Named Stream
Swift Creek
5d. River Basin
Neuse
5e. Provide a brief description of this project (attach site plan if available): The purpose of this project is to rezone this property to
B-2/CCOL. The owner wants to determine whether the existing ditch that runs along his property line is in a riparian buffer or not
in order to let potential future buyers/developers know about possible development/site restrictions near the existing ditch.
Please 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 Regional Office for assistance.
DWR Use Only: Is this stream call for the purpose of: buffer mitigation nutrient offset credit
Please return form to: Anthony Scarbraugh
943 Washinytun Square Mall
Washington, NC 27889 Nate: Submiifals on Friday after 7'1:(1(1 pm
will be stamped as received on fhe
Fax: [phone] next business day.
Email: anthuily.scatbraugh@iiL;denr.goy
Please contact Anthony Scarbraugh at [phone] if you have any questions.
State: ut Nurth Cal uhua I Env n uu.ucutal Quality I Wan Resuuices —Watut Quality Rt5poual Oyciatiuus—Washmgtuu Rugioual Office
943 WashiuHtuu Square Mail. Washiugtuu, NC 27889
252-946-6481

SAMPLE AGENT AUTHORIZATION FORM
PROPLKTY LLGAL DESCRIPTION -
EO I
ESCRIPTION-COI NO. PLAN NO.
STREET ADDRESS: Jolly Road/NC 11 S
Please print:
Property Owner:
Property Owner:
PARCEL ID: 25917
Happy Trail Farms, LLC
The undersigned, registered property owners of the above noted property, do hereby authorise
Igor Palyvoda of Baldwin Design 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):
P.O. Box 1863, Greenville, NC 27835
I elephone:
252-916-9028
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Author iced Signature
Date: 10/4/17
Authorised Signature
Date:

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