20180164 Ver 1_Agent Authorization_20180205

Water Resources
Environmental Quality
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
DWR Use Only: Project N: LO O(o
Date Received: 1l (,f
Buffer Applicability / Stream Origin Determination Request
Property Owner Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded Deed Wilbert Futrell
1b. Responsible Party (for LLC)
lc. Mailing Address 2218 Futrell -Robson Rd., Bethel, NC 27812
Id. Telephone Number 252-714-5518 1 le. Email address [e-mail]
2, Address of Property or Location of Project Site (including county, nearest named town, and highway or road name/ number):
Property address is 2034 Futrell Robson Rd., Bethel, Pitt County, NC. From Greenville take Hwy 11 north. Turn right onto Staton Mill
Rd. Go about 1 mile and turn left onto Futrell Robson Rd. Site is about Y mile on left.
3.
Agent / Consultant Information
3a. Agent/ Consultant Name
Scott Stone
3b. Company
Environmental and Soil Service, Inc.
3c. Mailing address
PO Box 82, Pinetops, INC 27864
3d. Telephone no.
252-531-3471
1 3e. Email address [e-mail]
4. Project/ Site Information .
4a. Name of project
Residential site
4c. Nearest Named Stream
Grindle Creek
4b. County
Pitt
4d. River Basin
Tar
S. Project Description (attach plan if available)
A residence is planned for the site. Soil that meets the criteria for aseptic system is limited; therefore, the area adjacent to the ditch
plays a role in the permitting of a septic system.
6. Has anyone from DWq visited the site? I N Staff Name: Date of Visit:
7. 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?
8. Please return form to: Anthony Scarbraugh
943 Washington Square Mall
Washington, NC 27889
Email: [e-mail]
-'% Nothinq Compares' -
Note: Submittals on Friday after 12:00 pm
Will be stamped as received on the
Next business day
State of North Carolina I Environmental Quality I Water Resources -Water Quality Regional Operations Section -Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
252-946-6481

Please contact Anthony Scarbraugh at the Washington Regional Office at [phone] if you have any
questions.

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lvirwmental
mW 4 pw P.O. Box 82
SerAcej Inc.
Pinetops, N.0 27864
Ph [phone]
Fax [phone]
E-mail: [e-mail]
Agent Authorization Form
LEGAL DESCRIPTION:
Wilbert Futrell Site Size: +1- 1.0 ac I Parcel #: Portion of 08098 County:
Son: 2034 Futrell Robson Rd. Bethel NC Pitt County)
Pro erty Owner: Wilbert Futrell
Th undersigned, registered propTthanroperty
f the above noted property, do here y authorize
c St ne, of Environm n I andInc. (Contractor / Agent) (Name of nsulting firm)
to ct on my behalf and take all acary to obtain a stream determinatio from NCDWR.
Pro erty Owner's Address (if differerty above):
2218 Futrell Robson Rd. Bethel NTel phone: [phone]
We hereby certify the above Informted In this application Is true and ac�urate to the best of
our knowledge.
Print Name:
�rAF&
Aut orized Signature:
owner

Scarbraugh, Anthony
From: Scott Stone <[e-mail]>
Sent: Monday, February 05, 2018 1:20 PM
To: Scarbraugh, Anthony
Subject: Re: [External] Stream call, Pitt Co
Attachments: 4414 -Signed agent authorization.jpg
Attached is the signed agent authorization
Thanks, Scott Stone
Environmental and Soil Service, Inc.
P.O. Box 82
Pinetops, NC 27864
Ph: 252-531-3471
E-mail: [e-mail]
-----Original Message -----
From: Scarbraugh, Anthony <[e-mail]>
To: Scott Stone <[e-mail]>
Sent: Fri, Feb 2, 2018 9:40 am
Subject: RE: [External] Stream call, Pitt Co
Soundsgood!
Anthony Scarbraugh
Environmental Senior Specialist
Division of Water Resources -Water Quality Regional Operations
Department of Environmental Quality
252 948 3924 office
anthonv.scarbrauohCcilncdenr.00v
943 Washington Square Mall
Washington, NC 27889
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
From: Scott Stone [mailto:[e-mail]]
Sent: Friday, February 02, 2018 9:35 AM

To: Scarbraugh, Anthony <[e-mail]>
Subject: Re: [External] Stream call, Pitt Co
CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to
[e-mail].
OK. I have sent one to client. He has not returned it yet.
I will send as soon as I receive it.
Thanks, Scott Stone
Environmental and Soil Service, Inc.
P.O. Box 82
Pinetops, NC 27864
Ph: 252-531-3471
E-mail: esssoil(cDaol.com
-----Original Message -----
From: Scarbraugh, Anthony<anthonv.scarbraugh(o).ncdenr.gov>
To: Scott Stone <esssoilCd,)aol.com>
Sent: Fri, Feb 2, 2018 9:32 am
Subject: RE: [External] Stream call, Pitt Co
Scott,
We are also requiring a signed agent authorization prior to scheduling an onsite visit. Please see the most updated
stream determination form and agent authorization.
Thanks,
Anthony Scarbraugh
Environmental Senior Specialist
Division of Water Resources — Water Quality Regional Operations
Department of Environmental Quality
252 948 3924 office
anthony.scarbraugh(o)ncdenr.gov
943 Washington Square Mall
Washington, NC 27889
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
From: Scott Stone [mailto:[e-mail]]
Sent: Friday, February 02, 2018 9:27 AM
To: Scarbraugh, Anthony <[e-mail]>
Subject: [External] Stream call, Pitt Co

CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to
[e-mail].
Anthony,
Please find attached a request for a stream call in Pitt Co. The client did not want to pay the $200 fee charged by Pitt Co.
Please let me know when yourself or Chris can make it to the site.
Thanks, Scott Stone
Environmental and Soil Service, Inc.
P.O. Box 82
Pinetops, NC 27864
Ph: 252-531-3471
E-mail: esssoil(Waol.com

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