20181711 Ver 1_Buffer and/or Stream Determination Request_20181214

Water Resources
*
Please note: fields marked with a red asterisk beloware required. You will not be able to submit the form until all
mandatory questions are ans�red.
Project Name:* Arlington Boulevard Improvements
Is this a transportation project?* r Yes C' No
What type of request is this?* r Buffer rJ IP Stream Determination
r Isolated Wetland r Stream
Check all that apply.
Owner I nformation
Name on the Recorded Deed:* City of Greenville
Responsible Party : City of Greenville
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: (xxx)xxx-xxxx
How would you like to received your determination?*
� USPS N7 Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
C•' Yes
C' No
Attach agent authorization letter:* AgentAuthorization Form.pdf 276.91KB
FiIF only
Agent/Consultant Information
How would you like to receive your C' USPS
determination letter?* r Email
Name of Agent:* Todd Tripp
Company Name:* The East Group
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit? *
�' Yes
C' No
�' Other

Staff Name: Unknown-Date also unknown but
previous City project
Date of Visit: 12/1/2016
Site Information
Nearest Highway/Street:* Arlington Boulevard
Nearest Town:* City of Greenville
Nearest Named Stream:* Greens Mill Run
River Basin:* Tar-Pamlico
County:*
Pitt
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
Qick the upload button or drag and drop files here to attach docurrent
USGS Online Mapping Excerpt.pdf 165.37KB
Wf 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.
(7ick the upload button or drag and drop files here to attach docurrent
Soils Map.pdf 132.44KB
Wf 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.
C' Address Lookup
C•' Manually
Latitude: 35°35'29.70"N
Longitude: 77°23'10.43"W
Misc attachments: Location of Stream Call.pdf 207.34KB
pdF or larn file types only
Bydigitallysigning below, I certifythat:
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 AcY')
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 AcY');
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 RequesY' form."
Signature
Date Submitted:
Initial Review
ID#*
Version *
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
Sign
12/ 14/2018
20181711
1
r Yes C' No
Garcy Ward:eads\gpward
Washington Regional Office - [phone]