HomeMy WebLinkAbout20190415 Ver 1_Determination Request_20190402Stream Origin/Buffer Applicability Determination
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 ansviered.
Project Name:* Mark Suggs irrigation pond
Is this a transportation project?* r Yes r No
What type of request is this?* V Buffer r- IP Stream Determination
r- Isolated Wetland V Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* Mark A Suggs
Responsible Party: (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 252-714-7701
How would you like to received your determination?*
r` USPS W Email
Email Address:* msuggs@pgemc.com
Is there an agent or consultant responsible for the request?*
r Yes
r No
Attach agent authorization letter:* Agent Authorization. pdf 141.04KB
FDF only
Agent/Consultant Information
........................................................................................................................................................................................
How would you like to receive your r USPS
determination letter?* r Email
Name of Agent:* William Wescott
Company Name:* Wescott Environmental Services,
Inc
Email Address:* wescottenvironmentalservices@gm
ail.com
Project Information
Has anyone form DWR done a previous site visit?
r Yes
r No
r Other
Date of Visit:
Site Information
Nearest Highway/Street:* NC 121
Nearest Town:* Farmville
Nearest Named Stream:* Little Contentnea Creek
River Basin:* Neuse
County:*
Pitt
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
nick the upload button or drag and drop files here to attach docurrent
USGS Topographic Map.pdf 124.07KB
Rif 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.
nick the upload button or drag and drop files here to attach docurrent
1974 Pitt County Soil Survey.pdf 151.94KB
Rif file type only
Soil Survey Link: https://wmw.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.
f Address Lookup
r Manually
Latitude: 35.60814
Longitude: 77.62663
Misc attachments: Maps and photos.pdf 2.67MB
pdf or ITrz 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:
Initial Review
IN*
Version*
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
Sign
4/2/2019
20190415
f• Yes f No
Chris Pullinger:eads\rcpullinger
Washington Regional Office - (252) 946-6481
[252] 402-9662
Wescott
Environmental
Services, Inc.
wescottenvironmentalservices@gmaiLcom
Agent Authorization Form
In
I, Mark Sues , hereby give permission to Wescott Environmental Services, Inc. to access
the following property for the purpose of identifying and delineating waters and wetlands. I
also give permission to the appropriate State and/or Federal agencies to accompany Wescott
Environmental Services, Inc. to verify the findings.
Wescott Environmental Services, Inc. is hereby authorized to act on my behalf when
interacting with Federal, State and Local agencies and for all plan submission applications and
permit submittals.
Parcel ID: 84659
Location: Property is located in Pitt County, approx. 2.3 miles west of Farmville at
4770 Hwy 121 W., Farmville, NC.
Project coordinates: 35.60814 N -77.62663 W
Name: Mark Suggs
Address: P.O. Box 722 Ai arized Signature
Farmville, NC 27528
Phone: 252-714-7701
Email: msuggs@pgemc.com
Date
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