20191261 Ver 1_Determination Request_20190923

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:* Kittrell Hill
Is this a transportation project?* r Yes r No
What type of request is this?* r% Buffer r IP Stream Determination
r- Isolated Wetland V Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* George E. Moore III
Responsible Party: (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 757-478-4184
How would you like to received your determination?*
r` USPS V Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
r Yes
r No
Attach agent authorization letter:* Agent Authorization_Kittrell Hill.pdf 200.39KB
FDF only
Agent/Consultant Information
.....................................................................................................................................................................
How would you like to receive your r USPS
determination letter?* r Email
Name of Agent:* Scott J. Frederick
Company Name:* Soil, Water, and Environment
Group, PLLC
Email Address:* [e-mail]
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:* Kittrell Hill Road
Nearest Town:* Farmville
Nearest Named Stream:* Old Woman Branch
River Basin:* Neuse
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 docurrant
USGS_Site Map_Kittrell Hill.pdf 340.35KB
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.
Click the upload button or drag and drop files here to attach docurrant
USDA Soils—Site Map_Kittrell Hill.pdf 979.31 KB
Rif file type only
Soil Survey Link: https://vmw.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.
r Address Lookup
r Manually
Latitude: 35°36'40.11 "N
Longitude: 77°32'42.05"W
Misc attachments: Kittrell Hill Road.kmz Less than 1 KB
pdf or lom file types only
By digitally signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• 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")
• 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
• I intend to electronically sign and submit the "Determination Request" form."

Signature
Date Submitted:
Initial Review
ID#*
Version
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
9/23/2019
20191261
F Yes r No
Chris Pullinger:eads\rcpullinger
Washington Regional Office - [phone]

Soft, VVW=l i Fnvimnmmt
Group
32_16 Avers IInva. 5lc U
Ralcigh. NC 27607
(919) R31-1.134
[phone]
[phone] (fax)
AGENT AUTHORIZATION FORM: JURISDICITONAL DETERMINATION/ENTRY
All information to 1be filled in by the current property owner:
Property Address:— _ - �G uc.� >, 3s� 3ti'y0. I I A�
PIN: f 3 ( Lot # (if applicable): Plan 4 (if applicable):
Property Owner (s) (please print); Aeon %G � Roe oe nri 19
Property Owner:
The undersigned, registered property owners of the above property, do hereby authorize
Scott J. Frederick. of Soil. Water. & Environment Group. PLLC c/o EcoTerra Partners,
Raleigh. North Carolina, to act as agent on our behalf in the identification and delineation
of jurisdictional wetlands and streams located on the above property.
We hereby authorize entry upon the property by authorized agents of the United States
Army Corps of Engineers/North Carolina Division of Water Resources to observe and
ensure compliance with Section 401/404 of the Clean Water Act and Buffer Rules.
The above information submitted in this form is true and accurate to the best of our
knowledge.
2 C-� 1 4`
�Client/Owner/ uthorized Signature Date /
Client/Owner/Authorized Signature Date
Property Owne s Address (if different than ( e property abo e)
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City, State Zip
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