1 Ver 1_Determination Request_20230208

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:* Proposed Restaurant
Is this a transportation project?* Yes No
Is this request for a mitigation site? * Yes No
What type of request is this?* Buffer IP Stream Determination
Isolated Wetland Stream
Check all that apply.
Owner Information
Name on the Recorded Deed: * Jovan Holdings LLC
Responsible Party : Joe Pleasant
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 704-906-6488
How would you like to received your determination?*
USPS Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?
Yes
No
Attach agent authorization letter: * 5 2023-01-23 - Completed Agent
366.24K6
Authorization - Lillington, NC.pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Michelle Measday
Company Name:* ECS Southeast LLP
Email Address: * [e-mail]
n

Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street:
Nearest Town: *
Nearest Named Stream:*
River Basin: *
County:
Harnett
E. Cornelius Harnett Blvd
Lillington
Cape Fear River
Cape Fear
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 document
Mount Oak Capital Figure 2.pdf 1.25MB
Pdf 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 document
Mount Oak Capital Figure 3A.pdf 568.1 KB
Pdf 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.
Latitude:
Longitude:
35.417620
-78.802374
Misc attachments: NC DWQ Stream Identification Form -
50.1 KB
Stream.pdf
7 Site Photos.pdf 6.1 MB
2022-10-20 MOC-2202 ALTA Survey.pdf 3.53MB
pdf or kmz 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');
• 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
Mtcl el% Measdal
Date Submitted: 2/8/2023
Initial Review
ID#*
Version *
Do you want to send for review?* Yes No