1234 Ver 1_Determination Request_20230131

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:*
Is this a transportation project?*
Is this request for a mitigation site?
What type of request is this?*
Owner Information
1525 Baker Road Site
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Name on the Recorded Deed: * Tarheel Storage Trucker Parking LLC
Responsible Party : Rana Humayun
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 336-991-1105
Email Address: * tarheelstoragel @gmail.com
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * 4a Agent Authorization. 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]
Project Information
.........
Has anyone form DWR done a previous site visit?*
Yes
No
Other
IP Stream Determination
Stream
110.81 KB

Date of Visit:
Site Information
Nearest Highway/Street: * Baker Road
Nearest Town: * High Point
Nearest Named Stream: * Richland Creek
River Basin: * Cape Fear
County: *
Guilford
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
BAKER ROAD- FIGURE 2.pdf 1.67MB
Pdf file type only
TOPO map look up: https://viewer.nationaImap.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
BAKER ROAD- FIGURE 3A.pdf 997.37KB
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.
Address Lookup
Manually
Latitude: 35.944893
Longitude:-79.961289
Misc attachments: NC DWQ Stream Identification Form.pdf 54.26KB
pdf or kmz 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
Michel% Measda�
Date Submitted: 1/31/2023
Initial Review
.................................................
ID#* 1234
Version *
Do you want to send for review?* Yes No