Ver _Determination Request_20240130

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
5309 Fortunes Ridge Dr
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Name on the Recorded Deed: * Gwen Littman
Responsible Party : (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 9734188636
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
IP Stream Determination
Stream
Attach agent authorization letter: * 5309 Fortunes Ridge Dr - Agent Form.pdf 52.23KB
PDF only
Agent/Consultant Information
...................................................................................................................................................................
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Leroy Jackson
Company Name:* RAI Experts, LLC
Email Address: * [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other

Date of Visit:
Site Information
Nearest Highway/Street: Fortunes Ridge Dr
Nearest Town: * Durham
Nearest Named Stream:* Unknown
River Basin: * Not Sure
County:
Durham
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
5309 Fortunes Ridge Dr - Survey_Plot
2.38M6
Plan.pdf
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
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 Address Lookup
provide this information. Manually
Project Look Up Address: Street Address
5309 Fortunes Ridge Drive
Address Line 2
City
Durham
Postal / Zip Code
27713-9353
Latitude:
Longitude:
Misc attachments:
35.9279316
-78.9258739
pdf or kmz file types only
State / Province / Region
NC
Country
US
By digitally signing below, I certify that:
o 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
• I intend to electronically sign and submit the "Determination Request' form."
Signature
agtarJ 01,44 Or
Date Submitted: 1/30/2024
Initial Review RRO
Do you want to send this for review? Yes No