2019__20190810

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?*
What type of request is this?*
Owner Information
Stream Determination
r Yes r No
F Buffer rJ IP Stream Determination
PF Isolated Wetland V Stream
Check all that apply.
Name on the Recorded Deed:* Rajinder Virk
Responsible Party: Rajinder Virk
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 9195996615
How would you like to received your determination?*
F W
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?
C' Yes
r No
Project Information
Has anyone form DWR done a previous site visit?*
r
Date of Visit:
Site Information
Nearest Highway/Street:* HWY 98, Daniel ST, Mineral Spring
Nearest Town:* Durham
Nearest Named Stream:* Chunky Pipe
River Basin:* Neuse
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 docurrent
Durham Property Record Search.pdf 219.5KB
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 docurrent
Durham Property Record Search.pdf 219.5KB
R1F 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 r Address Lookup
provide this information. r Manually
Latitude: -78.8154
Longitude: 36.0004
M isc attachments: 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');
• 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: 8/10/2019
Initial Review RRO
D# * 2019
Version * 1
Do you want to send this for review? r Yes r No
Select Reviewer: * Rick Trone:eads\rvtrone
Select Regional Office:* Raleigh Regional Office - [phone]