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Home My WebLink About20201091 Ver 1_Determination Request_20200723Please 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:* Shady Grove Is this a transportation project?* f Yes r No What type of request is this?* PF Buffer r IP Stream Determination r Isolated Wetland r Stream Check all that apply. Owner Information Name on the Recorded Deed:* Douglass Allen Jernigan Responsible Party: EBX, LLC a Resource Environmental Solutions entity (for LLC, Corporations, businness, agency, etc.) Telephone Number: 919-738-0632 How would you like to received your determination?* 1— 141 Email Address:* jmceachran@res.us Is there an agent or consultant responsible for the request?* Yes c' Attach agent authorization letter:* Jernigan Farms LOA Nutrient EXECUTED.pdf PDF only Agent/Consultant Information How would you like to receive your f USPS determination letter?* r Email Name of Agent:* Jamey MEachran Company Name:* EBX, LLC a Resource Environmental Solutions entity Email Address:* jmceachran@res.us Project Information Has anyone form DWR done a previous site visit?* f Yes r No f Other 53.54KB Date of Visit: Site Information Nearest Highway/Street:* Thunder Swamp Road Nearest Town:* Mount Olive Nearest Named Stream:* Thunder Swamp River Basin:* Neuse County: * Wayne Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo. aick the upload button or drag and drop files here to attach document Figure 2 - USGS - Shady Grove.pdf 1.47MB FtIF 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. aick the upload button or drag and drop files here to attach document Figure 4 - NRCS Soils -Shady Grove.pdf 864.13KB FtIF 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. f Address Lookup f Manually Latitude: 35.220 Longitude:-78.111 Misc attachments: Figure 3 - E)asting Conditions - Shady 2.5MB Grove.pdf Figure 5 - Historical Imagery - Shady 2.05M6 Grove.pdf Figure 1 - Vicinity - Shady Grove.pdf 2.96MB pdr or kne 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: Initial Review .................................................... ID#* Version* Do you want to send for review?* Select Reviewer:* J uae r. 7/23/2020 20201091 r Yes r No Chris Pullinger:eads\rcpullinger Select Regional Office:* Washington Regional Office - (252) 946-6481 LANDOWNER AUTHORIZATION FORM PROPERTY LEGAL DESCRITION: Deed Book:2832 Page:255 County: Wayne Parcel ID Number: 2563662469 Street Address: Shady Grove Road and Thunder Swamp Road, Mount Olive. NC 28365 Property Owner (please print: dQ,f Property Owner (please print: The undersigned, registered property owner(s) of the above property, do hereby authorize Resource Environmental Solutions, the NC Department of Environmental Quality, and the US Army Corps of Engineers, their employees, agents or assigns to have reasonable access to the above referenced property for the evaluation of the property as a potential stream, wetland and/or riparian buffer mitigation project, including conducting stream and/or wetland determinations and delineations, as well as issuance and acceptance of any required permit(s) or certification(s). Property Owners(s) Address: 781 Thunder Swamp Road, Mount Olive, NC 28365 (if different from above) Property Owner Telephone Number: - "1(� " 13 S - O (03 Z I/We hereby certify the above information to be true and accurate to the best of my/our knowledge. 144 AZ 4-e� %- Owner Autho ' d Si ture) (Date) Owner Authorized iggpt re) (Date) 0 0 61 -:4 shwy Grove Ch Jobca Grove Ch 6117 0 Cem �I 2 Ceirn A ice 5S Cam. Ch A _ _ Cem ClIDN 11— i � - - t r!- � qua "t'��J ,4' - �- - : ' - , `. Legend Cem Proposed Easement 90 by Figure 2 - USGS Quadrangle Date 7/14/2020 W E (Mount Olive 1977) Drawn by: MDE Shady Grove Mitigation Project Checked by: JRM �� 0 1,000 2,000 Wayne County, North Carolina 1 inch = 2,000 feet Feet I I F-- l�lixx%,A a Rp JI Ob' ry 117 U6'r"Y FA 7134 117 1135 1107 1138 1974 niversity of - _' R nt Olive 2 55 z 1135 gton ham Rocky Chapel Hill 0 e Raleigh ° Wilson � o t Legend i t7 421 Proposed Easement azt Gold oro _p Service Area - 03020201 u 431 - 14 Digit HUC - 03020201170030 Cal Yp � Shady Grove azt C 5-Mile Aviation Zone Mitigation Project Clinton 35.220,-78.111 O N Date: 7/23/2020 Figure 1 - Project Vicinity ae �- E s Shady Grove Mitigation Project Drawn by: MDE Checked by: JRM res 0 0.5 1 Wayne County, North Carolina 1 inch = 1 miles Miles I r' Legend Proposed Easement Project Parcel Stream --- -- Ditch N Date: 7/14/2020 Figure 3 - Existing Conditions w e Drawn by: MDE s Shady Grove Mitigation Project _ Checked by: JRM 0 300 600 Wayne County, North Carolina 1 inch =600 feet Feet prols