20220883 Ver 1_Determination Request_20220629

Stream Origin/Buffer Applicability Determination
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:* HL-0051 Jones Franklin Road at Athens Drive
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:* NCDOT
Responsible Party: NCDOT
(for LLC,Corporations,businness,agency,etc.)
Telephone Number:
How would you like to received your determination?*
USPS Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street:* Jones Franklin Road
Nearest Town:* Cary
Nearest Named Stream:* Simmons Branch
River Basin:* Neuse

County:*
Wake
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
HL-0051 Topographic Map Highlight.pdf 712.26KB
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
HL-0051 NRCS Soil Survey Map
522.61 KB
Highlight.pdf
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: 35.780483
Longitude: -78.720906
Misc attachments: HL-0051 Aerial Highlight.pdf 1.33MB
Kick-out Photos.pdf 611.91 KB
HL-0051 NCDWQ Stream Identification
865.3KB
Form.pdf
pdf or kmz file types only
By digitally signing below,I certify that:
a I have given true,accurate,and complete information on this form;
a 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")
a 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");
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature;AND
a I intend to electronically sign and submit the"Determination Request"form."
Signature
/ h
Date Submitted: 6/29/2022
Initial Review
ID#* 20220883

Version* 1
Do you want to send for review?* Yes No
Select Reviewer:* Rob Ridings:eads\rgridings
Select Regional Office:* Central Office-[phone]