Ver _N W BENSON QUAD_20230905

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
216 Massengill Pond Rd.
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Name on the Recorded Deed: * Shane L. & Debra D. Gates
Responsible Party : Lester Stancil & Associates, PLS, PA
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 919-639-2133 / 919-818-5798
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
IP Stream Determination
Stream
Nearest Highway/Street: *
Massengill Pond Rd.
Nearest Town: *
Angier
Nearest Named Stream:*
Black Creek
River Basin: *
Neuse

County: *
Johnston
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
N W BENSON QUAD.pdf 448.13KB
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
216 Massengill Rd,Angier,NC.pdf 581.56KB
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
216 Massengill Pond Road
Address Line 2
City State / Province / Region
Angier NC
Postal / Zip Code Country
27501 US
Latitude: 35.4835781
Longitude:-78.61387909999999
Misc attachments: 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;
• 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
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Date Submitted: 9/5/2023
Initial Review RRO

Do you want to send this for review? Yes No

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