Ver _Determination Request (2)_20240126

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 & 220 N Dixon Ave
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Name on the Recorded Deed: * Bhaskar Pusuluri
Responsible Party : (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 910-227-9867
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Attach agent authorization letter: * Agent Authorization-signed.pdf
PDF only
Agent/Consultant Information
...................................................................................................................................................................
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Sarah Menser
Company Name:* Soil Services PLLC
Email Address: * [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
IP Stream Determination
Stream
128.81 KB

Date of Visit:
Site Information
Nearest Highway/Street: * Dixon Ave
Nearest Town: * Cary
Nearest Named Stream: * Coles 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
USGS.pdf 1.12MB
Pdf file type only
TOPO map look up: https://viewer.nationaImap.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
NRCS.pdf 632.52KB
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
Latitude: 35.788887'
Longitude:-78.788804'
Misc attachments: RPT 1844-1.pdf 3.84MB
pdf or kmz 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
S/t tall, e/W, nk-t
Date Submitted: 1/26/2024
Initial Review RRO
Do you want to send this for review? Yes No