20240674 Ver 1_Determination Request_20240423

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
Name on the Recorded Deed:
Responsible Party :
Telephone Number:
Tarheel
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
John F Tricas
(for LLC, Corporations, businness, agency, etc.)
9196044404
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: * Tricas signed AA for Tarheel.pdf
PDF only
Agent/Consultant Information
...................................................................................................................................................................
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Jordan Burbage
Company Name:* Eco Terra
Email Address: * [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
IP Stream Determination
Stream
269.1 KB

Date of Visit:
Site Information
Nearest Highway/Street: Gallup Rd
Nearest Town: * Fearrington
Nearest Named Stream:* Bush Creek
River Basin: * Cape Fear
County: *
Chatham
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
CF02(LNH) - Tarheel Real Estate - Topo
1.22M6
Map - SD.pdf
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
CF02(LNH) - Tarheel Real Estate - Soils
1.49M6
Map - SD.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: 35.804722
Longitude:-79.056250
Misc attachments: CF02(LNH) - Tarheel Real Estate - LiDar
4.49M6
Map - SD.pdf
CF02(LNH) - Tarheel Real Estate - Aerial
3.54M6
Map - SD.pdf
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
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Date Submitted: 5/10/2024
Initia, i.v iv..
ID#* 20240674
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Blake Hartshorn: blake.hartshorn
Select Regional Office:* Central Office - [phone]