20240898 Ver 1_Determination Request_20240530

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:
Tobacco Flats
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
James Edward Moize Trustee
(for LLC, Corporations, businness, agency, etc.)
919-370-6792
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/Consultant Information
How would you like to receive your
determination letter?*
Name of Agent:* Jordan Burbage
Company Name:* Eco Terra
Moize signed agent authorization. pdf
PDF only
USPS
Email
Email Address: * [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
IF Stream Determination
Stream
587.46KB

Date of Visit:
Site Information
Nearest Highway/Street: * US Hwy 501 (Durham Rd)
Nearest Town: * Timberlake
Nearest Named Stream: * North Flat River
River Basin: * Neuse
County: *
Person
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
NU01(UFL) - N Flat R - Topo.pdf 1.49MB
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
NU01(UFL) - N Flat R - Soil.pdf 1.59MB
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: 36.306212
Longitude:-78.966981
Misc attachments: NU01(UFL) - N Flat R - Aerial.pdf 5.23MB
NU01(UFL) - N Flat R - LiDAR.pdf 1.66MB
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
C"70 .r ewm,kv
Date Submitted: 5/30/2024
Initial Review
ID#* 20240898
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Samantha Wooten:Samantha.Wooten
Select Regional Office: * Central Office - [phone]