20191424 Ver 1_Determination Request_20191016

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:* ECG Aviation Facility
Is this a transportation project?* r Yes r No
What type of request is this?* r Buffer r IP Stream Determination
r Isolated Wetland V Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* Elizabeth City-Pasquotank County Airport Authority
Responsible Party: Johnny Houston
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: [phone]
How would you like to received your determination?*
F- W
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request? *
r Yes
r No
Attach agent authorization letter:* 10132019.pdf 163.53KB
FDF only
Agent/Consultant Information
.................................................................................................................................................................
How would you like to receive your r uSPS
determination letter?* r Email
Name of Agent:* Kimberly Hamby
Company Name:* Timmons Group
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
r Yes
r No
r Other unknown
Date of Visit:

Site Information
Nearest Highway/Street:* SR 1100 - Weeksville Highway
Nearest Town:* Elizabeth City
Nearest Named Stream:* Pasquotank River
River Basin:* Pasquotank
County:*
Pasquotank
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 docurrent
43461 - Quad Map.pdf 875.56KB
Rif 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 docurrent
Hydrologic Soil Group - site only.pdf 360.91 KB
Ftlf 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.
C Address Lookup
F Manually
Latitude: 36.251707
Longitude:-76.176476
M isc attach me nts: pdf or krre file types only
By digitally signing below, I certify that:
• I have given true, accurate, and complete information on this form;
o 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');
o 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

Date Submitted:
10/16/2019
Initial Review
ID#*
Version
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
20191424
r Yes r No
Garcy Ward: eads\gpward
Washington Regional Office - [phone]