20191692 Ver 3_Stream Determination Request_20191212

State of North Carolina | Environmental Quality | Water Resources
1617 Mail service Center | Raleigh, North Carolina 27699-1617
919 807 6300

ROY COOPER
                                                                                                                Governor

MICHAEL S. REGAN
                                                                                                                 Secretary

LINDA CULPEPPER
                                                                                                                   Interim
Director

DATE STAMP HERE DWR Use Only: Project # _________________

Stream Origin/Buffer Applicability Determination
for Potential Mitigation Sites
Required Information
1. LAND OWNER INFORMATION
1a. Name(s) on Recorded Deed City of Raleigh
1b. Mailing Address PO Box 590, Raleigh, NC 27602-0590
1c. Telephone Number NA 1d. Email Address: NA
2. Has DWR visited the site before? Y / N - No
Staff Name:
Date Visited:

3. MITIGATION PROVIDER OR CONSULTANT
3a. Individual Name Barrett Jenkins Company: Restoration Systems, LLC
3b. Mailing address 1101 Haynes Street, Suite 211, Raleigh, NC 27604
3c. Telephone no. [phone] 3d. Email address:
[e-mail]
3e. Do you have permission to be on this property? Y / N - Yes
4. PROJECT & SITE INFORMATION
4a. Name of project Raleigh Farm Site (Nutrient and Buffer
Bank) 4b. County: Wake
4c. Nearest Named Stream Neuse River 4d. River Basin: Neuse 03020201
4e. Do you have permission to be on this property? Y / N - Yes
4f. Physical property address/nearest intersection:
Brown Field Road and Old Baucom Road
Longitude: 35.702468
Latitude: -78.496356
Is this stream call for the purpose of: BUFFER MITIGATION __Yes_ and/or NUTRIENT OFFSET__Yes__

Please attach maps of the site indicating project boundaries 1) on the USGS 1:24,000 Topo, 2) on the most recently
printed NRCS Soil Survey and 3) on a site aerial labeling all the features needing a determination. Must also include
an agent Authorization form.

Please return form to: Katie Merritt
Email: [e-mail]

Please contact the Central Office at [phone] if you have any questions.