20200571 Ver 1_Determination Request_20200428

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?*
What type of request is this?*
Owner Information
Blount -Person Streets Two -Way Conversion
r Yes r No
r% Buffer r IP Stream Determination
r Isolated Wetland PF Stream
Check all that apply.
Name on the Recorded Deed:* The City of Raleigh
Responsible Party: Kenneth Ritchie, P.E., MPA, Division Manager
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: [phone]
How would you like to received your determination?*
1— 141
Email Address:* Kenneth. [e-mail]
Is there an agent or consultant responsible for the request?*
(-- Yes
C
Attach agent authorization letter:* 02_BlountPerson_Agent Authorization
109.83KB
Form - Signed.pdf
PDF only
Agent/Consultant Information
How would you like to receive your f USPS
determination letter?* r Email
Name of Agent:* Mackenzie Richards
Company Name:* Kimley-Horn
Email Address:* mackenzie.richards@kimley-
horn.com
Project Information
Has anyone form DWR done a previous site visit?*
f Yes
r No
f Other

Date of Visit:
Site Information
Nearest Highway/Street:*
Blount Street
Nearest Town:*
Raleigh
Nearest Named Stream:*
Cemetery Branch
River Basin:*
Neuse
County: *
Wake
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
aick the upload button or drag and drop files here to attach document
BlountPerson_Fig2_USGS.pdf 3.31 MB
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.
aick the upload button or drag and drop files here to attach document
BlountPerson_Fig4.1_NRCS.pdf 4.47MB
BlountPerson_Fig4.2_NRCS.pdf 4.34MB
Rif file type only
Soil Survey Link: https://wwvv.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.
f Address Lookup
r Manually
Latitude: 35.780300
Longitude:-78.634368
Misc attachments: 04_Pigeon House Branch (S1)_NCDWR-
133.27KB
Stream Form.pdf
05_Cemetery Branch (S2)_NCDWR-
151.41 KB
Stream Form.pdf
BlountPerson_Fig1_Vicinity.pdf
905.57KB
BlountPerson_Fig3_Aerial.pdf
3.19MB
BlountPerson_Fig3_Aerial_datadriven. pdf
11.7MB
pdf or kT a file types only
By digitally signing below, I certify that:
o 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
Date Submitted:
Initial Review
...................................................
ID#*
Version*
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
4/28/2020
20200571
1
r Yes r No
Rob Ridings:eads\rgridings
Central Office - [phone]