20201148 Ver 1_Determination Request_20200827

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:* Falling Creek Farm Mitigation Site
Is this a transportation project?* f Yes r No
What type of request is this?* r Buffer rJ IF Stream Determination
r Isolated Wetland r Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* Ben R. Dunn
Responsible Party: (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 919-222-3215
How would you like to received your determination?*
r USPS PF Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
C'
Attach agent authorization letter:* Dunn B Agent Authr
260.74KB
25Aug2020_signed.pdf
PDF only
Agent/Consultant Information
...............................................................................
How would you like to receive your f USPS
determination letter?* r Email
Name of Agent:* Scott J. Frederick
Company Name:* Soil, Water, and Environment
Group, PLLC
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
r
r
r

Date of Visit:
Nearest Highway/Street:*
Nearest Town:*
Nearest Named Stream:*
River Basin:
County:*
S Jordans Chapel Road and HWY
13
Grantham
Falling Creek
Neuse
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
Figure 2_USGS_Newton Grove
3.71 MB
North_2019_Ben R Dunn.pdf
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.
Gick the upload button or drag and drop files here to attach documnt
Figure 3USDA Ben R Dunn.pdf 5.94MB
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.
C Address Lookup
r Manually
Latitude: 78°15'39.5"W
Longitude: 35°16'25.5"N
Misc attachments:
Figure 1_Falling Creek _SITE_red.pdf 289.93KB
pdf or kne file types only
By digitally signing below, I certify that:
o 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:
Initial Review
ID#*
Version*
Do you want to send for review?*
Select Reviewer:*
Select Regional Office:*
8/27/2020
20201148
F Yes f No
Chris Pull inger:eads\rcpullinger
Washington Regional Office - [phone]

Soil, Water, & Environment
Group
3216 Byers Drive, Ste B
Raleigh, NC 27607
[phone]
[phone]
[phone] (fax)
AGENT AUTHORIZATION FORM: JURISDICITONAL DETERMINATION/ENTRY
All information to be filled in by the current propejU owner:
Property Address: 412 S JORDANS CHAPEL ROAD—GRANTHAM, NC_ 28365
PIN:_ 2525261229_ Lot # (if applicable): Plan # (if applicable):
Property Owner (s) (please print): —Ben R. Dunn
Property Owner:
The undersigned, registered property owners of the above property, do hereby authorize
Scott J. Frederick, of Soil Water, & Environment Group, PLLC c/o Eco Terra Partners,
LLC, Raleigh, North Carolina, to act as agent on our behalf in the identification and
delineation of jurisdictional wetlands and streams located on the above property.
We hereby authorize entry upon the property by authorized agents of the United States
Army Corps of Engineers/North Carolina Division of Water Resources to observe and
ensure compliance with Section 401/404 of the Clean Water Act and Buffer Rules.
The above information submitted in this form is true and accurate to the best of our
knowledge.
Client/Owner/Authorized Signature Date
Client/Owner/Authorized Signature
100 GROVE CHURCH RD
Date
Property Owner's Address (if different than the property above)
_ MOUNT OLIVE NC _28365-8959
City, State Zip
Phone

I JACKSON RD
Figure 2: USGS Site-
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Map and Approximate O
Project Boundaries —
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35°16'25.5"N 78-15'39.5"W
I
C 2020 Google I : I -
_ Google Earth
Imagery Date: 3/23/2019 35.16'48.50" N 78.15'57.63" W elev Oft eye alt 7208 ft

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