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Home My WebLink About20201525 Ver 1_Determination Request_20201005Please 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 Name on the Recorded Deed:* Responsible Party: Telephone Number: Maple Swamp Nutrient and Buffer Mitigation Site f Yes r No r% Buffer rJ IP Stream Determination r Isolated Wetland r Stream Check all that apply. Richard C. Anderson Richard C. Anderson (for LLC, Corporations, businness, agency, etc.) 2528234730 How would you like to received your determination?* r USPS W Email Email Address:* bjenkins@restorationsystems.com Is there an agent or consultant responsible for the request?* r Yes r No Attach agent authorization letter:* Maple Swamp Anderson Land Owner Authorization. pdf PDF only Agent/Consultant Information How would you like to receive your f USPS determination letter?* r Email Name of Agent:* Barrett Jenkins Company Name:* Restoration Systems Email Address:* bjenkins@restorationsystems.com Project Information Has anyone form DWR done a previous site visit?* r Yes r No r Other 70.08KB Date of Visit: Site Information Nearest Highway/Street:* Bethlehem Church Road Nearest Town:* Leggett Nearest Named Stream:* Maple Swamp River Basin:* Tar -Pamlico County:* Edgecombe 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 docurrent Maple Swamp USGS.pdf 4MB 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. nick the upload button or drag and drop files here to attach docurrent Maple Swamp Soil Map.pdf 3.04MB 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 f Address Lookup provide this information. r Manually Latitude: 36.036346 Longitude:-77.545980 Misc attachments: Maple Swamp - VIABILITY-ASSESSMENT- 10.29MB REQUEST- FORM- pdf MAPLESWAMPPARCELS.shp.kmz 8.07KB pdf or lane 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 Date Submitted: 10/5/2020 Initial Review RRO ID#* 20201525 Version* Do you want to send this for review? F Yes r No Select Reviewer:* Stephanie Goss: eads\szgoss Select Regional Office:* Central Office - (919) 707-9000 n rr Ln 1.Y . 3' Maple Swamp Site USGS TOPO 2019 Draughn 24,000 RESTORATION Edgecombe County, NC r' Anderson Parcels N 0 0.125 0.25 0.5 0.75 1 Miles )k BUFFER MITIGATI UTRIENT OFFSET RCY COOPER Governor SITE VIABILTV ENT REQUEST MICHAEL S. REGAN `', •i a Secretory (Form must be complete and all ents included to process request) LINDA CULPEPPER NORTH CAROUNA Director Envlronmentaf Qualfry ❑ BUFFER MITIGATION ❑X NUTRIENT OFFSET ❑ BOTH Name Barrett Jenkins Company Restoration Systems, LLC Address 1101 Haynes Street, Suite 211, Raleigh, NC 27604 Phone (512)-230-0424 Email bjenkins@restorationsystems.com Do you have the right to access the property? Attachment 1 ❑X YES ❑ NO PARCEL/SITE DETAILS Proposed Site Name Maple Swamp Address 2599-1883 Bethlehem Church Road City: Tarboro Site Coordinates 36.036346,-77.545980 County: Edgecombe River Basin Tar -Pam 8-Digit HUC: 03020103 Sub -watershed (if in Jordan Lake or Falls) Will this be part of a stream or wetland project/bank? ❑ YES ® NO Has anyone from DWR or the USACE visited the site in the past 12 months? ❑ YES ❑X NO Has a riparian buffer or stream call been performed by Division of Water Resources staff on the subject site? ❑ YES ❑X NO Is the project receiving any state or federal grant money? ❑ YES ❑X NO Are there any State, Local or Federal Permits associated with the subject site? ❑ YES ❑X NO PARCEL/SITE ATTACHMENTS (provide items 1-4 as a separate attachment, not to exceed 10 pages) 1. Detailed description of the site including existing site conditions and Aerial Site Map; 2. Include a timeline of land uses and land use changes from 1990-Present; 3. Most recent 1:24,000 scale USGS Topo Map showing the site; AND 4. Most recent published NRCS county soil survey showing site; NCDWR - 401 & Buffer Permitting Branch Attn: Katie Merritt SEND COMPLETE REQUEST TO: 1617 Mail Service Center Raleigh, NC 27699-1617 orbs email to Katie. Merritt@ncdenr.gov Rt We A aA NoA UR R ++ 4 sd L es RCS ff vv oA GeA f MOB C. � T.a'L �. to Ro TaB 4Wh No€k � AaA AaA 'kB GfiA +::iOr7 Ra Ito � YVkB D i4 , / , ijRo g A4' "h ■ Ste T DgAr k Tads '' ik Wk.B tk-3A r4aA ExA B _` R� a� '°� r Taal .1.� i TaV A21Avh��cEzNee " NOB AAA r — ' — DgA • •. to a '�L, aA il IT ag pry ea NcA Maple Swamp Site NRCS Soil Map 1979 RESTORATION Edgecombe County, NC Anderson Parcels 0 0.125 0.25 0.5 0.75 N 1 i Miles LANDOWNER AUTHORIZATION FORM PROPERTY LEGAL DESCRITION: e( Deed Book: 66 Page: County: Parcel ID Number: `i 71�_` 616 ,7 Street Address: Xtf 6 h6d,_VL- u Ccoak ;-',G_ 066 v�('��'l�e.� �vL C.Inw, kferAA Property Owner (please print: ''�rS Property Owner (please print): IL% ,,d C(t4:11,rl 1�(27, The undersigned, registered property owner(s) of the above property, do hereby authorize of (Contractor/Agent/Project Manager)' (Name of Contractor/Age t Firm/Agency)' to take all actions necessary for the evaluation of the property as a potential stream, wetland and/or riparian buffer mitigation project, including conducting stream and/or wetland determinations and delineations, as well as issuance and acceptance of any required permit(s) or certification(s). I agree to allow regulatory agencies, including the NC Division of Water Resources, to visit the property as part of these environmental reviews. Property Owners(s) Address: [ '7cl AIC C~ : IOW (if different from above) Property Owner Telephone Number: _ l %,� V Property Owner Telephone Number: Wr�'}yl c��;�ferlall'y the above information to be true and accurate to the best of our knowledge. er Authors -Signature) (Property Owner Authorized Signature) fb/lle6zb (Date) 'Name of full delivery staff member (full -deliveries) or DMS project manager (design -bid -build), 'Name of company (full -deliveries) or DMS (design -bid -build).