20210019 Ver 1_Determination Request_20201204

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:* O'Berry Road Bank Parcel
Is this a transportation project?* f Yes r No
Is this request for a mitigation site? * r Yes r No
What type of request is this?* rJ Buffer IP Stream Determination
Isolated Wetland rJ Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:*
Frank and Debra Hines
Responsible Party:
(for LLC, Corporations, businness, agency, etc.)
Telephone Number:
919-738-1021
How would you like to received your
determination?*
V I— „I
Mailing Address:*
Street Address
524 Eagles Nest Road
Address Line 2
City
State / Frovince / Region
Dudley
NC
Rbstal / Zip Code
Country
28333-6170
US
Name on the Recorded Deed:*
James and Carolyn Lee
Responsible Party:
(for LLC, Corporations, businness, agency, etc.)
Telephone Number:
919-440-8274
How would you like to received your
determination?*
V USPS F- Email
Mailing Address:*
Street Address
524 Eagles Nest Road
Address Line 2
City
State / Rovince / Region
Dudley
NC
Rbstal / Zip Code
Country
28333
United States

Is there an agent or consultant responsible for the request?*
c:
r
Attach agent authorization letter:* OBerry LOA Combined.pdf 312.38KB
PDF only
How would you like to receive your f USPS
determination letter?* r Email
Name of Agent:* Andrea Eckardt
Company Name:* Wildlands Engineering Inc
Email Address:* [e-mail]
on
Has anyone form DWR done a previous site visit?*
Yes
c:
Other
Date of Visit:
Site Information
Nearest Highway/Street:* 796 OBerry Road
Nearest Town:* Dudley
Nearest Named Stream:* Thoroughfare Swamp
River Basin:* Neuse
County:*
Wayne
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
Figure2_USGSTopoMap_OBerry_Bank.... 991.68KB
Far 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
Figure 3_NRCS 1974 So i I s Ma p_O Be rry_B... 980.76 KB
Far 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.
r Address Lookup
f Manually
Latitude: 35.265142
Longitude:-78.076819
Misc attachments:
Fig u re 1 _SiteMa p_OBerry_Ba n k. pdf 2.02MB
pdf or Ivre 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: 12/4/2020
Initial Review
ID#* 20210019
Version* 1
Do you want to send for review?* r Yes r No
Select Reviewer:* Chris Pullinger:eads\rcpullinger
Select Regional Office:* Washington Regional Office - [phone]

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book:2301 Page: 53 County: Wayne
Parcel ID Number: 2575539705
Street Address: —60.85 acres of O'Berry Road, Dudley, NC
Property Owner (please print): Frank L. Hines and Debra A. Hines
The undersigned, registered property owner(s) of the above property, do hereby authorize
Wildlands Engineering, Inc. 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 US Army Corps of
Engineers, to visit the property as part of these environmental reviews.
Property Owners(s) Address: 524 Eagles Nest Road, Dudley, NC
Property Owner Telephone Number: 919-W38-1021
We hereby certify the above information to be true and accurate to the best of our knowledge.
(Property Owner Authorized Signature)
Owner Authorized Signature)

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book:2444 Page: 184 County: Wayne.
Parcel ID Number: 2575732643
Street Address: —52.36 acres of O'Berry Road, Dudley, NC
Property Owner (please print): James R. Lee and Carolyn H. Lee
The undersigned, registered property owner(s) of the above property, do hereby authorize
Wildlands Engineering, Inc. 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 US Army Corps of
Engineers, to visit the property as part of these environmental reviews.
Property Owners(s) Address: 2126 Emmaus Church Road, Dudley, NC
(if different from above)
Property Owner Telephone Number: 919-440-8274
We hereby certify the above information to be true and accurate to the best of our knowledge.
Owner Authorized Signature)
(Property Ow&r Authorized Signature)

Project Location
L _J Proposed Conservation Easement
� r
I
` e II
. 54
Southwest Goldsboro USGS 7.5 Minute Topographic Quadrangle
WILDLANDS
% P ENGINEERING
0 300 600 Feet
I I I I I
Figure 2. USGS Topographic Map
O'Berry Road Bank Parcel
Neuse River Basin (03020201)
Wayne County, NC

Figure 1. Site Map
W I L D L A N D S 0 200 400 Feet O'Berry Road Bank Parcel
%Vw ENGINEERING I I I I I t Neuse River Basin (03020201)
Wayne County, NC

Project Location
Ke
NoA
NoA
Tx
Dr Ra
11974 NRCS Soil Survey of Wayne County - Sh7e=et30]
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Figure 3.1A74NR[SSoil Survey Map
U 300 600 Feet O'8erryRood Bank Parcel
'p NeuseRiver Basin (03020201)