20210997 Ver 1_Determination Request_20210609

Stream Origin/Buffer Applicability Determination
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:* 48937
Is this a transportation project?* C' Yes r No
Is this request for a mitigation site?* f Yes No
What type of request is this?* 17 Buffer r IP Stream Determination
r Isolated Wetland r Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* NCDOT
Responsible Party: Heather W. Montague
(for LLC,Corporations,businness,agency,etc.)
Telephone Number: [phone]
How would you like to received your determination?*
I— I�
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
r
Has anyone form DWR done a previous site visit?*
Date of Visit:
Site Information
Nearest Highway/Street:* NC 54
Nearest Town:* Chapel Hill
Nearest Named Stream:* Little Creek
River Basin:* Cape Fear

County:*
Durham
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
Gick the upload button or drag and drop files here to attach docurrent
48937 Durham Topo Map.pdf 678.63KB
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.
Click the upload button or drag and drop files here to attach docurrent
48937 Durham Soils Map.pdf 337.26KB
Rif 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.
f Address Lookup
C' Manually
Latitude: 35.91059
Longitude: -78.98587
Misc attachments: 48937 Durham picture.pdf 1.08MB
pdf or krre 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")
o 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
o I intend to electronically sign and submit the"Determination Request"form."
Signature
Date Submitted: 6/9/2021
Initial Review
ID#* 20210997
Version* 1
Do you want to send for review?* C' Yes C No

Select Reviewer:* Rob Ridings:eads\rgridings
Select Regional Office:* Central Office-[phone]