20211174 Ver 1_Determination Request_20210728

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:* NW Cary Parkway Sidewalk at Black Creek
Is this a transportation project?* C' Yes r No
Is this request for a mitigation site?* f Yes C' No
What type of request is this?* 17 Buffer r IP Stream Determination
r Isolated Wetland 17 Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* N/A(Linear Transportation Project)
Responsible Party: Town of Cary;ATTN: Kyle Hubert, P.E.
(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?*
(
Attach agent authorization letter:* 02_NWCary_Sidewalk SIGNED_USACE...
207.39KB
Authorization Form(002).pdf
FCF only
Agent/Consultant Information
How would you like to receive your r USPS
determination letter?* C' Email
Name of Agent:* Emma Radford,WPIT
Company Name:* Kimley-Horn
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*

Date of Visit:
Site Information
.............................................................................................................................................................................................................................................................................................................................................................................................
Nearest Highway/Street:* NW Cary Parkway
Nearest Town:* Town of Cary
Nearest Named Stream:* Black Creek
River Basin:* Neuse
County:*
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
Qick the upload button or drag and drop files here to attach docurrent
Fig2_CaryPedBridge_USGS.pdf 886.57KB
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
Fig4_CaryPedBridge_NRCS.pdf 951.12KB
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.
r Address Lookup
C' Manually
Latitude: 35.820414
Longitude: -78.785330
Misc attachments: Fig1_CaryPedBridge_Vicinity.pdf 516KB
Fig3_CaryPedBridge_JD Features.pdf 1.67MB
04_CaryParkway_S1_NCDWR-Stream
120.79KB
Form.pdf
05_CaryParkway_S3_NCDWR-Stream
169.63KB
Form.pdf
pdf or Ivre 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
r e2,.5640rr fir _
Date Submitted: 7/28/2021
Initial Review
ID#* 20211174
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]