20211214 Ver 1_Stream Origin Buffer Applicability Determination_20210811

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Stream Origin/Buffer Applicability Determination
NORTH CAROLINA
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Processing Information
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:* HL-0008P
Is this a transportation project?* r Yes c, No
Is this request for a mitigation site?* C Yes ( No
What type of request is this?* I7 Buffer I— IP Stream Determination
r- Isolated Wetland I— Stream
Check all that apply.
Owner/Applicant Information
Owner Information
Name on the Recorded Deed:* NCDOT
Responsible Party: Mitchell Wimberley
(for LLC,Corporations,businness,agency,etc.)
Telephone Number: 9194174847
How would you like to received your determination?*
I— USPS Email
Email Address:*
Is there an agent or consultant responsible for the request?*
c Yes
(' No
Agent/Consultant Information
Project and Site Information
Project Information
.............................................................................................
Has anyone form DWR done a previous site visit?*

r Yes
(' No
c Other
Date of Visit:
Site Information
.......................
Nearest Highway/Street:* NC 50(Benson Rd)
Nearest Town:* Garner
Nearest Named Stream:* Swift Creek
River Basin:* Neuse
County:*
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
dick the upload button or drag and drop files here to attach docurrent
USGS Topo Map.pdf 289.41 KB
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 docurrent
NRCS Soil Survey.pdf 971.15KB
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 r Address Lookup
provide this information. c- Manually
Latitude: 35.637697
Longitude: -78.614346
Misc attachments: Feature A Inlet(4).pdf 175.86KB
Feature A Outlet(3).pdf 170.9KB
HL-0008P NCDWQ Stream Identification
80.57KB
Form.pdf
pdf or Ivre file types only
Sign and Submit

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*
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