20211803 Ver 1_Determination Request_20211102

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:* Alder Valley Mitigation Site
Is this a transportation project?* Yes • No
Is this request for a mitigation site?* • Yes No
What type of request is this?* Buffer IP Stream Determination
Isolated Wetland Stream
Check all that apply.
Owner Information
Name on the Recorded Deed:* Blanche J McFarland
Responsible Party: (for LLC,Corporations,businness,agency,etc.)
Telephone Number:
How would you like to received your determination?*
USPS Email
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter:* 211102-Alder Valley-Agent
587.11KB
Authorization Form.pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Jamey O'Shaughnessey
Company Name:* Eco Terra
Email Address:* [e-mail]
Project Information
.....................

Has anyone form DWR done a previous site visit?*
Yes
• No
Other
Date of Visit:
Site Information
Nearest Highway/Street:* Moores Mill Rd
Nearest Town:* Rougemont
Nearest Named Stream:* Flat River
River Basin:* Neuse
County:*
Durham
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
Click the upload button or drag and drop files here to attach document
Alder Valley-Topo 1-24000.pdf 1.13MB
Pdf 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 document
Alder Valley-Soil Map.pdf 1.32MB
Pdf 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 Address Lookup
provide this information. Manually
Latitude: 36°12'29.71"N
Longitude: 78°54'8.95"W
Misc attachments: pdf or kmz file types only
By digitally signing below,I certify that:
o I have given true,accurate,and complete information on this form;
a 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
0454empfratratty
Date Submitted: 11/2/2021
Initial Review RRO
ID#* 20211803
Version* 1
Do you want to send this for review? • Yes No
Select Reviewer:* Shelton Sulivan:eads\sosullivan
Select Regional Office:* Central Office-[phone]

• •
eco terra„
Agent Authorization Form
Parcel ID: 190561
County: Durham
Street Address: 1403 Moores Mill Rd. Rougemont, NC 27572
Property Owner: Blanche McFarland
The undersigned, registered property owners of the above noted
property, do hereby authorize employees of Eco Terra Partners LLC
(Contractor / Agent) to act as an agent on our behalf in the identification
and delineation of jurisdictional wetlands and streams located on the
above property.
We hereby authorize entry upon the property by authorized agents of the
United States Army Corps of Engineers, North Carolina Division of Water
Resources, and North Carolina Division of Mitigation Services to perform
duties in conjunction with the establishment of a mitigation or buffer bank.
The above information submitted in this form is true and accurate to the
best of our knowledge.
cr7 oc.* Usti
r/ t rized Signature Date
1403 Moore. Mitt Poa,6Q (oL..u560-vig-1 -1 NC- 7,s`72
Property Owner's Address (if different than property above)
7(9- .77-69 tT1
Telephone

Pro.ect Site
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