20220243 Ver 1_Determination Request_20220208

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: *
Is this a transportation project?*
Is this request for a mitigation site?*
What type of request is this?*
Owner Information
LaGrange III Riparian Buffer and Nutrient Offset Mitigation Bank
Yes No
Yes No
Buffer IP Stream Determination
Isolated Wetland Stream
Check all that apply.
Name on the Recorded Deed:* Robert Ham
Responsible Party : Greene Environmental Services, LLC
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 9192153899
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: * Authorized Agent for Greene
Environmental Services.pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * David Knowles
Company Name: * Greene Environmental Services,
LLC
Email Address:* [e-mail]
Project Information
7.34KB

Has anyone form DWR done a previous site visit?*
Yes
No
Other
Staff Name:
Date of Visit
Site Information
Anthony Scarbraugh
6/4/2014
Nearest Highway/Street:
Nearest Town: *
Nearest Named Stream:*
River Basin:*
County:
Lenoir
NC 903
LaGrange
Meeting House Branch
Neuse
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
USGS Topo Excerpt large scale LAG
303.95KB
Ill.pdf
Pdf file type only
TOPO map look up: https:Hviewer.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
Stream Det Soil Map Feb 2022.pdf 146.12KB
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 provide this information.
Address Lookup
• Manually
Latitude: 35.340692
Longitude:-77.787457
Misc attachments:
USGS Topo Excerpt Close up LAG Ill.pdf 67.9KB
pdf or kmz file types only
By digitally signing below, I certify that:

a 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)
a 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');
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a I intend to electronically sign and submit the "Determination Request' form."
Signature
�,4-ViE��1L
Date Submitted: 2/8/2022
Initial Review
ID#* 20220243
Version *
Do you want to send for review?* • Yes No
Select Reviewer: * Glenn Stewart:eads\gastewart2
Select Regional Office:* Washington Regional Office - [phone]

I
rA

Excerpt from USGS Topographical Map, Waterways (not indicated on map) for stream
determination are within red box. Greene Environmental Services, LLC. February 2022.

)LINA — SHEET NUMBER 3
0
N
-!1t
Soil Map for Stream Determination. Proposed LaGrange III Riparian Buffer and Nutrient Offset
Mitigation Bank, Greene Environmental Services, LLC. From Lenoir County Soil Survey, Sheet
3. Stream and Project Site indicated within red box.

Authorized Agent for Greene Environmental Services, LLC and contact person for stream
determination is:
David Knowles
Email: ocesdkggmail.com
Cell Phone: [phone]