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HomeMy WebLinkAbout20220308 Ver 1_Determination Request_20220211Please 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: * Beaufort WTP 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:* Steep Point Properties LLC Responsible Party : John Chadwick (for LLC, Corporations, businness, agency, etc.) Telephone Number: 252.752.4135 x253 (Rivers and Associates) How would you like to received your determination?* USPS v Email Email Address:* kim.williams@davey.com Is there an agent or consultant responsible for the request? Yes No Attach agent authorization letter: * Signed Agent Auth.pdf 1 MB PDF only Agent/Consultant Information How would you like to receive your USPS determination letter?* Email Name of Agent: * Kim Williams Company Name: * Davey Resource Group (previously LMG) Email Address:* kim.williams@davey.com Project Information Has anyone form DWR done a previous site visit?* Yes No Other Date of Visit: Site Information Nearest Highway/Street: * Pinners Point Rd Nearest Town: * Beaufort Nearest Named Stream:* Turner Creek River Basin: * White Oak County: Carteret 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 Fig2-Topo.pdf 692.01 KB 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 NRCS Soils.pdf 4.29MB 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: 34.729603 Longitude:-76.632911 Misc attachments: BeaufortWTPTract PrelimSketch Land... 713.46KB 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; 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") 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'); 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: 2/11/2022 Initial Review ID# * 20220308 Version * Do you want to send for review?* • Yes No Select Reviewer: * John Perry:eads\jmperry2 Select Regional Office:* Wilmington Regional Office - (910) 796-7215