20221129 Ver 1_Determination Request_20220615

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: * Goldsboro Bridge Buffer 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
Isolated Wetland
Check all that apply.
Owner Information
Name on the Recorded Deed: *
Responsible Party :
Telephone Number:
How would you like to received your determination?*
USPS Email
Email Address:*
Ann Morris Bryan Gardner
(for LLC, Corporations, businness, agency, etc.)
[e-mail]
Is there an agent or consultant responsible for the request? *
Yes
No
Attach agent authorization letter:*
Agent/Consultant Information
220401 - Ann Huffman - Agent
Authorization.pdf
PDF only
How would you like to receive your USPS
determination letter?*
Name of Agent: *
Company Name:*
Email Address:*
Project Information
• Email
Jordan Burbage
Eco Terra
[e-mail]
IP Stream Determination
Stream
369.01 KB

Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
.....................................................................................
Nearest Highway/Street: *
Nearest Town:*
Nearest Named Stream:*
River Basin:*
County: *
Wayne
2496 US Hwy 117
Dudley
Neuse River
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
Goldsboro Bridge Mitigation Site - USGS
Topo.pdf
Pdf file type only
2.04MB
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
Goldsboro Bridge Mitigation Site - NRCS
Soils.pdf
Pdf file type only
1.28MB
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: 35.339189
Longitude: -78.035675
Misc attachments:
By digitally signing below, I certify that:
pdf or kmz file types only
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
Date Submitted:
Initial Review
......................................................
ID#* 20221129
Version* 1
Do you want to send for review? * • Yes No
Select Reviewer: * Shelton Sullivan:eads\sosullivan
Select Regional Office: * Central Office - [phone]
6/15/2022

ecolterra
Figure 1: USGS Topographic Map
Goldsboro Bridge Mitigation Site
Neuse 03020201
35°20'21.08"N 78° 2'8.43"W
Wayne County, North Carolina
2019 USGS Topographic Quadrangles:
Southwest Goldsboro
W+E

Project Area
ecolerra
Figure 2: NRCS Soils Map
Goldsboro Bridge Mitigation Site
Neuse 03020201
35°20'21.08"N 78° 2'8.43"W
Wayne County, North Carolina
1974 NRCS Soil Survey Wayne County, North
Carolina Map Sheet #25
W+E
0 375 750
1,500
Feet

DocuSign Envelope ID: C4D24C86-B988-4A30-9A37-88FDA9D722F3
ecolerra
Agent Authorization Form
Parcel ID: 2 58779781'
County: Wayne
Coordinates: 1S°2o'21.o8"N 78° 2'8.43"W (US Hwy 117)
Property Owner: Ann Huffman
The undersigned, registered property owners of the above noted property, do hereby
authorize employees of Eco Terra, 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
,-DocuSign d by:
GuA,
GILL
3eee-HeaaSEE43 B...
4/13/2022 1 12:51 PM PDT
Owner/Authorized Signature Date
3119 Darien Drive Raleigh NC 27607
Property Owner's Address (if different than property above)
Telephone
1328 Dekalb Avenue NE, Atlanta, GA 30307 I EcoTerra.com