20221125 Ver 1_22-183_Determination Request_20220503_20220623

Stream Origin/Buffer Applicability Determination
Water
ResourcesryQUALITY
*
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
Name on the Recorded Deed: *
Responsible Party :
Telephone Number:
5217, 5227 & 5305 Mt. Moriah Road, Chapel Hill, NC
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Various - see agent authorization letters
Various - see agent authorization letters
(for LLC, Corporations, businness, agency, etc.)
How would you like to received your determination?*
USPS Email
Email Address:*
[e-mail]
Is there an agent or consultant responsible for the request?*
Attach agent authorization letter:*
Agent/Consultant Information
How would you like to receive your
determination letter?*
Name of Agent: *
Company Name:*
Email Address: *
Project Information
IP Stream Determination
Stream
Signed Property Owner Permissions - Mt.
Moriah Property Sage Ecological Project
No. 2021.153.pdf
PDF only
USPS
Email
Philip Beach
Sage Ecological
[e-mail]
4.68MB

Has anyone form DWR done a previous site visit?*
Yes
No
Other
TOCH site visit on January 28, 2022, and February
2, 2022.
Date of Visit:
Site Information
....................................................
Nearest Highway/Street: *
Nearest Town:*
Nearest Named Stream:*
River Basin:*
County: *
1/28/2022
Mt. Moriah Road
Chapel Hill
New Hope Creek
Cape Fear
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
Figure 1 - USGS Topo Map.pdf 1.35MB
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
Figure 2 - NRCS Soils Map.pdf 1.8MB
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.
Latitude: 35.9605
Longitude: -79.0047
Address Lookup
Manually

Misc attachments:
By digitally signing below, I certify that:
Figure 3 - Post Corps Review AJD PJD
2.9MB
Sketch Map-R.pdf
9890-84-9934, 9890-94-5812, 9890-95-
8043, 9890-83-5996 & 9890-74-0792 15.8MB
stream determ 2-2-2022 with markup.pdf
Stream Determination Appeal - 5217,
5227 & 5305 Mt. Moriah Road, Chapel 2.62MB
Hill, NC (Sage Ecological).pdf
pdf or kmz file types only
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
Date Submitted:
Initial Review RRO
.........................................................................
ID#*
Do you want to send this for review?
Select Reviewer: *
Select Regional Office: *
c
5/3/2022
22-183
Yes No
Shelton Sulivan:eads\sosullivan
Raleigh Regional Office - [phone]