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HomeMy WebLinkAbout20160393 Ver 2_Determination Request_20220922Stream Origin/Buffer Applicability Determination NORTH CAROLINA fnrrronmentui duality Processing Information 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: * Bandit Farms Riparian Buffer and Nutrient Offset Mitigation Site Is this a transportation project?* 0 Yes O No Is this request fora mitigation site?* O Yes 0 No What type of request is this?* ✓O Buffer O Isolated Wetland Check all that apply. Owner/Applicant Information C IP Stream Determination C Stream Owner Information Name on the Recorded Deed:* Responsible Party : Bandit Farms II, LLC Environmental Banc & Exchange (EBX), LLC a Resource Environmental Solutions (RES) entity (for LLC, Corporations, businness, agency, etc.) Telephone Number: 919-623-9889 How would you like to received your determination?* USPS Email Email Address:* JMCEACHRAN@RES.US Is there an agent or consultant responsible for the request?* Yes No Attach agent authorization letter:* Bandit Farms LOA .pdf 37.3KB PDF only Agent/Consultant Information Agent/Consultant Information How would you like to receive your determination letter?* USPS Email Name of Agent:* Company Name: * Email Address:* Jamey McEachran Resource Environmental Solutions (RES) JMCEACHRAN@RES.US Project and Site Information Project Information Has anyone form DWR done a previous site visit?* Yes No Other Staff Name: Katie Merritt and Sara Knies Date of Visit: 7/7/2015 Site Information Nearest Highway/Street:* Dairyland Road Nearest Town:* Hillsborough Nearest Named Stream:* Morgan Creek River Basin:* Cape Fear County: * Orange 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 3a - Historic USGS - Bandit 1.96MB Farms.pdf 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 7 - NRCS Historic Soils - Bandit 1.93MB Farms.pdf 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. Project Look Up Address: Latitude: Longitude: Misc attachments: Address Lookup Manually Street Address 3115 Dairyland Road Address Line 2 City State / Province / Region Hillsborough NC Postal / Zip Code Country 27278-8390 US 35.9775403 -79.14553529999999 Sign and Submit Buffer Viability Request - Bandit Fa rms. pdf pdf or kmz file types only 21.79M B 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") 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* l fleratitok