20221555 Ver 1_Determination Request_20220914

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: * Peach
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: *
M & B Lee, LLC
Responsible Party : William Frank Lee
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 919-604-9314
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
M&B Lee - Signed Landowner
Authorization Form_2022-08-25_.pdf
PDF only
LISPS
Email
Raymond J Holz
Restoration Systems
[e-mail]
IP Stream Determination
Stream
49.12KB

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: *
Johnston
Peach Orchard Road
Four Oak
Hannah Creek
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
Peach_Figure 02_USGS_.pdf 781.03KB
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
Peach_Figure 03_NRCS_.pdf 822.32KB
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:
Longitude:
Misc attachments:
35.385434
-78.347428
By digitally signing below, I certify that:
Peach_Figure 04_Existing
Conditions_.pdf
pdf or kmz file types only
O I have given true, accurate, and complete information on this form;
1.14MB

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#* 20221555
Version* 1
Do you want to send for review? * • Yes No
Select Reviewer: * Shelton Sullivan:eads\sosullivan
Select Regional Office: * Central Office - [phone]
9/14/2022

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LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
Deed Book: 5876 Page: 887-888 County: Johnston
Parcel ID Number: 02K14015
Street Address: NA - No Street Address
35.385434,-78.347428
Property Owner (please print): M & B Lee, LLC
The undersigned, registered property owner(s) of the above property, do hereby authorize
mond Holz
Restoration Systems, LLC
Grant Lewis of Axiom Environmental, INC
to take all actions necessary for the evaluation of the property as a potential nutrient offset mitigation
project, including conducting stream and/or wetland determinations and delineations, as well as issuance
and acceptance of any required permit(s) or certification(s). I agree to allow regulatory agencies, including
the US Army Corps of Engineers and North Carolina Department of Environmental Quality, to visit the
property as part of these environmental reviews.
Property Owners(s) Address: PO BOX 148
(if different from above)
Smithfield, NC 27577
Property Owner Telephone Number: [phone]
We hereby certify the above information to be true and accurate to the best of our knowledge.
Property Owner Authorized Signature)
William Frank Lee
Managing Member M & 13 Lee, LLC