20221585 Ver 1_Determination Request_20220916

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: * Lane Swamp 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:
Leonard Wayne Edwards
(for LLC, Corporations, businness, agency, etc.)
252-578-7149
How would you like to received your determination?*
USPS Email
Mailing Address:*
Street Address
470 Melton Bridge Road
Address Line 2
City State / Province / Region
Whitakers NC
Postal / Zip Code Country
27891 USA
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: *
Lane Swamp Agent Authorization -
SIGNED.pdf
PDF only
Scott J. Frederick
Eco Terra
[e-mail]
USPS
Email
IP Stream Determination
Stream
245.79KB

Project Information
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: *
Nash
Gaskill Farm Road
Whitakers
Lane Swamp
Tar -Pamlico
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-LS-USGS Map.pdf 1.56MB
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 3-LS-Soil Survey.pdf 1.35MB
Figure 3a-LS-Soil Survey -Nash Co-
106.8KB
1989.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.
Latitude:
Longitude:
Misc attachments:
36.102653
-77.749714
Address Lookup
• Manually
Figure 2-LS-LiDAR.pdf
Figure 4-LS-Historic Aerial-1982.pdf
pdf or kmz file types only
1.03MB
1.24MB
By digitally signing below, I certify that:

a 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 RRO
..........................................................................................................................
ID#*
Do you want to send this for review?
Select Reviewer:*
Select Regional Office: *
9/16/2022
20221585
• Yes No
Shelton Sullivan:eads\sosullivan
Central Office - [phone]