20221558 Ver 1_Buffer and/or Stream Determination Request_20221104

11 /21 /22, 8:34 AM
Non -DOT Review (Mitigation)
Stream Origin/Buffer Applicability Determination
Water Resources
ENVIRONMENTAL QUALITY
*
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? * Yes No
Is this request for a mitigation site? * Yes No
5608 Sheriff PI, Raleigh NC 27610
What type of request is this? * Buffer
u Isolated Wetland
Check all that apply.
Owner Information
......................................................................................................
Name on the Recorded Deed: *
Responsible Party :
Chanel T. Spencer
Master Home Improvement, LLC
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 9199236006
How would you like to received your determination?*
USPS Email
Email Address: *
masterhomeimprov.sindin@yahoo.c
om
Is there an agent or consultant responsible for the request? *
Yes
No
Project Information
Has anyone form DWR done a previous site visit? *
G Yes
@ No
o Other
Date of Visit:
Site Information
.....................................................................................
Nearest Highway/Street: *
Nearest Town: *
1-540 Hwy
Knightdale
IP Stream Determination
Stream
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11/21/22, 8:34 AM Non -DOT Review (Mitigation)
Nearest Named Stream: *
No sure
River Basin:* Not Sure
County: *
Wake
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Togo.
Click the upload button or drag and drop files here to attach document
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
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
Project Look Up Address: Street Address
5608 Sheriff PI
Address Line 2
City State / Province / Region
Raleigh NC
Postal / Zip Code Country
27610 Wake
Latitude:
Longitude:
Misc attachments:
By digitally signing below, I certify that:
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."
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11 /21 /22, 8:34 AM
Non -DOT Review (Mitigation)
Signature
Date Submitted:
Initial Review
.....................................................
ID#* 20221558
Version* 1
Do you want to send for review? * U Yes No
Select Reviewer: * Katie Merritt:eads\kymerritt
Select Regional Office: * Central Office - [phone]
11/4/2022
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