20230001 Ver 1_Determination Request_20221229

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: * Bailey Road Subdivision
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: *
IP Stream Determination
Stream
TRIANGLE DEV OF EASTERN CAROLINA INC
Responsible Party : Judson Whitehurst
(for LLC, Corporations, businness, agency, etc.)
Telephone Number:
How would you like to received your determination?*
USPS Email
Email Address: *
mupeedin©ibxengineering.com
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?*
owner authorization.pdf 218.3KB
PDF only
USPS
Email
Name of Agent: * Steve Brandt
Company Name: * CMH Homes Inc
Email Address: * [e-mail]
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: *
Martin
Bailey Road
Williamston
Collie 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
USGS MAP.pdf
Pdf file type only
29.45MB
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
soil_map.pdf
Pdf file type only
9.64MB
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: 35.815
Longitude: -77.148
Misc attachments:
By digitally signing below, I certify that:
pdf or kmz file types only
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
0 I intend to electronically sign and submit the "Determination Request" form."

Signature
Date Submitted:
Initial Review
.....................................................
ID#* 20230001
Version* 1
Do you want to send for review? * • Yes No
Select Reviewer: * Robert Tankard:eads\rbtankard
Select Regional Office: * Washington Regional Office - [phone]
12/29/2022

ROBERSONVILLE EAST QUADRANGLE
NORTH CAROLINA
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PROPERTY OWNER AUTHORIZATION
For Land Quality Permit and Stream Determination
I, Judson Whitehurst, registered agent for Triangle Developments of Eastern Carolina, Inc.
_, certify that I own the property identified as Tax Parcel 0601315 , and thus give permission to
CMH Homes, Inc. to develop the project as currently proposed as well as have the existing
farm ditches evaluated.
Signature: Date:
I, , a Notary Public for the State of _, County of
_, do hereby certify that
_personally appeared before me this day of
20 , and acknowledge the due execution of the authorization.
SEAL

My commission expires