20230137 Ver 1_Buffer and/or Stream Determination Request_20230112

Stream Origin/Buffer Applicability Determination
NORTH CAROLINA
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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: * New Farm
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
Owner Information
Name on the Recorded Deed:* Thelma McClenny
Responsible Party : (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 919-738-7042
How would you like to received your determination?*
USPS Email
Email Address:*
[e-mail]
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter:*
IP Stream Determination
Stream
SIGNED - Agent Authorization.pdf 455.99KB
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:*
Jordan Burbage
Eco Terra, LLC
[e-mail]
Project and Site Information
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: *
Wayne
Hwy 55
Grantham
Thunder Swamp
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
230111 - McClenny NOC - Figure 1 -
USGS Topographic .pdf
Pdf file type only
2.16MB
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
230111 - McClenny NOC - Figure 2 -
NRCS Soil Survey.pdf
Pdf file type only
6.79 M B
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:
35.220386
-78.192267
Sign and Submit
Address Lookup
Manually
pdf or kmz file types only
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*

Legend
Project Area
r j Property Boundary
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Esvi Community Maps Contributors, City of Goldsborp, State of North
Carolina' DOT, © OpenStreetMap, Microsoft, Esri, HERE,GArmi , feGraph,
GeoTechnologies, Inc, METI/NASA,...y_SG-S,-PA7q1-15S, US @iiiipmis. ureau,
----USDA, Esri, NASA, NGA, OSGS, FEMA
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Figure 1: USGS Topographic Map
Owner: Thelma McClenny
Neuse 03020201
Wayne County, North Carolina
35°13'13.39"N 78°11'32.16"W
USGS Topographic Quadrangle: Dobbersville

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Figure 2: NRCS Soil Survey Map
Owner: Thelma McClenny
Neuse 03020201
Wayne County, North Carolina
35°13'13.39"N 78°11'32.16"W
NRCS Soil Survey manuscript: Wayne County
Legend
Project Area
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o nervation Service (r RCS), NCDOT Project A
nity Maps Contri. utors, City of Goldsboro, State
©,OpenStreet o, Microsoft, Esri, HERE, Garmin,
gies, Inc, META" ASA, USGS, EPA, NPS, US Census •
Burea SDA, Esri, NASA, NGA, USGS, FEMA
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Agent Authorization Form
Parcel ID: 2543069032
County: Wayne
Street Address: W NC 55 Hwy Mount Olive, NC 28365
Property Owner(s): Thelma McClenny
The undersigned, registered property owners of the above noted
property, do hereby authorize employees of Eco Terra, LLC (Contractor /
Agent) to act as an agent on our behalf in the identification and
delineation of jurisdictional wetlands and streams located on the above
property.
We hereby authorize entry upon the property by authorized agents of the
United States Army Corps of Engineers, North Carolina Division of Water
Resources, and North Carolina Division of Mitigation Services to perform
duties in conjunction with the establishment of a mitigation or buffer bank.
The above information submitted in this form is true and accurate to the
best of our knowledge.
Owner/Authorized Signbture
//i /t3
Date
12 qt6 O/c' %key S444,-1 pc/. /y/agoh G/� ve, if/6- 283.65
Property Owner's Address (if different than property above)
9/f- 731- 7oyz
Telephone
1328 DeKalb Ave NE, Atlanta, GA 30307 I 404.596.8004 EcoTerra.com
Printed on 100% post -consumer recycled paper