20230245 Ver 1_Determination Request_20230213

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: * Georgianna Mitigation Bank Parcel
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:
How would you like to received your determination?*
USPS Email
Mailing Address:*
James O. Burch
(for LLC, Corporations, businness, agency, etc.)
Street Address
130 Giddensville Road
Address Line 2
City State / Province / Region
Faison NC
Postal / Zip Code Country
28341-5786 US
Name on the Recorded Deed:* Jared H. Burch
Responsible Party : (for LLC, Corporations, businness, agency, etc.)
Telephone Number:
How would you like to received your determination? *
USPS Email
Mailing Address: *
Street Address
638 Burch Rd
Address Line 2
City State / Province / Region
Faison NC
Postal / Zip Code Country
28341-5786 US
IP Stream Determination
Stream

Is there an agent or consultant responsible for the request? *
Yes
No
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
Gerogianna LOA.pdf
PDF only
USPS
• Email
Carolyn Lanza
Wildlands Engineering, Inc
[e-mail]
54.72KB
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
US Hwy 13 South
Grantham
Horse Branch
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
Fig2_TopoMap.pdf 1.36MB
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
Soil Survey Map.pdf
Pdf file type only
146.81 KB
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:
-78.159408
35.296784
By digitally signing below, I certify that:
Fig1_SiteMap.pdf
pdf or kmz file types only
2.54MB
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
.....................................................
ID#* 20230245
Version* 1
Do you want to send for review? * • Yes No
Select Reviewer: * Glenn Stewart:[e-mail]
Select Regional Office: * Washington Regional Office - [phone]
2/13/2023

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LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book: 3738 Page: 330 County: Wayne
Parcel ID Numbers: 2556168963, 2556156813 and 2.556156095
Street Address: US Highway 13 S, Goldsboro, NC
Property Owner (please print): James O. Burch and Jared H. Burch, Co -Trustees of the James
P. Burch Irrevocable Life Insurance Trust, dated March 30, 2009
The undersigned, registered property owner(s) of the above property, do hereby authorize
Wildlands Engineering, Inc. to take all actions necessary for the evaluation of the property as a
potential stream, wetland and/or riparian buffer 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). We agree to allow regulatory agencies, including the US Army Corps
of Engineers, to visit the property as part of these environmental reviews.
Property Owners(s) Address: 639 Burch Road, Faison, NC 28341
Property Owner Telephone Number: 910-596-1255
We hereby certify the above information to be true and accurate to the best of our knowledge.
Owner uthorized Signature) (Date)
Wpo
Owner Auffiorized Signature) (Date)

WILDLANDS
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Figure 1: Site Map
Georgianna Bank Parcel
Neuse River Basin 03020201
0 400 800 Feet
I i I i I
Wayne County, NC

Project Location
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Grantham USGS 7.5 Minute Topographic Quadrangle
WILD LANDS
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0 200 400 800 Feet
I I I I I
Figure 2: USGS Topographic Map
Georgianna Bank Parcel
Neuse River Basin (03020201)
Wayne County, NC