HomeMy WebLinkAbout20230677 Ver 1_Determination Request_20230417Please 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:* Copley Property
Is this a transportation project?* Yes No
Is this request for a mitigation site? * Yes No
What type of request is this?* Buffer IP Stream Determination
Isolated Wetland Stream
Check all that apply.
Owner Information
Name on the Recorded Deed: * Steve Ray Copley
Responsible Party : Wildlands Engineering, Inc.
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 9196240905
Email Address: * croessler@wildlandseng.com
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * Copley_LOA_signed.PDF 16.27KB
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Chris Roessler
Company Name:* Wildlands Engineering
Email Address: * croessler@wildlandseng.com
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street: * Isham Chambers Rd
Nearest Town: * Rougemont
Nearest Named Stream:* Camp Creek
River Basin: * Neuse
County: *
Durham
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
Copley_USGS_topo_snip.pdf 107.63KB
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
map2_SoilSurvey_DurhamCo.pdf 3.91MB
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
Latitude: 36.226223
Longitude:-78.828629
Misc attachments: Copley Ex A Opt 2_040623v2.pdf 1.21 MB
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
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Date Submitted: 4/17/2023
Initial Review
ID#* 20230677
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Shelton Sullivan:Shelton.Sullivan@ncdenr.gov
Select Regional Office: * Central Office - (919) 707-9000