HomeMy WebLinkAbout20230820 Ver 1_Determination Request_20230503Please 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?*
Is this request for a mitigation site?
What type of request is this?*
Owner Information
Name on the Recorded Deed:
Responsible Party :
Telephone Number:
Moon Cabin Mitigation Site
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Jimmy Wesley Duncan
(for LLC, Corporations, businness, agency, etc.)
704-989-0318
Email Address: * Duncan08@aol.com
How would you like to received your determination?*
Mailing Address: * Street Address
7701 West Duncan Road
Address Line 2
City
Indian Trail
Postal / Zip Code
28079
State / Province / Region
NC
Country
US
Is there an agent or consultant responsible for the request?*
No
Attach agent authorization letter: * LOA.pdf
PDF only
Agent/Consultant Information
.........
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Andrea Eckardt
Company Name:* Wildlands Engineering
IP Stream Determination
Stream
28.46KB
Email Address:* aeckardt@wildlandseng.com
n
Has anyone form DWR done a previous site visit?*
-)ther
Date of Visit:
Site Information
Nearest Highway/Street: * West Duncan Road
Nearest Town: * Indian Trail
Nearest Named Stream:* Goose Creek
River Basin: * Yadkin-PeeDee
County: *
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
Figure 3 USGS.pdf 332.75KB
Pdf file type only
TOPO map look up: https://viewer.nationaImap.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
Figure 6 Soil Map.pdf 229.98KB
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
7701 West Duncan Road
Address Line 2
City
Indian Trail
Postal / Zip Code
28079
Latitude: 35.1441565
Longitude:-80.56677839999999
State / Province / Region
NC
Country
US
Misc attachments: Figure 2 Site Map.pdf 830.08KB
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
Date Submitted:
Initial Review
............................................
ID#*
Version *
Do you want to send for review?*
Select Reviewer: *
Select Regional Office: *
���4 ,4?-
5/3/2023
20230820
1
Yes No
Shelton Sullivan:Shelton.Sullivan@ncdenr.gov
Central Office - (919) 707-9000