20230438 Ver 2_Determination Request_20230524

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:*
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:
Totten Mitigation Site
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Lynette G. Totten
(for LLC, Corporations, businness, agency, etc.)
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
IP Stream Determination
Stream
Attach agent authorization letter: * 2022 - Totten —Land Owner Authorization
291.89K6
Form.pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Kevin Yates
Company Name:* Clearwater Mitigation Solutions
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: *
College Street (NC Hwy 15)
Oxford
Jordan Creek
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
Totten_Fig 1 _SiteLocation.pdf 4.48MB
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
Totten_Fig2_SoilsQuad.pdf 1.47MB
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.
Latitude: 36.339506
Longitude:-78.589690
Misc attachments: Totten_ Figures —Stream
20.26MB
Forms_SAM_WAM_Photos. pdf
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;

• 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")
• 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');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit the "Determination Request' form."
Signature
(��iY �lltf'J
Date Submitted: 5/24/2023
Initial Review
ID#* 20230438
Version * 2
Do you want to send for review?* Yes No
Select Reviewer: * Shelton SUIIivan:[e-mail]
Select Regional Office:* Central Office - [phone]