20230883 Ver 1_Determination Request_20230615

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
Bass Lake Road/Hilltop Needmore Road/ Sunset Lake Road
Intersection Operational Improvements
Yes No
Yes No
Buffer IP Stream Determination
Isolated Wetland Stream
Check all that apply.
Name on the Recorded Deed: * N/A (Linear Transportation Project)
Responsible Party : Town of Fuquay-Varina; ATTN: Matthew Poling
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: [phone]
Email Address:* [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * 02_SIGNED_BassLake_USACE_KHA_...
228.5KB
Authorization Form.pdf
PDF only
Agent/Consultant Information
..................................................................................................................................................................................
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Emma Radford, WPIT, CA
Company Name:* Kimley-Horn
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: * Bass Lake Road
Nearest Town: * Fuquay-Varina
Nearest Named Stream:* Terrible Creek
River Basin: * Neuse
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
Fig2_BassLakeRd_USGS.pdf 836.13KB
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
Fig4_BassLakeRd_NRCS.pdf 1.28MB
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: 35.627888
Longitude:-78.779544
Misc attachments: Fig 1_BassLake_Vicinity.pdf 2.79MB
Fig3_BassLakeRd_Aerial.pdf 2.06MB
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
Date Submitted: 6/15/2023
Initial Review
ID#* 20230883
Version * 1
Do you want to send for review?* Yes No
Select Reviewer: * Rob Ridings: rob. [e-mail]
Select Regional Office:* Central Office - [phone]