20231026 Ver 1_Determination Request_20230725

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
Bear Grass Charter School Athletic Field
Yes No
Yes No
Buffer IP Stream Determination
Isolated Wetland Stream
Check all that apply.
Name on the Recorded Deed: * Janie C Coltrain
Responsible Party : Phil Hodges
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 252-714-0430
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street: *
6046 Bear Grass Rd
Nearest Town: *
Bear Grass
Nearest Named Stream:*
Turkey Swamp
River Basin: *
Tar -Pamlico

County: *
Martin
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
Bear Grass School site map.pdf 422.18KB
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
Bear Grass School soil map.pdf 216.44KB
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
6046 Bear Grass Road
Address Line 2
City
Williamston
Postal / Zip Code
27892
Latitude: 35.7712197
Longitude:-77.12411209999999
Misc attachments: pdf or kmz file types only
By digitally signing below, I certify that:
State / Province / Region
NC
Country
US
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: 7/25/2023

Initial Review
ID#* 20231026
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Robert Tankard:[e-mail]
Select Regional Office: * Washington Regional Office - [phone]