20231142 Ver 1_Determination Request_20230808

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:
Monkey Wrench Mitigation Site
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
IP Stream Determination
Stream
Lathan F. Hawkins and Katherine R. Hawkins
(for LLC, Corporations, businness, agency, etc.)
Email Address: * [e-mail]
How would you like to received your determination?*
Mailing Address: * Street Address
8405 Walnut Grove Church Road
Address Line 2
City
Hurdle Mills
Postal / Zip Code
27541
Name on the Recorded Deed:
Responsible Party :
Telephone Number:
State / Province / Region
North Carolina
Country
United States
Robert Edward Hengsterman and Staci Hawkins Hengsterman
(for LLC, Corporations, businness, agency, etc.)
Email Address:* [e-mail]
How would you like to received your determination?*

Mailing Address: * Street Address
8318 Walnut Grove Church Road
Address Line 2
City State / Province / Region
Hurdle Mills North Carolina
Postal / Zip Code Country
27541 United States
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * Hengsterman LOA.pdf 46.43KB
Hawkins_LOA.pdf 738.69KB
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Kaitlyn Hogarth
Company Name:* Wildlands Engineering
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: *
Walnut Grove Church Road
Nearest Town: *
Hillsborough
Nearest Named Stream: *
North Fork Little River
River Basin: *
Neuse
County:
Orange
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
USGSTopoMap.pdf 1.5MB
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
NRCS Soils Map.pdf 1.43MB
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: 36.218398
Longitude:-79.081006
Misc attachments: SiteMap.pdf 2.82MB
pdf or kmz file types only
By digitally signing below, I certify that:
• 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: 8/8/2023
Initial Review
ID#* 20231142
Version * 1
Do you want to send for review? * Yes No
Select Reviewer: * Shelton Sullivan:Shelton.Sullivan
Select Regional Office:* Central Office - [phone]