20231188 Ver 1_Determination Request_20230809

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
Pancake Mitigation Bank
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Name on the Recorded Deed: * Timothy Melvin Baumgartner
Responsible Party : Water & Land Solutions LLC
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 571-643-3165
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
Staff Name: Cheng Zhang
Date of Visit: 1/12/2016
Site Information
...........................................................................................................
Nearest Highway/Street: * Buckleberry Road
Nearest Town: * Rosewood
Nearest Named Stream:* Moccasin Creek
River Basin: * Neuse
IP Stream Determination
Stream

County: *
Johnston
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
Pancake - USGS Topo.pdf 562.94KB
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
Pancake - NRCS Soils.pdf 342.2KB
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: 35.388009
Longitude:-78.148077
Misc attachments: Pancake - Existing Aquatic Resources
874.09KB
Map.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;
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: 8/9/2023
Initial Review
..............................................
ID#* 20231188
Version * 1

Do you want to send for review? * Yes No
Select Reviewer: * Shelton Sullivan:Shelton.Sullivan
Select Regional Office:* Central Office - [phone]