2023001 Ver 1_Determination Request_20221107

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
4324 Bridges Street Extension Property
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Name on the Recorded Deed: * Wellons Grandchildren, LLC
Responsible Party : Gaye Wellons Mashburn
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 252.726.2151 ext 4
Email Address: * [e-mail]
How would you like to received your determination?*
Mailing Address: * Street Address
POB 1018
Address Line 2
City
Morehead City
Postal / Zip Code
28557
State / Province / Region
NC
Country
USA
Is there an agent or consultant responsible for the request?*
Attach agent authorization letter: * Bridges St Ext Agent
Authorization_Signed.pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Roy Brownlow
IP Stream Determination
Stream
28.31 KB

Company Name: * Tidewater Associates, Inc.
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest H ig hway/Street:
Nearest Town: *
Bridges Street Extension
Morehead City
Nearest Named Stream: * Unnmamed Tributary to Peltier
Creek
River Basin: * White Oak
County:
Carteret
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
Bridges St Ext USGS Topo.pdf 889.44KB
Pdf file type only
TOPO map look up: https://viewer.nationaImap.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
4324 Bridges St Ext Soils Map.pdf 756.84KB
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: 34.43.52.47
Longitude:-76.46.27.33

Misc attachments: Bridges St Ext LiDAR map.pdf 606.63KB
Bridges St Parcel Map.pdf 792.38KB
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:
Initia, f vviuvv
ID#*
Version
Do you want to send for review?*
Select Reviewer: *
Select Regional Office:*
ROB -q0WJ410W
11 /7/2022
2023001
1
Yes No
Michael Meilinger: Michael. Meilinger
Wilmington Regional Office - [phone]