0011 Ver 0_Determination Request_20231006

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 :
Coastal Kia
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
SPK Real Property Holdings
Pat Koballa
(for LLC, Corporations, businness, agency, etc.)
Telephone Number:
Email Address: * [e-mail]
How would you like to received your determination?*
IP Stream Determination
Stream
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * SPK Real Properties Holdings Agent
22.61 KB
Authorization Form signed.pdf
PDF only
Agent/Consultant Information
How would you like to receive your
determination letter?*
Name of Agent: *
Company Name:*
Email Address: *
n
USPS
Email
David Scibetta
Southern Environmental Group, Inc.
[e-mail]

Has anyone form DWR done a previous site visit?*
Yes
No
Other
Staff Name: Michael Meilinger
Date of Visit: 6/30/2023
Site Information
................................................................................................................................................
Nearest Highway/Street: * Savings Street
Nearest Town: * Wilmington
Nearest Named Stream:*
River Basin: *
County: *
New Hanover
Spring Branch (historic)
Cape Fear
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
Coastal Kia Topo 050223.pdf 392.84KB
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
Stevenson Mazda Soil Map 041718.pdf 230.64KB
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
155 SAVINGS ST
Address Line 2
City
Wilmington
Postal / Zip Code
28405
State / Province / Region
NC
Country
United States

Latitude:
Longitude:
Misc attachments: 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:
Initial Review
ID#*
Version
Do you want to send for review?*
Select Reviewer: *
Select Regional Office:
D.4v0 Sc1jffrr.4
10/6/2023
0011
0
Yes No
Michael Meilinger: Michael. Meilinger
Wilmington Regional Office - [phone]