2023010 Ver 1_Determination Request_20231011

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
Crystal Coast Sports Complex
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Name on the Recorded Deed: * JB5 Properties, LLC
Responsible Party : Jessica Burt, Manager
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 252-646-3245
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Attach agent authorization letter: * Signed Agent Authorization. pdf
PDF only
Agent/Consultant Information
.......................................................................................
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Charles M. Cullipher
Company Name:* The Cullipher Group, PA
Email Address: * [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
IP Stream Determination
Stream
25.48KB

Date of Visit:
Site Information
Nearest Highway/Street: * NC Highway 58
Nearest Town: * Peletier
Nearest Named Stream:* Godfry Branch
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
N C_Swansboro_20220816_TM_geo
31.13MB
(1).pdf
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
NCRS Map.pdf 881.68KB
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: 34.743
Longitude:-77.088
Misc attachments: Pre -File Site Plan.pdf 146.27KB
Vicinity Map.pdf 567.67KB
Narrative JB5.pdf 68.89KB
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
C itn tl�✓ �%/1! C iillij.+F�t
Date Submitted: 10/11/2023
Initial Review
D# * 2023010
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Michael Meilinger: Michael. Meilinger
Select Regional Office:* Wilmington Regional Office - [phone]