HomeMy WebLinkAbout20231498 Ver 1_Determination Request_20231101Please 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 :
Hungry Jack Mitigation Bank
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Christopher W. Smith
Water & Land Solutions LLC
(for LLC, Corporations, businness, agency, etc.)
Telephone Number:
Email Address: * catherine@waterlandsolutions.com
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: * Christopher Smith et al - Executed Agent
39.42KB
Authorization Form.pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Catherine Roland
Company Name:* Water & Land Solutions, LLC
Email Address: * catherine@waterlandsolutions.com
n
Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street: * Lexington Dr
Nearest Town: * Goldsboro
Nearest Named Stream:* Neuse River
River Basin: * Neuse
County: *
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
Smith - USGS Topo.pdf 856.56KB
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
Smith - NRCS Soils.pdf 416.23KB
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.
Latitude: 35.342285
Longitude:-78.048829
Misc attachments: Smith - Aerial Map.pdf 934.01 KB
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")
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: 11/1/2023
Initia, i.v iv..
ID#* 20231498
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Blake Hartshorn: blake.hartshorn
Select Regional Office:* Central Office - (919) 707-9000