2023018 Ver 1_Determination Request_20231106

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 :
Telephone Number:
176 Flamingo Lane
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Mark Malpass
(for LLC, Corporations, businness, agency, etc.)
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
IP Stream Determination
Stream
Attach agent authorization letter: * Agent Authorization Form 176 Flamingo
217.45KB
Ln.pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Noah Dean
Company Name:* Southern Environmental Group
Email Address: * [e-mail]
Project Information

Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street: * Flamingo Lane
Nearest Town: * Sneads Ferry
Nearest Named Stream:* New River
River Basin: * New
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
Topo Map Flamingo.pdf 726.78KB
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
Soils Map Flamingo.pdf 716.39KB
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.
Project Look Up Address
Street Address
176 Flamingo Lane
Address Line 2
City
Sneads Ferry
Postal / Zip Code
28460-6554
Latitude: 34.5482029
State / Province / Region
NC
Country
US

Longitude:-77.36191749999999
Misc attachments: 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:
Initial Review
.....................................................................................................................
ID#*
Version
Do you want to send for review?*
Select Reviewer: *
Select Regional Office:
/�M/F �/PIJiY
11 /6/2023
2023018
1
Yes No
Michael Meilinger: Michael. Meilinger
Wilmington Regional Office - [phone]