2023022 Ver 1_Determination Request_20231012

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:*
Renovation Church
Is this a transportation project?*
Yes No
Is this request for a mitigation site? *
Yes No
What type of request is this?*
Buffer
Isolated Wetland
Check all that apply.
Owner Information
Name on the Recorded Deed: * Renovation Church
Responsible Party : Mr. Lenny Moore
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 910-787-1525
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: * Signed Agent Authorization - Renovation
205.46KB
Church(3).pdf
PDF only
Agent/Consultant Information
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Kim Williams
Company Name:* Davey Resource Group
Email Address: * [e-mail]
n

Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street: * Hwy 17 & Sloop Point Loop Rd
Nearest Town: * Hampstead
Nearest Named Stream:* Nixons Creek
River Basin: * White Oak
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.pdf 222.26KB
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.pdf 517.45KB
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: 34.411616
Longitude:-77.652391
Misc attachments: Prelim Wetland Map.pdf 839.26KB
Vicinity.pdf 410.72KB
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;

• 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: 10/12/2023
Initial Review
D# * 2023022
Version * 1
Do you want to send for review?* Yes No
Select Reviewer: * Michael Meilinger: Michael. Meilinger
Select Regional Office:* Wilmington Regional Office - [phone]