20240360 Ver 1_Determination Request_20240126

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:
Jumping Jack Creek Mitigation Site
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Rickie W. Norris
Responsible Party : (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 919-868-5799
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Attach agent authorization letter: * Norris LOA executed.pdf
PDF only
Agent/Consultant Information
......................................................................................................................................................................
How would you like to receive your USPS
determination letter?* Email
Name of Agent:* Kaitlyn Hogarth
Company Name:* Wildlands Engineering
Email Address: * [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
Yes
No
Other
IP Stream Determination
Stream
32.93KB

Date of Visit:
Site Information
Nearest H ig hway/Street:
Nearest Town: *
Nearest Named Stream:
River Basin:
County: *
Johnston
Stricklands Crossroads Road
Four Oaks
Stone Creek
Neuse
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
USGSmap.pdf
Pdf file type only
1.85MB
TOPO map look up: https://viewer.nationaImap.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
NRCSmap.pdf
Pdf file type only
2.77M B
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: 35.376255
Longitude:-78.468870
Misc attachments: StreamDeterm_SiteMap.pdf 2.66MB
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: 1/26/2024
Initial Review
ID#* 20240360
Version *
Do you want to send for review?* Yes No
Select Reviewer: * Shelton Sullivan:Shelton.Sullivan
Select Regional Office: * Central Office - [phone]