Ver _Determination Request_20240305

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:* 4001 Laurel Drive, Durham, NC 27703
Is this a transportation project?* Yes No
Is this request for a mitigation site? * Yes No
What type of request is this?* Buffer IP Stream Determination
Isolated Wetland Stream
Check all that apply.
Owner Information
Name on the Recorded Deed: * Pedro Jackson & Laurie Jackson
Responsible Party : (for LLC, Corporations, businness, agency, etc.)
Telephone Number: 919-210-2155
Email Address: * [e-mail]
How would you like to received your determination?*
Is there an agent or consultant responsible for the request?*
Yes
No
Project Information
..................................................................................................................................................................................................................
Has anyone form DWR done a previous site visit?*
Yes
No
Other
Date of Visit:
Site Information
Nearest Highway/Street: * Laurel Drive and Bungalow Avenue
Nearest Town: * Durham
Nearest Named Stream:* Little Lick Creek
River Basin: * Not Sure

County: *
Durham
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
NC Durham
10.24M B
South_162430_1943_62500_geo. 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
_ags_1308a7b4-db60-11ee-8627
482.46KB
005056b090f2.pdf
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 Address Lookup
provide this information. Manually
Project Look Up Address: Street Address
4001 Laurel Drive
Address Line 2
City State / Province / Region
Durham NC
Postal / Zip Code Country
27703-5409 US
Latitude: 35.9570489
Longitude:-78.8449442
Misc attachments: 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
Il.I"/itP 10k

Date Submitted: 3/5/2024
Initial Review RRO
Do you want to send this for review? Yes No