20241123 Ver 1_Determination Request_20240819

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:* 1-6001
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: * NCDOT
Responsible Party : NCDOT
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 919-417-4847
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: *
US-264
Nearest Town: *
Zebulon
Nearest Named Stream:*
Little River
River Basin: *
Neuse
IP Stream Determination
Stream

County: *
Wake
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
1-6001 _M P-092-00311 _Topographic
3.05M6
Map.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
1-6001_MP-092-00311_NRCS Soil Survey
2.32M6
Map.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 provide this information.
Address Lookup
Manually
Latitude: 35.834473
Longitude:-78.328031
Misc attachments: MP-092-00311 Stream ID Form.pdf 867.01 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)
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: 8/19/2024
Initial Review
.................................................
ID#* 20241123
Version * 1

Do you want to send for review? * Yes No
Select Reviewer: * Rob Ridings:rob.ridings
Select Regional Office:* Central Office - [phone]