20241144 Ver 1_Determination Request_20240816

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:
Emmaus Church Rd
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Patel, Pravin N and Asmita
(for LLC, Corporations, businness, agency, etc.)
Email Address: * [e-mail]
How would you like to received your determination?*
Mailing Address: * Street Address
44 Pheasant Run
Address Line 2
City
Waynesboro
Postal / Zip Code
22980
State / Province / Region
VA
Country
USA
Is there an agent or consultant responsible for the request?*
No
Attach agent authorization letter: * EmmausAgentAuth.pdf
PDF only
Agent/Consultant Information
..........
How would you like to receive your USPS
determination letter?* Email
Name of Agent: * Alex Hornaday
Company Name:* Spangler Environmental Inc.
IP Stream Determination
Stream
264.64KB

Email Address:* [e-mail]
n
Has anyone form DWR done a previous site visit?*
-)ther
Date of Visit:
Site Information
Nearest Highway/Street: * Emmaus Church Rd
Nearest Town: * Dudley
Nearest Named Stream:* Caraway Creek
River Basin: * Neuse
County:
Wayne
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
Emmaus Church Rd Property - Topo delin
357.19KB
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
Emmaus Church Rd Property - Soil delin
784.25KB
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

Project Look Up Address
Latitude:
Longitude:
Misc attachments:
Street Address
1385 Emmaus Church Road
Address Line 2
City
Postal / Zip Code
28333-6227
35.27382
-78.000198
By digitally signing below, I certify that:
State / Province / Region
NC
Country
US
Emmaus Church Rd Property - Delin
Map.pdf
pdf or kmz file types only
908.74KB
• 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
64-wrw•w,et
Date Submitted: 8/16/2024
Initial Review
ID#* 20241144
Version * 1
Do you want to send for review?* Yes No