Ver _Determination Request (8)_20241003

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:
Olive Farm Park
Yes No
Yes No
Buffer
Isolated Wetland
Check all that apply.
Town of Apex
(for LLC, Corporations, businness, agency, etc.)
919-249-1166
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: *
June Lake Sta.
Nearest Town: *
Apex
Nearest Named Stream:*
Little Beaver Creek
River Basin: *
Cape Fear
IP Stream Determination
Stream

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
USGSmap.pdf 926.69KB
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
SoilSurveymap.pdf 1.63MB
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: 35.698912
Longitude:-78.927940
Misc attachments:
By digitally signing below, I certify that:
Address Lookup
Manually
Town Parcels.pdf
pdf or kmz file types only
1.35MB
d 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:
Initial Review RRO
Do you want to send this for review?
ID#*
Select Reviewer: *
Select Regional Office:*
�tt,� �ittYl�tJAr
10/15/2024
Yes No
24-371
Timothy Clark:timothy.clark
Raleigh Regional Office - [phone]