20190272 Ver 1_Determination Request_20190301

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?*
What type of request is this?*
Owner Information
Weyerhaeuser 300177-2019
r Yes r No
PF Buffer r IP Stream Determination
r- Isolated Wetland r Stream
Check all that apply.
Name on the Recorded Deed:* Weyerhaeuser
Responsible Party:
Cliff Tyson
Washington
(for LLC, Corporations, businness, agency, etc.)
Telephone Number:
252-229-8328
How would you like to received your determination?*
F W
Email Address:*
[e-mail]
Is there an agent or consultant responsible for the request?
C' Yes
r No
Project Information
Has anyone form DWR done a previous site visit?*
C
r
C
Date of Visit:
Site Information
Nearest Highway/Street:*
x'32
Nearest Town:*
Washington
Nearest Named Stream:*
Acre Swamp
River Basin:*
Tar -Pamlico
County: *

Beaufort
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 docurrent
300177topo. pdf
Rif file type only
114.53KB
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
Fttf file type only
Soil Survey Link: https://vwv.nres.usda.gov/wps/portal/nres/surveylist/soils/survey/state/?state Id=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.
r Address Lookup
r Manually
Latitude: 35.642
Longitude: -76.887
Misc attachments: 300177dem.pdf
113.14KB
300177highflight.pdf
167.11 KB
300177hillshade.pdf
103.61 KB
3001771ine.pdf
97.53KB
300177overview.pdf
137.6KB
pdf or lom 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 Sign
Date Submitted: 3/1/2019
Initial Review
D# * 20190272
Version * 1
Do you want to send for review?* r Yes f No

Select Reviewer: * Anthony Scarbraugh:eads\adscarbraugh1
Select Regional Office:* Washington Regional Office - [phone]

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