20190427 Ver 1_Determination Request_20190402

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
Name on the Recorded Deed:*
Clemments Property - 0 Clemmons Street
r Yes r No
PF Buffer
r- Isolated Wetland
Check all that apply.
Janice James Fuchs
r IP Stream Determination
F Stream
Responsible Party: Tillman Infrastructure, LLC
(for LLC, Corporations, businness, agency, etc.)
Telephone Number: 212-706-1677
How would you like to received your determination?*
F_ W
Email Address:* [e-mail]
Is there an agent or consultant responsible for the request?
F Yes
r No
Attach agent authorization letter:* Fuchs document AUTHORIZATION
FORM.pdf
FDF only
Agent/Consultant Information
How would you like to receive your r USPS
determination letter?* F Email
Name of Agent:* Christina Homer -Harrell
Company Name:* Trileaf Corporation
Email Address:* [e-mail]
Project Information
Has anyone form DWR done a previous site visit?*
C'
C'
13.81 KB

Date of Visit:
Site Information
Nearest Highway/Street:*
Clemmons Street
Nearest Town:*
Stokes
Nearest Named Stream:*
Briery Swamp
River Basin:*
Tar -Pamlico
County: *
Pitt
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo.
Qick the upload button or drag and drop files here to attach docurrent
SiteVicinityMap - Clemments.pdf 118.63KB
Fttf 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 docurrent
Soil map_Clemments.pdf 242.13KB
Fttf file type only
Soil Survey Link: https://v w v.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.
r Address Lookup
r Manually
Latitude: 35.712503805555556
Longitude: -77.26396225
Misc attachments: 14645161.10049199.LE Site
1.63MB
Plan. SE. NCSC.12182018 (1).pdf
pdf or krre 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
Date Submitted: 4/2/2019
Initial Review
IN * 20190427
Version *
Do you want to send for review?* f Yes r No
Sign

Soil Map—Pitt County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
2/12/2019
Page 1 of 3395437039543803954390395440039544103954420395443039544403954450395446039544703954480395437039543803954390395440039544103954420395443039544403954450395446039544703954480295170295180295190295200295210295220295230295240295250295260295270295280295290295300295310295320295330295340
295170 295180 295190 295200 295210 295220 295230 295240 295250 295260 295270 295280 295290 295300 295310 295320 295330 295340
35° 42' 46'' N 77° 15' 51'' W35° 42' 46'' N77° 15' 44'' W35° 42' 43'' N
77° 15' 51'' W35° 42' 43'' N
77° 15' 44'' WN
Map projection: Web Mercator Corner coordinates: WGS84 Edge tics: UTM Zone 18N WGS84
0 40 80 160 240
Feet
0 10 20 40 60
Meters
Map Scale: 1:835 if printed on A landscape (11" x 8.5") sheet.
Soil Map may not be valid at this scale.
MAP LEGEND MAP INFORMATION
Area of Interest (AOI)
Area of Interest (AOI)
Soils
Soil Map Unit Polygons
Soil Map Unit Lines
Soil Map Unit Points
Special Point Features
Blowout
Borrow Pit
Clay Spot
Closed Depression
Gravel Pit
Gravelly Spot
Landfill
Lava Flow
Marsh or swamp
Mine or Quarry
Miscellaneous Water
Perennial Water
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
Sodic Spot
Spoil Area
Stony Spot
Very Stony Spot
Wet Spot
Other
Special Line Features
Water Features
Streams and Canals
Transportation
Rails
Interstate Highways
US Routes
Major Roads
Local Roads
Background
Aerial Photography
The soil surveys that comprise your AOI were mapped at
1:15,800.
Warning: Soil Map may not be valid at this scale.
Enlargement of maps beyond the scale of mapping can cause
misunderstanding of the detail of mapping and accuracy of soil
line placement. The maps do not show the small areas of
contrasting soils that could have been shown at a more detailed
scale.
Please rely on the bar scale on each map sheet for map
measurements.
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL:
Coordinate System: Web Mercator (EPSG:3857)
Maps from the Web Soil Survey are based on the Web Mercator
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Albers equal-area conic projection, should be used if more
accurate calculations of distance or area are required.
This product is generated from the USDA-NRCS certified data as
of the version date(s) listed below.
Soil Survey Area: Pitt County, North Carolina
Survey Area Data: Version 15, Sep 10, 2018
Soil map units are labeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photographed: Apr 20, 2015—May
15, 2017
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor
shifting of map unit boundaries may be evident.
Soil Map—Pitt County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
2/12/2019
Page 2 of 3
Map Unit Legend
Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
ExA Exum fine sandy loam, 0 to 1
percent slopes
0.0 7.3%
NrA Norfolk sandy loam, 0 to 1
percent slopes
0.6 92.7%
Totals for Area of Interest 0.6 100.0%
Soil Map—Pitt County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
2/12/2019
Page 3 of 3
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
' w.11P1PC��
STREET ADDRESS: o Clemmons Street
Please print:
Property Owner:
Property Owner:
Stokes, NC 27884
Janice James Fuchs
PARCEL ID: 11864
The undersigned, registered property owners of the above noted property, do hereby authorize
Christina Homer -Harrell
(Contractor / Agent)
of
Trileaf
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
PO Box 94, Stokes, NC 27884
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
'v. t- n
Authoriz nature Authorized Signature
Date: 1� —1 v Date:

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Greenville NE Quadrangle, North Carolina (2016)
Contour Interval = 5 Feet
Latitude: 35° 42’ 45.0137” Longitude: 77° 15’ 50.2641”

North
Site Vicinity Map
Tillman Infrastructure - Clemments
0 Clemmons Street
Stokes, NC 27884
Site Location