20190645 Ver 2_Buffer and/or Stream Determination Request_20190627

Water Resources
ENVIRONMENTAL QUALITY
DATE STAMP HERE
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim
Director
DWR Use Only: Project #
Stream Origin/Buffer Applicability Determination
for Potential Mitigation Sites
3. MITIGATION PROVIDER OR CONSULTANT
Required Information
1. LAND OWNER INFORMATION
Company: Wildlands Engineering Inc
1a. Name(s) on Recorded Deed
Robert and Janie Mangum (9851671991) and Janie Mangum (9851763367 and
9851778621)
1b. Mailing Address
1449 Foggy Bottom Lane, Hillsborough NC 27278
1c. Telephone Number
919-967-4152
1d. Email Address:
2. Has DWR visited the site before? Y / N
Staff Name:
Date Visited:
3. MITIGATION PROVIDER OR CONSULTANT
3a. Individual Name
Andrea Eckardt
Company: Wildlands Engineering Inc
3b. Mailing address
1430 S Mint St suite 104
3c. Telephone no.
704-332-7754
3d. Email address:
[e-mail]
3e. Do you have permission to be on this property? Y / N
4. PROJECT & SITE INFORMATION
4a. Name of project
Mangum Homestead Mitigation Site
4b. County: Orange
4c. Nearest Named Stream
New Hope Creek
4d. River Basin: Cape Fear
4e. Do you have permission to be on this property? Y / N
4f. Physical property address/nearest intersection: 1449 Foggy Bottom
Lane, Hillsborough, NC 27278
Longitude: 79.1457700
Latitude: 35.9970100
Is this stream call for the purpose of: BUFFER MITIGATION _X_ and/or NUTRIENT OFFSET_X
Please attach maps of the site indicating project boundaries 1) on the USGS 1:24,000 Topo, 2) on the most recently
printed NRCS Soil Survey and 3) on a site aerial labeling all the features needing a determination. Must also include
an agent Authorization form.
Please return form to: Katie Merritt
Email: Katie. [e-mail]
Please contact the Central Office at [phone] if you have any questions.
State of North Carolina I Environmental Quality I Water Resources
1617 Mail service Center I Raleigh, North Carolina 27699-1617
919 807 6300

Site Map
%kW I L D L A N D S 0 150 300 Feet Mangum Homestead Mitigation Site
V ENGINEERING I i i i I Cape Fear River Basin (03030002)
Orange County, NC

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Project Location
Proposed Conservation Easement Boundary
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0 150 300 Feet �` Mangum Homestead Mitigation Site
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Cape Fear River Basin (03030002)
Orange County, NC

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1977 NRCS Soil Survey of Orange County - Sheet 22.1 ,
1977 NRCS Soil Survey Map
1111��, W I L D L A N D S 0 275 550 Feet Mangum Homestead Mitigation Site
��� ENGINEERING I i i i I Cape Fear River Basin (03030002)
Orange County, NC

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book (and Pages): Book 242, Page 1870, Book 3746, Page 106, and Book 362, Page 92
County: Orange County NC
Parcel ID Number(s): 9851671991, 9851778621, 9851763367
Street Address: 1449 Foggy Bottom Lane, Hillsborough, NC 27278
Property Owner (please print): Robert Wesley Mangum and Janie B. Mangum
The undersigned, registered property owner(s) of the above property, do hereby authorize
WildIands Engineering, Inc. to take all actions necessary for the evaluation of the property as a
potential stream, wetland and/or riparian buffer mitigation project, including conducting stream
and/or wetland determinations and delineations, as well as issuance and acceptance of any required
permit(s) or certification(s). I agree to allow regulatory agencies, including the US Army Corps of
Engineers, to visit the property as part of these environmental reviews.
Property Owners(s) Address: same
(if different from above)
Property Owner Telephone Number: 919-967-4152
We hereby certify the above information to be true and accurate to the best of our knowledge.
(Property Owner Authorized 0ignature) (Date)
Owner Authorized Silgrnature) (Date)